Dr Nathan Welch
NHS dentistry is changing!
How dentistry is provided via the NHS is proposed to completely change in April 2022.
For the last 16 years dental practices have had a set budget to deliver NHS services to their patients. Careful management of the number of patients was needed to ensure everyone seen received the correct care within the budget. Welsh government has decided to make major changes to this system. There are many issues which I will go through. After a lot of consideration we have decided to opt out and continue as we have for many years but we believe these changes will be enforced come April 2023 and many dental practices have opted in, so we thought we would write this blog to explain the changes!
Using the same budget dental practices now need use a large proportion of their budget to see patients not registered at the practice. This is to try and improve access to NHS dental services for those most in need. Make no mistake this will be at the expense of our (and other practices) existing patients.
Currently we allocate 70 hours of clinical time to NHS patients per week. 3640 hours per year.
The average time spent on an existing patient per year is an hour and a half. That is 2400 patients give or take. Which is our NHS list.
If we took on the proposed change we would need to allocate time every week to non-registered patients. The average of which take up 4 hours of clinical time. This wouldl take 1200 hours per year of clinical time.
This would result in existing patients being squeezed into a much smaller amount of time and therefore increased waiting times and you would be seen less often. Almost 800 existing patients would not been seen to make space.
We have already made changes over the last year to try an mitigate some of this change with most NHS patients who require fillings now seeing our dental therapist rather than the dentist. But this would only help to a small extent.
Welsh Government have pushed through this change to the absolute dismay of dentists in Wales. All this change does is look good on paper for getting non-registered patients seen. It is an absolute disgrace that it will lead to the neglect of patients already registered.
Please if you feel like we do that this contract sounds disastrous then write to your Local MP, the Health Secretary or the Welsh Chief Dental Officer. Please though do not take it out our staff. It is not our fault.
Nathan’s opinion “this new contract is an absolute disgrace of the Welsh Government, I pride myself on the high standard of care I provide my patients, and I have an ethical obligation to patients registered with myself to look after them. This new contract shows complete lack of care to registered patients, why should they have to wait to be seen so others can be. What happens if I don’t see a patient for 12 months instead of 6 and they develop mouth cancer that I could have picked up 6 months earlier than I ended up doing? It doesn’t bare thinking about but it’s all I can think about! If the Welsh Government wants more NHS dentist spaces then they need to train more dentists, therapists and nurses and increase the volume of patients that can be seen. Not trade my patients places for people who do not have a dentist.”
Over 90%* of dental practices are concerned that they will not be able to see their existing patients, with a quarter planning on handing back their NHS contract completely. We will not be doing that this year but if this new contract starts to affect our patients health we will consider this option in the future. Your oral health is what matters to us and neglecting you like the Welsh Government seem to want is unacceptable.
These were written based on the new contract which we have opted out of, I have left them to explain some of the common queries for the future. For this year there should be minimal change.
Is my NHS space secure?
Yes, as long as you have attended the practice in the last 24 months when you contact us you will still be registered.
Can I still have my 6 monthly check up?
This is very unlikely under the new rules. Although your dentist will recommend you will be seen using NICE (national institute of clinical excellence) guidelines which range from 3-6-9-12 month recall intervals for dentists, the practice is going to be unable to fulfil these due to NHS time constraints.
What if I have an emergency?
We will endeavour to see you as soon as possible as we do at the moment. True emergencies that pose a risk to life will be seen within 24 hours.
Other less pressing problems such as lost crowns and broken teeth are likely to have to wait several weeks for an appointment.
I have gum disease and come every 3 months, can I still do this?
Unlikely, you will now have to wait until others have been seen once before you can be seen again. This will be at the detriment of your oral health and we apologise but this is the guidance on how NHS care must now be delivered.
Will dentistry become like other NHS healthcare with huge waiting lists for treatment?
Absolutely yes. There is a very real risk of waiting months for treatment you need. This has been an endemic problem in NHS healthcare for decades and has now spread to dentistry.
I have been a patient of the practice for years and feel let down that I now can been seen, who do I complain to?
We feel exactly the same way. We care about your oral health and are being forced to potentially neglect you. Please complain to the people in power in Welsh Government.
Why can I be seen privately quicker?
Because the NHS budget of a dental practice only covers a finite amount of time, staff and resources. Additional clinical hours are used for private and membership plan patients as we always have done. We are expecting an increase in the amount of patients wanting to be seen privately because of this and have taken on an extra dentist and nurse.
Why can I see another dental practice quicker than I can see you?
Astonishingly this is a very likely position as you would be a non-registered patient at a new practice and count towards their yearly quota. As an NHS patient it is now sensible to rotate dental practice every 6 months on a 4 yearly rotation. If this sounds ridiculous then that’s because it is. But unfortunately for you and us it is true.
I already have my next check up appointment booked, will that still go ahead?
Maybe, we are unable to know what position we will be in month by month under this new contract. It is possible that your appointment will be cancelled to make space for other patients treatment or a non-registered patient. It could be delayed by days, weeks or even months. We apologise for this in advance and as mentioned before please do not take it out on our staff. All complaints about the new system should be directed to Welsh Government.
What about my children?
We will endeavour to see our child patients as best we can. Growing mouths needs close attention from the dentist to check for any problems regularly. But there will be instances where even children’s appointments need to be delayed due to the new system.
How can the Welsh Government do this?
They hold absolute power of NHS dental services. They have created a new system with so many targets that it is a logistical minefield.
For this year the only changes we will make in our practice in preparation for the future is that we will not book our recall appointments in advance. We will instead send out texts and emails inviting you to contact us to book your appointment.
We will continue to update you of any changes we hear about, although these changes were told to us 2 weeks before they were due to come into effect.
If what we described sounds like a problem, please do be proactive and complain to the correct aforementioned people so that we can change it before enforced next year.
*British Dental Association Survey results.