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NHS dentistry in Wales: Where does the clawback money go?

Blog Author Katrina Clarke

Blog Date 17/08/2017

The BDA’s response to the recent announcement by the Welsh Government Health Secretary, Vaughan Gething, that £1.3m would be invested in NHS dentistry, was sceptical for good reason.

It’s not because dentists don’t welcome a much-needed cash injection in the nation’s oral health – it’s the fact that it was presented as ‘new money’ when the Welsh Government spokesperson failed to mention that this £1.3m is actually being funded from the increased patient charges.

This misrepresents the real picture when you also add on the whopping £6.6m lost to NHS dentistry last year alone through clawback from general practice in Wales. In contrast the new money pledged to expand dental services only represents a fifth of this.

As I said in a BBC interview, we believe every penny that’s allocated to dentistry should be spent on dentistry. The BDA has good evidence that the annual clawback is being used by some of the Health Boards to balance their books.

Of course, we welcome the purported commitments to spend the dental budget on dentistry – such as the promised 10,000 new NHS dental places in some of the most deprived parts of Wales – but we are disappointed that the allocation of the £1.3m misses those in greatest need, like large parts of North and West Wales.

The shocking extent of how much money has been taken out of dentistry was only revealed after the BDA analysed figures on clawback obtained from the Health Boards under the freedom of information legislation. Betsi Cadwaladr University Health Board were unable to send information on clawback in time for our article, but the Daily Post reports this week that it’s actually £2.94m!

Realistically, how can the nation’s oral health be turned around when the dental budget has in effect been slashed by £7m or more each year?

This inevitably leads to poorer access for patients to NHS dentistry. As it stands there are currently only 4.7 NHS dentists in Wales per 10,000 population and many people face long delays on NHS waiting lists as a result, if in fact they can access NHS dentistry at all.

It also has an impact on dentists. Morale is low for Welsh dentists who perform mostly NHS dentistry, and only 26% of whom feel they are fairly remunerated.

Recruiting and retaining dentists in Wales is difficult. Several practices have closed recently, and in one well publicised case in Dolgellau, Betsi Cadwaladr University Health Board told the Daily Post that it couldn’t attract dentists to the area, and those that do operate in the area are “ditching [their] contracts.”

As in England, clawback arises where dentists fail to hit their UDA targets – not due to a lack of patients, but by spending greater time with patients most in need of treatment. This is a prime example of how the system fails patients, while other dentists, with spare capacity to see NHS patients, can’t because of the perverse contract.

Mr Gething acknowledges that more work is needed to reform the dental contract. He could start by tackling the unfair UDA values and the pressures of clawback. There is nothing enshrined that says Health Boards have to take the clawback money, despite what the Welsh Government spokesperson would have the public believe.

He also needs to ensure that the Welsh Government does not wash its hands when Health Boards use money allocated to dentistry to shore up gaps in expenditure elsewhere – it must exert leverage on them to spend the dental budget on much needed improvements in dental health.

There also needs to be joined up government planning. The building of 20,000 more homes in Cardiff was approved last year. Current plans show that by 2026, 41,400 new houses will be built. For Cardiff, it is predicted that the population will rise from 320,000 to nearly 400,000 by 2026. The population of Wales is growing and its dental needs must be considered.

Health Boards can balance the books, but can they also balance their responsibilities and duties? That’s the real bottom line

Katrina-Clarke-300px72dpi.jpgKatrina Clarke
Chair, Welsh General Dental Practice Committee