Aim This research was undertaken to explore NHS general dentistry in Wales, from the perspective of both the dental practice and the general population, in order to understand patient access to NHS general dentistry. The health boards' dental budgets, and how well they have been used for primary care general dentistry, were examined. Contributory factors to patient access problems were also examined.
Background Our research shows that access for new patients has dropped to an all-time low in recent years. Causation is multifactorial. In Wales, dentists must achieve 95% of their UDA target or their practice will face 'clawback'; having to pay back monies for not achieving UDA targets. Practices may also hand back monies from their contract if they feel they will end up facing clawback at the year's end.
Methods The clawback and handback data, budgetary and contract reduction data, and practice opening and closures numbers, were acquired in the period of March 2017 to April 2018 via a series of freedom of information requests to each of the Welsh health boards. Telephone interviews with dentists and practice owners were conducted in the summer of 2017. Patient access information was gathered from the health boards and from contacting dental practices where this information was not available.
Results It was found that, on average, only 15% of all NHS practices in Wales were accepting adult NHS patients in 2017-2018 and 21% of all NHS practices had waiting lists. Cwm Taf had the best access to an NHS dentist, however, this figure was not high at 52% (15 practices). Cardiff and Vale patients were the most likely to struggle to find a dentist, with just two practices in the whole health board accepting adult NHS patients. In Wales, clawback and handback resulted in £16,322,445 of the general dental service (GDS) budget being unspent from 2014/2015 to 2016/2017. This figure increases in consideration of the monies lost from practices through contract reduction, with contracts being reduced by more than £4,000,000 from 2014/2015 to 2016/2017, making a total of £20,322,445 of the budget not being spent on NHS dentistry over a period of three years. This means that, on average, 6% of the Welsh GDS budget was unspent every year between 2014 and 2017.
Conclusion Dentists want to be able to treat more patients and see more patients with a higher need, but limitations upon patient access and the fear of clawback within the current contract make this very difficult. An increasing population and a further handback of NHS contracts mean it is likely that this problem of access will continue to worsen. The current system of clawback and handback only exacerbates the access problem because taking on new patients is a risk to dentists trying to achieve such tightly managed targets. Dentists are incentivised in the current UDA contract to treat healthy patients. A larger proportion of high needs patients can result in a practice failing to reach its targets and facing clawback, handback or contract reduction. Clawback is prevalent in all health boards, meaning that patients with poor oral health are disproportionately affected. Inverse care law is felt acutely in general dentistry.
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Owen, C., Seddon, C., Clarke, K. et al. NHS general dentistry in Wales: evaluation of patient access and budget expenditure. Br Dent J 226, 967–978 (2019). https://doi.org/10.1038/s41415-019-0407-3