The New Dental Contract

Over the last year we have devoted a significant amount of time in Plenary and committee to discussing NHS dentistry. Next month sees the culmination of much of that debate with the introduction of the new dental contract in Wales. The changes being brought about offer a fresh start for dentists and patients. The establishment of a new dental contract sees a move away from the current general dental services fee-per-item remuneration, to an annual payment that is no longer directly related to dentist activity.
NHS dentistry is moving away from a one-size-fits-all approach towards a high-quality, flexible service tailored to patients’ needs, with anticipatory, preventative and reactive therapeutic care. The guidance from the National Institute for Health and Clinical Excellence on recall intervals supports this move away from a service based on frequent items of service to one with fewer interventions, which frees up time for a more preventative approach.

One of the central aims of the reform is to improve access to NHS dentistry, and substantial additional resources are going into NHS dentistry from 2006-07. The new commissioning system means that if a dentist leaves a practice, the resources for his or her contract revert to the local health board. This will give LHBs an assured floor of resources that is not affected by the decision of an individual dentist.

The current remuneration system arbitrarily distributes resources according to the location and commitment of general and dental practitioners, not local oral health needs. This has resulted in an inequitable distribution of resources and service provision. LHBs’ new responsibility for local dental services will allow them to commission services to meet particular local oral health needs. Access for patients will be determined by the contract agreed between the local health board and the dentist.

A little under a year ago, I gave the go-ahead for the roll-out of personal dental services across Wales. These were based on new ways of working and have proved popular with dentists and patients alike. Almost 50 per cent of dentists have decided to move across to PDS pilot schemes ahead of the new contract and to adopt new ways of working early. That not only enables dentists to enjoy a guaranteed income and gives them scope to plan services and an end to the item-of-service treadmill, but has created access for 193,000 new patients across Wales. This is a success story.

The vast majority of this additional access has been secured through existing dental practices that have made a long-term commitment to the NHS. All the evidence from PDS pilots shows that the abolition of the item-of-service payment means that dentists carry out simpler courses of treatment, with an average of 30 per cent fewer items of service within a course of treatment, which allows more time for prevention. We now want to ensure that we focus on areas that have not benefited to the extent that others have through the expanded access provided by PDS pilot schemes.

There seems to have been some misunderstanding about what will happen to these PDS schemes after 1 April, and I would like to take the opportunity to clarify the arrangements. Dentists in PDS schemes will have the choice of a new GDS contract or a permanent PDS agreement. If they choose the PDS agreement, their current PDS pilot scheme will form the basis of the contract, but it will need to be revised to take account of the new ways of monitoring dentists’ commitment, by moving to weighted courses of treatment, typically reflecting their historic work over the test period. It is certainly not the intention to unpick the PDS pilot schemes—including the financial arrangements—only to deal with the differences between transitional provisions for GDS dentists and PDS pilot schemes: in other words, the new ways of monitoring the system and the new patient charge system. Dentists with PDS pilot arrangements can decide which type of contract they want, but will not have to change the type of services that they provide.

This is, inevitably, a time of great uncertainty for some in the dental profession. The reforms that we are implementing are vital and we shall continue to work closely with the profession in Wales—as we have strived to do in drawing up the contract details—to ensure that the reforms deliver their intended benefits. We will also be part of an England-and-Wales implementation group, currently being set up by the Department of Health, and we will look to see what other measures are necessary to support the profession and LHBs locally.

There should be no doubt as to the Assembly Government’s commitment to NHS dentistry, and to a modern and responsive dental service across Wales.