Select Committee on Welsh Affairs Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



  Q20  Mr Crabb: In your memorandum you compare the ratio of Welsh dentists to Scottish dentists; has Wales always fared worse in this regard or is that a recent phenomenon?

  Mr Geddes: Yes, is the short answer to that. We have always had a larger number of patients per dentist in Wales than any other part of the UK—Northern Ireland in particular fare best.

  Q21  Mr Crabb: If Scotland considers that its own shortfall is about 215 dentists, have you come up with a shortfall figure for Wales?

  Mr Geddes: The workforce plan that was published as part of Routes to Reform suggested that we need another 45 dentists in Wales, but then of course Scotland moved the goalposts again. We have not done any further work on that.

  Q22  Mr Crabb: Do you think there is an optimum number of dentists per 10,000 people that decision-makers should be working towards as a target? I think we have heard the figure of five dentists per 10,000 people mentioned.

  Mr Geddes: That would give a list size of one to 2,000 which is actually slightly more than the current average Welsh list size which is about 1,700, so we would probably need a few more than that.

  Q23  Mr Crabb: Do you think that is a helpful way of looking at the problem, working towards that kind of target level?

  Mr Geddes: Yes.

  Q24  Mr Crabb: So in a place like Pembrokeshire where there are 2.4 dentists with 10,000 people you have a long way to go.

  Mr Geddes: You have indeed.

  Q25  Hywel Williams: I just wondered if you could explain why it is historically the case that the ratios in Wales have been higher. It is an accepted fact, but why is that the case? Is it to do with the rurality, is it to do with poverty, is it to do with distribution of the dental schools, or what is the cause?

  Mr Geddes: The first dental school was established in Wales or its first graduates came out in 1964. Historically, the source for dentists in Wales tended to be the London schools, presumably because it was an easy train journey home, and Liverpool of course serving North Wales. We had some very interesting data a few years ago when we looked at the distribution of dentists after graduating, and it is quite interesting that 40% to 50% of them stay within 35 to 40 miles of their dental schools. So if you look at the figures for Wales and go back to 1964, you will find that there were about 400 dentists and we now have over 900, and it is mainly because the dental school has been producing dentists and they have stayed mainly, I suppose, in the south of the country because again, historically, Liverpool has provided a lot of the dentists for North Wales and actually Birmingham for North Wales as well.

  Q26  David Davies: You have rather thwarted my question actually, because I was about to suggest that maybe it does not actually matter where you have the dental schools because the graduating dentists will go where the employment opportunities are, but what you are saying suggests that that is not a correct assumption.

  Mr Geddes: The employment opportunities are where the population is and if you look at the demography of Wales it is along the two bands, north and south, and in the middle I am afraid we have a shortage of patients really.

  Q27  Mr Crabb: It is my understanding that rural parts of Wales do not have much problem in attracting GPs so why is there such an issue in terms of encouraging dentists to come and practise in places like Pembrokeshire and Ceredigion?

  Dr Wills-Wood: The problem is that the viability of a practice in rural Wales is very difficult. Stuart alluded to the fact that we have a certain list size; in rural Wales it is very difficult to have NHS lists of that size to maintain practice viability. The way medical practice is funded is completely different to dental practice and the start-up or capital costs of an NHS dental practice come from the dentist, there is no assistance from the Welsh Assembly, there is no assistance from the local health board and when you are sitting down putting your business plan together to set up the practice, those are the key things that you are looking at. There are other issues as well with rural areas, you need to attract good staff into the practice and of course you have a smaller potential workforce to use. There are transport difficulties as well, occasionally, and patients find it difficult to get to centres where there are dental surgeries so there can be a high percentage of failed appointments because of those difficulties. Also, the training opportunities for dentists in those area tend to be at a distance from postgraduate centres and the training opportunities are less, although I have to say in Wales we do have a very good network of postgraduate training facilities.

  Q28  Mr Crabb: To summarise, are you suggesting that the economics of NHS dentistry in rural Wales just do not work?

  Dr Wills-Wood: Yes.

  Q29  Chairman: For the record, could you tell us where the situation is worst in Wales? Is it the case that it is in rural areas and valley areas?

  Dr Wills-Wood: I would say that looking at the practices that have closed along the M4 corridor, they have gone from the valleys and gone more towards the M4 itself, so they are moving out of the valleys and staying in the conurbations along the M4. In West Wales, for example, we have no real new practices there and in the mid part of Wales there are no practices there either.

  Q30  Nia Griffith: If we are talking about dental schools, can you explain a little bit of what the responsibilities are of the Department of Health in respect of the Cardiff Dental School?

  Mr Geddes: I am not sure that they have any. The Cardiff Dental School is now part of Cardiff University, so I would assume that Cardiff University is funded in much the same way as any   UK university is, through that university mechanism. The Cardiff Dental School, like any other dental school or medical school, of course will provide an element of NHS care and the NHS will provide some funding to the dental and medical schools in Cardiff. I am afraid I cannot be any more specific than that because I do not know.

  Dr Wills-Wood: Interestingly, the one point you are raising about funding is we understand in England that in respect of the conversion of a hygienist to a therapist, the courses there are funded by the Department of Health; in Wales we understand there is no funding for the conversion courses for hygienists to therapists and the costs of the course are £6,000, which is a lot of money for youngsters to find to convert across.

  Q31  Nia Griffith: You see that as an incentive, if it could be provided it could actually help to fill a partial gap.

  Dr Wills-Wood: Yes.

  Q32  Nia Griffith: Although presumably there is a limit to what therapists can actually undertake.

  Dr Wills-Wood: Therapists are a very important part of the future. Stuart was alluding earlier to the fact that they can do quite a significant amount of work in practice, but the important point of a good therapist in a practice is that while that therapist is doing perhaps the routine dentistry, it would free me up as a principal dentist to do the urgent work and the emergency work, so there is the other side to look at where the therapist is concerned as well.

  Q33  Nia Griffith: That is very useful. You mentioned in your document that the intake is about 64 currently a year in Cardiff Dental School, but you are suggesting that it needs to be at least 74, is that the case?

  Mr Geddes: That is the planned expansion, that is what is being planned for.

  Q34  Nia Griffith: As you say, research has shown that students tend to stay in the area they have trained in or their home town, so what would you see as the long term solution, an increase in the number of students in Cardiff or a second dental school somewhere else in Wales?

  Dr Wills-Wood: I would not go for a second dental school, what I would look for is something like an outreach centre, perhaps in West Wales or in North Wales, so that the undergraduates are exposed to different parts of Wales, so they can go and see what it is like to work in different parts of the community. At the same time it brings another element of NHS dentistry to these areas as well.

  Q35  Nia Griffith: You would see them still under the auspices of Cardiff University rather than seeing them set up, say, in Bangor or Swansea or whatever.

  Dr Wills-Wood: Yes.

  Q36  Nia Griffith: Because you would be duplicating costs presumably if you did that.

  Dr Wills-Wood: Administratively it would be more sensible to do that, but also for example Swansea has a medical school and that seems to be working well, so a parallel dental course for instance.

  Q37  Nia Griffith: You are suggesting that we should keep it in Cardiff rather than have a second dental school.

  Dr Wills-Wood: Yes, one dental school for Wales.

  Q38  Nia Griffith: Basically you are saying then that the funding would have to come from the university.

  Dr Wills-Wood: As we understand it, with the merger now the dental school is part of Cardiff University and funding would come through the universities, how they are funded across Britain.

  Q39  Nia Griffith: Presumably we could look at   another source in terms of funding that independently.

  Dr Wills-Wood: I am sure the dentists would be only too happy to look for more sources of income.

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