Reformed dental contract to be rolled-out nation-wide by 2021

(Title Image: National Assembly of Wales)

AMs debated the Health Committee’s report on dentistry yesterday afternoon – which has been summarised here.

Dentists discouraged from taking on patients with complex needs

Chair of the Committee, Dr Dai Lloyd AM (Plaid, South Wales West) explained the situation regarding the dental contract in detail. In essence, there are three pricing bands for treatment regardless of how many procedures are undertaken in each band, which discourages dentists from taking on high-needs patients. There was a need for a more preventative approach to oral health:

“That is why the Committee’s first recommendation is to replace the current….targets system with a new, more appropriate and more flexible system for monitoring outcomes, to include a focus on prevention and quality of treatment. As I said, this system will focus on prevention and quality of treatment.”
– Chair of the Health Committee, Dr Dai Lloyd AM

Recruitment is a perennial concern regarding health in general, but the Committee was pleased to hear there were no problems in recruiting to dental schools in Wales – though recruitment of Welsh-domiciled students is low.

Shadow Health Minister, Angela Burns AM (Con, Carms. W. & S. Pembs.) focused on the issue of actually getting a dental appointment in the first place:

“About 45% of the population – that’s almost 1.5 million individuals – have not seen a high street NHS dentist in the last two years. I’m concerned about the stagnation that these figures because, nine years ago, 55% of the population was being treated within the NHS dentistry service. Today, 55% of the population is being treated in the NHS dentistry service. That sounds like good news but our population’s grown by almost 200,000, so, actually, we’re beginning to reverse and, rather than reverse or stagnate, we need to improve.”
– Shadow Health Minister, Angela Burns AM

Only 15.5% of dental practices in Wales were accepting new adult NHS patients and 27% accepted children. This threatened to undo all the positive work of the Designed to Smile scheme.

Access issues were echoed by Sian Gwenllian AM (Plaid, Arfon) who said all six dental practices in her constituency refuse to take new adult NHS patients, meaning people often leave dental problems alone until they become serious enough to secure an emergency appointment through NHS Direct.

Quality, Prevention & Access

Health Minister, Vaughan Gething (Lab, Cardiff S. & Penarth), said that while calls to bin the UDA target system were premature, the system was being changed – and in ways which go beyond mere “tweaking”.

A third of all dental practices in Wales will soon be taking part in a reformed contract focused on quality, prevention and access, compared to 1% of practices in England.

“I expect over half of all practices to be part of the reform programme by October 2020, leading to a full roll-out of contract reform in 2021. The broader set of monitoring measures and the removal of low-value UDAs under contract reform will help to reduce the need for health boards to recover funding from dental contractors.”
– Health Minister, Vaughan Gething

He accepted there was more to do to address dentist shortages in some parts of Wales, but an e-booking system for orthodontics referrals has now been rolled out nationally meaning Wales is the first part of the UK to have a fully digital referrals system for specialist dental treatment. This will provide health boards with an accurate picture of the volume of specialist referrals so they can make better plans.

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