Only one in six dental practices in Wales are accepting new NHS patients, shows an analysis of practice data submitted in April this year, and published today by the British Dental Association (BDA).
The “discredited target driven system for NHS dentistry,” which was introduced in 2006, is firmly to blame for this access crisis, insists the BDA.
Analysis of the information supplied by every practice in Wales in April 2019 reveals that only one in six (55 out of 355 or 15.5%) across Wales are able to offer appointments to new adult NHS patients. Only around one in four (27%; 96) are taking on new child NHS patients.
What’s more, there is huge local variation, with no practices taking on new adults on the NHS and just a single practice taking on new child NHS patients in Hywel Dda Health Board (covering Carmarthenshire, Ceredigion, and Pembrokeshire).
Even in areas with the best access rates like Cwm Taf, only around half (53.6%; 15) practices are taking on new adult NHS patients.
Access rates have deteriorated sharply since a 2012 analysis undertaken by the Liberal Democrats found that 37% of new adult patients were able to find an NHS appointment. Access then halved by 2017 and has since stayed depressed, says the BDA.
Four out of 10 (41%) practices now report they are taking daily enquires from new patients seeking appointments. One practice in Cardiff and Vale reported receiving more than 60 calls a day from would-be patients. Another in Powys said that they get "endless calls daily."
The percentage of practices operating NHS waiting lists has increased slightly from 21% to 25% in the past two years. But feedback from providers has indicated many have simply given up on maintaining them, due to the vast sizes of the lists and long, unpredictable waiting times.
The analysis adds to research* published today in the British Dental Journal which looks at the relationship between funding and access.
“Since 2006 both Wales and England have operated the same discredited target-driven system for NHS dentistry. In both nations it has fuelled access problems, and sparked a crisis in retention and recruitment,” says the BDA.
Dentists must achieve 95% of their contractual target or their practice will face “clawback”, returning their budget back to Health Boards. Practices also often hand back funds if they feel they will fail to hit their targets at the end of the contract year.
Consistent “underperformance” has led to permanent reductions in these contract values, and with it, the amount of NHS dentistry practices can perform.
The study found that while access levels remain critical, £20.3m of the NHS dental budget has been lost through the operation of the contract from 2014-17, amounting to, on average, 6% of the total budget each year.
Freedom of Information requests indicate monies lost are not routinely being reinvested in frontline services. Fear of missing targets and facing “clawback” is also actively discouraging practices from taking on new patients with higher needs.
Hywel Dda is now the only health board that has a centralised waiting list, but no practices are currently accepting patients from it. One local practice reported having 1,000 people on their list, another over 3,000.
In Betsi Cadwalader, one practice reported that their waiting list has been in existence for five years at least, but they are not adding new names to it as the would-be patients have "no chance" of getting an appointment.
Chair of the BDA's Welsh General Dental Practice Committee, Tom Bysouth said: "For too many families in Wales, NHS dentistry is now just a nice idea rather than a reality they can depend on.
"We've found practices giving up on even going through the motions with waiting lists. NHS patients are left with few options but to travel or miss out on the care they need.”
He continued: "At the heart of this problem is a broken NHS contract that is fuelling a recruitment and retention crisis, while siphoning budget away from frontline services.
"There is a growing consensus in the Assembly recognising the need for real change. These findings need to spur the Welsh government and Health Boards on to deliver a system that works for patients."
Plaid Cymru Assembly member, and chair of the National Assembly's Health, Social Care and Sport Committee, Dr Dai Lloyd stated: "These figures confirm that the current NHS contract arrangements for dentists simply aren't working. The low number of practices taking on new NHS patients and the variation between different parts of Wales is a significant concern – people are not receiving the services that they need.
"Recently, the Health, Social Care and Sport Committee undertook a review of dentistry in Wales, and we were clear that changes need to be made by the Welsh government in order to improve matters, and the current contract arrangements need to change if we are to see improvements…Doing nothing is not an option."
*Owen C, Seddon C, Clarke K, et al. NHS general dentistry in Wales: evaluation of patient access and budget expenditure. British Dental Journal, volume 226 no. 12, June 28 2019