BDA Wales leads calls to consign failed NHS contract to “dustbin of history”
The British Dental Association Wales has welcomed conclusions from the Welsh Assembly Health, Social Care and Sport Committee that transformative change is needed in NHS dentistry in Wales – starting with binning the widely discredited target driven contract system.
The report highlights how the system is failing the needs of patients in Wales’ most deprived communities, who are often poorly served by dental care.
The BDA told the Committee last year that £20 million has been lost from local NHS dental services since 2015, where practitioners are unable to meet the tough targets set by government in their contracts. This money, known as 'clawback', is often not reinvested to meet the growing demand for NHS dental services.
The BDA provided evidence from official sources showing patients in Wales are now facing a 'postcode lottery' of care, with wholly unacceptable journeys to see an NHS dentist. The BDA found residents in Aberystwyth faced a 90-mile round trip, while even those in the Welsh capital Cardiff faced a nearly 30-mile trek.
Dai Lloyd AM, Chair of the Health, Social Care and Sport Committee, said: "Paying someone the same amount to deliver a course of treatment on a patient regardless of the amount of work involved makes little sense."
He added "this Committee believes it is time to end the current arrangements and find a new way of making sure everyone in Wales has access to quality dental services regardless of where they are.”
Current reforms to the NHS contract centre on modest tweaks of the activity-based model. The Committee has also backed the BDA's calls to ensure budget assigned to NHS dental care remains within the service, and for the Welsh Government’s pioneering Designed to Smile programme to maintain the full provision for 5 and 6 year-olds and to be extended to cover older children.
Tom Bysouth, Chair of the BDA's Welsh General Dental Practice Committee, said: "We want to thank the Committee for providing the unvarnished facts about NHS dentistry in Wales. Last year we told AMs that since 2006 the perverse incentives set out in our contract have hurt both patients and practitioners.
"On access and on care for our most deprived communities, this system has failed on every front, and has fuelled a collapse in morale among the profession.
We are pleased this Committee recognises the need to consign this discredited system to the dustbin of history."
The report has taken up key recommendations made by BDA Wales last year, which included:
• The contract must move away from UDAs and towards meaningful performance measures and capitation for effective preventative dentistry and the provision of care needed for patients with poor oral health.
• Welsh Government should enforce Health Board KPIs for delivery of the GDS contract. Health Boards should account for how the clawback will be fully reinvested, including in oral health programmes for children of all ages. No clawback money should be reabsorbed into the general budget.
• Welsh Government must conduct an evidence-based review of the dentist workforce ensuring the requirements for the future for all dentistry crafts, including community dentists, will be fully met. The Government must not rely on skills-mix as the alternative to training more dentists in Wales.
• Health Boards must produce clear plans on how they intend to reduce waiting lists for orthodontic services, as well as updates on the effectiveness by showing outcomes data.
• The Government should fund the D2S programme sufficiently that the 5 and 6 year-old children can receive the same benefits of inclusion as they did previously, including fluoride varnish.
• The Government should ensure that age-appropriate oral health programmes for up to 12-year-olds are delivered through schools in all Health Boards in order to address the high prevalence of decay in that age group. There are more than enough funds from clawback to provide this.
Committee recommendations include:
• That the Welsh Government replaces the current Unit of Dental Activity targets with a new, more appropriate and more flexible system for monitoring outcomes to include a focus on prevention and quality of treatment;
• That the Welsh Government ensures and monitors the consistent reinvestment of clawback money recovered by health boards back into dentistry services until a new system for monitoring outcomes is in place; and,
• That the Welsh Government undertakes an evaluation to determine if the UK wide recruitment system effectively supports a strategy to increase the recruitment of those who are Welsh domiciled and the levels of retention of students generally following training