Dentists Who Invest Podcast

New NHS Contract Reforms Are Coming... with Mr Johnny Minford [CPD Available]

• Dr. James Martin • Season 3 • Episode 394

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The landscape of NHS dentistry is shifting once again as the Labour government unveils its vision for contract reform. This thought-provoking conversation with dental accountancy expert Johnny Minford unpacks the substantial changes ahead for dental professionals across the UK.

We delve deep into the new hybrid payment model that combines traditional UDAs with a £70 fee-per-item component for specific treatments – a significant departure from the pure UDA system that has dominated since 2006. Johnny offers expert analysis on how these changes might impact practice finances and clinical decision-making, while raising important questions about whether these incremental modifications will deliver the transformational shift that NHS dentistry desperately needs.

Perhaps most intriguing is our exploration of the "neighbourhood health service" concept, which could fundamentally alter how basic dental care is delivered. As Johnny explains, this approach might improve patient access but risks redirecting routine treatments away from traditional practices, potentially pushing dentists toward becoming de facto specialists rather than family oral healthcare providers. We consider the wider implications for practice business models and patient relationships if this trend continues.

The conversation takes a particularly compelling turn when we examine the government's proposals for increased oversight through structured audits, model associate contracts, and practice handbooks. These developments signal a potential power shift in how dentistry is regulated and practiced, raising legitimate concerns about professional autonomy in an already heavily regulated field. Johnny's insights on the employment status question are especially valuable, as he breaks down the financial mathematics that make employed status potentially damaging for both associates and practice owners.

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Dr James:

The NHS contract is something that shifts around perennially for us dentists and this year is zero exception. I'm joined today by Mr Johnny Minford, expert accountant to UK dentists. We're going to be exploring what those changes are, what they mean for dentists, also talking about how fee per item is being reintroduced to the NHS system. Lots to look out for. Looking forward to this one. I'm also happy to share that there is free verifiable cpd associated with this podcast episode. Whenever you finish the episode, all you have to do is click the link in the podcast description. It'll take you right through the Dentists Who Invest website. You'll be able to complete a short questionnaire and, once passed, you fill in your reflections and we'll go ahead and email over to you your verifiable cpd certificate, which is entirely free. What that means is this podcast episode will be able to contribute towards your verifiable cpd hours during this learning cycle. NHS contract reforms. This happens semi-regularly around about this time of year, would you say, johnny? Is that correct?

Johnny:

It is correct, but it's not entirely true at the moment. The difference that we have just at the moment is that we have a new government from last year and before they were elected they said a lot of things about what they were going to do for the NHS reform on dentistry. So then now they have to start thinking about delivering, and that's where we are. That's where some of these things have come into play. So what they have done they've had a survey a month or two ago about what it costs to run a dental practice. I'm not entirely sure how much response they got for that and how that fits into what we're doing now. But this next survey, which runs to the 19th of August. But this next survey which runs to the 19th of August, is something where they're trying to get a consultation on some of the procedures that they've brought in the progress and they're hoping to bring this lot in in April 2026. So not very far away from that. So they have introduced a number of new things.

Johnny:

This builds on what the previous government brought in in, maybe two, three years ago. A lot of what they're doing are, as I see it, small, multiple, small scale changes. These things are positive and if you're an NHS dentist, you're going to get a little more UDAs for some of the things. They're going to change some of the clinical aspects. I'm not going to go into the clinical side, but fissure sealant stuff that you're doing on dentures and rolling out fluoride treatments, that type of thing. You get more for doing these things now than you would have done in the past. That's always a good thing and not yet seeing all of these changes from a clinical perspective building into some sort of a transformational change. But again, we're early days yet. We are still in a consultation and there may well be more things come out of this consultation than what has already been announced that's fascinating.

Dr James:

So a combination of UDAs and fee per item.

Johnny:

UDAs, and then you've got an extra fee on top, which is, at this point, is £70. And that's the same across the UK. So it doesn't really take into consideration the underlying costs of running a dental practice. It's just you get £70 for certain things. There's also new care pathways which they've introduced, the detail of which will be interesting to see how that is rolled out, because that sounds a lot more like a doctor's GP types of things, talking about pathways for patients with a heavy dental need, for patients with a heavy dental need with low oral care. So it's that sort of thing. Now that takes it slides away from some of the UDA type things, but we've yet to see how that will be settled. As to how dental practices get paid for that, dental practices get paid for that.

Johnny:

But behind all of this, they are attempting to they say they're attempting to move away from the UDA system towards a more of a preventative thing. Again, we're at early days yet, so we got preventative, which is a good thing, but we've been talking about that for years and years. Maybe this is a movement towards that, but I don't see how the small changes that we're looking at now. I don't see how that makes such a big thing and moves everything towards preventative. So maybe they'll bring this in and then maybe after a year they'll upgrade it or do something else to it to actually bring the preventative aspects in. I know there is talk about some sort of a capitation probably not the way we used to know capitation before 2006, but there may well be something along those sorts of lines that they try and make fit.

Johnny:

What we are seeing at the moment which is good, is there's a constructive engagement, which is good, is there's a constructive engagement, whether or not the constructive engagement is accepted and listened to and worked on again. We're early days, we need to be seen, but there'll be lots of people who will be saying at this stage James, oh, it's all the same, they're never going to do anything. Well, if we all think that, then it probably never will do anything. So I think what we have to do is in some way encourage where we are and, if we can, if there's something comes out of it, it won't be for the lack of the industry engaging with the Department of Health, because that's the last thing we want. Is the industry not engaging, but the Department of Health then saying oh well, we tried and you didn't. So, whatever our politics, I think that's something we have to just pick up the ball and try and run with it.

Dr James:

Well, yeah, I mean, if nothing, no one engages, then the one thing that's true is everything stays the same. Yeah, I mean, if no one engages, then the one thing that's true is everything stays the same. And you know, the UDA system certainly has no shortage of detractors, shall we say, in its present form.

Johnny:

Any other headlines, or would you say that what you've just said is the main salient points From a clinical point of view, yeah, I think it's going the right way and we shouldn't pour cold water on that. There are a couple of things in there, though, that I see that I haven't seen where that's going to lead us on here and that's going to come down to probably some unintended consequences, which changes always have unintended consequences. So we need to think about that. We also need to think, as time goes on, what the reaction of the clinicians are, because I have no doubt that there's some clinicians will be very welcoming to what's happening. Other clinicians will be less welcoming, or even on the private side of things don't forget, the NHS has a splash on even as a wholly private practice, because everybody paddles about in the same pool when it comes to oral care, and if you make the water a little deeper or a little shallower, then it has a splash back on who else is paddling in that pool. So that's something we have to think about as well. Let me just give you a couple of little examples of qualitative things.

Johnny:

One of the things that was talked about or announced in this is this idea of the neighborhood health service. Again, it seems a good idea at first sight and I think probably from the patients that it is and what it's doing is pushing a lot of the lower level work, if you want to call it on that basis, into a who have a dental practice, who are used to dealing with that sort of thing and offering those sorts of treatments that are going on. And I think sometimes if you have a practice which everybody is, the clinician has worked very hard, for example, to work towards a preventative approach, so they've got a lot of, you know, band A, band 1 type treatments that are running through, and then suddenly you've got something opening up next door down the road as part of some sort of a neighborhood health service that potentially has the ability to see the patients at a time which suits them, then that's going to have an effect on that type of practice. So I would be slightly worried about that. We don't know how this is all going to pan out yet, but that's something which is there as part of that it comes down to.

Johnny:

They're talking about the upskilling of a dental practice, of the team of a dental practice, and again, that's something that a lot of us have been talking about for years and years and years. And we've got people training as therapists, we've got the hygiene side opening up and for them to come in and work within a dental practice and working to the extent of their scope cannot be but a good idea. As I say, many successful practices already do that NHS and private. A lot of us have been talking about this for years, but that is a good idea. But if you start pushing that through, let's say, a neighborhood schemes, then that does take it away from the dental practices themselves, and one of the things that they have said is that it leaves the dentist free then to do the higher value items or the more technically difficult items.

Dr James:

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Johnny:

and again as a concept, is that a good idea?

Johnny:

it probably is, but actually a lot of dentists don't want to do. They don't want to have four or five days a week with, you know, four difficult, technically difficult treatments every single day. It's actually probably nice for a dentist to have maybe a difficult technical treatment actually in between times, as if you exam scale and polish sort of thing it mixes up what they do.

Johnny:

Yeah sort of thing. It mixes up what they do. Yeah, and for clinicians there's a lot of dentists. Well, that's, that mix of work is what you do. The dentists don't all want to be specialists.

Johnny:

But where we're going with this, it seems to me we're on a little slope here towards taking out all the day-to-day oral care and leaving the expensive stuff with the dentist. You would ask whether the dentist would, if you're doing that specialist work or higher level work, if you want to call it that, whether they would do it on the NHS or whether they would just say well, do you know what? I'm just going to go put it on a private book where I can charge more for it, because you're no longer as a dental practice, you're no longer a community dentist working with the people, with whatever comes in through the door, with the children. You're no longer that sort of family dentist thing and I'm not sure how that's going to play out as far as the dental community is concerned. I mean, you've been a dentist, James, you know it. Does that make any sense, or am I reading it wrong?

Dr James:

Well, I mean, I can see how the end game or the end product of that system may become the way that we talked about just a second ago. Uh, I guess what it partly comes down to is um, do they insist that every practice is run like that? Um, or you know, can other members of the dental team then pick up that role where they are the uh family dentist inverted commas. You know what I mean? I mean, if you have uh direct access with a therapist or something along those lines, do they then replace the dentist? Does he or she then become that person, that role model? Um, it's, it's like all these things all about the implementation, isn't it?

Johnny:

it is, and I think is about control. I'm also reading some other control things into the consultation process that we are seeing. Part of that is the offer of money to do structured audits within a dental practice, annual peer reviews, annual appraisals from somebody else coming into your dental practice. Now, in my experience, a lot of dentists are doing. They do what they do because they like doing their thing. They like to be in charge of what they do and how their practice is operational. It's their choice. You start offering bringing in the structured audits in a wider scale, in a wider scale. That in itself okay, you're feeding back what the practice is doing, but you're also feeding back with information so that from the Department of Health, you can start to control what the practices are doing. No-transcript, this, I think, is taking it another step further, Because if you've got a dental practice and you do have the choice to run it with therapists and hygienists the way you want, that's perfect.

Johnny:

But what we're seeing here is the start of something which is moving the basic oral care away from a dental practice. I can't see that this being the start of something which then doesn't continue. And there are people in the industry who do say, yes, we will move that basic oral care and the whole oral preventative aspects and so on away from people who aren't connected with the Department of Health and let these guys be private and so on, but they're not controlled by the Department of Health and make the NHS dentistry, which, again, the NHS dentistry is about health care, oral care, but it's also about money. So if you could move that out into employed people and community care, for example, you're taking a lot of the higher value and potentially elective treatments which are currently funded on the NHS. We're taking those away from the cost of the NHS. So I could be just making that up, but it appears to me that that is a potential way that this will go.

Dr James:

I see. So they haven't. The details are a little loose for the moment. Right, there's a consultation.

Johnny:

I don't see where the the details are, but I think we're in consultation and I think we'll start getting stuff like. This current government wants to do stuff and it wants to do it quickly, which is why some of these changes are going to come in next april. Um, okay, well, be some changes that come out after this consultation and, in the autumn, moving things away. What I do think is possibly more positive than the way the last government made the decisions is that we all know where we're going to be were going to be With the last government it was it sort of it drifted and you never quite knew what was going to happen and when it was going to happen. One positive thing about this is, even if what the suggestions are negative, at least you're going to know, and the business of dentistry needs clarity, and if we know, then we can act on it. There's another thing that's going to come out of this again which is interesting. They're talking about a model contract for associates. That is also a big change.

Johnny:

Up until now, a practice could organise its own associate contracts and work with the associates to do that, and also with therapists and also with hygiene, if you wanted, the BDA, which is not connected with. The government has always had its own contract, the BDA contract, which is essentially the standard one which many, many practices over a lot of years have taken. They've made the amendments to that, but using the BDA contract as your starting point, the talk now is that the Department of Health will create their own model contract. That, once again, if that becomes the standard, you are having the government dictating contracts, not the BDA, which is representative of dentists themselves creating the contract, and the government generally has a view to saying well, we're going to create the contract in our own likeness, in what we wanted to say, which is not necessarily what the dentist might want it to say. So that slightly worries me. It also worries me that they're going to create a handbook. So if you're a dentist, this handbook is supposed to be this is how you should run your practice, this is how you should deliver your clinical.

Johnny:

I'm not convinced about that. I'm really not, because with the best will in the world, I don't think the government are qualified dentists, and who knows best how to treat their patients and deal with the patients than the dentist, who has that care first and foremost in his mind, and whether the model contract such as it is, whether that actually simply deals with how the relationship works between associates and principals, but how much of it is actually starting to dictate what dentists can and can't do. That worries me, and it worries me. We're on a slippery slope on that one.

Johnny:

And if the government has the ability to take the model contract away from the BDA and you are having associates coming out of the healthcare sector sorry, the health universities, which of course is also government controlled that they are going to be, if you like, encouraged very heavily to adopt the government's contract, which may be more related to cash and money and the treasury than actually to oral care. Now I would like to be very wrong on that. I'm just playing the devil's advocate and saying this is where it might end up, which means the government has the ability to control the direction and facilities that are given to associates, who will become principals in the fullness of time and it'll become de rigueur that this is how they practice dentistry in the UK Again.

Johnny:

I'm a little bit worried about that. I'm going to go through a deeper thing on this one. There's also a talk sorry, just a phrase in one of the procedures and one of the suggestions that dentists don't know if they are employed or self-employed. Let me be very clear on this one. It is not in the dental industry's interest to be employed, because if you have an employed associate because if you have an employed associate then a dental practice pot the money that's available to treat the patients is limited to the number of patients that you've got. It's limited to the money coming into the practice. So if you're going to pay an associate let's say 100,000 a year let's say if they do 100,000 pounds worth of work at the gross level, then that 100,000 pounds has to be distributed to somebody. If it's going to the associate, the associate will get their share of it, whether it's a percentage or a number of UDAs, whatever. Whatever it might work. But you've got £100,000 worth of income to distribute going to be employers national insurance, which is 13.5 percent or something. I don't think I might have my figure wrong on that one, but that's only going up.

Johnny:

We've had all this talk about the increase in the employers national insurance, so that first tranche of that, so of your 100,000, then you've got 80-some thousand sorry 85,000, 86,000, which is available for the dentist, the associate.

Johnny:

Then that gets divided up and your dentist then has to pay as an individual employees national insurance, which is another chunk out. So the dentist ends up with a lot less money in their pocket, for the same amount of £100,000 is coming in from patient work, shall we say. Now, the dentists were already having difficulty with recruiting associates. How many more associates are we going to get if we actually say to them, do you know what you would have got as income? A lump that's going to go to the government and national insurance instead is a disaster. What you could do is say, actually we'll pay the associates exactly the same as if they were self-employed, but the extra costs of the national insurance comes out of the practice pot. Now, that's not going to go down well either. So somewhere along the line, if we move towards an employment situation for one person or another, this is going to feel like a rat sandwich.

Dr James:

So you were very deliberate with your words earlier. It's not good for the dental industry, as in everyone right, because the money's got to come from somewhere, but it's good for the government potentially. But anyway, I mean, listen, let's finish on a high note. Have us dentists got anything to look forward to with the NHS contract?

Johnny:

I think so. I think these things are going in the right sort of way. I think, whilst the government is trying to create a more controlled delivery of oral care, I think they're actually having that engagement in oral care, which is good. And I think, as this develops out, if the consultation is right and people are keeping an eye on where the consultation is taking us, I think it's going to be either positive or, if it's not positive, at least we'll have clarity and we can do something about it.

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