News / MPs call for weighted capitation switch for dental contract

The committee’s report – NHS dentistry – called for a move away from paying dentists for units of dental activity – the contractual basis introduced in 2006. Instead the proposed weighted capitation approach would pay dental care providers a lump sum based on the number of patients they treat and reward preventative work. The committee said the change would reduce inequality and better incentivise integrated care compared with the current contracts.

The report described a crisis of access, resulting in a decline in oral health. Many of the problems had been highlighted before, but previous recommendations for change had not been acted on and warning signs, such as projected underspend in the primary care dental budget, had been ignored.

Committee chair Steve Brine said that ‘rarely has an inquiry been more necessary than this one’. ‘The problem is compounded by people being unaware of what they’re entitled to and a contract that is unfit for purpose when it comes to paying dentists for treating NHS patients,' he added. 'Today we register in the strongest terms possible our concern for the future of NHS dental services and the patients who desperately need access to them.'

Under the current dental contract system, dentists must deliver a certain number of units of dental activity (UDAs) each year, with units falling into one of three differently remunerated bands.

Although the government originally argued that the UDA system would incentivise prevention over treatment, it has been roundly criticised since its introduction. Concerns included UDA targets being set at unrealistic levels, a lack of reward for training, the failure to address dentist workload, treatment bands being too wide and no payment for preventative services.

It has also led to long-term underspending on dental services, with commissioners using dental service budgets to plug other budget gaps. The MPs highlighted reports of a £400m underspend in last year’s primary dental care, which had been driven by a reduction in NHS dental contract activity and a lack of dentists to meet demand. An earlier committee report had also concluded that the UDA system was not fit for purpose.

Under a capitation system, payments could be weighted according to patient need. The capitation approach would also incentivise whole dental teams and encourage integrated care, the report said..  

It also recommended that the dental budget ringfence – introduced for 2023/24 – should be made permanent. It argued for changes in patient registration for better routine data collection to track activity and plan for improving staff retention.

The report also called for dental professionals to be represented on integrated care boards to make sure the boards have the expertise they need to make informed decisions around contracting and commissioning dental health services.