Update on NHS Dental Reforms and Proposals for new Patient Charges System in Wales

In my statement on 26 April 2005 I announced a deferment of the implementation of the new dental contract but stated that it would be introduced by April 2006. I also set out arrangements for the rollout of Personal Dental Service (PDS) pilot schemes in Wales.  

I am now able to confirm that the new dental contract in Wales will come into effect from 1 April 2006. I am also taking the opportunity to provide an update on PDS in Wales and proposals for consultation on the introduction of a new patient charges system to be implemented at the same time as the new contractual arrangements.  

PDS

The interest among dentists in moving to the new ways of working which PDS contracts allow has been considerable and the first PDS scheme based on the new ways of working went ‘live’ on 5 July. Five further applications are currently being considered and there have so far been over 70 expressions of interest throughout Wales.

Patient charges

Successive reports have found that the current charging system is complex, bureaucratic for dentists and confusing for patients. The Audit Commission  recommended that patients should have clearer information about charges and the Office of Fair Trading investigation, to which the Assembly Government contributed a cross Government response, highlighted the lack of clarity for patients and the public about what charges apply to NHS and private treatment.

Under current arrangements charge paying patients pay 80% of treatment costs up to a maximum for a course of treatment, currently £354 in Wales (£384 in England). The General Dental Service contract provides a single national menu of over 400 treatments with each item being paid through a fee charged to the national budget. The cost per treatment is linked to the dentist per item of service. Since new contractual arrangements for dentists providing NHS care are due to come into effect in October 2005, which will reform the way in which dentists work and end the item of service regime, then a new payment system for patients must come into effect at the same time.

A Working Group, chaired by Harry Cayton, the Department of Health’s Director for Patients and the Public, was asked to propose a simpler, transparent charging system, which would raise the same proportion of total dental expenditure as now. The Working Group included UK patient and consumer representatives, the dental professions including the British Dental Association along with representation from the Assembly Government. The main recommendation of the Group’s report is that there should be a three band payment system for a course of NHS dental treatment:

• Band 1 (maintenance - e.g. check-up, scale and polish)  
• Band 2 (treatment - e.g. fillings, extractions)
• Band 3 (complex treatment - e.g. dentures or crowns)

The report recommends that the range of treatments within a band are defined and a patient would pay a set amount for any treatment within that band. It was recognised by the Group that at the point of change there could be some winners and some losers, but it was felt that a banding option improved overall affordability and equity and that individual patients who lose on some occasions will gain on others. The fewer the bands, the simpler the system is for dentists and patients to understand.

It is clear that there is a need for the patient charge system to be simplified and more transparent. Patients, their representatives and others have said that dental charges for both NHS and private treatment are unclear, difficult to understand and raise concerns about the potential cost of treatment. In future, it is intended that dental charges will continue to bear relation to the level of service provided but will no longer be directly related to the dentists’ remuneration. The new arrangements are not intended to increase the proportion of revenue raised from charges but to ensure there is greater clarity about the cost of NHS treatment for both dentists and the public.  

I have considered the proposals and the Groups’ report and agree that a new patient charge regime should be introduced at the same time as a new dental contract in Wales and accept the principle of a banded system. It is proposed to carry out a consultation exercise on the recommendations as proposed by the Working Group on patient charges and on draft regulations in Wales. These will come before the National Assembly through the standard legislative process in due course.

No decision has yet been made about the charges per band which are currently under consideration. However, I can say that entitlement to free dental treatment and help with charges will continue as now as will free dental examinations for people aged under 25 and 60 and over.