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Dancing to the Tune

Many of our NHS practitioners will have been dismayed to receive the form ‘2021/22 Year End Reconciliation’ from the NHSBSA.

This sets the performance for the various stages of last year, H1, Q3, Q4, and measures it against the reduced targets which were set just in advance of those periods. I, and some of my colleagues, were concerned that in certain circumstances it would be very difficult to meet the targets, and we were doubly concerned that the sliding scale of how quickly support dropped off was too steep.

Many practices met, or almost met, the targets. Some did not achieve them because they took the decision not to focus on the NHS work, or to concentrate on private. This piece is not about those practices. It is about the large number of Principals of clinics who tried their hardest but did not achieve their targets for reasons outside their control; reasons which made it almost impossible, whatever they might have done, to meet the objectives.

A clinician absent from work for a period of months after an accident or severe illness (much has been written about the mental impact of Covid of course) is an obvious and clear example. But it is the indirect impact of the pandemic which has been much more heinous. Severe staff absences amongst the nursing and other clinical team have a magnified impact, especially in smaller practices where the ability to be flexible is curtailed; sharing one third of the workload amongst two remaining staff is more problematic than one tenth among the remaining nine. Direct illness of a team member is one thing, but there has been a much more widespread indirect impact of Covid on childcare provision – a team constituted mainly of people with children of nursery or primary school age cannot help but have been affected. Coupled with the Government’s instruction to ‘stay at home’, this has robbed clinics of their functioning team, and consequently their ability to achieve targets. The staff and overheads still have to be paid. No furlough schemes, or SEISS. Access to other government support denied, because the NHS was providing the support. And as we emerged from the lockdowns, certainly practices should have been able to find their own feet again.

But whilst this impacted everyone, some practices were randomly affected more than others due to particular situations, and there is certainly an argument that smaller practice teams are less able to cope with staff absences than larger ones. Some of these situations would have been difficult to tie down and quantify precisely, such as a rural area being part of a long-term Covid hotspot, but some are more easily measurable, such as a debilitating illness, physical or mental, affecting the principal’s or other clinicians’ time at work.

Were these matters which were outside the control of a practice owner considered in advance of the target setting? If they were not, is there not a case for reconsidering legitimate cases where through no fault of their own, principals have been brought to the edge of financial bankruptcy by the size and impact of the clawbacks?

Hindsight is a great thing! but it surely should be recognised and rethought if it shines a light on something wrong. Those who set the targets had little capacity to predict these consequences, but now we know, should we not be taking them into consideration?

Given that at the time we were all making it up as we were going along, perhaps the targets should have been set in a more flexible way, acknowledging that there was the potential for providers to be influenced by outside criteria. A number of us at the time predicted exactly the circumstances which - outside our clients’ control - would give rise to an inability to reach the targets.

NHS dentistry has many positives. It plays a good tune, but it must recognise that dentists in real life cannot dance to that one tune at all times and whatever the circumstances.

This is the caring, nurturing Healthcare sector; perhaps NHS dentists should receive the same courtesy of understanding as the other sectors of the NHS, the doctors, the GPs, the general nurses, the hospital workers. Some practices will fall and close their doors with the impact of the application of these clawbacks. Make no mistake; it will not be Covid which has caused the destruction of these practices and the elimination of access to NHS dentistry for their patients, but the unbending application of rules made on the hoof.

For practices who are not caught, but are watching bystanders, NHS funded dentistry will surely lose its lustre as a ‘haven’ and the intransigent application of the rules as implemented by the BSA will be a massive factor in driving clinicians towards the embrace of private sector, and the death knell of NHS dentistry.