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Government publishes further end of year reconciliation guidance

We are pushing the Welsh Government to revise the rubric in the end of year guidance to Local Health Boards (LHBs).

Our message is clear in various communications to the Chief Dental Officer, and to the Director and Deputy Director of Primary Care and Mental Health.

Government officials must give a much stronger steer towards a holistic assessment of contract-holder performance based on a reasonable assessment of what has been possible to achieve under the experimental volumetrics in 2022-23.

Further guidance was eventually distributed on Friday 10 March. A report has also been published on the Welsh Government's January engagement event (in Welsh) and a resulting set of FAQs (in Welsh).

This further guidance on end-of-year reconciliation has been met with dismay by the Welsh General Dental Practice Committee (WGDPC). It describes solely the greater flexibility on carrying over clawback into the next financial year, but with no further mitigations based on the patient profile of the practice, or the work achieved.

We consider that the lack of a proper holistic approach in official guidance has sounded the death knell for the high trust environment that was repeatedly espoused by dental branch this time last year. The political rhetoric of clawback being there to protect taxpayers gives no credence that this last year has been one large, failed pilot for most practices.

In our recent survey around 70% of practices were expecting clawback, which tells us the targets for the volumetrics were flawed from the outset. Contract holders must now attempt individual negotiations with their health boards so that further mitigations are sought at their LHB's discretion.

Practice owners must argue their value to their contract manager. However, this tactic is unlikely to work for many; one third of contract holders have already determined they will be reducing their contract value for next year and over 10% are planning on handing back their contracts entirely.

The long-awaited FAQs were being held out as a way forward to help parties understand the government's rationale. Dental branch has used a fallacious argument that: "access and activities significantly drop if NHS contractors are paid ACV without any expectation on volume of patients or activities." Volumetrics for new patients were simply plucked out of the air on the pretext of the Steele Review (2009) advocating rebalance towards prevention, "rather than just delivery of restorative care".

Dan Cook, Vice Chair of WGDPC, said in response:

"It's very disappointing that the Steele Report has been misappropriated to justify this completely non-preventative, non-evidence-based approach.

"As for a document dated January 2023 coming out now, it speaks volumes about how much or how little we mean to them."



GDS reform programme FAQ January 2023 V1

GDS reform programme FAQ January 2023 V1 CY

GDS Reform Programme Engagement Event January 2023 Report V1

GDS Reform Programme Engagement Event January 2023 Report V1 CY

Flexibilities letter