Written Statement - The review of Orthodontic provision in Wales and piloting new models of dental care

Orthodontics

In September 2009 I established an expert group, chaired by Professor Stephen Richmond, Professor of Orthodontics at Cardiff University School of Dentistry, to look at the provision of orthodontics in Wales. This was in response to reported difficulties by patients seeking orthodontic treatment in some parts of Wales and also follows a recommendation made by the NHS Dental Contract Task & Finish Review Group who highlighted orthodontics as an area requiring further consideration.

The membership of the orthodontic group included representatives of the dental profession, British Dental Association (Wales), specialist orthodontists, patient groups, Local Health Boards, and other key stakeholders. The aim of the review was to produce recommendations that would improve and enhance the provision and delivery of services.

I have now received the group’s report, which I welcome, and would like to take this opportunity to thank Professor Richmond and the other members of the group who undertook the review. It is a comprehensive and detailed report containing 17 wide-ranging recommendations to improve orthodontic services for consideration by the Assembly Government, Local Health Boards and the dental profession.

The report reaches interesting and challenging conclusions. In such difficult economic times it is encouraging that the group believe current spending on orthodontics in Wales – some £12.7 million annually – is capable of largely meeting the orthodontic needs of Welsh patients. The report also makes clear there is little unnecessary treatment undertaken although there is a need for improved validation and further confirmation regarding the quality of services provided.

What also comes over clearly is that the current system of provision and management of orthodontic services in Wales contains inconsistencies and inefficiencies. In addition access to services is not uniform. The report suggests that these can be addressed, and higher cost-efficiencies achieved, through better procurement, contract/service management and skill mix.

I agree with the report’s recommendation for the need to develop an implementation process to ensure the work of the group is progressed. This is particularly important around the effective and efficient procurement of orthodontic services. The report also suggests the establishment of a strategic advisory forum on orthodontics. I believe the roles of the implementation group and the forum can be combined, initially to support implementation and then moving on to report annually on orthodontic services in Wales. I have asked officials to look at establishing a group, with assistance to be provided by the Welsh Dental Committee and Public Health Wales.

The report deserves the widest possible circulation and consideration, with the dental profession having the opportunity to examine the conclusions and comment on its recommendations. To this end I will ensure that the report is made available to dentists in Wales who provide NHS care, to Local Health Boards and other interested parties including Assembly Members. 

The National Assembly’s Health Wellbeing and Local Government Committee is currently undertaking an inquiry into orthodontic services in Wales which has already taken written evidence and has started receiving oral evidence. The report of the expert orthodontic group will be central in helping inform the Committee’s deliberations, and I intend that in considering the recommendations of the orthodontic report any additional issues identified by the Committee are covered as part of the implementation process.

New models of care

I would also like to take this opportunity to provide an update on work being undertaken to examine possible changes to the dental contract’s current system of Units of Dental Activity. This work stems from the original review of the dental contract and our wish to build in greater equity for patients and contractors while ensuring that improvements are made around quality and prevention.

These are challenging and complex issues and I have agreed with the group examining possible new models that there is a need for piloting and robust evaluation of any proposals.

We have now reached a position where we will start to pilot two new models of care from April 2011. I expect the pilots to run for 2 years.

The first is a Quality and Outcome Utility Pilot to test a new way of working, to address issues of access, quality and prevention. This involves piloting a contract monitoring team, quantifying patients access to NHS dental services using a number of criteria and a formula to adjust the practice contract activity. After a rigorous selection process four practices have been selected to pilot this model. The practices are located in Abergavenny, Cardiff, Dolgellau and Swansea.    

The second pilot is aimed at Preventive Dental Care for Children and Young People and involves changes to how a dentist is paid to treat children. A capitation based payment system will be introduced for 0-18 year olds, underpinned by a registration scheme with a variable additional payment linked and weighted for local deprivation. The aims of this pilot are to give incentive to prevention in care of the primary and mixed dentition, complement our Designed to Smile oral health programme and test the introduction of quality and access indicators. The five practices who are piloting this model are located in Aberdare, Conwy, Cwmbran, Newport and Swansea.