Ministers at odds with dentists over ‘biggest reforms in decades’

Wales’ health secretary set out plans for the biggest changes to NHS dentistry services in almost two decades despite still being at loggerheads with the profession.

Jeremy Miles said the Welsh Government will launch a consultation on dentistry reforms, which will mark a significant change to the old 2006 contract, by the end of the month.

In a statement on March 18, Mr Miles told the Senedd the new general dental services contract will be implemented rom April 2026.

Describing the reforms as the biggest in nearly 20 years, the health secretary said the central aim will be to make it easier to access NHS dentistry.

But, in an open letter last month, the British Dental Association (BDA) accused the Welsh Government of “spin, half-truths or doublespeak” on the future of dental services.

‘Contentious’

Mr Miles warned of issues with the current model, which is based on the “treadmill” of units of dental activity, saying substantive contract reform is required.

He said instead of recalling everyone every six months for a routine check-up, the new contract will be based on prevention and needs-based provision of treatment.

Negotiations between ministers, the NHS and the BDA over more than a year to design and develop the new contract ended without full agreement.

Mr Miles told Senedd members: “As is the case in all negotiations, there are aspects that all parties can readily agree on; there are some points that may be more contentious. Not everyone gets everything that they want but it is an improvement for everyone.”

He said key aspects of the reforms include:

• creating a single route of entry for people to access NHS services;
• implementing a ‘fairer, more transparent’ remuneration system;
• disincentivising unnecessary routine examinations;
• adjusting patient charges; and
• making changes to terms and conditions, such as around parental leave.

‘Struggling’

Urging people to have their say as part of the consultation, which he suggested will open next week, Mr Miles said: “It’s one of the biggest changes, probably the biggest change in dentistry within the NHS in coming up to close to a quarter of a century.”

James Evans, the Conservatives’ shadow health secretary, told the Senedd that 189 NHS dentists, or about 13% of the workforce, have left the service in Wales since 2022.

He said the BDA has warned 2025 could see the largest number of contracts handed back in history, with more dentists reducing NHS commitments due to financial pressures.

Mr Evans compared a 6% contract uplift, which the BDA has described as a real-terms cut following the “flawed” negotiations, with an 11% increase for GPs.

“NHS dentistry is in crisis,” he said. “Patients are paying more while receiving less. Dentists are leaving in record numbers and practices are struggling to stay afloat.”

‘Cooking the books’

Mr Miles claimed the reforms have been broadly backed by the profession, with eight in 10 practices taking up the offer of a contract variation since 2022.

He said he was not prepared to wait any longer after talks broke down, taking a unilateral decision earlier this year to implement the 6% increase to contract payments.

Mabon ap Gwynfor raised the BDA’s warning of a dental desert spreading across the country, with a rise in so-called DIY dentistry and an increasingly disaffected workforce.

The Plaid Cymru politician accused the Welsh Government of ploughing ahead on a road to ruin and turning a blind eye to a rapidly unfolding crisis in the sector.

Warning dentists have been kept in the dark since September, Mr ap Gwynfor said: “On the one hand, this government says that it is unlocking hundreds of thousands of extra appointments but the BDA accuses them of cooking the books.”