As a consultation on radical changes to NHS dentistry enters its final phase, the British Dental Association Cymru has urged the Welsh Government to heed the warnings of the profession, pause and pilot untested plans and avoid a wholesale exodus from the workforce.
Despite worthy sounding policy goals – to improve oral health, refocus on prevention, enhance the wellbeing of the workforce, and deliver better value for money – the professional body is warning that the plans as they stand risk achieving the exact the exact opposite results.
A major survey of dentists across Wales shows:
- Only 2% of dentists responding feel that changes would support the long-term sustainability of NHS dentistry in Wales.
- Just 2% agree that reforms would improve population health, with only 5% saying that they would enhance prevention. 2% feel reforms would support continuity of care, with the same proportion believing it would enhance early detection of oral health conditions. 8% say that reforms would actually improve access to NHS care. A mere 6% think the proposed system would provide good value for money for the taxpayer.
- Dentists have been left in an invidious position, that risks an exodus from the NHS. 42% would be unwilling to go back to working under the historic discredited system of targets going forward. 72% would not be willing to work under the proposed reforms as they stand.
- 73% of dentists say they are likely to reduce their NHS commitment in the event the model is imposed next year. 64% say they are likely to go fully private.
Changes are expected to be fast-tracked for rollout next year with limited scrutiny in the Senedd. The Welsh Government has resisted calls for piloting, despite Jeremy Miles, the Cabinet Secretary for Health and Social Care, describing the package as the "biggest change in nearly 20 years."
Despite a headline focus on prevention there are only tokenistic measures to expand fluoride varnish application. The shift to move healthier patients to appointments of up to 24 months apart is likely to limit the scope to act on the early signs of disease, including oral cancers, and stymie opportunities for preventive advice and treatment.
The removal of patients from practice lists to a centralised database where they would be allocated to different practices on a first come first served basis would likely escalate this, undermining continuity of care, and spelling the end of the ‘family dentist’, with parents and children at risk of being split up and allocated to different providers.
The changes would also see the Community Dental Services, who currently treat groups such as people with special needs and learning disabilities, take responsibility for the highest needs patients, with no clarity on whether they will receive any extra resource to do so. Failure to appropriately fund the CDS to take on this additional workload would come at the expense of the most vulnerable patients in society.
The system would bring radical changes to the way dentists are paid, with rewards for delivering a ‘care package’ to patients with ongoing or complex needs. The proposed level of payment fails to reflect the true cost of care, and risks leaving NHS providers delivering care at a loss. The Westminster Government is currently undertaking an exercise to measure the surging costs NHS dentists now face, but no such work has been undertaken in Wales.
The BDA has also lambasted the Welsh Government for its seeming unwillingness to meaningfully engage with the public on reforms that would change the face of dental care in Wales.
Russell Gidney, Chair of the BDA’s Welsh General Dental Practice Committee, said:
“On improving access and outcomes and refocusing on prevention, the Welsh Government set lofty goals, but its reforms risk achieving the exact opposite.
“Now dentists are stuck between the devil and the deep blue sea, between a failed status quo and an unpopular, untested alternative.
“Common sense must prevail. Ministers must be willing to listen, pilot plans and avoid a leap in the dark that could destroy this service.”