Dr Caroline Seddon details how BDA Wales continues to campaign on your behalf as face-to-face clinical care looks set to expand.
Since the COVID-19 pandemic reached our shores, dentists in Wales have faced financial uncertainty and challenging working conditions.
At the BDA in Wales, we have been working tirelessly to support members and lobby politicians in both Wales and Westminster. We have produced an abundance of guidance and advice and on all matters relating to dental practice during the pandemic and the impact on NHS and private dentistry.
It has been a long haul and we are far from the end. However, as we reach a turning point where practices can start to expand care, I want to update you on what we are doing on your behalf.
1. Pushing for an expansion of care to include AGPs
In Wales, dental practices have remained open throughout the red alert period. During this emergency phase some 12,500 patients have been treated, many remotely, and a further 6,000 patients have been referred to the urgent dental centres (UDCs). This has been a lifeline for patients in urgent need.
However, we know that many patients who are in dire need of treatment don’t currently qualify via the triage system. So we made the case to Dr Colette Bridgman, Chief Dental Officer (CDO) for Wales, to open up the GDS and expand the provision of aerosol generating procedures. It would mean more patients can receive AGPs through approved AGP centres. This is now happening. Practices can set up for AGPs for NHS patients by contacting their Local Health Board.
Similarly, practices will be able to offer AGPs for private patients in immediate need of treatment. The Health Inspectorate Wales will have oversight of this. We hope that all these practices can start performing AGPs from 1 July, or when the country moves to amber alert. It may be sooner. The new
Standard Operating Procedure (SOP) addresses this very scenario for amber alert.
I have also been in contact with Health Boards this week to clarify our position on the contractual obligations of mixed contract practices.
We are very clear that such a practice has the choice of setting up a private-only AGP centre - they are under no contractual obligation to set up an NHS AGP centre as well.
The only obligation upon such practices is to offer a referral to an NHS AGP centre elsewhere in the GDS should an NHS patient require that treatment. By the same token if the mixed practice is providing only private AGPs to private patients at this next stage there is no regulatory requirement to inform the LHBs.
2. Lobbying government to support private practice
"We have urged the Chancellor to improve the financial security for dentists throughout this crisis and continue to repeat this message."
We have urged the Chancellor to improve the financial security for dentists throughout this crisis and continue to repeat this message.
We also joined a coalition of health care professions and together wrote to the Chancellor urging for financial support for all the professions’ practitioners. As well as our own letters to Mr Sunak, we ran a campaign for dentists across the UK to contact their MPs to lobby for better support for private dentistry. As a result of this, 101 MPs wrote to the Chancellor demanding new financial support packages for dentists and dental practices. To date, he has not replied to his Parliamentary colleagues or to us.
I also wrote to all 40 MPs in Wales about the lack of support for private dentistry and, in particular, self-employed dentists earning over £50K. More than a quarter of MPs replied to convey their concern. Some then requested new measures from the Chancellor. Others wrote to Ken Skates, Minister for Economy, Transport and North Wales.
Ben Lake, MP for Ceredigion, was particularly supportive and tabled
early day motion #338.
The Chairs of WGDPC and Welsh Council wrote to Rebecca Evans AM, Minister for Finance and Trefnydd, and Ken Skates AM, copied to Vaughan Gething Minister for Health, about the plight of private practice and the measures that Welsh Government could put into place. Eventually Ken Skates and Vaughan Gething did respond although their replies were anodyne.
We continue to campaign on behalf of private practices, particularly as we know the expansion of face-to-face care will not solve all the issues that have arisen since the outbreak of the pandemic.
3. Urging for an increase in NHS contract value for dentists
In Wales, practice owners received 80% of the contract value in Q2 to reflect the pandemic measures and the loss of patient charge revenue. This is why the abatement went above the reduced lab and materials costs of 13%. We made the case that the 20% abatement for Q2 was swingeing but the Welsh Government was not prepared to make up the short fall.
By comparison, in England practitioners did initially receive 100% of contract value however, they were warned from the outset that there would be a retrospective abatement to adjust for materials and lab costs not incurred during practice closures. This is likely to be in the high teens, so in fact not much below Wales.
We have been tirelessly pressing this issue, and Wales is now moving to 90% of NHS contract value for Q3. This will reflect that practices need to cover basic costs but calculates that PCR will remain depressed. We are pushing for 100% in Q4 and are making a strong case for the sustainability of practices.
4. Shaping a new model for NHS dentistry
"We want to ensure that the new measures for NHS dentistry will work effectively for you during the pandemic de-escalation."
We want to ensure that the new measures for NHS dentistry will work effectively for you during the pandemic de-escalation. We have been in regular contact with Dr Bridgman to argue for this.
There are a few things to make clear at this stage. This scheme is not NHS contract reform nor is it a new contract. Crucially we have established there is no target for numbers of patients seen in this financial year, which means that a practice is highly unlikely to suffer clawback. There is also the opt-out clause should a practice prefer to keep to their UDAs.
The new measure for contract holders is based upon the learning from contract reform. For each patient seen over a 12-month period, practices will be expected to record their oral health needs and risk. The practice will then complete an assessment and provide any required preventative treatment like fluoride varnish in that time. Where a patient needs an AGP they will get it, with the most urgent cases being seen first.
There is clearly a lot of practical detail to be clarified, especially in light of the new SOP, however in principle, this change will provide financial stability. We therefore support removing the UDA, and replacing it with more autonomy for practices to deliver patient care in the way it suits them best.
5. Looking to the future
I receive many enquiries from members who are concerned or confused, however over the last few weeks this has intensified. Things are moving at such a pace that I may not always have the answer to all of your questions right away. However, I will continue to keep you updated as new developments unfold, and give you our understanding and advice in the moment.
Let’s work together and do our best to improve this situation.
Finally, I thoroughly recommend listening to
this episode of Jason Mohammed on BBC Wales. Jason is joined by Lauren Harrhy, Deputy Chair of our WGDPC on the phone-in to answer patient questions about going back to the dentist. I hope you find it useful.
Dr Caroline Seddon
National Director BDA Wales