Examination of Witnesses (Questions 40
TUESDAY 13 DECEMBER 2005
DR M C WILLS-WOOD
Q40 Mrs James: I just wanted to come
back to this therapist idea. You mentioned it first of all when
I was asking questions about the aging population of dentists
etc, and it certainly seems that you have some clear ideas about
how that could work and what gaps it could effectively fill. Have
you approached any of the bodies that we have mentioned today
about possible courses and how that would fit into the overall
dentistry picture in Wales?
Dr Wills-Wood: In all fairness,
the dental school has set up a therapists course and has set up
a hygienists course, but it is very early days still. For example,
what we would be looking at long term is perhaps the therapists
working in practices in different parts of Wales, again coming
under the Cardiff Dental School. The development of the dental
team is very important to the future of NHS delivery in Wales
because, as you say, we are short of dentists, we are never ever
going to be able to replace or have sufficient number of dentists,
we have to look to expanding the roles of our auxiliaries and
supporting staff and I think it is the way forward.
Q41 Hywel Williams: You said earlier
on that having a dental school in an area increases the chances
that the dentists will stay in that area, and that is certainly
my experience, having been involved in postgraduate training in
another health-related profession before I was elected. Do you
think that having a branch in North Wales and a branch in west
Wales from the Cardiff School would fulfil that very desirable
Dr Wills-Wood: In the current
climate it probably is the best way forward because we also have
to look at how these students are going to be taught, because
we are short of academic dentists as well. For example, with the
increase in the number of undergraduates in Cardiff the clinical
dentists who come from GPDS work in practice and work part-time
in the dental school. They are going to have to do more clinics
in the dental school, while at the same time they are doing less
service work in the NHS. So there are a lot of issues about setting
up a dental school and I think in the current climate it would
not be possible to set up a new dental school in Wales.
Q42 Hywel Williams: Is there a lower
figure that is required or a critical mass that you need in terms
of students in order to justify people hiring staff and so on?
Dr Wills-Wood: I believe there
is a critical mass to each intake in each area.
Q43 Hywel Williams: Do you have any
idea what that might be?
Dr Wills-Wood: No, I do not.
Mr Geddes: Can I just go slightly
laterally on that point? Chris has said that the cost of establishing
a dental school, unlike a medical school where you simply can
take bodies and put them into district hospitals, are really quite
a lot and there is an awful lot of money involved in capital investment
in chairs and drills and all the other things that you probably
do not like. One of the ways that you can get young practitioners
into an areaand we have found this to be quite successful
in Walesis to establish vocational training schemes, and
we do have these across Wales now and we are pretty well covered.
We are finding that principal dentists often apply to become trainers
because they see that by getting a youngster in straight from
university they can mould them and educate them as part of a proper
training programmeit is not an ad hoc training programme
by any means, it is a very formal arrangementbut they work
in the practice and it is 12 months where there is no end commitment
on either part, the trainee can leave or the trainer can say it
has been nice having you here for a year and goodbye, but if they
do get on they will often stay, and that is certainly a means
of attracting dentists to some of the outer areas. Certainly in
West Wales and North Wales there are some very nice lifestyle
options there and you do not have to work in a city to have a
good lifestyle. It is important that practices there are encouraged
to become trainers and attract trainees who, in the long term,
hopefully will stay there.
Q44 Hywel Williams: How is the trainee
Dr Wills-Wood: It is funded centrally.
The Welsh Assembly has looked at this and, unlike in England,
this will be administered and financed centrally, the Vocational
Trainee scheme. Following what Stuart was saying, it was very
successful in West Wales this yearall bar one of the VDPs
stayed in West Wales so I think we had eight extra dentists come
to your part of the world this year. I think the beauty of the
fact that it is administered centrally is that we know the funding
work is there, we can follow how it is being administered but,
more importantly, we know that the standards are consistent across
Wales as welleach LHB knows that they have a training practice
in their area and we know what standards that graduate is going
to be exposed to.
Q45 Mr Jones: You have already mentioned
the desirability of attracting practitioners from overseas and
in your submission you are critical of the Welsh Assembly Government
saying that they have no structured plans for recruitment of overseas
dentists. You draw attention to the fact that whilst in England
the Department of Health finances postgraduate deanery programmes
of £100,000 to support overseas and refugee dentists, there
are over 50 dentists in Wales who are trying to pass the International
Qualifying Exam but are having to fund themselves. Why is this?
Are you aware of why the Welsh Assembly Government does not provide
any support for these students?
Dr Wills-Wood: To bring you up
to date, sir, we are starting to score a little bit of success
with this. After April 1 we understand that for international
dentists coming into Wales there will be a budget allocated to
the postgraduate department for an induction course. One important
thing is that international dentists come under clinical governance
with the local health boards because, in all fairness to these
dentists, they are not used to working within the NHS in Wales
and we really want to know that they have a smooth introduction
into the culture of Wales and into how practice works in Wales.
So between now and April we believe that the local health boards
will have to find the money for any induction courses and we think
it is about £2,500 per dentist over a two-week period,
run through the postgraduate department. Part of our project board
that is overlooking the new contract is actually looking at this
issue and the Welsh Assembly is starting to identify a budget
to help international dentists, but this will all be post-April
1 of next year.
Q46 Mr Jones: I was interested to
see also that you referred specifically to refugee dentists. We
are obviously familiar with Polish dentists who appear to be one
of that country's major exports, along with plumbers, but what
sort of numbers are we talking about in terms of refugees?
Dr Wills-Wood: We cannot get hard
figures for this. We have asked the postgraduate department to
look into it, but the general impression is that the postgraduate
department is getting a number of phone calls from refugee dentists
in Wales who want to stay in Wales and work in Wales, so what
we are hoping for next is to identify these individuals and see
exactly where they are in Wales.
Q47 David Davies: Can we be absolutely
certain that anyone who has applied to undergo that exam is fully
qualified in their country of origin and that the standards applied
in those countries are at the same level that they are in the
Dr Wills-Wood: That would come
under the remit of the General Dental Council who would look at
the suitability of the dentist to hold a licence to work in this
country. At the moment, for example, if we have dentists coming
to the local health boards we are trying to find out about them
and we approach, for example, the authority of that country. We
have some translation work done for us and then we go to that
board, but sometimes it is not always a council in a foreign country,
it is sometimes an association which has a dual role and then
we check out not only who the dentist is who is applying to work
under that local health board but also who the referee is as well,
so there are two levels to be looked at.
Q48 Hywel Williams: Can I tell you
about a case I had a couple of years ago and ask you just to comment
on this. You know that there is a great lack of Welsh-speaking
dentists in Wales, in rural Wales in general. I had someone who
was a Welsh-speaking dentist, but he could not be employed because
he was from the Welsh-speaking community of Patagoniathat
is, he could speak Spanish and he could speak Welsh but he could
not speak English, and eventually he packed his bags and went
back to Buenos Aires, not having found work. The law says at the
moment that prospective dentists from outside the EU must be able
to speak English, and I understand that that is the rule with
doctors as well, but do you think that perhaps that could be amended
in this particular and perhaps peculiar case in respect of the
Dr Wills-Wood: I must admit that
this would be for the General Dental Council; I cannot comment
Mr Geddes: We did have a little
while ago, seven or eight years ago, an influx of dentists who
were Iranian, but who were trained in Sweden and who had got Swedish
nationality so they then could come and work here. We did, on
a number of occasions, highlight the difficulties with language
in North Wales, but it was their inability to speak English let
alone Welsh that caused a problem.
Q49 Mrs James: I am very interested
in the opportunities to attract returnees. Again, in your paper
you have outlined that the Keeping in Touch returning to dentistry
campaign was successful in attracting five or six people back
in, but where does the final responsibility for that campaign
reside? Is it with the Department of Health or with the Welsh
Dr Wills-Wood: This is for the
Welsh Assembly Government, it is part of the funding that goes
to the postgraduate department.
Q50 Mrs James: As an add-on to that,
who funds the dental postgraduate department at the UK level?
Dr Wills-Wood: In England it is
done through the deaneries, so I am afraid I do not know the exact
mechanisms of funding for English ones.
Q51 Mrs James: And in Wales?
Dr Wills-Wood: The Assembly.
Mrs James: It was a simple question but
I wanted to get an answer to it. Thank you.
Q52 Nia Griffith: Could you update
us on the current negotiations on the general dentist service
contracts and perhaps give us a bit of background?
Dr Wills-Wood: Firstly, they are
discussions, we have never been in negotiation with the Welsh
Assembly Government. The Welsh Assembly Government has approached
the new contract slightly different to England in that it has
set up a project board to oversee the introduction of the new
contracts because, in effect, it is a Welsh Assembly Government
contract which will be offered to dentists. The current state
of play is that this week all NHS practices will have a contract
value posted to them to tell them how much the value of their
contract is and how much work or what type of work they are expected
to do to reach that contract. Part of the problem here has been
this time-lag that Stuart has spoken to about following England,
so we hear the stories that are happening in England and that
dentists have made decisions that they wish to move out of the
NHS towards the private sector; it will be interesting now over
the Christmas period to see what dentists think of the contract
values that have been given to them and the amount of work that
is attached to each contract. Interestingly, part of the project
board has been set up to look at the risk analysis so that if,
for example, there are more movements away from the NHS to the
private sector, the project board is looking to see what effect
that will have on our colleagues in, for example, community dental
services, on the hospital dental services and also our medical
Q53 Nia Griffith: From your soundings
and talking to colleagues and what you know of the contracts to
date, do you think that is a very real risk?
Dr Wills-Wood: Yes. We are often
told that the contract will bring more dentists back into the
NHS, but I would say that there is actually no evidence for that.
What I would hope and probably the best that the Welsh Assembly
could hope for is that this contract will maintain its current
base level of NHS commitment. I do not see any increase at the
moment as it is.
Q54 Nia Griffith: What is the expected
time for people to respond?
Dr Wills-Wood: It is a very, very
tight time schedule for the local health boards now. They will
have to come and talk to each individual dentist between January
1 and effectively March 1, so there is a lot of pressure on our
local health boards to get this sorted.
Q55 Nia Griffith: You are already
getting feedback from English colleagues that dentists are not
very pleased, but I understand from your paper that the conditions
for the Welsh dentists are slightly more generous, is that right?
Dr Wills-Wood: They are different,
yes, in that we have a 10% reduction in the work activity and
we have a 5% tolerance level if the contract is not met. Unfortunately,
these tolerance levels and this reduction are there to meet new
aspects of the contractin particular there is a vast increase
in the amount of clinical governance that will have to be done
in the practice. We are happy to be part of clinical governance,
the problem is that we do not quite see how clinical governance
is going to fit in with this new contract on both sides, in all
fairness, because the local health boards will have a lot of additional
work to run this new contract and we are concerned about transitional
arrangements between March and April and we are also concerned
that the LHBs will not understand the new contractswe are
not quite sure that they have the expertise overnight to meet
this new contract.
Q56 Nia Griffith: Let us look at
a worst case scenario: that the contract goes out and an awful
lot of dentists decide to opt out of the NHS. Is there any opportunity
or any door open for renegotiation do you think?
Dr Wills-Wood: Yes, if things
are not looking as if they are going smoothly I think what will
happen is that there will be negotiation with the personal dentist
services where the local health boards will commission certain
forms of treatment or treatment to certain groups with dentists
Q57 Nia Griffith: It will be down
to the local health board then and they might say if all of you
are going to leave NHS could we perhaps reconsider on these particular
issues and look at these parts of the contract again, or they
could issue a separate contract, change in some way.
Dr Wills-Wood: The local health
boards could, in discussions with a dentist, tailor the contract
to suit the local health board area, that is the dental needs,
and also to help the dental practice as well.
Q58 Nia Griffith: Do they have a
fair amount of flexibility then or not?
Dr Wills-Wood: We are not exactly
sure how much flexibility they have. We are, for example, all
very keen that if the LHBs are to prioritise contracts and personal
dental services we would like children to be prioritised and we
would like also exempt categories.
Q59 Nia Griffith: I will just follow
that up a little if I may, Chairman. The local health boards are
there for setting up the contracts and holding the contracts.
The money is initially ring-fenced, is it, for dentistry?
Dr Wills-Wood: That is right.