A changing of the guard

09 December, 2019 / editorial
 Arthur Dent  

Or the new CDO is revolting? There are so many questions about rumoured plans for a new SDR, a new financial model, and – wait for it – a new IT system

It appears we have a new CDO. Congratulations to Tom Ferris on his secondment. I’m still waiting for my official email; you? It probably says a lot about the kind of distribution lists I’m on, but I get all the other ones from the Scottish Government about SDR updates. Maybe not the ideal start from a communications point of view but I think that’s pretty much par for the course?

So, what can we expect from the new CDO? Well, it appears that we are about to enter into a short period of change. What do I mean, I hear you mutter as you read this on your way to something more interesting? Well, I am reliably informed that we are going to move into a new quality-driven model of delivery via a new SDR with a new financial model complemented by a newly designed clinical IT system which will integrate with PSD. And all this by winter 2021 or spring 2022. Now, being that this is based on the OHIP and the previous CDO’s mantra was “evolution not revolution” the above seems a lot like a revolution. To redesign a whole system, financial model and the SDR is quite an undertaking. I’m not necessarily suggesting it’s a bad idea. I often think that putting a bomb under the system and starting again is the only way to effect real change. However, I’d prefer to take that philosophical stance from the sidelines when I’m not up to my neck in financial quicksand.

To put my business and the approximately 1,000 other dental practices in Scotland who interact with NHS dentistry at risk of wholesale change in terms of what they do, how they do it, and how and what they are paid to do it, is potentially catastrophic. Not to be the harbinger of doom and all but, in Scotland, we don’t have the greatest record in terms of large-scale revisions and investments. I would offer the Scottish Parliament building, Edinburgh’s tram network and, in healthcare, the massive overspends on the new Queen Elizabeth Hospital and Edinburgh Children’s Hospital as evidence.

The other factor is the timescale for this. Ambitious is frankly a massive understatement; 24-30 months from now they want this to be up and running (possibly in early adopter practices). Two and half years to re-design and re-organise the whole of NHS dentistry in Scotland. I’d repeat that statement but I’m running out of ‘rant room’. Really?

Let’s move away from the emotive and difficult stuff like model of delivery, financial model, and the SDR. Did you notice I sneaked in a new clinical IT system designed and delivered by the Scottish Government? Now, God knows we all have issues with our IT systems. They don’t do all the clinical or financial stuff we’d like. They don’t talk to PSD properly (anyone else having EDI problems?). They don’t do the new prior approval thing very well. However, they are already designed, working, updating, supported and independently contracted to each and every practice.

Do we think that we can produce a new system from scratch in 24-30 months? Do we think it will be any better than the existing systems? Do we actually need the Scottish Government to spend time and money from the dental budget creating something that already exists, and they don’t currently pay for? It’s like Denpro; why create something which already exists and operates by the standard economic tensions of supply and demand and dentists have to fund it from their practice income regardless? I am not an economist, but it doesn’t make much sense.

Maybe from the dentists’ point of view we think we might get something for nothing and no longer have to pay software maintenance fees? That may be so but what are the tie-ins? If it’s ‘free’ then surely, we are not the clients and would have great difficulty in complaining if it’s not working? Will it deal with private work? Most practices are not 100 per cent NHS; if we need a different system to run our private work, what’s the point? Is this a method of the SG finding out what private work we do? Maybe that’s good for stats but I’m pretty sure most practitioners would be a bit cagey about that.

If it does operate like R4 or Exact, and so on, and charge fees, are they going to be competitive? Does it create a monopoly where you have to use their system to access NHS fees? Would the other suppliers make a legal challenge to this or would they just see Scotland as a lost leader and desert the sinking ship? If they do charge fees on a single system monopoly, what’s to say they won’t end up charging us a fortune?

So, as usual, I just ask questions and don’t give any answers. I don’t even claim to have all the questions. I’m pretty sure there are some really sharp operators out there with many more questions and concerns. And now here’s the real concern: the groups who are consulting on these changes are announced and there are very few GDPs involved. Those who are, come from the political fora. While I understand that’s the usual conduit; surely a couple of random practice owners that do a lot of NHS work might be good to have in the mix? Expose some of the potential flaws early in the process. Give a real-life perspective. Maybe make the whole thing workable for those who actually operate the system? I am a cynic. I am also deeply concerned.

Tags: CDO / Information Technology / Insider

Categories: Magazine

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