'There could be no NHS dentists in two years'

A dentist says he feels "strangled" by NHS contracts and believes NHS dentists may not exist in two years' time.

Dr Harj Singhrao, who has a practice in Newbridge, Caerphilly, said money was allocated on a "one size fits all basis" meaning in high need areas like his, he had to lose money in order to provide good care.

It comes as the British Dental Association (BDA) Cymru published an open letter accusing the Welsh government of "peddling half- truths", adding more practices were looking to hand NHS contracts back.

The Welsh government said: "We are working to ensure the NHS dental contract is fairer for patients and to the dental profession."

Dentists who want to treat NHS patients sign a contract with the Welsh government, which then gives them money per patient under the condition of certain targets, such as seeing a certain number of new patients.

If these targets are not met, dentists may have to pay some money back as a penalty.

Any person seeing an NHS dentist has the same monetary value to the practice if they have a check up or have hours of treatment, according to the BDA.

Dr Singhrao is the principal dentist at Newbridge Dental Care and had to pay £50,000 back to the Welsh government.

He said this was because he took on too many new NHS patients, but had to close a position at his practice as a result.

He said the formula of treating every patient across Wales equally "does not work".

"What we find is people either disappear for years and come back with serious problems or are here all the time, so it's not financially set up to be able to compensate for high need areas," he said.

In real terms, he added, in the hour it takes to do a complex treatment he could do four child check-up appointments.

"So I lose out, not only because I only get paid once, but because I could also treat someone else."

He said most dentists wanted to treat NHS patients but could not afford it, and added he thought many dentists would have to stop treating them.

He said: "We are giving access to patients and we are being punished for it.

"I can [afford to do it] but a lot of dentists can't do that. It's all or nothing.

"As a business you can probably run three years [treating NHS patients]."

However Dr Singhrao added he had "hope" NHS contracts could be renegotiated and penalties softened so dentists could provide good care across the board.

"Ethically there is no way I would give up treating children," he said, adding he wanted high and low need areas taken into account and children to be prioritised in contract negotiations.

Figures show more 10% of dentists have left the profession every year since 2010-11.

Last year was the second highest since 2010.

In the letter addressed to the Health Secretary Jeremy Miles, The British Dental Association Cymru Wales accused the Welsh government of peddling "half-truths" about their messaging and statistics.

It asked for more money for dentists and less admin for them to be able to continue to keep treating NHS patients.

The letter concluded: "The reality is that NHS dental activity has stalled and may be about to fall off the cliff if the issues we and others have raised repeatedly are not addressed very soon."

Dr Russell Gidney is the author of the letter on behalf of the BDA.

He runs a practice in Chepstow, Monmouthshire, and recently handed back his NHS contract.

He said the "headcount figure" was the reason, which led to "a lot of sleepless nights" over families he had treated for 20 years.

"It's very difficult to put yourself in a position where you see a patient and fundamentally you look at them and think it's physically going to cost me money to treat and maintain this person.

"It was not a decision I envisaged [making] even coming out of Covid. I'd always wanted to keep NHS at the practice. That had always been one of my standards."

He said although there were still dentists training and people want to treat NHS patients, it was not desirable.

"There's only so much of that kind of personal cost and pressures [new dentists] will go through to do that.

"Unfortunately, there are other ways that they can work that take the pressure away from them."

He said the BDA wanted to be involved in negotiations and accused the Welsh government of "ceasing" conversations.

"We need open conversations. The budget will not do everything for everyone so we need to be honest about what we can do.

"The system isn't fit for purpose. We need open conversation to address the problems that are there and see what we can do.

"The system is breaking. The system is breaking the dentists."

A spokesman for the Welsh government said: "We have spent 13 months working with the British Dental Association to design the new contract.

"We will be putting the proposals out for consultation soon before any new contract is finalised."

Plaid Cymru representative for north Wales Llŷr Gruffydd MS said: "If contacts don't work for dentists, it doesn't work for patients", and said contracts needed more negotiation.

He said it was particularly a problem for north Wales where only three out of 55 practices he contacted treated NHS patients, one with a three-year waiting list.

He said one constituent tried to removed a tooth themselves and ended up with sepsis.

"These are the real-life consequences of not getting the service they need and this is the real cost of picking up the tab for the NHS," he said.

Welsh Conservative shadow health secretary, James Evans MS said: "Dentistry access is very limited to non-existent in many parts of Wales, particularly for our rural communities. The Welsh Labour government has failed to widen access and reduce waits.

"Perhaps if Labour wasn't more concerned with hiring more politicians as opposed to dentists, then the funding would be available to end this crisis."

Additional reporting by Ffion Lloyd Williams and Stephen Fairclough