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​Access crisis leaves just 1 in 6 practices accepting new NHS dental patients in Wales

28 June 2019

Practices accepting new adult NHS patients by health board, April 2019

 Practices accepting new adult NHS patients by health board, April 2019


New research from the BDA points to the full scale of the access crisis in NHS dental care across Wales.


Contact with every practice in Wales in April 2019 has revealed:


  • Only 1 in 6 practices (55 out of 355 or 15.5%) across Wales are able to offer appointments to new adult NHS patients, with only 27% (96) practices taking on new child NHS patients;
  • There is huge local variation with no practices taking on new adults on the NHS and just a single practice taking on new child NHS patients in Hywel Dda Health Board (covering Carmarthenshire, Ceredigion, and Pembrokeshire). Even in areas with the strongest access rates like Cwm Taf only 53.6% (15) practices are taking on new adult NHS patients;
  • Figures have deteriorated markedly since a 2012 analysis undertaken by the Liberal Democrats found that 37% of new adult patients were able to find an NHS appointment; showing that access then halved by 2017 and has since stayed depressed;
  • 41% of practices now report they are taking daily enquires from new patients seeking appointments. One practice in Cardiff and Vale reported receiving more than 60 calls a day from would-be patients. Another in Powys said that they get "endless calls daily";
  • The percentage of practices operating NHS waiting lists has increased slightly from 21% to 25% in the last two years. However, feedback from providers has indicated many have simply given up on maintaining them, due to the vast sizes of the lists and long, unpredictable waiting times.

The analysis builds on research published today in the British Dental Journal looking at the relationship between funding and access. Since 2006 both Wales and England have operated the same discredited target-driven system for NHS dentistry. In both nations it has fuelled access problems, and sparked a crisis in retention and recruitment.


Dentists must achieve 95% of their contractual target or their practice will face 'clawback' returning their budget back to Health Boards. Practices also often hand back funds if they feel they will fail to hit their targets at the end of the contract year. Consistent 'underperformance' has led to permanent reductions in these contract values, and with it the amount of NHS dentistry practices can perform. 


The study found that while access levels remain critical, £20.3m of the NHS dental budget has been lost through the operation of the contract from 2014-17, amounting to, on average, 6% of the total budget each year. Freedom of Information requests indicate monies lost are not being reinvested in front line services as a matter of routine. Fear of missing targets and facing clawback is also actively discouraging practices from taking on new patients with higher needs.


Hywel Dda is now the only health board that has a centralised waiting list, but no practices are currently accepting patients from it. One local practice reported having 1,000 people on their list, another over 3,000. In Betsi Cadwalader, one practice reported that their waiting list has been in existence for five years at least, they are not adding new names to it as the would-be patients have "no chance" of getting an appointment.


Previous BDA analysis had shown patients across the country were facing up to 90-mile journeys for access.


The Welsh Assembly's Health, Social Care and Sport Committee recently backed BDA calls for reform. In A Fresh Start: Inquiry into Dentistry in Wales it called for an end to the unsustainable NHS contract system, for comprehensive reinvestment of clawback, and for action to address a collapse in morale among the profession. BDA Wales is looking forward to a positive response from the Welsh Government to the inquiry's recommendations.

Chair of the BDA's Welsh General Dental Practice Committee Tom Bysouth said:

"For too many families in Wales, NHS dentistry is now just a nice idea rather than a reality they can depend on. 


"We've found practices giving up on even going through the motions with waiting lists. NHS patients are left with few options but to travel or miss out on the care they need.

"Across Carmarthenshire, Ceredigion, and Pembrokeshire NHS dentistry amounts to a single practice that can only take on new child patients. It's hardly comprehensive care from cradle to grave.

"At the heart of this problem is a broken NHS contract that is fuelling a recruitment and retention crisis, while siphoning budget away from front line services.

"There is a growing consensus in the Assembly recognising the need for real change. These findings need to spur the Welsh Government and Health Boards on to deliver a system that works for patients."


Plaid Cymru Assembly Member, and Chair of the National Assembly's Health, Social Care and Sport Committee, Dr Dai Lloyd stated:


"These figures confirm that the current NHS contract arrangements for dentists simply aren't working. The low number of practices taking on new NHS patients and the variation between different parts of Wales is a significant concern – people are not receiving the services that they need.


"Recently, the Health, Social Care and Sport Committee undertook a review of dentistry in Wales and we were clear that changes need to be made by the Welsh Government in order to improve matters, and the current contract arrangements need to change if we are to see improvements.


"The committee made a number of recommendations to the Welsh Government around changing the current arrangements, and finding a new way of making sure everyone in Wales has access to quality dental services regardless of where they are. We now await the response of the Welsh Government to our recommendations. Doing nothing is not an option."


BDA Wales

BDA Wales campaigns for the interests of all dentists working in Wales. With our elected committee members, we negotiate on behalf of the profession on terms and conditions, pay and contracts: join us.