In April last year a new dental contract came into force, bringing changes to patient charges as well as dentists' work and pay. Jill Davies takes a look at the effects one year on
April Fool's Day last year saw the arrival of a dental contract pledging simpler charging and better access to local services.
The contract devolved responsibility for commissioning NHS dental services to local Primary Care Trusts (PCTs) and was the subject of debate and discussion before it was even introduced. As far back as November 2005, the British Dental Association (BDA) was warning the contract could signal an exodus of dentists from the NHS, with many citing the 'drill and fill' culture and fears of even less time for preventive dental work as the reasons for their potential departure.
And what a difference a week makes. By 7 April 2006, seven days into the new contract, nearly 2,000 dentists had left the NHS, according to the BDA, with many others signing their contract 'in dispute'.
So, if a lot can happen in the world of dental treatment in a week, what sort of difference has a year made?
The aim of the 2006 dental contract was to promote better access to NHS dentistry and involved three standard charges for all NHS treatment. The system was designed to make regular treatment slightly more expensive and more complex treatment less so - the net effect being that, while some people would be paying more, others would be charged less and, overall, costs to the consumer would be clearer, but would average out about the same.
However, this does not seem to be happening, as costs to the consumer seem to be increasing. A check-up would have previously cost around £6 but now costs £15.50 because of the 'Band 1' set fee.
Alternatively, where one crown treatment is set to cost the NHS patient the 'Band 3' fee of £189 - they can also have up to 10 crown treatments for the same set fee; undoubtedly good news for the NHS patient, but bad news for the NHS dentist who must carry out more treatments for the same fee. It can also lead to a situation where NHS patients wait until they need more than one treatment and pay for them all at the set fee - worse news for dentists who are keen to encourage their patients to adopt a preventative attitude to their dental care.
Whereas NHS patients may have previously been able to anticipate how much their treatment was likely to cost, now fees have either gone up or down, resulting in confusion for some - despite the aim of a clearer, fairer charging system.
In fact, it would arguably be fair to say that the verdict on the contract to date from patients, health experts and the industry is just as unclear - the jury is, for the time being at least, still out.
Dissatisfaction
Certainly, there have been reports of dissatisfaction. The new contract has altered the dental landscape for some in terms of convenience. With many dentists' books full (under the contract, they are given a set amount of money for a specific number of patients and, therefore, there is no incentive for them to take on more), the consumer is having to travel further to find an NHS dentist with vacancies for new patients.
Others are only taking new patients on if they are on a capitation plan (whereby patients pay a monthly premium and the dentist is obliged to carry out any necessary work, albeit sometimes at an extra cost). Yet, even in this situation, the consumer has to be dentally fit before they can even become a policyholder.
According to a 2006 Dental Practitioners' Association survey, 64% of respondents said they did not have the capacity to accept new NHS patients, 80% believed the three-banded patient charge system was not workable and only 5% rated the new system as more preventive than the old.
Meanwhile a BDA survey of 650 dentists in October 2006 echoed this, with 78% of dentists saying they had not been seeing any more patients since the new contract came in.
But there are positives for NHS patients, such as the less expensive multiple treatments - although this can be viewed as a bonus only by those already on a dentist's books. And the Government has been quick to reassure the public that NHS dentistry is expanding, stating that PCTs are now commissioning more dental services than under the old contract.
Consideration should also be made for those with good oral health. The National Institute for Clinical Excellence (NICE) introduced guidelines for regularity of visits to the dentist, which suggest they may need only attend every 12 to 24 months - overall, this would save a patient several six monthly check-ups, despite the price increase, and would free up availability for other patients.
For healthcare providers, dentistry is one of the core benefits that could lead to a further boost in business. The contract will have a long-term impact and, with the changes that are taking place, consumers are under increasing pressure to ensure they have adequate funding in place to cover the cost of routine and preventive dental treatment.
Indeed, as costs to the patient increase, so will the popularity of healthcare cover such as healthcare cash plans and stand-alone dental plans, as people seek the security they provide. In an age of spiralling healthcare costs, full or partial reimbursement is, of course, a major factor in the appeal of cash plans.
Just as the dental changes impact on consumers, they are likely to have a domino effect on organisations as well. Employers view healthcare cover as a positive and relevant benefit for their employees and, as a consequence of the contract, anything that includes dental cover is equally attractive.
As attention focuses on the dental market, it is to be expected that intermediaries will look to healthcare options that include dental cover. The 2006 contract has been in the news since before it was even introduced and is bound to be an important factor for consumers and employers alike when considering healthcare cover.
The popularity of cash plan products among intermediaries is, therefore, increasing and helping to propel the market forward, particularly as intermediaries are able to offer plans that provide a range of healthcare benefits in addition to dental.
From a business perspective, it is fair to say that the dental contract has had an impact. At Westfield, we have seen a significant increase in dental claims and the level of dental claims across the board for policyholders and their dependants has risen in 2005/2006 compared with the previous year.
With dentists in the BDA survey not optimistic they would be able to see more patients and the BBC recently reporting dentists are turning away patients because local health chiefs are running out of funds, the outlook does not look particularly rosy. Patients will be continuing to explore new ways to fund dental treatment and providers need to be ready to respond as healthcare demands increase.
If, as seems more and more likely, people are forced down the private route, providers need to ensure that their products can help arm policyholders with the tools they need to navigate an ever-changing world of healthcare options and, crucially, one where NHS provision and availability is diminishing.
The healthcare market is in a constant state of flux; the market changes and those in the industry have to change with it - it is the ability to adapt that is paramount. In order to not just survive, but thrive, healthcare providers must develop products and services that cater to and match market needs.
Ultimately, we must all view the dental market not as a threat but as an opportunity.
Jill Davies is executive director at Westfield Health
