New Contract Out for Consultation
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- Published: Tuesday, 15 April 2025 10:56
- Written by Peter Ingle
- Hits: 1639
When it comes to NHS dentistry what happens in Wales tends not to stay in Wales. A variety of contractual changes and key decision makers show links to the English service. Furthermore, since last summer both nations have had Labour administrations. Ministers Wes Streeting and Stephen Kinnock, must be watching the latest developments in Wales with some interest.
GDPUK has already covered the ever frostier relationship between the Welsh government and BDA, but the latest developments appear to have set the temperature even lower.
The Welsh government have now released a consultation on their intended new contract. Reform of NHS general dental services | GOV.WALES
Amongst the proposed changes are:
- a single route of entry to access NHS dental services
- the implementation of a different remuneration system claimed to be fairer and more transparent
- disincentivising ‘unnecessary’ routine examinations
- changes to patient charges
- changes to contract terms and conditions
The document refers to proposed ‘segmentation’ for the new contract. This involves some of the total contract value being reserved for specific types of activity. Notably, the ‘percentage assigned to contract segments can be varied by the health board depending on population needs and practice profile.’
UDA’s will be replaced by ‘Care packages’ which look like a halfway house between fee per item and the strictly limited bands of a UDA based system. There are 14 different care packages for adults, and 5 assessment based ones for children. However there will be a limit on the number of high value treatments. No more than 10% of the 70% of annual contract value allocated to the care packages segment, is to be delivered through the provision of the high value packages.
Contract payments will continue to be made in twelve monthly instalments. End of year reconciliation and clawback will remain part of the new contract.
Urgent care, or the lack of it, has been a major political driver in contract reform. Under the new arrangements urgent appointments will need to include a global oral health assessment. Such care should be done in a way that provides, where possible, a long term solution, and with the patient’s consent, urgent care should consist of permanent definitive treatment, including restorations. Practices will need to be open and available for urgent care Mon-Fri 9am 5pm.
High Needs patients, defined as requiring ten or more interventions such as fillings or extractions, which include endodontic treatment, will be referred into a separate pathway.
There are other changes, including the handling of missed appointments, parental leave, a requirement to attend four cluster meetings per year, as well as in contract management where amongst other changes the notice period for Variations and Terminations will increase from 3 to 6 months.
A Dental Access Portal (DAP) will be introduced as a means of allocating patients to practices. Once a patient has signed up to the DAP, they will be assigned a practice in their local area.
Patients given a recall interval of 18 months or more will revert to the DAP post assessment, so not necessarily return to the same practice. This is described as a positive feature: “Being allocated to a different clinic can be beneficial. Receiving care from different practices ensures that patients are seen by peers, thereby enhancing clinical governance. This approach aligns with the wider healthcare system, where patients see multiple health care professionals to address their clinical needs.”
The BDA are at pains to emphasise that the published model is NOT (the BDA’s use of caps and bold) a negotiated contract.
Their response to the consultation is headed: “Hard to follow: A consultation on a new unnegotiated contract.”
The BDA say that while items that they raised have been ‘cherry-picked’, the detail they provided has ‘been stripped out’. Dialogue had ceased by last Autumn, and they had been kept in the dark on the final document.
It was hard enough for dentists to make sense of the consultation but in the BDA’s opinion there was no attempt to involve patients. There was, “simply no prospect a lay person will comprehend what this model means for them.”
The BDA went on to strongly advise dentists to hold off replying to the questions at the end of the document, which they said are unacceptably leading.
This all follows the BDA’s blunt statement from late March that: “Honesty and transparency remain in short supply.” At the time, the BDA expressed its thanks to the opposition parties in the Senedd who had been able to “spell out the facts.”
At the end of March the BDA observed: “Negotiations between ministers, the NHS and the BDA had been ongoing for over a year, but arbitrary deadlines have cut dialogue short, and left the profession in the dark.” The latest exchanges between the Welsh government and the BDA will do little to lift the gloom that is also descending over hopes for English contract reform.
The New Wales GDS contract, dumbing down continual care :(
This seems desperate and treating patients like 'things', substituting continual care in Dentistry (it's USP frankly) to instead be bounced around in the already fragmented NHS medical services, where many problems occur as a result :oThis has the dead-hand of an Accountant remote from any clinical frontline dental care (let alone prevention lol), treating people as widgets on a spreadsheet, giving patients NO CHOICE in who, where, when, they access NHS Dentistry!!
It does though look like an AMAZING PR OPPORTUNITY FOR PRIVATE DENTISTRY that is patient-focussed, with continual care, rapport and best-practise at it's core, compared to the proposed fragmented-care system :o
Shockingly bad proposals, on first examination frankly :(
Though for those who have any dignity and choice, this is a great example of how NOT to do it and will hopefully make the many appreciate the routine continual care we have been providing for decades, when properly resourced.
Yours observationally ,
Tony.
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