The year in perspective
By Stephen Tidman
Lab work down
As expected, The Information Centre (IC) of the NHS published its report on the first year of the new commissioning arrangements in England and salutary reading it makes for dental technicians. We have reported in DentalLab the outcome of each of the four quarters so it should come as no surprise to our readers that band 3 treatments were 50% down on what was being provided under the old item of service contract - accounting for just 4% of courses of treatment.
This year-on figure is lower than quarters 3 and 4, which showed band 3 treatments stabilising at 4.5% of courses of treatment or 56% of what they were. The reason for this was the very low provision of band 3 treatments in the first quarter, reflecting the calm after the storm of GDPs trying to get these treatments through under item of service in the run up to the changeover in April 2006. At the beginning of the first quarter, band 3 treatments were just 2.2% and had only reached 3.7% by the end of the quarter. This slight improvement continued into the second quarter, reaching 4% before stabilising at 4.5% rather than continuing to increase to the 8% they were under item of service.
Patient charges
One of the consequences of this reduction in more expensive band 3 treatments was a significant shortfall in patient charge revenue and, interestingly, exempt adults had the highest proportion of band 3 treatments. Up to the publication of these statistics, there had only been hints that patient charge revenue might be below target. As it turned out it was £475 million, a massive £125 million short of the £600 million assumed in the ‘indicative gross allocations’ issued to PCTs. Ominously, in intimating that there might be a problem, the Department’s review of the reforms, One Year On, said ‘A practice’s NHS income and the annual services it agrees to provide are not affected by how much money is raised from charges. Some PCTs, however, may have deferred commissioning of new services while they establish the reasons for low charge income.’
The shortfall in patient charge revenue is what I have been expecting all along as the patient charge for many individual items in band 3 have increased significantly - like bonded crowns which have more than doubled in price. This is something Government and the Department have refused to acknowledge, instead focussing exclusively on the overall maximum charge for a course of treatment, which fell from £378 to £189 (patient charge for band 3). It does not take a Nobel prizewinner in economics to realise that price increases of this magnitude will have significant effects on demand. Indeed, the dental suppliers have seen an increase in sales of over 30% in elevators, used to extract teeth, as many patients opt for extraction rather than treatment.
Band 2 items were also down from 40% under item of service to 30%, again contributing to the shortfall in patient charge revenue. On the other hand, band 1, checkups and simple treatments were up from 50% to 54% – a significant increase, given the size of the base. Urgent treatments (treatments not directly comparable to items under the old fee scale) stood at 11%, well above expectations and again, exempt adults had the highest proportion of these treatments.
Private treatment
The majority of chargeable courses of treatments delivered to charge paying adults were band 1 treatments at 57%. The IC report also found that the same percentages of adults (52%) were seen in the 24 months to 31 March 2007 compared to the period ending 31 March 2006. Taken together, these seem to suggest that more patients were opting for private treatment following an NHS check-up. The move to private practice is highlighted in the IC’s publication of Dental Earnings and Expenses in Great Britain for 2005/06, also published last month. Unfortunately, because of the complications of transfers of gross fees between associate dentists, this data is only available for single-handed dentists, accounting for less than 30% of practitioners. However, associates will replicate this trend. In 2005/06, earnings from the NHS accounted for just 41.9% of total earnings, a further significant fall from the 47.6% the previous year, when it first fell below 50%.
To view the two reports, visit: www.ic.nhs.uk
