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Political tide must turn to save GDS contract reform in Wales

​We examine your views following our survey on the GDS contract reform volumetrics, or the UDA-only option, and the choices you are facing for 2023-24.

Russell Gidney
Russell Gidney Chair WGDPC

A rapid report reveals a bleak picture ahead.

250 General Dental Practitioners (GDPs) responded to our survey, and it is crystal clear that the profession’s confidence has been lost in both the contract reform process and in the political leadership. Your comments made for very sobering reading and are summarised below.

The likely outcomes from this unfolding picture resonate with everything we have been warning the Welsh Government about for many months. The feedback you have provided is very timely as Welsh Government notified us that they wish to engage us in formal negotiations that will lead to the legislation for the new GDS contract.

A forum for serious debate

I replied to the Welsh Government this week explaining that to develop our negotiation mandate, a process of engagement with the profession is required. The results from the first survey provide an excellent foundation and I invite you to take part in further surveys.

I have spelt out that if the political tide does not turn as a matter of urgency, then the NHS dental service in Wales will become hollowed out."

I included an eleventh-hour request for them to offer us a forum for serious debate and have stated the dire situation with the current financial year and the need to radically improve the clawback situation. I have also stressed the need to revisit the volumetrics targets and reconciliation mechanisms in 2023-24.

Practices should not be expected to take on the lion’s share of the financial risks while trialling untested metrics. I have spelt out that if the political tide does not turn as a matter of urgency, then the NHS dental service in Wales will become hollowed out. Your responses make this patently clear.

Your thoughts on health minister’s comments

We asked for your thoughts on the health minister’s recent comments on clawback in the Senedd and 96% disagreed:

  • “I found this infuriating to read, and I am disgusted the minister has such little regard for the profession. Such belittling comments from someone who has absolutely no clue what it’s like day to day doing NHS dentistry - it’s insulting to read this.”
  • “… We are at saturation point now, which means dentists will simply leave if clawbacks are enforced without very good reason with the contract so heavily stretched as it is.”
  • “This is truly offensive to dentists who have worked tirelessly in the last 12 months to meet targets that are completely made up and have no relevance on the needs of the patients walking through the door.”
  • “My practice may not have a future. I am a young practice owner. The health minister should be encouraging people like me to stay in the system. She is doing the absolute opposite. Running costs have become extortionate. If clawback happens it will be catastrophic.”

Looking at our options ahead for 2023-24 the picture is deeply troubling for the sustainability of NHS dentistry."

Your position on the health minister’s assertion that the reform system is working was equally damning with 96.8% disagreeing:

  • “… I have yet to meet a happy dentist under this contract. Of the 10 dentists I work with 4 are leaving due to this contract. I suspect this is what she wants. So that NHS dentistry no longer needs to be funded when there are no more dentists left willing to work for it.”
  • “Totally out of touch!! Every dentist I’ve spoken with who works in the NHS has expressed unhappiness of the current system.”
  • “Everyone working on NHS has had enough. I earn less than 15 years ago. Private work props up the NHS. The system has been ruined for years. UDAS were terrible. ACORNS add a new layer of nonsense to the profession. I struggle to fit in all my regular patients without now having a metric for new patients.”

We asked whether you support the current reform measures and volumetrics. Responses were in overwhelming (90%) disagreement. Comments included too much pressure to see high volumes of patients which results in poorer levels of care, too many metrics that are impossible to meet and mental wellbeing in the worst state it has ever been in; all due to the failing contract. Looking at our options ahead for 2023-24 the picture is deeply troubling for the sustainability of NHS dentistry.

Moving forward

Over 70% of practice owners in the reform programme are expecting clawback this year. Not surprisingly, only 39% intend to stay in the reform program in 2023-24. A further 15% intend to revert to the UDA-only default position. Nearly a third intend to reduce the contract value for 2023-24 and on current projections around 13% intend to hand back contracts at the end of this financial year – and this is on top of contracts already handed back.

The prospects viewed by practice owners on the UDA-only contract are hardly any better. Clawback is expected in over 63% of practices and a similar number (61%) expect to stay with UDAs next year. Over a quarter will reduce their contract value and approximately 18% will hand back contracts at the end of this year.

I have been invited to a meeting with the health minister next month and will relay the strength of feeling of the profession and the reasons why.

I aim to achieve three things:

  • Stop the clawback for this financial year and next (with a few exceptions relating to decreased workforce)
  • Explain that legislation is not the fundamental problem and rushing it through will not solve the system reform crisis
  • Seek political leadership that supports a culture of trust and fair reward in NHS dentistry.

If I fail to achieve these objectives, you have made it plain there will be a seismic shift in service delivery in 2023 into 2024. I will fight for fair treatment of NHS dentists and will not give up until all avenues are finally exhausted. Your support in these endeavours is crucial and I truly believe our collective strength can win through.

If you are experiencing any difficulties with negotiating a variation to your contract for 2023-24, our advice team are here to support Extra and Expert members. Call 020 7935 0875 or email the team for support.