An NHS dentist has spoken of how new contracts are driving NHS dentists out of the service and into private practice.

NHS dentistry in Wales is said to be " hanging by a thread " as record levels of dentists quit NHS work, leaving many struggling to access care.

In 2021, six per cent of Welsh NHS dental posts were lost, with 83 fewer dentists working across health boards than the year before.

The new contracts are said to focus on 'risk' assessment rather than regular six-month check-ups, which is said by some to be forcing dentists to choose between their old and new patients. Since the pandemic, dentists are also being paid based on work they carried out two years ago, rather than the work being carried out on the ground today. You can read more health stories here .

READ MORE: 'I ripped out bits of tooth with pliers' Patients performing their own dentistry as NHS care impossible to find'

The dentist, who is in his 30s, did not want to be named, but has been working for the NHS in south Wales since 2017.

He attributes the mass exodus of NHS dentists to a pilot new contract first introduced in Wales back in 2015 - a contract which was later "forced" into action during the pandemic.

He said: "The new contract focused on preventative care for patients, and would get dentists to focus their time on the patients who had worse oral health. This didn't really have much success as they couldn't work out how to remunerate the dentist. The new contract involved spending much more time with patients encouraging them to improve their oral health and much less time doing the treatment that they were paid to do.

"When the pandemic hit, the decision was made to pay dentists a flat rate based on their workload prior to the pandemic. If you did 600 UDAs [Units of Dental Activity] a month before the pandemic then you would be paid for the equivalent of 600 UDAs a month."

Subscribe to the WalesOnline newsletter today

You can now get all of the need-to-know news sent straight to your inbox by signing up for our free WalesOnline newsletter.

It takes just seconds to subscribe - simply click here, enter your email address and follow the instructions.

For NHS dentists, this means getting paid based on work you carried out two years ago - rather than work carried out on the ground today: "[During the pandemic], someone got the smart idea to force through the pilot contract. Since then dentistry in south Wales has hit a stalemate. Currently, dentists are still paid based on previous levels, even though the work we are doing now is incomparable.

"This has left me having to seriously consider looking for private jobs. At least then I can have some security and control over my future, instead of leaving it to the whims of people who have never experienced working as an NHS dentist.

He added: "Pretty much every dentist I have spoken to either feels this way or is old enough that they don't really care and will just ride the wave and retire early if they have to."

The UDA system was technically abolished last year, but critics have said that it has already driven NHS dentists away from the service.

UDAs

The UDA system counts how many courses of treatment each practice performs, such as check-ups or fillings. Dental practices set targets of UDAs to achieve, but dentists can be forced to pay back money to the practice or health board if they fall short of the target.

The dentist said: "On the previous dental contract (since 2006), dentists worked on the pseudo-commission system of UDAs. There were three tiers of treatment which were worth different UDA values and different patient costs."

Failing to fulfil a certain level of UDAs could result in dentists having to pay the practice or health board out of their own wages, he said.

"On the previous contract, the health board would allocate a certain amount of UDAs to a practice and a dentist would be assigned to perform a certain number of UDAS annually. Failure to hit this target would result in the dentist having to pay back the practice and health board money for the unperformed work."

Patients seem to be following their long-term dentists into the private sector.

The dentist said: "Under the new contract our patient reviews are based on risk, not regular six monthly check-ups. This means that a lot of dentists who are older than myself and have built up a list of patients they know well and have looked after for a decade or more are now having to tell them they can't be seen as instead they need to see patients they have never seen before.

"While there is a need to get new patients seen, it would be much better to incentivise dentists to take on new patients. The new system is causing dentists to pick between their old patients and new, unknown patients, and unsurprisingly they are picking the people who have been in their care for years. This older cohort of dentists has also built up relationships with patients that are strong enough that many will follow them into private dental care."

Missed appointments can also cause big problems for dentists.

The dentist said: "There is a very poor precedent set for taking on new patients that a large number simply fail to come back and miss appointments. In my first job, I started a new patient book from scratch and most days I would spend at least one or two hours sitting around due to patients not showing up.

"The new contract has flipped the deck and the focus is all about risk and access, so dentists are being pushed to see the patients they have looked after less and less in exchange for new patients. This is causing a lot of tension among dentists at the moment as due to the pandemic we still have lots of patients who have not been seen for almost two years now.

"We have gone from there being no reason to take on new patients, to it being forced. I can't help but feel like it's ridiculous that nobody thought it may be worth incentivising dentists to see new patients. Instead they are forcing them to do something they don't particularly want to do, then act surprised when they look to go private."

In terms of support, the dentist said he didn't feel "even slightly" supported by the general public or the health board.

He said: "The general public think dentists are greedy and think all the decisions we make are just financial. The BDA (British Dental Association) seem to think all these changes are great and are more interested in supporting the political narrative than supporting the dentists on the ground. I genuinely don't know a single dentist who thinks the way we are currently having to work is a step in the right direction.

"The health boards are only interested in costs and funding. Myself and many other dentists see their current behaviour as a way to slowly push dentists to go private. If they slowly make the NHS more miserable to work within, dentists are going to flock to the private sector. Then they can turn around and blame us for not wanting to help people and work for the NHS while also saving money on funding.

The Welsh Government previously told WalesOnline: "We are committed to meeting the needs of NHS dentistry patients in Wales through preventive care and increased access, supported by contract reform. While the pandemic has paused some of this work, we will continue to support practices during the recovery period as focus is placed on increasing access to those most at risk.

"As Covid-19 is still in circulation, public health measures such as physical distancing, enhanced PPE, and infection control requirements, mean fewer patients can be seen in person and practices have been asked to treat people according to need. We are providing health boards with £3m in 2021-22 to boost access to NHS dental services, and £2m recurrently from 2022-23 to support increased provision."

To get the latest email updates from WalesOnline click here.