Reform of Units of Dentistry Activity system in Wales

Welsh Assembly Dentistry Inquiry

In May 2019 the National Assembly’s Health, Social Care and Sport Committee published an inquiry into dentistry in Wales. Reform of the current Units of Dentistry Activity system was one of the key recommendations. This briefing explores the current system and proposed reforms.

The current system

The NHS (General Dental Services Contracts) (Wales) Regulations came into force in Wales in 2006. Treatment was categorised into three treatment bands with each linked to differing Units of Dentistry Activity (UDA). While the system was introduced with the intention of securing a steady monthly payment for dentists, it failed to take into account that one band of treatment may need to be carried out over a series of appointments and the dentist would not be remunerated for the time taken to complete the treatment. The value of a UDA can differ in the various Local Health Boards in Wales. The Committee believes that some Health Boards have set the value to a level which is too low to be workable. If the dental practice delivers a minimum of 95% of their annual contracted UDAs, they will have fulfilled the contract. Anything below that and the Health Board will “claw back” funds or the dental practice can opt to “roll over” the remaining UDAs into the next year.

The current system may act as a disincentive for dental practices to take on patients who need extensive dental treatment. This is because a dentist will have to commit more time to completing a single course of treatment than for that of a healthy patient.

Recommendations for reform

  • Replace the current UDA system.
  • Reinvest claw back money into dentistry services.
  • Evaluate UK wide recruitment system and its ability to retain dentists in Wales.
  • Collaborate with Local Health Boards to ensure the e-referral orthodontic system is efficient.
  • Develop existing oral health programmes aimed at children to include older children and teenagers

The chair of the Committee, Dai Lloyd highlighted that “paying someone the same amount to deliver a course of treatment on a patient regardless of the amount of work involved makes little sense”. This was echoed by the Chair of the Welsh General Dental Committee, Tom Bysouth who stated that “dentists would like the UDA put in the bin”.

The Welsh dental pilot programme ran from 2011 to 2015 as a means of testing alternative dental contracts in Wales. In 2017 the Chief Dental Office announced that the pilots would not be adopted in Wales, instead a larger pilot would be trialled involving 22 dental practices across Wales. It was noted that by reducing the targets set by the Health Board through the UDA system, dentists were able to provide more preventative treatment and could commit more time to encouraging patients to improve their oral health.

The Health Social Care and Sport Committee believe that a new system would be beneficial to dentists and patients, and would encourage dentists to take on patients who require extensive dental treatment.

This would have a significant impact in areas of economic deprivation where there is currently limited access to NHS dental treatment. The correlation between economic deprivation and poor dentition has been a focus for the Welsh Assembly in the past. In 2005 The British Association for the Study of Community Dentistry published research that revealed that children in Merthyr Tydfil had the worst oral health amongst children in the UK. Five years olds in the area at the time had the most decayed, missing, or filled teeth amongst that age bracket. In an effort to tackle this, the Welsh Government launched the Designed to Smile scheme in 2009. The scheme introduced a preventative programme from birth where parents are provided toothpaste and toothbrushes and encouraged to take their child for a dentist appointment before their first birthday. This was then continued into infant and primary schools where children are encouraged to brush their teeth in school and free fluoride varnish treatment is available. More information on the Designed to Smile scheme can be found here. The Committee noted the success of this scheme and recommended that the Welsh Government continue this programme for older children and teenagers.

While the proposals go some way to addressing the shortcomings of dental services in Wales, the inquiry makes no recommendations regarding the availability of dental services in Wales. Some areas in Wales rely on mobile units due to practice closures. This is particularly problematic in North Wales where in rural areas there is a shortage of NHS dentists and a difficulty recruiting dentists to practice in these areas.

Conclusions

The Committee’s report will now be considered by the Welsh Government. They will then be responsible for developing an alternative dental contract system in Wales if they believe that this is the appropriate next step. The Welsh Government is expected to respond to these recommendations within six months.

As healthcare is a devolved matter, any developments would only be applicable to dental services in Wales.

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