We have been in intense negotiations with the Welsh Government over the last 18 months, working to secure a new NHS General Dental Services (GDS) contract. Our aim has been to reshape how dental care is delivered in Wales, ensuring a sustainable and accessible model that better serves both dental professionals and patients.
The mandate we received from the profession going into the negotiations was to deliver a contract that pays fairly for work done and focuses on the prevention of disease and providing quality treatment for those in need. This is within a sustainable delivery model that shares the business risks much more equitably.
We have consistently raised concerns about the current contract variation model, especially the continuing perverse incentives to not treat high needs patients. Annual contract variation may have achieved some space to see some new patients but this has been at the expense of historic patients. To be blunt, the permutations of contract variation have provided just another swings and roundabouts form of service delivery.
Furthermore, practices have been in the objectionable position of chasing capitation targets first, and treating patients second, to try to avoid pervasive clawback. Unsurprisingly, a significant number of contract holders have handed back their NHS contracts in the last year and a half, unwilling to hold out for something better. This report by Bangor University lays out the stark repercussions.
We made it clear in negotiation meetings that a new model of service is our vision and that merely tweaking the existing contract of service with the volumetrics targets could not provide the changes needed. We were eventually successful in bringing our counterparts around to our way of thinking.
Regrettably, government officials prematurely closed the negotiation process, arguing that the timeline to completion demands cessation of this important phase of the reform process. This means that many elements of the contract remain indeterminate. The Government’s solution is to take the draft model to public consultation; however, it remains to be seen how much of the areas of accord will translate into the final offer to the profession.
One of the Welsh Government’s primary goals of the new contract is to enhance patient access to dental care across Wales, especially for those who have struggled to find NHS dental appointments. To meet this objective the Government is introducing a nationwide system of patient access called the Dental Access Portal or DAP. It will go live in November across Wales, having been piloted during the summer in Powys. This will be a soft launch where practices are encouraged to signpost new patients to the DAP. In future, however, the Government may choose to use the DAP exclusively to funnel all new patients to practices.
There is still much work to be done through the newly formed government-led working groups, which will thrash out considerable amounts of detail within the new GDS contract structure. Meanwhile, we will remain in active dialogue with government officials to ensure they are fully aware of the dental profession’s perspectives. Other work includes the impending annual uplift negotiations for the 2024-5 award, once we are in receipt of an uplift offer from the Government.