It seems a year doesn’t go by without some sort of crisis or demand for action in the Welsh NHS – usually around treatment times. That hasn’t been helped by the Covid-19 pandemic.
One part of the health and social care system which perhaps hasn’t been focused on as much – but faces as many challenges as any other part – is dentistry.
Dental services were subject to an inquiry by the Fifth Senedd’s Health Committee (Senedd Home summary).
One of the first post-devolution NHS crises I remember was access to NHS dentistry.
During the First Senedd (1999-2003), the news would often publish/broadcast see pictures of long queues outside practices as soon as they announced they were taking on new NHS patients. The question is, has that situation improved much since then?
In December 2002 it was reported that 45% of the adult population in Wales were registered with an NHS dentist.
That doesn’t tell you anything about treatment, but in September 2021, the proportion of adults treated by NHS dentists was….45%. There’s an obvious pandemic disclaimer, as the rate was over 50% until mid-2020. So you can argue that the situation has improved but maybe not as much as it should have done in 20 years.
The good news is that the proportion of children treated by an NHS dentist is higher at around 59%. Oral health amongst children has gradually improved over the years too with declines in the proportion of children suffering from tooth decay – helped by the fact that under-18s are entitled to free dental treatment.
Recruitment may not be the problem
It takes the same length of time to complete undergraduate training for dentists and doctor and the earliest part of undergraduate courses are similar. Likewise, both dentists and doctors need to complete a foundational training programme after graduation before specialising in a particular area.
The big difference between NHS dentistry and NHS medicine is that dentists work as independent/private contractors and fees are charged for dental treatment. Even NHS patients at dental practices need to pay unless they’re eligible for free care (i.e. claiming certain benefits) – though the fees are set and fixed by the Welsh Government.
As a result, dentists usually earn more than doctors – especially earlier in their career – as they can set fees for private work and use that to top up any income they get from NHS work (if they choose to do NHS work at all). They usually have a better work-life balance too as most work 9-5.
However, dentists often have to be business-minded, if they’re going to be an associate/partner in a practice, in a way that most doctors don’t. Dental surgery can also be surprisingly dangerous (in terms of the equipment used and the risk of cross-infection) and dentistry is more physically demanding than most branches of medicine.
The good news is that there doesn’t appear to be any problems in recruiting dentists (though there are shortages in specialities like orthodontics). There are currently around 1,400 dentists undertaking NHS work in Wales (roughly 0.45 dentists for every 1,000 people, though this varies from county to county).
Wales’ only dental school (at Cardiff University) is often oversubscribed and trains a relatively high proportion of Welsh-domiciled students – that’s before counting Welsh dental students studying elsewhere in the UK.
The problem isn’t the number of dentists as there isn’t necessarily a shortage (though the more, the better obviously); it’s getting them to take on NHS work. To look at the reasons why that isn’t happening, you need to consider the contract – more on that next.
