The consultation on what Cabinet Secretary for Health and Social Care Jeremy Miles MS dubbed NHS dentistry’s "biggest change in nearly 20 years” is heading into its final straight. It is a huge shift, but what little our patients have heard of it, comes off the back of damning feedback from this profession.
It’s vitally important that our members speak out and respond directly to the Government consultation.
Here’s everything you need to know:
Lofty goals, dismal outcomes
We can’t fault the sentiment behind these reforms. Worthy sounding goals to improve oral health, refocus on prevention, enhance the wellbeing of the workforce, and deliver better value for money. It’s very hard to argue with sunshine, lollipops and rainbows. The problem is dentists have told us these policies look set to achieve the exact opposite outcomes.
The numbers speak for themselves: only 2% of dentists responding to our latest survey feel that these changes would support the long-term sustainability of NHS dentistry in Wales. Just 2% agree that these reforms would improve population health, with only 5% saying that they would enhance prevention. 2% feel that these reforms would support continuity of care, with the same proportion believing they would enhance early detection of oral health conditions. A bare 6% think the proposed system would provide good value for money for the taxpayer. A mere 8% say the suggested reforms would actually improve access to NHS care.
"Dentists have told us these policies look set to achieve the exact opposite outcomes."
Why the hostility?
It’s easy to see why dentists have so little time for these proposed reforms.
Despite a headline focus on prevention, the only investments in this area are tokenistic measures to expand fluoride varnish application.
The shift to move healthier patients to appointments of up to 24 months apart will likely limit the scope to act on the early signs of disease, including oral cancers, and limit opportunities for preventive advice and treatment.
Meanwhile, the arrival of the Dental Access Portal and the prospect of it being a single route of access from next year risks turning practices into impersonal treatment factories.
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 undermine continuity of care and spell the end of the ‘family dentist’.
"All of this is not news to officials who heard loud and clear from us during negotiations."
We have been offered a vision of the future where parents and children face being split up and allocated to different providers. Given the wholesale absence of centralised records and x-rays, it’s hard to see how this change will save money, if practices are having to start from scratch with each patient.
The attempt to deliver wholesale reform on a standstill budget appears to be an exercise in futility. 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, despite this consultation being the perfect opportunity to do so.
We were supportive in principle of the move to reward dentists treating patients with ongoing or complex needs via a ‘care package’. But the proposed level of payment fails to reflect the true cost of care, and risks leaving practices stuck delivering care at a loss.
All of this is not news to officials who heard loud and clear from us during negotiations.
Stuck between the devil and the deep blue sea
But it’s not just the role of the family dentist that is at stake, it’s the future of NHS dentistry itself.
Dentists have been left in an invidious position: 42% are unwilling to go back to working under the discredited UDA system going forward. 72% are not willing to work under the proposed reforms as they stand.
NHS dentistry will only exist in Wales as long as dentists are ready and willing to work within it.
Now trapped between a failed status quo and an unpopular, untested alternative, we face a likely exodus from the service, without a radical rethink.
Officials often trot out the line that there is no perfect system… as if that lets them off the hook to devise an improved system. Dentists are no fools; they know they must make any state system work despite its flaws. But there are limits to this.
Given the new service model has been assembled by a faceless group that rejected much of what the profession’s representatives told them, officials should not be surprised that it has had such a poor outing with the wider profession.
Avoiding a leap in the dark
These proposed changes are set to be fast-tracked for rollout next year, with limited scrutiny in the Senedd. Basically, MSs have the option to allow or block the secondary legislation. They don’t have the option to amend what is placed in front of them.
The other option - of returning to UDAs instead of pressing for change - would only mark the inevitable death throes of the service that we can see happening in slow motion over the border.
Clearly, Welsh Government’s stated objectives, and patient needs, won’t be served by taking a leap in the dark or reverting to discredited UDAs. Common sense must prevail. Ministers must be willing to listen, improve and pilot these plans.
"We are determined to ensure the voice of dentists is heard."
A way forward
Despite the constant claims of the Welsh Government that this new model is the product of negotiations with us, this is not a ‘negotiated’ contract. Indeed, the very design of this consultation seems geared to avoiding meaningful feedback from the profession and the public.
Our critique of the consultation process has been rebuffed by Mr Miles and questions asked of him have gone unanswered. Nevertheless, we will be submitting our response capturing all those parts of the model that need changing and pointing out the weaknesses of the consultation process.
We are determined to ensure the voice of dentists is heard.
If you’ve not responded, now is the time. Spell out what these changes will mean for you, your team and the community you serve.
You can use our template as a guide for your response and please make your individual views known to the Government directly. This can be done via post, email or online. The deadline of 19 June is fast approaching so please act soon.