Internet Explorer and Edge browser users:
To download Word, Excel or PowerPoint files please right-click on the file you wish to download, and select 'Save target as...'

Dentistry in Wales - far from a rural idyll

Blog Author Tom Bysouth

Blog Date 15/02/2018

Rural WalesEvery year the BDA look into the issues facing dentists in Wales from poor morale and difficulties in recruiting to rising expenses, rising indemnity costs and an inflexible contract. Dentists across Wales have responded in numbers and this evidence will be presented to the body who will provide recommendations on pay  – the Review Body for Doctors and Dentists Remuneration (DDRB). The results are alarming, and we need real action from the DDRB to make a positive impact on the working lives of dentists to mitigate a looming crisis.


62% of associates in Wales said they would not recommend a career in dentistry, the highest percentage in the UK. Our other findings paint an equally bleak picture, with nearly half of practice owners rating their morale as low or very low, less than a third of associates and practice owners feeling they are fairly remunerated, and almost two thirds of practice owners experiencing difficulties in recruiting dentists.


Similar issues exist within the domiciliary service, with fewer younger dentists involved in this type of work and a service that is increasingly patchy and underfunded, leaving the most vulnerable unable to access dental care.


So what lies behind these alarming figures and, more importantly, how can we turn them around?


First we need to look at the pressures placed on general dental practices by an inflexible contract that fails to address the significant social inequalities across Wales.


With practices in deprived areas having to deal with complex and difficult cases, the inflexible system of UDAs results in both increased difficulties for patients wanting to access care and financial pressures on practices, who face end of year clawback. Clawback has doubled in the past year to £6.6m and is not always reinvested in dental care – one health board is known to have moved £2.5m in dental underspend to other areas. This is unsustainable and places a huge pressure on practices, delaying investment, increasing stress and damaging morale.


Wales had taken a different approach to England on reform, but the Welsh CDO has said pioneering work with two Swansea practices piloting 100% capitation contracts will not be taken forward. Instead in Wales we are looking at modifications of the 2006 contract, where some UDAs can be used for prevention. Although reforming the dental contract lies outside of the remit of the DDRB its effect on the health of practices in Wales cannot be overlooked when the Body makes its recommendations. Whatever route we end up taking, evidence direct from our members will sit at the heart of our arguments.


Government also has a duty to address the significant recruitment problems that practices are struggling with, especially in rural west Wales.


We know this is putting incredible pressure on colleagues and is jeopardising the viability of practices in some cases. Patients in Dolgellau lost their only dental practice last year. We have raised the issue with the Welsh Assembly but we await a concrete plan of action.


Of course training new dentists is only part of the story. We need to make the profession an attractive career option, for current dentists as well as new ones.


Looking at the contract will help in the longer term but there is action that can taken now.


The re-introduction of NHS commitment payments would reward dentists for NHS work and help associates, in particular, who generally have a higher proportion of NHS work and form the vast majority of the workforce. And as we know the majority would not currently recommend their career to others.


We need to tackle rising indemnity costs faced by dentists in Wales, and we know that these can currently incentivise reducing hours or partial retirement. Retention could be improved, we believe, if the NHS were to subsidise these cost increases. Such early loss of skilled dentists only serves to worsen the recruitment problem across Wales, and indeed the whole of the UK.


Finally for dentists across the UK we would recommend an inflation increase plus 2% to tackle rising costs, to show dentists they are valued, and improve morale, recruitment and retention.


Read our complete evidence and the results of our survey of dentists in each of the four nations in our 2018/19 evidence submission.


Tom Bysouth

Chair, Wales General Dental Dental Practice Committee


Dentists' pay: What we do for you

Each year we use our evidence to fight for a fairer pay for associates, practice owners, and community dentists, and we call for pay parity for dental clinical academics.

We work across England, Northern Ireland, Scotland and Wales, and provide evidence to the Governments on your behalf.

We want an end to the public sector pay cap for doctors and dentists – we believe the continued decline in income for dentists is affecting not just the profession, but the access to care dentists can provide for patients.