In 2014, CCGs were invited to show their interest in taking on a greater role in the commissioning of primary care services – including dental services. More than 70 per cent opted for either joint or delegated commissioning arrangements. The third option was greater involvement in primary care decision-making.
Both joint commissioning and delegated commissioning mean CCGs have (among other responsibilities outwith dentistry): ‘the opportunity to discuss dental, eye health and community pharmacy commissioning with NHS England and local professional networks but have no decision-making role’.
Greater involvement means: ‘CCGs who wish to have greater involvement in primary care decision making could participate in discussions about all areas of primary care including primary medical care, eye health, dental and community pharmacy services, provided that NHS England retains its statutory decision-making responsibilities and there is appropriate involvement of local professional networks.’
A new policy book
In January 2016, NHS England issued the Policy Book for Primary Dental Services (https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/01/policy-book-primary-dental-services.pdf) to ‘provide commissioners of primary care services the context, information and tools to safely commission and contract manage primary dental contracts.’
This policy book listed the types of dental contract (GDS Contract, PDS Agreement and PDS + Contract) and compared their features.
There are also sections on contract variations, contract breaches, adverse events, managing disputes and practice closedown.
Financial Recovery and Reconciliation
Chapter 11 gives guidance on the management of the mid-year and year-end financial reconciliation and recovery process for dental contracts.
For the mid-year review, the Commissioner must determine the number of UDAs and UOAs provided by dental contractors between 1 April and 30 September, and do so by 31 October of the same year.
Contractors who provided more than 30 per cent of activity in the period are sent a letter and particular attention is paid to those over delivering by 50 percent or more. The letter reminds contractors that: ‘any over delivery of your contracted activity will not be paid for although we may agree to carry forward up to 2 percent of activity in the following financial year.’
It thanks them for their ongoing commitment to provide NHS dentistry.
Contractors under delivering by 30 percent or more are again sent a letter but are also required to participate in a mid-year review of their performance. This meeting can take place by telephone and if the contractor provides reasonable explanations and/or remedies, the Commissioner may take no further action. Failing this, the Commissioner may require the contractor to comply with a written plan to remedy the situation or withhold payment – calculated as laid out in the policy book.
In June each year NHS Dental Services (NHS DS) will provide Commissioners with contract level data – actual dental activity against each contract for the previous financial year. For under delivery of UDAs or UOAs below 96 percent, the Commissioner recovers the overpayment. Between 96 and 100 percent (the so-called 4 per cent tolerance) the Commissioner need take no action if the contractor agrees to make up the shortfall within no less than 60 days.
Unless the contract specifies differently, Commissioners are not required to pay for over delivery. Commissioners may allow a tolerance of up to two per cent per year which they may pay for or carry forward.
Exceptional circumstances are considered on an individual basis.
Downloadable from the NHS England website (https://www.england.nhs.uk/dental/) is Annex 7 – year end reconciliation template calculator (the policy book contains a different Annex 7, which is a bit confusing). This template allows for analysis by Commissioners of contracted activity, actual activity, over and underperformance and comments to be entered for each practice.
The concern for dental providers
This year-end accounting procedure is not flexible and makes no allowance for atypical situations or the evidence to underpin these situations.
Depending on where you are in England will dictate how flexible, or otherwise, Commissioners will be in terms of under performance and over performance. With most being constrained by limited budgets, some quite inflexible enforcement seems likely. And then, of course, most Commissioners will have ‘the opportunity to discuss dental, eye health and community pharmacy commissioning with NHS England and local professional networks’ – albeit with no decision-making role. However, their opinions and recommendations will surely be influential.
About the author
Amanda Atkin is a change management consultant, focusing on the healthcare sector in which she has considerable expertise and experience. Amanda's skills range across contractual management, performance management, operational delivery and leadership development to strategic planning as well as governance and regulatory compliance.
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