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New CDS proposal to plug GDS gaps

Welsh Government recently published Welsh Health Circular – The Role of the Community Dental Service (CDS) and Services for Vulnerable People.

Welsh Health Circular

It lays out the various CDS functions that Local Health Boards are expected to deliver. These include the usual scope of community dental services:

  • Paediatric dentistry including GA & sedation
  • Special care dentistry
  • Post-grad training
  • Domiciliary home care
  • Oral Health promotion - D2S & GaB
  • Epidemiology.

However, there are new aspects including:

  • Urgent Care in hours
  • General Dental Services (GDS)/Public Dental Services (PDS) where there is none, or when contracts have been handed back
  • Develop tier two and three specialist services other than special care and Paediatrics.

We welcome the Honorary Contracts being streamlined and fast tracked so that we can work across borders as well as recognition of shared care service, the importance of a workforce retention strategy and that robust IT systems support good data collection.

Despite this, most CDS surgeries don't have enough staff to deliver their own services and deal with waiting lists so these new proposals will need additional investment and an expanded workforce. Neither are anywhere on the horizon.

The CDS can't be everything to everybody. Across Wales the service is already struggling with a backlog of vulnerable patients. Many surgeries within the CDS need estates upgrading including new equipment and IT infrastructure, as these are directly impeding the rate of patient throughput and causing a growing backlog. We have previously pointed this out in our letter to the Health Minister who responded by stating that Local Health Boards have to find the funding from existing budgets.

This directive raises the spectre of the CDS becoming a salaried service covering all levels (1, 2 and 3) and all areas of NHS dentistry. It boldly states that:

"In some Health Boards it may even be appropriate to replace an entire NHS independent GDS practice with a salaried model in situations for example when a contract has been handed back."

The undertow is that these new functions should be put in place to shore up the eroding GDS, where increasingly practices are looking to reduce their NHS commitment. However, with no new funding and no spare dentists to deliver the extra services within the CDS these new proposals are purely aspirational, and we question the veracity of the directive. The next meeting of the Wales Committee for Community Dentistry will scrutinise this directive and raise these issues with the Chief Dental Officer.