The difficulties of accessing NHS dentistry in Wales have recently received widespread attention, with some members of the Senedd describing it as a “crisis”.
However, the full extent of this ‘crisis’ is unknown, with no clear picture of how many people are currently waiting to see an NHS dentist.
This was one of the conclusions of the Senedd’s Health and Social Care Committee report on dentistrywhich will be debated in the Senedd this week (June 21).
This article discusses some of the key issues facing NHS dental services in Wales and how the Welsh Government has responded.
Access to dental services
Access to dental services was are severely affected by the COVID-19 pandemic, creating a multitude of patients in need of dental care and treatment. However, there were longstanding access problems before the pandemic.
During a discussion on dentistry at Plenary on 24 May 2023, some Members referred to research findings they had carried out, highlighting the difficulties of accessing an NHS dentist across Wales and the lack of dentists taking on new NHS patients. During the discussion, The BBC’s findings from August 2022 were reported, which found that 93% of NHS dental practices in Wales were not receiving young adult NHS patients.
The Minister for Health and Social Services responded to that debate to say did not “recognize reported outcomes” and that 78% of practices in Wales in 2022-23 were operating under new dental contract reform arrangements that required them to see new patients. The Minister said:
“The fact is they saw 174,000 new patients last year. So it simply cannot be true that 93 percent of practices received no new adult patients.”
The Report of the Commission and Members of the Senedd they also referred to a ‘three tier system’ in dentistry in Wales. One level is people who can access an NHS dentist and another level is people who pay to go privately. A third tier is people who do not have access to an NHS dentist and cannot afford to pay privately.
Missing data
There is no clear picture of how many people are currently waiting to see an NHS dentist or how many people have been unable to get on the NHS dentist waiting list as there is no central waiting list. Also, there is no central data on the number of privately treated patients. The situation is further complicated because people can join different waiting lists.
Some health boards have developed central lists for their own health board area. In October 2022, the Commission was told that there were 15,500 patients on the waiting list at Cardiff and Vale University Health Board and anyone on the list could wait around 26 months from the date of registration to get an NHS dental appointment .
Without adequate data, it is impossible to know how to target resources where they are needed most. Improved data is essential to determine the level of need in order to effectively prioritize services, reduce inequities and enable greater monitoring and accountability.
The Report of the Commission called on the Welsh Government to consider a single central waiting list across Wales. The minister confirmed in April 2023, officials were already in discussions with Digital Health and Care Wales to design a waiting list for dental services in Wales. The minister said that she hopes that a central data registry will be implemented by the end of this year.
Dental contract and financing
From April 2022NHS practices could choose to be part of Welsh Government dentistry contract reform program, which will focus on prevention and needs-based care. This means moving away from routine six-monthly exams for all patients. The aim is to free up appointment capacity for new patients. The Welsh Government provides one an additional £2 million each year to improve access to dental services across Wales.
However, the British Dental Association (BDA) claimed in January 2023 that the new NHS contracts issued by the Welsh Government which include a requirement to see new patients are at the expense of those already registered with practices. BDA sent one I open a letter to the Welsh Government warning that the new contracts will force practices from the NHS, and it has he also warned that NHS dentistry in Wales could disappear.
Renegotiations for a new dental contract are about to begin. The Welsh Government confirmed in April 2023 that it had written to the BDA stating its intention to enter into formal negotiations on the new dental contract.
NHS dental costs has been based on historical patient care delivery and the funding model is based on 50% of the population accessing dental care through the General Dental Service.
The Report of the Commission calls on the Welsh Government to investigate whether current levels of funding are sufficient to deal with the backlog of patients. The Welsh Government responded by saying that Once a central waiting list is established, it will be able to determine the scale of people waiting for NHS dentistry and assess the level of funding required.
I look forward
The Welsh Government is taking measures in relation to dentistry in Wales. However, there appears to be a disconnect between what stakeholders and the Welsh Government are reporting on the extent of NHS dental access problems.
The minister believes dentistry in Wales is recovering, but has acknowledged that there is “a huge amount of work to be done” and the need for “a lot of money to fix it”, meaning the task won’t be easy and it won’t be “fixed overnight”.
Determining the number of people waiting to access an NHS dentist and prioritizing services accordingly will provide a starting point for addressing the current issues. The level of funding provided will also be an important factor. The Welsh Government will need to work closely with the dental profession to deliver a new contract that works for patients and dentists and delivers the improvements that appear to be urgently needed.
Article by Rebekah James, Senedd Research, Parliament of Wales
