Prior to 2006 dentists were paid for whatever NHS treatment they provided from an item of service fee scale.
They could set up wherever they wished to practice and would be paid for the NHS treatment they did.
The then Labour Party wanted to bring Dentistry into the wider NHS fold and to take control of the dental budget.
The result was a fixed contract based on the activity during a test period in 2005 (which nobody knew was a test at the time!).
All practices were awarded contracts for X numbers of Units of Dental Activity (UDA) at a value of £Y.
Adjacent practices could have widely different UDA rates such that for example Practice A might have been awarded 30,000 UDA at £20/UDA (value £600,000) whilst the adjacent Practice B might get 20,000 UDA at £30. It all depended on the type of treatment done previously – the irony is that very few dentists who were “tested” will still be working in that practice yet the legacy UDA rate still continues.
Where Clawback is so cruel is that fixed costs of running these practices will be very similar if not identical.
Yet if Practice A delivered less than 96% of their contracted UDA they would face clawbacK of 4% ( £24,000).
The irony is that if practice A delivered 20,000 UDA they would have a clawback of £200,000 – but practice B delivering 20,000 UDA would keep all its funding and be deemed to have “performed”.
Such indiscriminate and unfair clawback does impact practices and their teams. Low-value UDA prevents recruitment and makes under-delivery more likely.
Of course, things have moved on and the minimum UDA rate any practice receives is now £29.30 after the DDRB award. But there will still be other practices paid nearer £40 per UDA so the inequalities still exist.
Sadly the pressures of clawback can drive behavior and we are currently in the quarter where on average most UDA are delivered – about 30% of all contracted UDA are delivered between January and March.
The risk posed by clawback is whether colleagues are delivering patient care or UDA – and it is totally understandable that the focus is on ensuring at least 96% of the contract is delivered.
It is well recognized that patients face huge challenges in accessing NHS dental care. I am sure it would astound and annoy many patients to learn that the restriction on their ability to access NHS care is linked to the practice ‘running out” of UDA – the budget is fixed and whilst occasionally additional activity is approved later in the financial year practices do have to titrate the care they provide.
What is even more frustrating is the UDA system reduces access to care for those most in need. They are a risk to UDA delivery, and a risk to clawback increasing. No Professional should be put in the position of wanting to provide the patient with the care they need whilst also being concerned that in doing so they make clawback more likely.
Being a practice owner has huge responsibilities to look after patients and staff whilst investing in practices.
Any system which indiscriminately and unfairly removes funding from a practice already on life support is not fit for purpose.
Of course, there are instances of people deliberately not delivering the contract to keep the cash flow the regular monthly payment gives – they of course need to repay funds – but they are also few and far between.
This year clawback was recovered from October to December 2024 – yet the DDRB increase in funding has yet to be received ( due March 1st 2025) – the Government is keen to recover funds but less keen to pay for the services delivered. Elected on promises of reforming NHS dentistry we still wait for the current Labour Government to correct the damage they inflicted 19 years ago.
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