Wales contract reform: Scoring the proposal

Some elements of the proposed model are acceptable with adjustments; however, we believe that several of the measures included in the proposal are counterproductive and must be withdrawn.

The proposed model is untested, and the risks are unknown. We are pushing for a managed transition over three years and a pause on fully enforcing contractual terms to rebuild the trust of the profession.

Care packages

Care packages for adults and children define the measure of care provided to restore dental health to patients across Wales. These would replace UDAs.

Current proposal

• Care packages have the potential to properly fund treatment for all types of patients including high-needs (red)
• If operated fairly, these care packages have the potential to provide high-quality care and support data collection for improvements in contract management.

Our score

How could this score be improved?

• The draft pricing model from Welsh Government must be updated to reflect the escalating costs of dental practise
• Issues around practitioner retention and the increase in Employers’ National Insurance Contributions should also be addressed in the proposal.

Urgent care for new patients

Urgent care slots for new patients ensure there is capacity when vital treatment is required.

Current proposal

• Commissioning of protected urgent dental care to ensure capacity for patients
• Practices to be paid fairly for making urgent care slots available.

Our score

How could this score be improved?

• Allow unused slots for walk-in patients rather than restricting to NHS 111 referrals.

Very high needs patients

A separate care pathway for patients with very high needs would ensure there is proper renumeration and bespoke capacity for this care.

Current proposal

• Patients will be sent on a separate care pathway through the Community Dental Service (CDS).

Our score

How could this score be improved?

• Do not send very high needs patients to the CDS, which does not have capacity to provide this service
• A Personal Dental Services contract should be supplied for these patients instead
• Mandate Local Health Boards (LHBs) to publish regular data on GDS and CDS capacity and waiting times for planning and accountability.

Reconciliation and collecting patient charge revenue

Centralising the collection of charges would ease the burdens places on practices to do this.

Current proposal

• LHBs will collect patient charges centrally
• Year-end reconciliation will need to be submitted within 35 working days after 31 March.

Our score

How could this score be improved?

• We welcome these proposals and would make no further changes.

Dental Access Portal (DAP)

The DAP is currently being used as a centralised waiting list for each LHB.

Current proposal

• The DAP will be used to create significant extra capacity for new patients by returning very low risk (green) patients back to the DAP
• Green patients may be sent to different practices across their Health Board for their checkups.

Our score

How could this score be improved?

• The DAP cannot be used to create meaningful capacity in this way, green patients should not be sent back to the centralised list
• The recall times of green patients could be extended within the new contractual framework to prevent damage to continuity of care
• Patients should not be sent to different practices across their Health Board; this will cause unnecessary clinical and administrative burdens with duplication of patient histories and additional radiographs.

Patient failure to attend

Missed NHS appointments waste NHS capacity and are a financial risk to dental practices.

Current proposal

The draft model does not address this problem.

Our score

How could this score be improved?

• A mechanism needs to be put in place for practices to claim remuneration for missed appointments
• The higher the proportion of NHS care offered by a practice, the higher the potential risk to its business sustainability. A fairer system is required to manage patient non-attendance
• Patients must take responsibility for their attendance or not remain with the practice.

Repairs and replacements

Repair and replace treatments, especially in urgent care, come with risks and rely on the patient’s self-care to ensure a successful outcome.

Current proposal

• Dentists will be liable for the costs of a repair or replacement treatment for a 12-month period in urgent care and a 24-month period in routine treatment.

Our score

How could this score be improved?

• The periods of liability do not recognise the issues that may arise from a patient’s methods of self-care
• The costs associated with repairs and replacement should be covered by the NHS, not by dentists.

Cluster collaborative meetings

Dental practices are to attend mandatory cluster collaborative meetings.

Current proposal

• Each dental practice to be involved in mandatory meetings
• If practices do not attend a meeting, this would be a breach of contract.

Our score

How could this score be improved?

• The fees offered in the model must sufficiently cover lost earnings and be in line with the Dental Guild Rate
• Missing meetings should not constitute a breach of contract, only loss of fees.

Contractual terms

There are several terms in the proposed contract covering notice periods, contract values, earnings, and opening hours that we reject. Also, we are calling for LHBs to provide capital funding to support practice developments.

Current proposal

• The notice period to terminate a contract between a dental practice and LHB will be extended from three months to six months
• LHBs will be able to reduce the contract value halfway through the financial year
• A cap on weekly earnings
• Mandated opening hours across the week.

Our score

How could this score be improved?

• Do not extend the notice period for termination of the contract
• An independent body should be established to manage disputes on performance, clawback, and targets
• LHBs cannot unilaterally reduce contract values mid-year, this creates financial instability and does not account for the ebb and flow of work across the year
• A cap on weekly earnings will disproportionately impact female dentists and must be amended
• Mandated opening hours is discriminatory and must be amended for single-handed or small practices which require reasonable adjustments to allow for flexible working and caring responsibilities
• Create a capital investment scheme to support practice expansion, digital upgrades, and equipment renewal, especially in rural and underserved areas.

Occupational health and CPD fees

Dentists in Wales require access to occupational health services and wellbeing support. They should also be supported with CPD.

Current proposal

• The Health Education and Improvement Wales Workforce Plan acknowledges the need for dentists to have more access to wellbeing resources
• Dentists to be placed on an equal footing with other NHS workers for CPD funding.

Our score

How could this score be improved?

• Dentists' entitlement to health and wellbeing services and CPD fees should be aligned with those of other NHS workers.