Select Committee on Welsh Affairs Minutes of Evidence

Examination of Witnesses (Questions 1 - 19)



  Q1  Chairman: Good morning, welcome to the Welsh Affairs Committee. Can I at the outset thank you very much for the memorandum which you have sent us, which we found extremely helpful, and could I also remind you that we do intend to finish at about 12 noon; if you have any additional information that you wish to give us subsequently, we will be delighted to receive it. Could I, for the record, ask you to introduce yourselves?

  Mr Geddes: I am Stuart Geddes, I am the director of the BDA looking after the members' affairs in Wales.

  Dr Wills-Wood: I am Chris Wills-Wood, chairman of the Welsh General Dental Practitioner Committee, representing general practitioners in Wales.

  Q2  Chairman: Could we begin by looking at the UK Department of Health responsibilities. Can you explain to us exactly how the responsibility for NHS dentistry is actually divided between the UK Government and the Welsh Assembly Government?

  Mr Geddes: All matters regarding health are devolved to the Welsh Assembly Government, as you are aware, and dentistry is included in that. Therefore, all matters related to dental policy go back to the Assembly; the day to day administration of dental services in Wales is done through the local health boards, the business service centres in Wales, and payments and things like that are done by the Dental Practice Board under contract from the Welsh Assembly Government.

  Q3  Chairman: What are the key areas in which the Department of Health could improve the provision of NHS dentists in Wales?

  Mr Geddes: At the moment, of course, dentistry and dental matters do all go back to the Assembly and the current on-goings, certainly with new contract discussions, are something that is really being led by the Department of Health in England and we have found—this is what our colleagues in the Assembly civil service tell us -that there is a little lag of time between the information coming from London and coming across Offa's Dyke and into Wales. It is these timescales that have been causing us some of the difficulties that we have had just recently. We obviously are not directly involved with the Department of Health because we do our business with the Assembly Government, but we have to rely on what they say and they often tell us that it is the lack of communication between the Department of Health civil servants and the Welsh Assembly civil servants that causes the Assembly difficulty, and then that of course causes us some difficulty because we are not getting information that we can pass to our members.

  Q4  Chairman: Is that a matter that the BDA at UK   level could address by ensuring that that information is flowing more readily to you?

  Mr Geddes: We do ensure that myself and any other Welsh member who is interested in particular discussions is present when the Department of Health is meeting with the BDA to have discussions about, for example, the contract things. We often find that the Welsh Assembly are not present at those meetings and occasionally they tell us they did not know about them. We have been quite proactive, in fact, in keeping our Welsh Assembly colleagues informed as to the timetable of some of the meetings that have been going on, and we have therefore tried to ensure that they are present when the DoH is meeting the BDA.

  Q5  Chairman: Have you written to them formally to draw their attention to the fact that they should actually be present?

  Mr Geddes: We have not written, sir. We have a very good relationship with our Welsh Assembly officials and we find that an email or a phone call is often sufficient.

  Chairman: We can perhaps explore this is in a little more detail later on in the session. Mr Jones.

  Q6  Mr Jones: Thank you, Chairman. Going back to the question of meetings, you referred in your paper to a meeting that the Secretary of State for Wales had arranged in November with Patricia Hewitt, Rosie Winterton and representatives of the BDA. How often do you have meetings with the Secretary of State for Wales and the Secretary of State for Health?

  Dr Wills-Wood: This is the first meeting we have had with the Secretary of State for Wales. He has always been interested in dental matters in Wales, but this arose from the fact that there have been problems in Neath with many practices moving towards the private sector.

  Q7  Mr Jones: It is his home turf.

  Dr Wills-Wood: Yes, his home turf. He first came to talk to us about it as the local constituency MP and then he took it on as more of a broad issue for Wales. It is the first time we have ever met the Minister or Secretary of State for Health in England.

  Q8  Mr Jones: Presumably you would like such meetings to continue.

  Dr Wills-Wood: Yes, I think we would. One thing, for example, is that after April 1 cross-border issues in Wales will still have to be looked at and I would have thought it would sit more within the House of Commons than within the Welsh Assembly.

  Q9  Mr Jones: Do you have similar meetings with representatives of the UK or Welsh Assembly Government?

  Dr Wills-Wood: We have met the Minister, Dr Brian Gibbons, on a number of occasions in Wales, yes.

  Q10  Mr Jones: Is that a regular scheduled meeting or is it ad hoc?

  Dr Wills-Wood: It has been ad hoc in the past, but I am led to believe that it will become more frequent as the contract negotiations proceed.

  Q11  David Davies: You have stated that there are 927 principal dentists in Wales; how many of these offer NHS services?

  Mr Geddes: By and large the majority of them. We have very few practitioners in Wales who are completely in the independent private sector, the vast majority are offering NHS services because they work in the mixed practice environment, they combine an element of NHS work with private independent practice.

  Q12  David Davies: Is it possible to pin that down and say how many spend more than, say, 50% of their time on NHS rather than private work? It could be the case that all of them are maybe taking the odd NHS patient and then doing private work; is there any way of knowing?

  Mr Geddes: There is not a means of identifying the percentages and the exact numbers. We use as a guideline the historic registrations of patients and we do follow those figures quite closely. We note that in Wales we have not seen the plummeting in the numbers of NHS registrations that have occurred in certain parts of England, but we are as a profession in Wales very heavily committed to the NHS anyway, that has always been the way that dental services have been delivered in Wales. It is only recently that the tide has turned there.

  Chairman: Mr Geddes, could you raise your voice a little. Do not be afraid to shout, we will not be offended.

  Q13  David Davies: If there is only one fewer principal dentists now than there was in 2000, why do you think that the situation appears to be so much worse now?

  Mr Geddes: The situation of?

  Q14  David Davies: NHS dentistry provision.

  Mr Geddes: You have probably put your finger directly on it there. We have not vastly increased the numbers of principal dentists in Wales, so effectively we have the same workforce trying to deliver enhanced services to more people.

  Q15  David Davies: It is the extra services that have to now be offered which has caused the problem; you are trying to do that with the same number.

  Mr Geddes: It is partly that and also, of course, patients' demands are changing with dental practices moving away from simply the repair of dental disease to providing other things in terms of cosmetic veneers and improvement in appearance and that sort of thing, the things that dentists are now very able to offer.

  Q16  Mr Jones: Getting back to the point you made about most practices accepting NHS patients in Wales, I have discovered that in the areas of both Conwy and Denbighshire local health boards there are now no dentists who are accepting new NHS patients. Is it the case that the fact is that most practices do accept NHS patients, but are not accepting new NHS patients, at least not new adult patients?

  Dr Wills-Wood: That is a fair summary, yes. For example, in my practice my NHS list is full, I have no spare capacity to take on new patients. We are not deregistering patients or anything like that, but our workload is such that we have just sufficient clinical time to treat that list, we have no more capacity to take on extra NHS patients.

  Mr Geddes: We need to differentiate between accepting and actually maintaining the list size. Certainly, most dental practitioners in Wales would have an NHS list of patients who are their regular NHS patients. Whether or not they are accepting new patients is of course very variable across the whole of the principality, and you will have probably seen a piece in the Western Mail, I think about 10 days ago, which outlined the difficulties in some of the areas, and your constituency area in particular, where I believe there was only one practice accepting new NHS patients.

  Q17  Hywel Williams: Are you aware that there is this intention, in Conway at least, to set up what are called super practices? I am not familiar with what that actually means; I wonder if you could tell the Committee what that means and whether you think it is a good thing or not.

  Dr Wills-Wood: Across Wales there are, as you describe, a number of super practices. They are practices that have what we call corporate status: they are owned by a company and they will run the practice as a company. There are some in North Wales and we believe there will be some in West Wales. They are being set up, as we understand, with   growth money from the Welsh Assembly Government and each dentist would have a contract file attached to it. The local health boards are looking at this, perhaps with open arms in some respects in that, yes, you can address the NHS access problems immediately; the problem is they are worried about the long term funding because they are looking down the line in three years time, will there be money to run these new practices? That really is as the state of play is at the moment, but the director of finance of the local health board in North Wales has already asked the question about the long term funding of these practices.

  Mr Geddes: The other issue about these practices as well comes back to workforce. The principals in dental practice in Wales do have quite considerable difficulty in attracting new dentists, youngsters, into their practices, and there are concerns with the one in Wales that is the principal corporate, Integrated Dental, about where they are going to get dentists from to be able to fill the surgeries in these new super  practices that they are hoping to establish. Experience from England would suggest that they will be bringing in dentists from probably Poland, Portugal, Spain, maybe the Indian sub-continent and using those individuals and those practices.

  Q18  Mrs James: I just wanted to come in on that issue. You mentioned in your briefing paper that at present dentistry is an aging profession in Wales, but there has been an increase in dental training places at Cardiff Dental School. Will that be enough to replace those dentists who are coming up to retirement?

  Mr Geddes: The workforce is aging. We have currently 109 practitioners between 55 and 59 and a further 36 who are over 60 in Wales. The training school at the moment brings in 54 in the current year: that will be fine in six years when they graduate but we have a lag in the interim period where we need to look at other sources of dentists.

  Q19  Mrs James: It is a concern then.

  Mr Geddes: Yes. There are other means of course of addressing the needs of patients. We could also, perhaps, expand to looking at bringing in dental therapists where their training course is slightly shorter; they could be used to fill vacant associate positions in practices in Wales.

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