Our mandate lays out our terms for negotiation and the elements that need to be covered in a new General Dentistry Service (GDS) contract.
Under the social partnership model, mandates from NHS Wales and the Welsh Government will be amalgamated with ours to form a tripartite mandate, before tripartite negotiation discussions commence.
Key aims of contract reform
"We support the central tenets of contract reform, but not unconditionally."
We support the central tenets of contract reform, but not unconditionally. We do not believe that the current version of the reform model is the right one and have spent the last year shining a light on its weaknesses and the clear need for improvements.
Political discourse is making it clear that the Welsh Government intends to use the new contract to increase access for new patients and patients with high needs. This would use greater levels of skills mix, but limit access for those with good oral health, resulting in claims that NHS dentistry is available for everyone who wants it.
Truly increasing access to everyone who needs NHS dentistry is not possible without a significant increase in the dental budget and service capacity. Skills mix and extended recall times will help but cannot make a significant impression alone. A divergent, stripped-down NHS service to spread a limited budget even further is not an option we support.
Dissatisfaction with the reform model
"The profession has communicated deep dissatisfaction with recent manifestations of the GDS reform model."
The profession has communicated deep dissatisfaction with recent manifestations of the GDS reform model. The current volumetrics lack sensitivity in comparison with the already insensitive Units of Dental Activity, and do not measure and reward prevention work.
The volumetrics do not support skills mix and the targets are not achievable with a patient-centred approach. The calculations the targets are based on are fundamentally flawed. To make matters worse, the year-on-year attrition of the real value of the practice contracts makes for a less and less attractive business proposition.
We must return to the drawing board. We will not debate the current, deficient, GDS reform model. We will unpick the volumetrics and targets, considering what needs to be in the mix. The model must support what is valued, not value what is easily measured. Some elements should be optional and attract extra funding, such as involvement in cluster working.
The size of the future budget is a key issue informing the direction of travel. Welsh Government rightly wants value for money for taxpayers, but the taxpayer will ultimately benefit from an engaged workforce who see NHS dentistry as a career and vocation.
The dental budget
"The size of the future budget is a key issue informing the direction of travel."
Inflation has destroyed an already precarious balance sheet for many practices and the dental budget now falls very short. NHS dentists have been working on the cheap for too long, often to professional and personal detriment.
Many dentists and Dental Care Practitioners (DCPs) have had enough of the current NHS conditions and are looking to downsize commitments by moving to private practice or retiring early. Things must fundamentally change to halt this decline.
A fully funded and extensive prevention programme could offer significant financial savings in the long term and positively impact the management of associated conditions. This means moving away from focusing on fluoride applications to a contract that supports professional judgement of the best prevention treatment options.
Fully funded prevention programme
Further restricting the provision of dental treatment capacity to allow funding from a fixed budget to be drawn into preventative programs will detract from available treatment capacity. This will result in even greater levels of oral disease, increasing the level of complex treatment that will be needed, which will far outweigh any potential savings from preventative work.
"The new GDS contract is an opportunity for government and the NHS to signal how much they value the dental profession."
Reform measures to date overlook the attrition of the workforce commitment. Headcounts may be stable, but full-time equivalent numbers are dwindling. The Health Education and Improvement Wales strategic dental workforce planning is in very early stages and focusses on skills mix without paying due attention to the problems of reduced commitment.
Primary care is largely made up of contractors, who can supplement their income from private work, but that does not mean they should be treated as second-class workers in their NHS service. We will be arguing for enhanced benefits including protected Continuous Professional Development time and full access to NHS occupational health support. The new GDS contract is an opportunity for government and the NHS to signal how much they value the dental profession.
We hope that a newly negotiated GDS contract will provide longer-term career prospects, and a more attractive path for early-career dentists.
Dental practices being told by Local Health Board contract managers to stay with the current reform metrics this year because they are here to stay are being misinformed. Nothing is decided, and we are clear that fundamental changes are needed.
Where does that leave practices?
Practices should only be making an active choice to stay with the reform model if it works for their practice and patients. Practices with below average patient target numbers would probably see some benefits from staying with the reform programme for now.
Recent surveys have all shown that many dentists, DCPs and practices are repudiating the reform conditions. We expect that engagement with the reform programme will be significantly reduced to around 50% of contracts for 2023-24.
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