Page last updated at 07:03 GMT, Thursday, 13 November 2008

Warning of 'dire' dental service

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New NHS contracts for dentists and orthodontists mean patients lose out, says David Howells

New orthodontic patients in west Wales have no hope of being treated by the NHS for two years despite a 262,000 under spend, a consultant has claimed.

Dr David Howells, who has practices in Llanelli and Carmarthen, has written to managers, calling the situation "dire".

Carmarthenshire Local Health Board returned 262,000 earmarked for dental treatment for the last financial year to the Welsh Assembly Government.

It said it was working with its partners to address capacity issues.

Dr Howells said: "It is no exaggeration to state that recent events have had a catastrophic impact upon an already dire situation."

He said his Carmarthen practice had over 650 patients waiting to be seen.

He said he had exhausted NHS funding to see new patients not already in the system until the new financial year next April.

The only families who can be certain of accessing orthodontic advice and care are those who can afford to make their own provision
Dr David Howells, consultant

Dr Howells said those joining the list now had no prospect of being seen in less than two years.

While waiting on the list, many would reach their 18th birthday and lose eligibility for NHS-funded treatment, he added.

Since the retirement of a full-time consultant based in Haverfordwest with clinics in Carmarthen and Aberystwyth, Dr Howells said no workable attempt had been made to continue that service.

He claimed patients on the hospital orthodontic new patient waiting list in Withybush Hospital, Haverfordwest, were advised in writing that treatment could be available at Prince Phillip Hospital in Llanelli.

Dr Howells said the letter named himself as the consultant who would provide the service, although he was not asked beforehand and did not have spare capacity.

'Time-consuming and expensive'

"Orthodontics is capable of delivering dramatic and lifelong enhancements to dental health, confidence and well-being for our young patients," he said.

"It is however a time-consuming and expensive service to provide."

He said working under the old funding system still used in Scotland and Northern Ireland "market forces were ensuring that NHS orthodontic services in west Wales were growing strongly."

Dr Howells said "regrettably" Wales implemented Personal Dental Services (PDS) contracts first introduced in England.

The LHBs have established a planning group to look at the long-term sustainability of the hospital orthodontic service in west Wales
Carmarthenshire, Ceredigion and Pembrokshire Local Health Boards

Instead of being paid for each NHS treatment they carry out, dentists are given a guaranteed income based on their historical income.

"Waiting lists are huge and growing and the only families who can be certain of accessing orthodontic advice and care are those who can afford to make their own provision," said Dr Howells.

Carmarthenshire LHB said it had made every effort to ensure the dental allocation was fully spent in 2007/08.

However, despite actively monitoring the dental contact, 262,000 was returned to the assembly government.

It said it had now asked ministers to consider giving back that money.

In a joint statement the Carmarthenshire, Ceredigion and Pembrokshire LHBs said they were working with the NHS trusts to address "on-going capacity issues."

"Following completion of the orthodontic review which was undertaken last year, the LHBs have established a planning group to look at the long term sustainability of the hospital orthodontic service in west Wales," it said.

"Whilst the LHBs request waiting list information from orthodontic practices on a regular basis, the numbers supplied include those currently awaiting an assessment and it is unclear at this point how many of these would go on to receive NHS orthodontistry treatment within primary care.

"The LHBs have been reviewing lists to determine the appropriateness of referrals but rely heavily on information supplied from their orthodontic practitioners in order to achieve as accurate a position as possible."

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