Changes to NHS dentistry in Wales – an untested system causing havoc

Practice Plan regional support manager Louise Anderson shares her experience of supporting practices in Wales during this year’s contract alterations.

Among the many changes to the NHS dental contract in Wales was the extension of the notice period required by contract holders wanting to return their contract from three months to six months. As the deadline approaches for those wishing to leave at the end of this contract year, Practice Plan Regional Support Manager Louise Anderson reflects on how the changes have been received.

The changes to the NHS dental contract in Wales introduced in April this year were hailed as a ‘once in a generation’ opportunity to improve patient access. However, as someone who works with practices daily, it appears that the intention does not live up to the reality.

The Welsh Government’s stated aim with this new contract was to improve patient access to dental care. However, several months on from its introduction, it is questionable whether that will be achieved thanks to increased patient charges, extended recall intervals and lack of continuity of care.

With the unmet need for NHS dentistry in Wales standing at one third of the adult population, 20% saying they were unable to secure an appointment in the last two years, and a further 13% having effectively given up trying, there is little doubt something needed to be done to improve patient access to care. However, rushing through an untested system without adequate guidance for either practices or patients was never likely to win hearts and minds in the profession.

Poor support

To compound the felony, patient-facing materials failed to appear until weeks after the new charges came into effect, leaving practices to deal with disgruntled patients in reception unsupported by any official posters or leaflets. Having spent more than 35 years in dentistry in Wales, I have worked with several iterations of the contract. Without a doubt, the way this contract was introduced is the worst I have seen. As well as having to cope with an increased administration burden, software systems unready to deal with the changes and confusion over what could and could not be charged for, dentists I spoke to in the early stages felt disrespected by the way the contract was introduced. Their concerns were left unaddressed and dismissed, and their voices unheard.

An indication of the contract’s unpopularity came in some early canvassing of opinion. One month after its introduction, Welsh dental advisory firm ProPractices polled 15%-20% of contract holders on their experience of the contract’s implementation. This showed 100% of respondents rated it as either ‘poor’ or ‘very poor’. In addition, 83% said they were at risk of reducing their NHS commitment without further support.

There is a great deal of confusion about the administration of the contract. In the absence of any official guidance, for many dental teams their main source of information is a WhatsApp group. Its several hundred members post questions in the hope that someone has already encountered the problem and found a solution.

Delivering the contract

There is also huge concern that the contract is undeliverable. A recent informal straw poll of members of the WhatsApp group showed that the majority of those who responded believed that, after the third schedule, they had achieved between 25% and 50% of where they would have expected their performance to have been. This does not bode well for the rest of the contract year. In fact, I have spoken to several dentists who have written to their Local Health Board to inform them that they believe the contract in its current form is undeliverable.

A likely contributor to underperformance is the structure of the care packages. With the move away from UDAs to a monetary-based system, the charges patients are being asked to pay are making fulfilling the contract harder to achieve. For example, a simple restorative procedure is charged at £37.50 plus the cost of the examination (£27.21 for a new patient examination), which is unlikely to make a dent in contract values, especially as being paid for work done is proving problematic.

Admin burden

Administration of the new contract has been trying and frustrating for practices. I speak to practice managers daily who tell me that 95% of their time is now spent dealing with rejected claims, processing claims, interrogating eDEN, an online data tool, and Compass to try to get a handle on where they are with the contract. They also need to try to work out various statistics and calculate associates’ pay.

Front-of-house team members are charged with ensuring that the correct payment is taken for the correct care package while also dealing with unhappy patients who are now expected to cover the cost of lab fees as well as the care package. The increased charges and lab fees have resulted in patients declining treatment due to costs.

Gaming the system

While the new contract arrangements aim to increase patient access, the reality is that existing patients are gaming the system. New patients are expected to register for the DAP (Digital Access Portal) so that they can then be allocated to the practice nearest to them with availability. However, in some cases patients who have had treatment recommended but do not wish to wait six weeks to be fitted in at the recommending practice are logging on to the DAP in an attempt to be seen sooner. Consequently, instead of facilitating appointments for new patients, the DAP is being used to recycle an existing cohort of patients who are already ‘in the system’.

Patient choice

The extension of recall periods has proved particularly unpopular with both patients and clinicians alike. Dentally fit patients need not be recalled before 18 months to two years, and possibly longer if their practice cannot fit them in. Although in line with NICE guidelines, dentists fear that this interval leaves patients vulnerable to decay and periodontal issues.

Prior to this, patients were generally recalled annually, rather than six-monthly as in some other parts of the UK. As a potential alternative to having patients waiting for up to two years for a routine examination, I have been helping practices to set up low-cost annual dental membership plans to offer their patients. These plans entitle patients to one examination, one hygiene appointment, x-rays, emergency appointments and a discount off treatment. They are aimed at those who want to continue seeing ‘their’ dentist annually rather than being assigned to any NHS dentist at the practice or, in an emergency, any NHS dentist working for the Local Health Board.

In accordance with GDC standards, the plans are presented to patients as one of a number of options available to them and have proved popular. One practice that introduced these low-cost annual plans signed up 1,100 patients in just three weeks. As well as providing some certainty for patients, they offer a predictable income for practices concerned they may not fulfil their contract or who may be considering a move away from the NHS altogether at the end of the contract year.

More to come?

The Welsh Government has said that around 6% of NHS dental contracts in Wales had been handed back by March 2026. It is difficult to say with any certainty how many patients are likely to have been affected. However, as approximately 1.41 million people were treated by NHS dentists in Wales over the preceding two years, this could be around 85,000 patients, although no official Wales-wide estimate of patient impact has been published and the actual figure could be higher or lower. I am aware that at least some of those contracts were handed back as the holder did not wish to work under the new contract conditions. As we reach the October deadline, how many more practices will join their ranks?

Practice Plan has been welcoming practices into the family since 1995, helping them to grow profitable businesses through the introduction of practice-branded membership plans. If you’re looking for a provider to be by your side through a safe move from NHS to private then, with over 300 years’ dental experience in our field team, you’re in safe hands with Practice Plan… Be Practice Plan and get in touch.

Call 01691 684165 or visit www.practiceplan.co.uk/be-practice-plan/.

This article is sponsored by Practice Plan.