UDAs remain a broken currency

The Unit of Dental Activity (UDA) remains the currency by which dentists operating in the NHS system in England and Wales are paid. Introduced in 2006, it took only three years before a report roundly condemned these as an inappropriate method for paying dentists.1

I have to report that, sadly, the Chair of the group who produced the report, Professor Jimmy Steele, recently passed away and his untimely passing has stolen, from UK dentistry, one of its cleverest, most clear-thinking minds. Our thoughts and prayers are with his family. This sad event has removed a person who sought to devise a more equitable system for paying dentists in England and Wales and it is to be hoped that the momentum for change will not be stalled by his passing.

We like case studies in Dental Update. Here I report three related to UDAs. First, I saw a patient who had been injured when a car reversed into her as she attempted to cross a road. Her UL1 was avulsed, and UL2 fractured. There was a family wedding shortly after this unfortunate incident so, quite rightly, the dentist whom she attended made the patient (who was exempt from payment) a one tooth partial acrylic denture: 12 UDAs, minimal laboratory fee. The UL2 was, in my opinion, restorable (large composite or, at worst, a crown) but, shortly after the wedding, it was extracted and a new partial upper immediate denture was placed: another 12 UDAs, minimal lab fee. Two months later, the patient complained that the denture was loose and another was made: another 12 UDAs, minimal lab fee. When I saw the patient, her teeth were covered in plaque and there were heavy calculus deposits in many areas. On being asked, the patient advised that she had not received any scaling and polishing or oral hygiene instruction during the three courses of treatment in which the dentures were made: all that seemingly mattered was the multiple gathering of 12 UDAs.