Widespread attention has been given recently to the difficulties in accessing NHS dentistry in Wales, with a number of Senedd Members 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’s report on dentistry, which will be debated in the Senedd this week (21 June).
This article discusses some of the key issues facing NHS dentistry services in Wales and how the Welsh Government has responded.
Access to dental services
Access to dental services was severely impacted by the COVID-19 pandemic, creating a backlog of patients in need of dental care and treatment. However, there were long-standing access issues prior to the pandemic.
During a debate on dentistry in Plenary on 24 May 2023, a number of Members referred to findings of surveys they had undertaken, highlighting difficulties across Wales in accessing an NHS dentist, and the lack of dentists taking on new NHS patients. During the debate, BBC findings from August 2022 were referred to, which found that 93% of NHS dental practices in Wales were not taking on new NHS adult patients.
The Minister for Health and Social Services responded in that debate to say she did not “recognise the reported outcomes” and that 78% of practices in Wales in 2022-23 were operating under new dental contract reform arrangements which required them to see new patients. The Minister said:
“The fact is that they saw 174,000 new patients last year. So, it simply can’t be true that 93 per cent of practices did not take on a new adult patient”.
The Committee’s report and Members in the Senedd have also referred to a ‘three-tier system’ in dentistry in Wales. One tier is the people who can access an NHS dentist and another tier is the people who pay to go privately. A third tier is the people who can’t access an NHS dentist and can’t afford to pay privately.
Lack of 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 onto an NHS dentist waiting list as there is no centralised waiting list. There is also no centrally held data on the number of patients being treated privately. The situation is further complicated by people being able to register on a number of waiting lists.
Some health boards have developed centralised lists for their own health board area. In October 2022, the Committee was told there were 15,500 patients on the waiting list in Cardiff and Vale University Health Board and anyone joining the list could expect to wait around 26 months from the date of joining to receiving an NHS dental appointment.
Without sufficient data, it is impossible to know how to target resources where they are most needed. Improved data is necessary to determine the level of need in order to prioritise services effectively, reduce inequalities, and enable greater monitoring and accountability.
The Committee’s report called for the Welsh Government to consider a single centralised waiting list across Wales. The Minister confirmed in April 2023 that officials were already in discussions with Digital Health and Care Wales to scope a design for an all-Wales dental waiting list. The Minister said she hopes that a central data registry will be in place by the end of this year.
Dental contract and funding
From April 2022, NHS practices could choose to be part of the Welsh Government’s dental contract reform programme, which will focus on prevention and needs-based care. This means a move away from routine six-monthly check-ups for all patients. The aim is to release capacity to provide appointments for new patients. The Welsh Government is providing an additional £2m each year to improve access to dental services across Wales.
However, the British Dental Association (BDA) claimed in January 2023 that new NHS contracts issued by the Welsh Government that include a requirement to see new patients are to the detriment of those already registered at practices. The BDA sent an open letter to the Welsh Government warning that new contracts will force practices from the NHS, and has also warned that NHS dentistry in Wales could disappear.
Renegotiations on a new dental contract are about to begin. The Welsh Government confirmed in April 2023 that it had written to the BDA setting out its intention to commence formal negotiations on the new dental contract.
NHS dentistry spend has been based on the historical delivery of care to patients and the funding model is based on 50% of the population accessing dental care through the General Dental Service.
The Committee’s report calls for the Welsh Government to explore whether current levels of funding are sufficient to tackle the backlog of patients. The Welsh Government responded by saying that once a centralised waiting list is in place, it will be able to establish the scale of people waiting for NHS dentistry and make an assessment of the level of funding required.
The Welsh Government is taking some action in relation to dentistry in Wales. However, there appears to be a disconnect between what stakeholders and the Welsh Government are reporting in terms of the extent of the problems with accessing NHS dentistry.
The Minister believes that dentistry in Wales is recovering, but has recognised that there is “a huge amount of work to do” and a need for “a lot of money to fix it”, meaning the task will not be easy and will not be “fixed overnight”.
Determining the number of people waiting to access an NHS dentist and prioritising services accordingly will be a starting point in tackling 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 form a new contract that will work for patients and for dentists, and lead to the improvements that seem to be urgently needed.
Article by Rebekah James, Senedd Research, Welsh Parliament