As dentists in Wales are asked for their views on a new NHS dental contract, Nigel Jones speaks to BDA Wales’ Lauren Harrhy to get her views.
Nigel Jones (NJ): As someone who was on the negotiation team in the tripartite negotiations with the Welsh Government and the NHS in Wales to try to develop a new contract, now that there’s a contractual framework out for consultation, what’s your initial take on things?
Lauren Harrhy (LH): The initial take from the profession, which I would also reflect, is that the relationship between our historic patient base and the practice is at risk.
The way that the consultation looks to be planning the new contract is that patients, once stable, will be returned to a centralised waiting list for each health board area until they’re due to have their next dental check-up.
Now, we don’t know what the demand is for this; the Welsh Government doesn’t know what the demand is either, so we don’t know how long that waiting list will be. Obviously if you’re in a health board area where there aren’t that many NHS practices but there are plenty of people, that waiting list will be very long and access back into dental practices will be tricky.
There are good things to highlight as well. The aims of the contract are to make it easier for patients to access NHS care. And it should also, if it works properly, feel like the treatments we’re doing are recognised and remunerated more appropriately now. It doesn’t mean that there’s more money, but it should mean that, psychologically, we’ll feel that we’re not doing more endo for free and so on.
Another feature of the consultation is that the patient charge revenue (PCR) collection is to be taken out of the practices. This has had mixed reviews. I thought this was a positive because essentially, we end up as tax collectors for the government and all the problems that come along with that. Also, our card machines and our banking fees mean that we never actually get our full contract value while we’re collecting money that we essentially give out or have withheld from the board. So there are pros and cons with that.
NJ: Picking up on the centralised patient waiting list, Lauren. I’ve been trying to work out what that will mean for continuity of care because everything I’ve read tells me that continuity of care is important. However, this seems quite an efficient way of helping improve access but not necessarily an effective way of ensuring continuing care is ensured. Would that be an appropriate thought?
LH: I think so. They’re calling the centralised waiting list the Direct Access Portal, or DAP. So, the DAP in overall terms seems like a great idea. Patients register online with the DAP, and then when capacity becomes available at an NHS practice within the health board, they can have an appointment with that practice.
The practicality is that managing the DAP is an enormous administrative burden on the health board. Also, it means that patients who don’t have very good access to transport will find it difficult to move between practices. So, equity of care is going to be tricky, and I think as more practices hand back their NHS contracts, we’ll see that those waiting lists become longer.
NJ: You touch on an interesting point there in terms of practices handing back contracts because I guess a lot of people will struggle from a patient care perspective with the sort of setup proposed. For me there’s also this question mark about goodwill and what that break in continuity means in terms of patient loyalty and how that might affect the value of people’s businesses. Is it your sense that people will hand back contracts?
LH: Absolutely. There’s no doubt that there will be practices who will look at this contract and think that it is not for them. They may have spent years, decades even, building up goodwill with their patients, so they have a loyal patient base who they enjoy looking after. And I think that this puts that at significant risk.
NJ: I suppose there’s almost a sense that if you just go with the contract and see how it goes, what you might find is a dilution of your goodwill that reduces your ability to go private in the future. So, I guess it will focus the minds of a lot of people right now.
LH: Absolutely right. I’ve had a bit of a flavour of this already because I did reduce my contract a couple of years ago and private dentistry take-up has been lower than I expected because my patients were reallocated to other practices. They included patients that I’d been looking after for up to eight years at that point.
Quite a few of them thought it was okay as they’d got a place at another NHS practice. What they didn’t really appreciate (and why would they?), that the way that contract variations worked in Wales meant that they weren’t going to get seen quickly or all that often.
So, I’ve had a taste of the breakdown in goodwill that can happen when patients feel that they’re on a waiting list somewhere already. The problem with this that I foresee is that, unless patients are made aware of the fact that the DAP is going to mean a long and potentially inconvenient wait for appointments for them, and they won’t get to see the same dentist every time, which can be important to patients, they will think: ‘That’s OK because I’m on an NHS waiting list.’ That might discourage them from picking up private dental treatment where it might have been the more appropriate thing for their circumstances.
NJ: Yes, it’s an interesting concept. It’ll be fascinating to see how that plays out in reality.
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
