The BDA Fights Back

Fresh on the heels of the editorial in the current BDJ come two releases which signify a sea change in the way the BDA will be perceived by the membership and hopefully by the DoH too.

Perhaps as a response to Tony Kilcoyne’s letter to the BDJ the BDA have again asked that the new decontamination regulations be evaluated by NICE. It strikes me that the 60 references apparently supporting this edict are as difficult to find as the evidence behind the WMDs that led us into the Iraq war.

Next a rejection of the “new” version of the 2006 contract, the so called Warburton or PDS+ contract.

BDA calls for NICE evaluation of decontamination evidence base

The British Dental Association (BDA) has today called once again for a full review of the evidence base for the HTM 01-05 guidance document on decontamination in dental surgeries. The BDA has written to the Department of Health (DH) renewing its 2007 call for a National Institute for Health and Clinical Excellence (NICE) review of the evidence, after it emerged that three areas of the guidance have already been amended before the document is even printed.

The three changes to the guidance that have already been made are:

The use of potable water for the rinse stage of decontamination is now permitted. This is a climbdown from the previously intended requirement for reverse osmosis and freshly distilled water, after studies showed low concentrations of endotoxins in England’s potable water supplies.

The period for which instruments can be stored after they have been processed in a validated vacuum sterilizer has been increased from 30 days to 60 days.

The revision of the requirement for two sinks for decontamination to allow the option of two bowls incorporated into a single unit instead.

Concern about these changes has been heightened by a consistent failure by the Department of Health to publish the references that they say form the evidence base for the document, despite repeated requests by the BDA for it to do so.

Calling for the guidance to be referred to NICE, BDA Executive Board Chair Dr Susie Sanderson said:
“It is telling that changes to the content of HTM 01-05 have had to be made already. The changes expose the uncertain evidence base on which the document is founded and will be a cause of great concern to dentists. These doubts can only be exacerbated by the failure of the DH to publish its evidence base for the document.

“This guidance will apply to family dentists and public dental facilities alike, so complying with it will cost both dental practice owners and the taxpayer significant amounts of money. The dental profession is absolutely committed to the highest standards of patient safety and is happy to invest in pursuit of those standards. But the investment has to be in changes for which there is a robust evidence base. To establish that evidence base the BDA believes the guidance must be looked at in detail by NICE.”

Link to press release here.

Dental access contract still unsuitable as changes do not go far enough says GDPC

The unnecessarily complex contracts for dental access funding make them risky and inappropriate for dental practice, despite some changes made by the Department of Health (DH), the BDA’s General Dental Practice Committee (GDPC) has said today.  The final version of the ‘PDS+’ agreement developed for the current round of dental access procurement has been published today by DH.  It runs to nearly 50 pages and 17 schedules.

John Milne, Chair of GDPC, said:

“Although it must be an individual business decision, we advise dentists to think very carefully and seek advice before taking on one of these contracts as the dangers of breach are rife, and the consequences of breach may be very damaging to practices.”

The GDPC, advised by specialist lawyers, has spent more than four months explaining in detail to DH why its proposed contract was unsuitable, one-sided and unsafe for practitioners. The first version, based upon a medical model, was wholly unacceptable and we advised members not to sign it.  While DH has made some significant changes, we still do not feel that the contract is acceptable.

The main reasons are:

1. The requirements are one-sided, leaving all the risk of a complex and untried payment mechanism with the dentist.
2. Fundamental new provisions, such as the payment mechanism, the need to comply with new key performance indicators and the ‘dental care assessment’ of patients should have been developed and piloted in conjunction with the wider profession through the implementation of the Steele review.
3. The contract is over-specified and a large majority of the controlling provisions remain, leading to intrusive micromanagement. Practices will need to devote considerable resources to managing the contract and ensuring that the requirements are met.  For most practices, this will require a dedicated contract manager and for the contract value to reflect the risks and extra work required.

Members are advised to take specialist advice if considering bidding for access contracts.  The contract, which DH says is not actually mandatory for PCTs to adopt, is on the BDA’s website here. BDA guidance notes are available here for BDA members.

Link to the press release here.