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  • Zoë Mack

The Recovery Plan, Flexible Commissioning, Golden Hellos - but what will it actually mean for us...?

Updated: May 24

In my first blog for the 'post Recovery Plan era' I reflect on the plan itself, the direction for NHS dentistry in our area and nationally, and the return of NHS compliance focus. 

As we all know the Recovery Plan was big on ideas and scant on detail, so it has taken some time for NHSE to gradually notify commissioners of details for some of these schemes. Thus some aspects of the Recovery Plan are still opaque and frustrating many of our practices across LASC, perhaps none more so than...

Golden Hellos

This week finally saw more information announced on “golden hellos” which were included in the recovery plan as a way to aid recruitment of dentists in areas frequently dubbed dental deserts. However, with anything announced by ministers, the devil is in the detail and this is only just being revealed. The LDC have long held concerns about the limited number of these “offers” which would be made available nationally. And now we can see our allocation is by our North West region as a whole and has yet to be subdivided - my thoughts? it's probably going to be safe to leave your socks on when counting the availability!

Once our commissioning teams have been given their allocation they will finally be in a position to plan and prioritise, but until then everyone across Lancashire and South Cumbria is frustratingly held in a wait and see position. Our commissioners fully understand that a "golden hello" could make a difference for practices struggling to recruit, but would ask that you wait until they have clear information of allocation and are in a position to be able to respond. For now as an LDC we would also recommend holding off on including any promises to applicants for vacant positions. 

Flexible Commissioning News

Another area in development is that of Flexible Commissioning; often dubbed "the Pathways". Some practices have been involved in short term pathways post Covid which have aided and supported recovery. However, the ICB was informed by individual pathway practices and the LDC (click here to read our recent letter to the ICB), that short term commissioning in an independent business, such as a GDS practice situation poses considerable issues. Thankfully this has been acknowledged and appreciated. What has now been secured is a commitment to a funded 2 year offer, details of which will be announced soon.

Pilots for these new longer term schemes (e.g. the paediatric pathway) have addressed the issue of FTA rates, which cause waste and losses within GDS. They have explored methods for driving down rates and then taken the FTA rate into consideration when drafting the funding model - the Enhanced UDA to be offered having taken likely FTA rates into account. Should these rates exceed the model when out in GDS, then it will be something that the LDC will raise with the ICB on behalf of practices.

Given the longer term goals and needs, new projects are to be supported by free training from NHS WT&E (former HEE) for dental teams (specifically designed for purpose and ready at launch) enabling more opportunities for development in-role with extended duties and new skills. There is also support from specialists and knowledgeable points of contact.

Crucially the new schemes see prevention, which isn’t the focus of the current contract, finally acknowledged and taking its rightful place.

The LDC hopes that practices will be offered flexible commissioning contracts which are financially rewarding of their continued NHS commitment and willingness to expand their offer, beyond educational benefits and career development through up-skilling.

Dental Vans

There are no plans for dental vans in our area; dental vans are not something that we would support, on the basis of past history of similar projects not being effective in our area. 

Underlying Contract

Finally, I would draw everyone’s attention back to the base dental contract itself - firstly the uplift to a minimum £28 UDA value; those practices eligible should have been approached by the ICB representatives already, and secondly upcoming return of focus upon contractual obligations.

We are now in a post-Covid phase, so standard quality assurance monitoring (modified during this unusual period) is to be reinitiated as previously. I will be sharing more about this in an upcoming blog about the Dental Assurance Framework and the data collected by the BSA, but for now one top tip to share is to pay attention to your FP17 submissions and their completeness. Data can be significantly effected by the computer software which you run and how this system is used - it is always worth ensuring system support contracts are in place, spending time to understand your system and instigate training; avoid inadvertently flagging up for further compliance investigation. For example, most clinicians I speak to readily admit they are far better at remembering to apply fluoride than record it. So get the credit for your clinical diligence and ensure the BSA record it as compliance! 

While visiting NHS compliance it is also probably worth remembering that the deadline for NHSE Workforce returns is imminent, and that this is a compliance issue which does risk a remedial notice being issued to practices.

Furthermore, within contractual obligations are clauses that may surprise and are not always that well discussed or understood. In conjunction with Leanne Fawcett (Dental Delivery Assurance Manager LASC ICB) we will be sharing our top tips to watch out for and ensure that you don’t get caught out, and that you remain safe from breaching your NHS contract. Please see the first of these helpful hints and tips below.

National Comparison

And nationally how do we compare? LASC LDC were represented at the BDA Regional Liaison Group earlier this month where we discussed progress with LDC colleagues from across the country focusing upon Flexible commissioning and the Recovery Plan. It was noticeable that in our area we are benefiting from an engaged commissioning team that are prepared to listen to our concerns, and that we do have flexible commissioning established with more being planned. This is not the case everywhere, so we are making progress. However, there are a few areas further ahead. We are keen to keep apprised of their successes and share valuable learning experiences in other regions with our commissioning team.

In closing I have edited to add the news which broke yesterday about the General Election being called - I would love to be optimistic about a possible change of government meaning an injection of new money into NHS dentistry and a revival. However when you have a promise from Labour of talking to the BDA the first day after the election it really does not inspire confidence; neither does their comments about compulsion and tie-ins for new graduates.

Already the civil service are beginning the groundwork for a 2yr DF style model. Surely, if the service was attractive enough to retain existing experienced dental professionals (with high productivity) it could easily expect to welcome new willing graduates into the fold, the word compulsion would not even come into it. Those studying medical sciences tending to be altruistic individuals starting with ideals. The fact that compulsion is even being considered shows just how unattractive this contract now is... await the legal challenges! It starts in the dental profession and then a precedent is created for compulsion in the other professions; I somehow doubt compulsion to provide legal aid would go down all that well with our legal colleagues!

And let's not forget we need the trainers for these longer term placements... which means... oh yes, retention! And thus we return full circle.

Hold on everyone, we may now be in for a rocky ride...

Zoë Mack, BDS LLM

LASC LDC Communication & Engagement Lead



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