Tom Bysouth, Chair of the WGDPC, warns that patient numbers across dentistry in Wales will dwindle without fundamental and ongoing reform.
Dentistry in Wales was in crisis before this pandemic. Now COVID-19 has demolished the flawed foundations the service was built on. Without urgent reform and financial support the COVID-19 crisis will leave dental services in Wales compromised beyond repair.
Practices cannot survive the combination of higher costs and fewer patients without help from the government. Private dentistry has been left to fend for itself, while many mixed contract and NHS providers are now operating at a loss. This is not a sustainable situation. Action and reform must happen now.
This week myself and colleagues reiterated these crucial points to the
Senedd Cymru’s Health, Social Care and Sports Committee (watch from 1hr 45mins).
We called for the following 10 changes at the Senedd’s Health Committee:
1. Allow all practices to undertake more routine work now
This is essential for all NHS, private and mixed contract practices. By undertaking routine work, practices are able to reduce the risk of missed mouth cancers and subsequently reduce the impact on the wider health service.
2. Instigate the full reinstatement of contract value for GDS NHS practices
This will enable the Community Dental Service to step down their work in the urgent dental centres and allow community dentists to concentrate on their vitally important role, including the management of special needs. The government must bridge the funding gap which has arisen in GDS practices by reinstating 100% contract values now so dentists can provide full levels of treatment.
3. Do not treat this as a piloting year
The recovery year and support for NHS contracts is welcomed but we must not use this as the piloting year. Full piloting and testing must be done in normal times with full consultation with the profession. Any new GDS contract requires a full negotiation process. Negotiation and consultation could start from April 2021. Before then we need clarity around the government’s timeframe.
4. Identify all dental team members as key workers
We need all practice staff, including private contractors, to be able to work and to provide care during de-escalation of lockdown. Without key worker status, many dentists are not eligible for childcare. Extending key worker status to the whole dental team is vital.
5. Review evidence into infection risk and fallow time
We need further evidence into infection risk in the dental surgery and fallow times. This particularly applies to the decision of the Welsh Government to differ from the FGDP guidelines in terms of 60 minutes of fallow time from an aerosol generating procedure. Reductions in fallow time is key to being able to improve the oral health for more patients.
6. Investigate why fit testing is only required in the UK
Fit testing is not a requirement in other countries. In fact, there is discrepancy in much PPE guidance. In many countries dental teams are only using level 2 PPE for the vast majority of procedures. We need to investigate this further and ensure Welsh dental teams are not disadvantaged as they try to recover.
7. Guarantee PPE supplies
The government must take all available steps to ensure PPE is supplied to dental practices across Wales. This must include any essential fit testing. They should also provide grants for reusable PPE to help reduce practice waste and the impact of COVID-19 on the environment.
8. Reintegrate services to ensure children and vulnerable adults are not at risk
At risk groups have become a ticking bomb since the outbreak of the pandemic. Children and vulnerable adults are still the forgotten group. Designed to Smile, our free and successful preventative programme to improve oral health in children, is now on hold. As is Gwen am byth, our programme for improving oral health in older citizens living in care homes. The young, old, susceptible, and disadvantaged will suffer poorer oral health as a result. We must ensure that children and vulnerable adults do not become the lost group from this pandemic. Reintegration of existing services will be key.
9. Reassure the public via a wider health campaign
The government must undertake a campaign to help practices communicate their message that dental teams are experts in cross infection control. They need to reassure the public that dental practices are controlled and safe environments to which they can return without fear or concern.
10. Allow eligible patients an extension on payment exemptions
Patients whose eligibility for treatment and exemption from NHS fees has elapsed during the pandemic should be granted an extension. This includes:
a) Mothers of babies under 12 months who would normally receive free NHS care where available.
b) Orthodontic assessment made possible for those who would ordinarily have been referred before their 18th birthday. We note that in England, provision has been made for orthodontic referrals.
We know that Ministers have pledged a recovery year for dentistry and we welcome this positive move. However, we desperately need reform and we need it to happen now. This is the only way that we can keep delivering better oral health for Wales.
Chair of the Welsh General Dental Practice Committee