Memorandum submitted by the British Dental Association (BDA) (CBPS 28)

The British Dental Association (BDA) welcomes the opportunity to present evidence to the Welsh Affairs Committee on the provision of cross border public services. The British Dental Association (BDA) is the professional association for dentists in the UK. It represents over 20,000 dentists working in general practice, in community and hospital settings, in academia and research, and in the armed forces.

The historical situation.

Until the introduction of the new dental contract in April 2006 we were unaware that there were any problems with the cross border provision of dental services. There was a flow of patients from the border counties of Wales into England for specialist services within primary care which included orthodontic treatment - mainly from north Wales to Chester.

Children born with cleft lip and / or palate have historically been treated in Liverpool Alder Hay and in Bristol in collaboration with the Welsh regional centre in Swansea in the south and with outreach clinics in north Wales. We are led to believe that this continues and is satisfactory.

The current situation.

Post April 2006 north Wales has had difficulties with the provision of orthodontic treatment. Historically many referrals were made to specialist practices in and around the Chester area. The Primary Care Trust (PCT) in Cheshire decided to invest in additional orthodontic services as it too had concerns about the current level of provision but in doing so banned the practices from taking on new patients from north Wales (CH6 and above postcodes). This had two effects, firstly it vastly increased waiting lists within north Wales - which had inadequate services anyway and secondly, it destabilised the business plans of the practices that had proposed developing their own services as they relied on patients from north Wales using the new provision.

In terms of general dental practice there appear to have been few problems. What there have been are mainly around the direction by Local Health Boards of patients needing referral for specialist care.

Differences between England and Wales.

The Performers' list regulations are different so if a dentist wishes to come to Wales to work, they will have to submit an application to be placed on the 'all Wales' list. This application will be scrutinised by a committee of the Dental Postgraduate Department, the business service centre in Swansea which handles these applications and the local health board where the applicant wishes to work. It may be approved but subject to conditions. This may deter applications to practice in Wales.

Patient charges for dental treatment are different. In Wales they are lower and have not been increased for a number of years. Prescriptions are not charged in Wales but whereas this benefit is only available to Welsh patients, there is no restriction on patients from England seeking and obtaining dental treatment in Wales.

Dentists in training.

Once graduated dentists will usually go on to do one year of vocational training in a supervised environment within dental practice (VDP). The funding for dental vocational training differs across the border. In Wales it is held centrally by the dental postgraduate department whereas in England it is devolved to the PCTs.

One of the training schemes (the Marches scheme) has historically used training practices in England but the new contract and the way in which vocational training is funded has made this extremely difficult as the PCTs appear unwilling to fund VDPs working in an English practice but undergoing additional training in Wales.

There are some other issues where differences between the two countries contrive to make life difficult for practitioners rather than patients!

For example, we seem to be heading for differing cross infection control regulations. We cannot and should not work with differing standards in each of the home countries.

The Welsh Assembly Government is proposing to register and regulate private dental practitioners. As we have a UK organisation regulating the profession (The General Dental Council) we can see no reason to duplicate.

19 March 2008