The consultation on the reform of NHS dental services in Wales closed in mid-June – Louise Anderson shares her thoughts on the proposals as we await the result.
Despite many highlighting the opaqueness of the related documents, the consultation on the Welsh Government’s Reform of NHS Dental Services in Wales received a relatively high number of responses. More than 5,000 people took the time to respond, an unusually high number, second only to the 20mph speed limit consultation.
Although this may appear to represent strong public engagement, it is still only a fraction of the three million people who live in Wales. Nonetheless, the response rate is due in part to the work done by practices and local dental committees to raise awareness among patients, with some even distributing NHS information sheets and encouraging patients to respond.
The proposed changes mark a significant shift in both the way practices operate and how patients access care. The proposals have produced a mood within the profession, which is far from optimistic but rather fearful, confused, and angry.
Patients affected directly
There have been a number of changes to dentists’ contract arrangements over the years. Most of these previous alterations have affected how practices deliver care and receive funding. However, the proposed reforms will have a direct effect upon patients, and this has resonated with practices as they feel responsible for their patients.
For the first time, patients deemed ‘dentally fit’ will be discharged from their usual practice and placed on a central list. Access to routine oral health examinations will then be online through the Dental Access Portal (DAP). As part of the proposed amendments recall intervals for routine examinations will also be extended to between 18 and 24 months. When they fall due, patients will be contacted and allocated to the next available appointment at a practice within their health board. This means ‘family’ NHS dentists will become a thing of the past.
This system is a concern for many people. There is the potential for families to be split across multiple practices, continuity of care could be lost, and with health boards covering large geographical areas, patients may be forced to travel long distances and negotiate Wales’ limited transport infrastructure.
Uncertainty due to lack of detail
One of the most troubling aspects of the proposed contract is the lack of detail in the proposals. I was able to join a call with the chief dental officer, who when asked for greater clarity on issues such as the definition of ‘urgent treatment’ was unable to provide an answer. This vagueness makes it nearly impossible for practices to plan or make informed decisions.
The introduction of care packages adds another layer of complexity. How will practices decide which patients receive treatment? What happens when funding runs out? These unanswered questions leave practices in limbo, uncertain as to what the changes will mean for them.
The DAP (Dental Access Portal)
The DAP has already been introduced for new and urgent patients. However, several months into the contract year many practices have yet to receive their patient allocations. This delay threatens their ability to meet targets and raises doubts about the system’s scalability. If the DAP cannot handle current demand, how will it cope when hundreds of thousands of patients are added next year?
The proposed shift to collecting patient charges through the DAP rather than in the practice highlights further challenges. Moving everything online excludes patients without access, such as those who are unable or unwilling to use digital services. According to Digital Communities Wales, digital exclusion in Wales is higher than the rest of the UK with 7% of the population (around 170,000 people) unable to access the internet.
However, the proposals make no mention of how patients without digital access would pay the patient charge. Also, if patients fail to pay, it’s unclear whether practices will be penalised or if the government will accept the debt.
Software, payments, and recall: more questions than answers
The practicalities of administering the new contract are also unclear. Practices use different software systems, and whether these various systems would be ready to process claims by April is open to question. There are also concerns around the reliability of the DAP. Should it fail to deliver patients to practices, what are the repercussions for contract holders who fall short of their targets? Will they be penalised financially?
Impact on patients and practices
The emotional toll these changes may take is considerable. Dentistry is a personal service, and patients like to be treated by a dentist they know and trust. Dentists also like to get to know their patients as individuals and build rapport. Introducing the DAP would strip NHS patients of the certainty that they will see their usual dentist who understands their needs, fears, and medical histories.
Practices may also be forced to treat unfamiliar patients who will turn up cold without prior records. Medical histories will need to be taken at each appointment along with X-rays which increases the time spent with a patient and the risk of overexposure to X-rays.
Practice owners who have spent years building up and investing in their practice may see its goodwill value plummet due to the uncertainty around patient numbers. For new practice owners, the uncertainty affects their financial stability and long-term plans.
Dental membership plans
Some practices are choosing to introduce affordable membership plans to offer patients the security of being able to remain with their regular practice. Opting for private dentistry via a membership plan may become the only way for patients to guarantee access to their preferred dentist.
However, despite plenty of dentists opting to introduce membership plans, there are others who believe they have no need to act, as the proposals in their current form will not be adopted. However, as the DAP is already in use, then significant change of some sort seems inevitable.
Political implications
There are several political considerations as to whether the proposals will be enacted by next April. Senedd elections are scheduled for May 2026, and so the government may delay implementation until after they have been held to avoid backlash. With the popularity of the Reform Party and Plaid Cymru on the rise in Wales then should Labour lose control of the Senedd, the future of the contract could shift again.
In the meantime, the dental profession remains shrouded in uncertainty. Business planning, including recruitment, is suffering and morale is low. At the heart of every decision are people, which seem not to have been considered here. Little wonder so many are choosing to explore private options.
Greater clarity is essential
The proposed Welsh dental contract changes represent a seismic shift in how care is delivered and accessed. While the intention behind the proposals (improving access) is laudable, the plan itself lacks vital detail and consideration for its human impact.
It’s clear that the proposals in their current form are likely to hasten the demise of NHS dentistry in Wales.
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