Select Committee on Welsh Affairs Minutes of Evidence

Examination of Witnesses (Questions 80 - 99)



  Q80  Hywel Williams: So if you were having emergency treatment for something which would otherwise be in Band Two or Three, that would be charged at Band One and they might put up with toothache in order to get that—if they were silly enough.

  Dr Wills-Wood: Yes.

  Mr Geddes: Coming back on that point actually, we   were very proactive in trying to get the Confederation of Community Health Councils in Wales to respond to the document on patient charges. I am not aware that they have done that, we did offer to go and talk to them and offer them help and advice on this, but that offer was not taken up.

  Q81  Nia Griffith: Could I just come in on that about patient behaviour in relation to payment because in my area, Llanelli, we have found that a lot of patients come and complain about the Denplan type of programme where they are asked to pay so much per month. They make a comparison with the vet where, if they need to pay, they pay there and then for that particular item and they are not asked to pay a monthly fee, they can still go to a veterinary practice without doing that, whereas some of the dentists are not letting you go unless you are on these types of plans. There is a tremendous resistance to the idea of, if you like, everybody paying a premium all the time, so you are quite right to point out that we may find some very significant difficulties with this type of contract. I do not know if you want to comment on those private schemes, but the issue here is really is there a way of making these bands more appropriate so that you cannot end up in that sort of situation that I was just describing.

  Dr Wills-Wood: Patient charge banding is something that the Welsh Assembly will have to look at. For example, as we understand it under Band One the examination for under-25 and over-60 will remain free but, for example, if you have to have a radiograph taken you would then have to pay the full band charge. As I say, this is something that the Welsh Assembly is looking at. It has made it clear that it is not using patient charges to increase revenue, it will be cost-neutral, but we seem to be in a position where we think that a lot of patients probably will be worse off. There is always the argument that a small minority under Band Three, about 3%, will be better off, but we are talking of a very, very small minority against the general population who will be facing patient charges.

  Q82  Nia Griffith: You see that as a disincentive in fact.

  Dr Wills-Wood: In certain instances, yes.

  Mr Geddes: We really do not know though how the public is going to take to this, and the whole thing of the banding and the charges has not been piloted. There were certainly opportunities in England to do this with the pilot PDS schemes that have been around for a few years but, unfortunately, this was not subject to Wales.

  Q83  Hywel Williams: Is there any reason why it should not have been piloted initially?

  Mr Geddes: That would have been a decision for the Department of Health to make.

  Q84  Hywel Williams: A political decision then. Can I just confirm, therefore, that there has been no research as far as you know in terms of the incentive and disincentive effects of charging in terms of income levels?

  Mr Geddes: No.

  Q85  Hywel Williams: For example, in my constituency where wages are low you would not know objectively whether that is going to lead to a lesser take-up.

  Dr Wills-Wood: No, there has been no research and, as I say, we just do not know what patient behaviour is going to be.

  Q86  Hywel Williams: It is a bit of a shot in the dark then.

  Dr Wills-Wood: A very big shot in the dark.

  Mr Geddes: The introduction of the charging system for when the whole contract changes is a very major upheaval for practices.

  Chairman: Could we end with some questions about cross-border services. Mr David Jones.

  Q87  Mr Jones: You have referred to referrals to Chester hospital traditionally from the north-eastern parts of Wales and you have indicated that a primary care trust in Chester has refused to continue to fund these referrals. Are you aware of the level of funding that was given to that PCT to fund the treatment of Welsh patients?

  Mr Geddes: No. The exact level, I am afraid, we do not know. It is not just referrals to the secondary service; it is also referrals to other primary care providers. The particular problem that they have had in that area is for orthodontic treatment where there is a specialist practice, a primary care practice, in Chester providing orthodontics. They have always provided orthodontic treatment for people from north Wales, so in their allocation for the next and subsequent years that funding is there still. They have had the Welsh money but they are now not wanting to take on Welsh patients. This is only reported to us by the practitioners involved in Wales, not in Chester.

  Q88  Mr Jones: Do we know why they do not want to take on Welsh patients?

  Mr Geddes: Again, it is simply a question of access to their local population. The PCTs in the Chester area have concerns that their patients are not being seen and they want them seen. They are trying to put pressure on the practices who have historically provided care for Welsh people not to take them and, of course, new patients where there has been no historic funding are also disadvantaged. As you know, there is quite a significant flow of workforce across the border to business parks in Chester and very often, of course, people prefer to have their dental treatment in an area close to where they work rather than where they live. It is more convenient for them.

  Q89  Mr Jones: Indeed. Places such as Saltney, for example, are virtually a suburb of Chester. Do we know how many patients we are talking about?

  Mr Geddes: In terms of actual figures, no, sir, we do not have those figures.

  Q90  Mr Jones: Do we know what sort of area we are talking about?

  Mr Geddes: It is mainly midway across north Wales into the border areas.

  Q91  Mr Jones: So it could be as far as, for example, my constituency in Colwyn Bay?

  Mr Geddes: Yes.

  Dr Wills-Wood: There are not only cross-border issues at the moment in the north; there are also cross-border issues in the south, across the marshes, and we have had instances of community dental service problems where patients are housebound and because they are registered with a doctor in England we cannot get them to have dental treatment. This may be something that we will have to look at because we fail them miserably. We need to sort these issues out.

  Mr Geddes: That service is provided by the salaried primary dental care services. They go into Herefordshire to treat people living there but they do not actually have a contract to do that. It is based on where they live and where they have their medical care. Conversely, in Mr Davies's constituency, of course, we have Chepstow where the population is only about 12,000 and it has actually got 17,500 registered NHS patients, and it is because they all flood in from the Forest of Dean.

  Q92  David Davies: Which brings me to my next question. First of all, why are they flooding in from the Forest of Dean to Chepstow?

  Mr Geddes: I am sorry; I am to blame for that.

  Q93  David Davies: Is it because we have got such good dentists in Chepstow?

  Mr Geddes: It is historic. There was one large practice in the Cinderford area which I am afraid when I took up this post I retired from and it left an awful lot of patients looking for dental services and they were directed by the West Gloucester PCT to go to a practice in Chepstow.

  Q94  David Davies: Do we receive any extra money to the Welsh block grant, because I suppose that is where it would be, to treat these patients? I suppose the Government in England might argue that we did. I would argue that we do not and that possibly we   should stop funding this or demand that Gloucestershire PCT, which I suppose is responsible for them, funds it.

  Mr Geddes: Up until 31 March next year it really is not an issue because any treatment provided for a patient in a Welsh practice, be they English or wherever they come from, is funded on the old axiom of service arrangements, so it is a matter of whatever you do attracts a fee and that comes through the Dental Practice Board. At the moment that is not cash limited.

  Q95  David Davies: Is that devolved? Is it coming directly from Westminster or is it coming through via the Welsh Assembly, because if it is coming via the Welsh Assembly then it is effectively coming out of the block grant that would fund all sorts of other services?

  Mr Geddes: I think it is a non-cash limited budget at the present. I think it just flows in a steady trickle from the departments in Westminster through to the Welsh Assembly and there is no valve to shut that off.

  Q96  David Davies: My understanding—and perhaps I will turn to the Chairman to ask if I have got this right—is that the block grant goes en bloc to Wales and that part of that will cover the Health Service and part of that Health Service money will be for dentistry, so effectively those patients who are coming over to Chepstow are being funded directly or indirectly from money which could otherwise be spent elsewhere.

  Dr Wills-Wood: As I understand it, the GDS services are not part of that block grant at present. The issue will arise after 1 April, for example, if we are having personal dental services, about what the local health board would be commissioning off our practices. They will have the right to say, "We wish to commission only children, for example, within our LHB area". These are issues for the future without a doubt.

  Q97  David Davies: Can I be absolutely clear about this, that after 1 April of this year anyone who is receiving treatment in Chepstow and who comes from the Forest of Dean/Gloucester area will effectively be being treated using money which has gone to the Welsh Assembly to treat patients in Wales?

  Mr Geddes: That is not quite right because the historic basis of the funding for the practices will take into account the treatment provided to those patients historically.

  Q98  David Davies: But we have already ascertained that in Chester, where the opposite problem is happening, the English PCTs are not playing by the same rules, so on the one hand we are having to look after Welsh patients who should be being treated in Chester where the PCT has had extra money from the Government to include that, and yet at the same time in Chepstow we are still treating patients from England out of money that could otherwise be spent in Wales. Do you see what I mean? Am I putting the question clearly enough?

  Mr Geddes: Yes. Theoretically, if you decided not to treat patients from the Forest of Dean that money would still be available to the practice and they would be able to take in new patients from Wales and the borders, the Welsh side of Offa's Dyke, in other words.

  Q99  David Davies: It is a bit unfair on us, is it not?

  Mr Geddes: I think dentists in that particular area are just being magnanimous in looking after the patients in the way we would expect them to do.

  David Davies: If only Chester would take the same view.

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