Eluned Morgan, Minister for Health and Social Services
Since March 2020 NHS Dentistry has been under significant pressure to meet patient need and deliver care in the context of the COVID-19 pandemic. Dental teams and health boards have made a huge effort to maintain access to essential dental services for those in the population experiencing pain and problems. Thank you to everyone who has been involved.
During a respiratory virus pandemic, dentistry has been one of the most complex areas of primary care delivery to scale back, provide and recover. Particularly given the common use of aerosol generating procedures such as fillings, and the proximity of clinician to patient in dental care delivery.
In the second wave of the pandemic, and during this long amber phase of reset and recovery, dental teams are continuing to focus on prioritising urgent care. They are dealing with the needs of vulnerable groups, addressing the backlog of treatment resulting from scaling back dentistry, and reintroducing routine assessment and care as capacity opens up.
The return of services will continue to be gradual. We know that this has been a challenging time and recognise the impact that COVID-19 has had on individual members of the dental team and on the profession as a whole. The approach we are taking proposes to deliver dental services for those most in need, with the treatments provided increasing as the COVID-19 risk reduces. We need dental practices to continue to follow strict infection control measures, including social distancing, to protect practice staff, patients and the wider community. Practices will be encouraged to see patients using suitable recalls periods determined by their patients’ needs and risk.
Prior to the pandemic some 40% of all dental practices holding NHS dental contracts in Wales were engaged in or had signed up to be part of contract reform. We had hoped that we would be able to restart contract reform in October 2021 as part of our on-going system reform programme aligned to A Healthier Wales.
However, COVID-19 remains a public health concern and dental teams need to maintain necessary infection control measures. We have therefore decided to delay the contract reform component of system change until April 2022.
We are now viewing this year as a reset and recovery period but are committed to system reform in dentistry and moving forward collaboratively with the programme in 2022. We do not want to see a drift back to previous ways of measuring activity when we have made such improvements using more clinically meaningful measures developed with dental teams.
Instead of Units of Dental Activity to monitor contracts, four alternative measures are being developed and tested. This work, using all members of the dental team, prepares the ground for contract reform re-start and we remain committed to the principles of Prudent Healthcare. We want to see dental clinicians continue to expand ‘using the whole team’ in care and delivery and focus on outcomes. Increasing the use of skill mix in dentistry is, and will be, a key element of system reform.
It is intended these measures will be used over the next couple of years without change, to give stability to practices and health boards. Starting contract reform in April 2022 will be a familiar way of working and discussions are on-going regarding the legal requirement for any change to Regulations or Directions for 2022-23.
It will take time to agree details and test the impact of the measures and it needs to be about more than short term fixes to the contract monitoring measure. But during the pandemic all dental teams have had the opportunity to experience how we want to reset dental services and oral health programmes. We are not starting afresh and will build on the development so far and use the tools and expectations we have already - with a commitment to continue to invest in dental services and support the delivery of system change.
A Healthier Wales, and the Oral Health and Dental Services response to it, is the strategic plan and it provides clear direction and intention going forward. Our Programme for Government includes an undertaking to deliver better access to dental services and for the reform of primary care services. The reform of dentistry is underway and this Statement confirms our commitment to continuing with the reform programme including improvements in accessing services.