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GDS contract reform at difficult crossroads

After 10 months of working with new GDS volumetrics, or the UDA-only option, we have provided an overview of the choices NHS dentists are facing for 2023-24.

Russell Gidney
Russell Gidney Welsh General Dental Practice Committee Chair

We want to hear what your future holds and urge you to share your views in our short survey.

General Dental Service (GDS) contract reform is approaching a crossroads; or more precisely, practitioners who work in NHS dentistry are at a difficult crossroads. We have been consistently warning Welsh Government for many months that the option to stay in GDS reform or NHS dentistry altogether is looking less certain for many practitioners.

I wrote an open letter to the Chief Dental Officer (CDO) last month, which was endorsed by the Local Dental Committees, expressing our considerable frustrations and mounting concerns. This letter remains unanswered. We have shared our views in BBC coverage, providing detailed evidence of the shortfalls of the current volumetrics. There have been some small changes to the targets for this coming April, however, these do not go far enough to keep practices from an uncertain future.

Practices are facing difficult options

Many practice owners say the figures just don't add up. We are hearing that several practices are considering reverting to Units of Dental Activity (UDAs) as a default contract position for 2023-24. This is a sad indictment of the failure of the Welsh Government to heed our warnings.

Many practices are likely facing significant clawback despite our vociferous arguments that the metrics are untested. Despite early reassurances of working in a high trust environment, it seems the Health Boards are under pressure to clawback significant sums from practices.

To add to the misery, it will likely be June or July when the final judgement is made on whether a practice qualifies for mitigation and how much clawback practices are liable for. We understand health boards are finding this task extremely challenging given all the uncertainties of the current reform system. For many practices this latest blow is likely to be the final straw.

Welsh Government unrelenting about clawback

We are aghast to read the Health Minister's response in the Senedd Chamber/Siambr about clawback. This amounts to a complete lack of regard for the financial risks that practices are operating under with untested targets:

15:56:04 "… Of course, when you introduce something new, there is a little bit of difficulty and tension in the system. Obviously, if we're going to pay people to do a job, they need to deliver on that job, and if they don't deliver on that job, yes, we are going to clawback money. I'm not going to apologise for that, because we are the guardians of the taxpayers' money as well. That is the deal. You pay for a service, if you don't deliver the service, you're not going to get paid. So, they [dentists] may not like that, but I'm afraid that is the situation…

…So, I'm not going to apologise for the contract that we've put in place… We're trying to achieve this in the face of very severe financial constraints where we have to maximise the ability of the taxpayer to get as much as they can from the system. Eluned Morgan MS, 31 January 2023

UDAs and reducing commitments

While we cannot in all conscience endorse a proposal to suspend contract reform for a year and temporarily resume the UDAs as a default position while reform conditions are reset, we are acutely aware that many practices are considering reverting to UDAs on an individual basis for 2023-24. We understand that many practices are considering handing back or reducing contracts. Final numbers of contracts to be handed back are in flux but it is likely to be around a 300% increase on previous years, representing circa 5% of the dental budget. In some health boards we understand it may be higher.

Currently, many practices are still considering the options, hoping for clarity about how the end of year process will play out for them. No matter what route you choose for 2023-24 we are here to support you.

How we are supporting you

We will be posting several short blogs over the coming weeks with updates of our messages to government officials. We will address the perilous state of GDS reform, exploring the options of returning to UDAs, and handing back, or reducing contracts. To help us understand your position we will be issuing three rapid surveys alongside the blogs. Your responses are anonymous, and results will be used in our meetings over the next two crucial months. Please take a few moments to reply to the first survey.

We will be holding an open meeting of the Welsh General Dental Practice Committee next month for all dental professionals. We are the officially recognised negotiators of any future GDS contract so urge you to attend and keep up to date. More details of how to attend the meeting will follow.

Many of you have told us that you have been struggling with anxiety, stress, depression and burnout; and some with huge concerns for the future of your practices. If you are living with mental health struggles, there are several support services available. Health Assured offers confidential support on a range of issues for members. For non-members, all dental health professionals across Wales can access confidential mental health support through Canopi. I urge you to seek help if you need it and share the resources with colleagues who are struggling.

Your voice counts – together we are stronger.