Select Committee on Welsh Affairs Minutes of Evidence

Examination of Witnesses (Questions 40 - 59)



  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 outcome?

  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 area—and we have found this to be quite successful in Wales—is 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 programme—it is not an ad hoc training programme by any means, it is a very formal arrangement—but 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 scheme funded?

  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 year—all 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 well—each 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 United Kingdom?

  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 Patagonia—that 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 Welsh language?

  Dr Wills-Wood: I must admit that this would be for the General Dental Council; I cannot comment on that.

  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 Assembly Government?

  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 colleagues.

  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 contract—in 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 contracts—we 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 individually.

  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.

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