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Thousands of teeth may unnecessarily be pulled for profit in UDA system


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The results of an investigation by The Times has raised concerns that the UK’s current fee-per-item payment system benefits NHS dentists who are putting profit before patients. (Photograph: Stephen Kiers/Shutterstock)
Dental Tribune International

By Dental Tribune International

Thu. 11 August 2016


LONDON, UK: According to a new investigation conducted by The Times, thousands of teeth could be needlessly extracted in the UK every year because it is more lucrative for NHS dentists to take them out than try to save them. Moreover, the findings suggest that the current fee-per-item scheme makes it too easy for dentists to exploit the system and see more patients than they should for monetary reasons.

As reported by the paper, some dentists earned almost £500,000 a year by cramming in up to 60 patients per day. Concerns have arisen because dentists have received the same flat fee from the NHS for different types of treatment since the last reforms in 2006. Since then, a unit of dental activity (UDA) system has been applied in NHS dentistry, according to which practitioners are paid for the number of UDAs they perform in a year—irrespective of the time taken for each procedure.

For example, a dental check-up counts for one unit, while a tooth extraction, filling and root canal, respectively, count for three. However, a root canal procedure is more complex and time-consuming than pulling out a tooth and takes on average double the time of an extraction.

When introduced ten years ago, the new NHS dental contract held the promise of shifting dentistry towards a preventative-based care approach. However, some developments suggest the contrary. A freedom of information request by revealed that ten dentists in England performed more than 18,000 UDAs during 2015/16, compared with eight in 2014/15. According to Henrik Overgaard-Nielsen, chairperson of the British Dental Association’s General Dental Practice Committee, dentists deliver around 6,600 UDAs per year on average, with a few over 10,000.

In April, a survey by the British Dental Association found that the NHS payment system was inadequate in meeting patients’ needs. According to the survey results, 93 per cent of the dentists who participated reported that chasing government targets was limiting their ability to care for high-needs patients who require complex or repeat treatment. Another 83 per cent said that the system is holding them back from preventive work.

Commenting on the survey results, Overgaard-Nielsen said at the time: “The survey shows that those in most need have become the least welcome in NHS dentistry, thanks to a system that puts government targets before patient care. We are seeing the results of a conveyor belt model of provision that has left dentists without the time or the freedom to deliver the treatment their patients require.”

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