Examination of Witnesses (Questions 20
- 39)
TUESDAY 13 DECEMBER 2005
MR STUART
GEDDES AND
DR M C WILLS-WOOD
Q20 Mr Crabb: In your memorandum
you compare the ratio of Welsh dentists to Scottish dentists;
has Wales always fared worse in this regard or is that a recent
phenomenon?
Mr Geddes: Yes, is the short answer
to that. We have always had a larger number of patients per dentist
in Wales than any other part of the UK—Northern Ireland
in particular fare best.
Q21 Mr Crabb: If Scotland considers
that its own shortfall is about 215 dentists, have you come up
with a shortfall figure for Wales?
Mr Geddes: The workforce plan
that was published as part of Routes to Reform suggested
that we need another 45 dentists in Wales, but then of course
Scotland moved the goalposts again. We have not done any further
work on that.
Q22 Mr Crabb: Do you think there
is an optimum number of dentists per 10,000 people that decision-makers
should be working towards as a target? I think we have heard the
figure of five dentists per 10,000 people mentioned.
Mr Geddes: That would give a list
size of one to 2,000 which is actually slightly more than the
current average Welsh list size which is about 1,700, so we would
probably need a few more than that.
Q23 Mr Crabb: Do you think that is
a helpful way of looking at the problem, working towards that
kind of target level?
Mr Geddes: Yes.
Q24 Mr Crabb: So in a place like
Pembrokeshire where there are 2.4 dentists with 10,000 people
you have a long way to go.
Mr Geddes: You have indeed.
Q25 Hywel Williams: I just wondered
if you could explain why it is historically the case that the
ratios in Wales have been higher. It is an accepted fact, but
why is that the case? Is it to do with the rurality, is it to
do with poverty, is it to do with distribution of the dental schools,
or what is the cause?
Mr Geddes: The first dental school
was established in Wales or its first graduates came out in 1964.
Historically, the source for dentists in Wales tended to be the
London schools, presumably because it was an easy train journey
home, and Liverpool of course serving North Wales. We had some
very interesting data a few years ago when we looked at the distribution
of dentists after graduating, and it is quite interesting that
40% to 50% of them stay within 35 to 40 miles of their dental
schools. So if you look at the figures for Wales and go back to
1964, you will find that there were about 400 dentists and we
now have over 900, and it is mainly because the dental school
has been producing dentists and they have stayed mainly, I suppose,
in the south of the country because again, historically, Liverpool
has provided a lot of the dentists for North Wales and actually
Birmingham for North Wales as well.
Q26 David Davies: You have rather
thwarted my question actually, because I was about to suggest
that maybe it does not actually matter where you have the dental
schools because the graduating dentists will go where the employment
opportunities are, but what you are saying suggests that that
is not a correct assumption.
Mr Geddes: The employment opportunities
are where the population is and if you look at the demography
of Wales it is along the two bands, north and south, and in the
middle I am afraid we have a shortage of patients really.
Q27 Mr Crabb: It is my understanding
that rural parts of Wales do not have much problem in attracting
GPs so why is there such an issue in terms of encouraging dentists
to come and practise in places like Pembrokeshire and Ceredigion?
Dr Wills-Wood: The problem is
that the viability of a practice in rural Wales is very difficult.
Stuart alluded to the fact that we have a certain list size; in
rural Wales it is very difficult to have NHS lists of that size
to maintain practice viability. The way medical practice is funded
is completely different to dental practice and the start-up or
capital costs of an NHS dental practice come from the dentist,
there is no assistance from the Welsh Assembly, there is no assistance
from the local health board and when you are sitting down putting
your business plan together to set up the practice, those are
the key things that you are looking at. There are other issues
as well with rural areas, you need to attract good staff into
the practice and of course you have a smaller potential workforce
to use. There are transport difficulties as well, occasionally,
and patients find it difficult to get to centres where there are
dental surgeries so there can be a high percentage of failed appointments
because of those difficulties. Also, the training opportunities
for dentists in those area tend to be at a distance from postgraduate
centres and the training opportunities are less, although I have
to say in Wales we do have a very good network of postgraduate
training facilities.
Q28 Mr Crabb: To summarise, are you
suggesting that the economics of NHS dentistry in rural Wales
just do not work?
Dr Wills-Wood: Yes.
Q29 Chairman: For the record, could
you tell us where the situation is worst in Wales? Is it the case
that it is in rural areas and valley areas?
Dr Wills-Wood: I would say that
looking at the practices that have closed along the M4 corridor,
they have gone from the valleys and gone more towards the M4 itself,
so they are moving out of the valleys and staying in the conurbations
along the M4. In West Wales, for example, we have no real new
practices there and in the mid part of Wales there are no practices
there either.
Q30 Nia Griffith: If we are talking
about dental schools, can you explain a little bit of what the
responsibilities are of the Department of Health in respect of
the Cardiff Dental School?
Mr Geddes: I am not sure that
they have any. The Cardiff Dental School is now part of Cardiff
University, so I would assume that Cardiff University is funded
in much the same way as any UK university is, through that
university mechanism. The Cardiff Dental School, like any other
dental school or medical school, of course will provide an element
of NHS care and the NHS will provide some funding to the dental
and medical schools in Cardiff. I am afraid I cannot be any more
specific than that because I do not know.
Dr Wills-Wood: Interestingly,
the one point you are raising about funding is we understand in
England that in respect of the conversion of a hygienist to a
therapist, the courses there are funded by the Department of Health;
in Wales we understand there is no funding for the conversion
courses for hygienists to therapists and the costs of the course
are £6,000, which is a lot of money for youngsters to find
to convert across.
Q31 Nia Griffith: You see that as
an incentive, if it could be provided it could actually help to
fill a partial gap.
Dr Wills-Wood: Yes.
Q32 Nia Griffith: Although presumably
there is a limit to what therapists can actually undertake.
Dr Wills-Wood: Therapists are
a very important part of the future. Stuart was alluding earlier
to the fact that they can do quite a significant amount of work
in practice, but the important point of a good therapist in a
practice is that while that therapist is doing perhaps the routine
dentistry, it would free me up as a principal dentist to do the
urgent work and the emergency work, so there is the other side
to look at where the therapist is concerned as well.
Q33 Nia Griffith: That is very useful.
You mentioned in your document that the intake is about 64 currently
a year in Cardiff Dental School, but you are suggesting that it
needs to be at least 74, is that the case?
Mr Geddes: That is the planned
expansion, that is what is being planned for.
Q34 Nia Griffith: As you say, research
has shown that students tend to stay in the area they have trained
in or their home town, so what would you see as the long term
solution, an increase in the number of students in Cardiff or
a second dental school somewhere else in Wales?
Dr Wills-Wood: I would not go
for a second dental school, what I would look for is something
like an outreach centre, perhaps in West Wales or in North Wales,
so that the undergraduates are exposed to different parts of Wales,
so they can go and see what it is like to work in different parts
of the community. At the same time it brings another element of
NHS dentistry to these areas as well.
Q35 Nia Griffith: You would see them
still under the auspices of Cardiff University rather than seeing
them set up, say, in Bangor or Swansea or whatever.
Dr Wills-Wood: Yes.
Q36 Nia Griffith: Because you would
be duplicating costs presumably if you did that.
Dr Wills-Wood: Administratively
it would be more sensible to do that, but also for example Swansea
has a medical school and that seems to be working well, so a parallel
dental course for instance.
Q37 Nia Griffith: You are suggesting
that we should keep it in Cardiff rather than have a second dental
school.
Dr Wills-Wood: Yes, one dental
school for Wales.
Q38 Nia Griffith: Basically you are
saying then that the funding would have to come from the university.
Dr Wills-Wood: As we understand
it, with the merger now the dental school is part of Cardiff University
and funding would come through the universities, how they are
funded across Britain.
Q39 Nia Griffith: Presumably we could
look at another source in terms of funding that independently.
Dr Wills-Wood: I am sure the dentists
would be only too happy to look for more sources of income.
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