The future of NHS dentistry in Wales can no longer be taken for granted.
We know the reasons. An NHS contract that remains unfit for purpose, an underfunded system that actually penalises colleagues for time spent on prevention. We are seeing the results, as practices find it harder to recruit and retain talented staff, and as patients travel further or wait longer to access NHS dental services.
On 27 September I had the opportunity to take these messages directly to members of the Welsh Assembly.
Dental treatment: patients travelling long distances
They were told that in 2018 patients across Wales are facing a Postcode Lottery of care, with stark inequalities in both access and outcomes. We shared our findings on the lengths some families are going to secure treatment.
Our analysis of official data shows new patients in Aberystwyth are now facing up to 90 mile journeys to seek access to NHS dental care.
Members of the Health and Sports Committee I addressed represent places like Cardiff, Torfaen and Newport where their constituents looking to find a dentist have to travel at least 30 miles.
This is not 'access' by any reasonable definition.
Our research tells us that just 15 per cent of practices are taking on new adult patients and only 28 per cent are able to see new children.
Funding for NHS dentistry: where does it go?
I told AMs that when problems such as this are rife, the £20m in clawback and contract reduction taken from dental practices in the last three years simply cannot be justified.
Funding needs to be earmarked for total reinvestment into NHS services to guarantee access.
But these problems are driven by a bigger failure to meaningfully reform the NHS contract and bring in a prevention-focused model.
The current NHS system effectively sets limits on the number of patients dentists can treat. Colleagues are penalised if they don't hit targets, and are not allowed to do more even if they have the surgery time to meet demand.
Fundamentally it's a model that values tick boxes and targets over patient care. Over 90 per cent of GDPs we've surveyed say it has limited their capacity to treat high-needs patients who require extra time and attention.
As we took our evidence to the media the Welsh Government expressed "disappointment" at our failure to recognise the steps they've taken on reform.
We recognise progress where we see it. The great success of Designed to Smile is a case in point, one which colleagues in England have held up as a model.
Oral health: prevention for all?
Yet as health professionals we have a duty to make any concerns clear – and when Ministers appear to be refocusing a successful programme on a narrower age group which risks depriving five and six year-olds of the benefits of the programme, we will not rose tint our response, especially given the present state of access to NHS dental services.
And on NHS contract reform, when it comes to the models being tested, we do see failure, both to let go of targets, and to properly invest in a preventive model.
We hear reticence from health boards over moves away from the currency of a UDA and urge Welsh Government to use all their available levers to pressure health boards into freeing dentists from the shackles of a system which has resulted in a sustained drop in the morale of dentists and reduced access for new patients.
BDA members will wholeheartedly support the sentiments set out in the Welsh Government's strategy 'A Healthier Wales', that prevention, health improvement and equality are key to sustainable development.
But these are just words without a willingness from all to remove pernicious activity measures and to provide adequate funding to improve access, maintain quality and embed prevention.
Yes, it may be "disappointing" for some to hear, but guaranteeing the future of this service, and unlocking its real potential will only be possible with the appropriate resources and a coherent plan.
Tom Bysouth, Chair
Welsh General Dental Practice Committee
BDA Wales campaigns for the interests of all dentists working in Wales. With our elected committee members, we negotiate on behalf of the profession on terms and conditions, pay and contracts: join us.