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Petition Number: P-06-1364 Petition title: Dentistry crisis in Wales. Ensure all adults and children have access to a dentist. Text of petition: In October 2022 there was a 26-month waiting
list to register with an NHS dentist and have a check-up in
Wales. Everyone should have access to dental care, regular check-ups and timely treatment. Unfortunately, my dentist has left the NHS to practice privately. As a result I’ve been looking for another NHS dentist and the nearest I found was 79 miles away from my home, which is not acceptable.
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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’.
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. Some of the issues relating to access to dentistry were also brought to light during a Plenary debate on 21 June 2023.
The Senedd’s Health and Social Care Committee carried out an inquiry into dentistry and published its reportin February 2023, which made 16 recommendations in relation to dentistry services in Wales. In its response to the report, the Welsh Government accepted 11 recommendations, partially accepted a further 3 and rejected 2 recommendations. A Plenary debate on the report was held on 21 June 2023.
The oral evidence sessions and written evidence for the inquiry revealed that 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.
The Committee’s report called for the Welsh Government to consider a single centralised waiting list across Wales. Welsh Government officials are in discussions with Digital Health Care Wales to scope a design for an all-Wales dental waiting list and there is a commitment to delivering that solution in this financial year.
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.
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.
The Welsh Government has begun the process that will lead to a formal discussion on a new dental contract.
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.
Correspondence from the Minister for Health and Social Services to the Committee on 15 October 2023 highlights that the majority of dentists are independent, self-employed practitioners who can choose whether they contract a proportion of their time to provide NHS treatment on behalf of Health Boards. As a consequence, they may provide only NHS care, work totally outside the NHS or as is commonly the case, provide a mixture of NHS and private dental care.
The Welsh Government is said to be working with Health Boards to address gaps in service provision through their operational plans. The Minister acknowledges that access to dentistry is not where the Welsh Government would like it to be and that “significant and substantive changes will take time and require financial investment which is difficult in the current financial climate”.
In relation to the termination of NHS dental contracts, the Minister states that at the start of April 2022 there were 413 dental contracts in place across Wales; 26 of those contracts have been terminated for a range of reasons such as retirement, practice sale and practices choosing to move to private only provision. In the majority of cases where contracts have been varied or terminated, Health Boards have already, or are in the process of recommissioning replacement services. The Minister notes that this “shows that there is a genuine appetite for taking on NHS contracts”. It is also highlighted that when a dentist decides to reduce or end their NHS commitment, the funding for the lost provision remains with the Health Board in order for it to replace the level of NHS dental services.
The Welsh Government is said to be working with Health Boards to ensure that as part of the recovery of services, measures are included to ensure dental practices see new patients. The Minister states that since April 2022 almost 246,000 new patients have gained access to an NHS dentist across Wales. It is noted that although the Welsh Government aims to continue to invest in dental services to increase access for new patients, there may be a delay while appointments for routine care become available in some local areas.
As the workforce is seen as a key part of improving access to NHS dental care, the Welsh Government is said to be “looking to identify and establish innovative opportunities to upskill and improve career pathways in dentistry to make working in Wales more attractive”. Health Education and Improvement Wales is working with stakeholders to focus on both recruitment and retention of the dental workforce in Wales. A scheme has been launched recently to incentivise dental trainees in dental practices across rural Wales, rather than more popular urban areas. The aim is that this will help to increase access to NHS care for local people in rural Wales.
Skill-mix (i.e. making use of the skills of the whole dental team) is also seen to play a significant role in the provision of NHS dental care. From April 2023 dental therapists, hygienists and clinical dental technicians can open and close NHS courses of treatment which increases the capacity of the existing workforce.
The Minister advises that those seeking access to NHS dental services should contact their Health Board for the latest information on access in their local area and with a view to joining a practice waiting list. The Health Board will be able to provide details of the current level and location of available NHS dental services in the locality. They will also be able to provide details of the access sessions and availability of urgent treatment the Health Board provides for those residents not currently placed with a practice. As an interim measure, it may be possible to arrange for children to be seen by the Community Dental Service, especially if there are any concerns about a child’s oral health or the length of time since their last dental check-up.
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Every effort is made to ensure that the information contained in this briefing is correct at the time of publication. Readers should be aware that these briefings are not necessarily updated or otherwise amended to reflect subsequent changes. |