Jenny ReesWales health correspondent
Controversial plans that would have meant patients would be allocated a dentist for each check-up, rather than staying with a family practice, have been dropped.
A new NHS contract will instead pay dentists to see people based upon their oral health needs, instead of routinely seeing them twice a year, with gaps of up to two years between check-ups.
The Welsh government said those who needed active treatment or support would be seen more regularly and dentists could decide on individual risks.
The British Dental Association Cymru acknowledged “some important wins” but said “plastering over a few of the biggest cracks is just superficial repairs” and the true cost of care was not reflected.
Proposals outlined by the Welsh government in June would have created a centralised waiting list for adults, who would be allocated a check-up appointment anywhere within their health board area.
Under those plans treatments would have been done in the same surgery, but patients would then return to the register for their next check-up.
However, the consultation highlighted concerns about the lack of continuity of care.
The refreshed policy, which comes into effect in April 2026, would mean patients with healthy teeth could be recalled by dentists every 18 to 24 months, in line with the maximum interval set out by NICE guidelines.
Practices would receive a fixed amount to support ongoing care for healthy patients, rather than payments per visit.
The professional body, BDA Cymru, has raised concerns that longer recall times would limit the ability to spot early signs of disease, including oral cancers, and hinder the opportunity to advise patients.
It also highlighted a lack of opportunity for changes to be implemented in the legislative process.
Russell Gidney, Chair of the British Dental Association’s Welsh General Dental Practice Committee said “we need to see the small print”.
“Ministers are taking forward the biggest changes NHS dentistry in Wales has ever seen via a route that will all but rule out fixes once draft laws reach the Senedd.
“If our MSs can’t iron out the creases later, the Welsh government must ensure real threats to this service don’t make the final cut of their plans.”
General fee rates to NHS dentists will rise from the proposed £135 to £150.
Those who pay for NHS treatment will pay half the costs, capped at a maximum £384, regardless of how much care they need.
The Welsh government said about half the Welsh population was exempt from paying NHS dental charges, including children under 18, pregnant women, hospital dental patients and people receiving certain benefits.
Dr May Bassett, who is based in Abercynon, Rhondda Cynon Taf, said system changes in recent years meant patients were seen less frequently, meaning many of their dental issues were “beyond the point of repair”.
“We work a lot on an emergency care basis now,” she said.
“A lot of the new proposals are urgent-care based, so we’re not seeing our preventative advice really getting to people.
“It tends to be going towards an extraction-only service, whereas previously we would screen a lot for a diagnosis of early tooth decay and also for oral cancers.
“We’re getting to a point where it’s no longer an option to treat with fillings or root canal.”
She explained some patients would only be able to see an NHS dentist at the point where they were in intense pain and an emergency appointment was required.
More complex solutions like root canals need to be done in multiple stages, and as “second-stage” appointments cannot be offered in emergency clinics, she said patients often opted for the tooth to be removed to end the pain.
“There are repercussions when it comes to an extraction-based therapy,” she said, explaining remaining teeth move into the space, or there could be further tooth decay, which can cause other jaw problems.
“Obviously function is a major issue, when chewing your food you tend to go for softer, more unhealthy foods. So it can have repercussions on general health when the dental health is not your main focus.”
She raised concerns that reducing the frequency of check-ups would only exacerbate the problem, adding oral cancers could be treated successfully when identified early.
“It’s going to create a social divide, where people who can afford to keep their teeth healthy will have good teeth,” she said.
“People who can’t afford it will have poor oral health and subsequently, poor general health as a result.
“It seems like a final nail in the coffin for NHS dentistry.”
She said she worked purely in the NHS for many years, but “found burnout very quickly” so now does a mix of NHS and private dentistry, after training in orthodontic and aesthetic dentistry.
“The amount of patients you’ve got to see in the time you’re given within the NHS, it’s an impossible workload to sustain.”
She explained dental practices were privately owned, rather than being solely funded by the NHS, and relied on private income.
The most recent contract meant they were paid per NHS patient, regardless of how much work each patient required.
“A lot of people are making a loss on their NHS work currently – if that changes and the losses become worse, you’re looking at a mass exodus from the NHS, so more funding and better staffing levels are needed.”
