Examination of Witnesses (Questions 80
TUESDAY 13 DECEMBER 2005
DR M C WILLS-WOOD
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 thatif
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,
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
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
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,
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
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 understandingand
perhaps I will turn to the Chairman to ask if I have got this
rightis 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
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
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
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.