Over the last fortnight we have been giving oral evidence to the Health and Social Care Committee at the Senedd as part of the inquiry into the state of NHS dentistry. Our written evidence, submitted last month, lays out our arguments and recommendations for the future very clearly.
Contract reform is no panacea
Fair remuneration for dental work is at the top of our list of recommendations. This should always be the case, regardless of the metrics and targets in the yearly iterations of General Dental Service (GDS) contract reform. This is an immutable bottom line and without it the days of NHS dentistry are numbered.
Fair remuneration is an immutable bottom line and without it the days of NHS dentistry are numbered.
Wales cannot have NHS dentistry, without NHS dentists. Over the last nine months we have heard from the Health Minister and the First Minister that contract reform will improve access, and skills mix is the solution. Meanwhile, the GDS is seeing a net decline in numbers, as well as dwindling engagement.
Backlogs and bureaucracy
We received questions from the Health Committee about reducing backlogs and how well dental services have been able to recover from Covid. The pandemic merely added to the backlogs already present which have been there since well before Covid struck.
Bureaucracy is growing around contract reform, leaving dentists spending longer on each patient. Not on care, but instead on filling out forms. The current system is broken and only provides care for half the population at best. [Russell Gidney 09:32:24]
Capped budget increases rationing
Prior to the pandemic we were faced with a dental budget incapable of providing care for everyone who needs it. This budget allocation was fixed in 2006, [Dan Cook 09:55:11] but now the new Chancellor is making it clear that we are entering austerity, which means even more rationing.
The Health Minister recently talked about 112,000 new patient appointments this year, identifying just one of the volumetrics practices are working towards at the expense of historic patients. This is a big shift from the narrative given by the Chief Dental Officer (CDO) in the summer stating that extending recalls will create 112,000 extra appointments.
The Welsh Government needs to be honest with the public that they are only willing to fund a strictly rationed system and no amount of rearranging the deckchairs can fix the problem. This misleading messaging is causing angry patients to take aggression out on staff. [Russell Gidney 09:56:27] [Dan Cook 09:57:00]
Unprecedented tally of contracts returned
The Health Minister reportedthat 14% of GDS contracts have been handed back, amounting to approximately 45 contracts. This number could easily double by year end. Baroness Morgan has suggested that these contracts can simply be redistributed, but we urge a reality check. If dentists are voting with their feet, then the NHS workforce capacity is shrinking, and practices cannot keep mopping up released contracts.
Practices cannot keep mopping up released contracts.
This is no surprise to us - a quarter of dentists surveyed over the summer intended to decrease NHS activity. The Government's approach to contract reform with unachievable targets and the looming threat of clawbacks risks being the final nail in the coffin.
Reaching tipping point
We face a GDS crisis unlike anything we've seen before. NHS practices are haemorrhaging associates and practice owners are being forced to throw in the towel. NHS dentistry needs real, immediate, meaningful change before gravity takes hold and the landslide becomes unstoppable.
We have been calling for a proper workforce review as a matter of urgency, but general dentistry is reaching a tipping point and it may already be too late. It cannot continue to rely on the goodwill of colleagues keeping a failed system afloat. Today goodwill is in short supply and there are no life rafts left.
Targets at what cost?
Dentists across Wales feel that new government targets are being put ahead of patient needs. The administrative burden has grown substantially, resulting in unpaid paperwork at unsocial hours. Unachievable targets are forcing practices to forgo recalling patients at all. We can't roll the pastry any thinner.
We have given preliminary feedback to Dr Dickenson on the recently announced volumetrics for 2023-24. The proposal to separate NHS and private sessions will not be workable or desirable and will have unintended negative consequences. If the CDO insists on this, it will likely lead to further contracts being returned to the Health Boards in early 2023.
Growing strain on Community Dental Service
The Community Dental Service (CDS) is feeling the strain of growing referrals from general dentistry to the detriment of vulnerable patients. [Manolis Roditakis 9:37:00 - 9:37:38] People who need care from the CDS are being pushed to one side. There is a difference between unscheduled care and urgent care, but patients often don't appreciate the difference. [Ruwa Kadenhe 9:45:30]
Baroness Morgan sees the expansion of salaried dental officer posts in the CDS as supporting local communities who have limited or no access to general dental services normally provided by the independent contractor model. In some health boards it is already a struggle to fill vacancies in the CDS.
Future of the CDS
The oral health needs and co-morbidities of older people will become more complex in the future. This must be factored into service planning. [Manolis Roditakis 10:06:00] The current model only covers urgent needs in the domiciliary service and cannot stretch to routine care.
It's a worsening struggle to fill vacancies in practices. Dental therapists are a vital part of the team, and a mix of skills is essential but too many posts remain unfilled. [Vicki Jones 10:21:10]
Working conditions and the plight of patients is eroding the mental healthof dental officers. Colleagues feel abandoned and are increasingly seeking mental health support, something we expect to escalate in 2023 if action is not taken now. [Manolis Roditakis 10:33:35]