Welsh Dental Committee newsletter: April 2026

Community by Design is a strategic service planning approach developed through the Strategic Programme for Primary Care in Wales, led by NHS Wales and Welsh Government. Its purpose is to redesign health and care services so that care is delivered as close to people’s homes as possible, with hospitals used only when clinically necessary. At its core, Community by Design starts from the assumption that:

If care can safely and effectively be provided in the community, it should be.

The approach is being applied to specific clinical and service pathways, including: 

• diagnostics delivered closer to home 
• community-based clinical interventions 
• medicines management and shared care 
• advice and shared decision making tools in the community 
• rethinking routine monitoring and reviews 
• better risk management to support community care
• digital enablers such as shared records

A response to national priorities

Community by Design was developed in response to several national priorities in Wales:

• A Healthier Wales: shifting the system towards prevention, early intervention and wellbeing 
• rising demand and complexity in secondary care
• health inequalities between communities 
• workforce pressures and the need for better multidisciplinary working 
• Net Zero Wales, by reducing unnecessary hospital travel and carbon‑intensive care pathways 
• the approach aligns closely with the Primary Care Model for Wales (PCMW) and cluster‑based working. 

Community by Design will not redesign dental services directly, but will reshape the environment in which NHS dentistry operates.

In Wales, several of the specialties are represented by Strategic Advisory Forums (SAFs) which were established under the WDC in 2011, following an NHS England review of specialist services and at the request of the then Chief Dental Officer, David Thomas. These forums have never held statutory status or formal governmental responsibility. At the request of the Dental Strategic Oversight Group, WDC was tasked with establishing the ongoing role and governance of the forums.

WDC members expressed that the SAF continues to provide significant value and that its work should be supported and developed.

The original intent of the SAF was as a short‑term mechanism to support the development of Managed Clinical Networks (MCNs) and to provide advice on specialist services. Regional MCNs are now well-established for most specialties, and feed into national SAF. The dual structure of MCN and SAF creates complexity in governance, as responsibilities are split between regional and national bodies.

Several options were considered for ongoing governance and leadership, each of which has implications for accountability, resource allocation, and stakeholder engagement.

Members agreed that WDC is no longer the most appropriate route for the SAF to advise or provide feedback to Welsh Government, and that this has not been the practical function of the group for some time. Following discussion, a consensus was reached on an alternative approach. The term "Strategic Advisory Forum" is no longer considered suitable, as it reflects the circumstances of its inception rather than its current purpose. 

Going forward, the work previously undertaken by the SAF will be aligned to the ongoing Wales system reform programme and be assumed into a workstream, providing a direct and formal route for the group to feed into Welsh Government.

The Managed Clinical Networks will continue to function under the Health Boards, ensuring local delivery of specialist services based on population need.

Further details on the newly emerging workstreams will be communicated by the reform programme team in due course.

At our March 2026 WDC meeting, Akhila Muthukrishnan, Consultant in Special Care Dentistry provided an update covering areas such as:

• workforce
• training
• wellbeing
• waiting times
• referral pathways
• MDT preventive oral health care
• safeguarding
• accessibility
• IT transformation

Roles for developing services for special care patients were identified for various organisations and stakeholders:

• education and workforce: WG, PHW, HEIW, GDC
• teaching and training: WG, HEIW, SCD 
• career progression: CDS
• GA waiting times: scrutiny and reporting for WG, HB, SCD
• referral pathways: HB, SCD, acceptance and discharge criteria
• physical access: estate, planning for WG, PHW, HB, SCD
• transport: WG, Local government, HB, SCD
• access to urgent care: WG, SCD, HB
• digital access: WG, SCD, HB
• communications: SCD, HB

Akhila Muthukrishnan highlighted examples of good practice: 

• workforce: Nurse-led clinics in Swansea Bay and North Wales CDS 
• workforce: Special Care Dental Nurses and Dental Therapists in Swansea Bay 
• referral pathways: South East Wales & Swansea Bay for GDS domiciliary, GDS sedation 
• MDT Prevention: Swansea Bay, South East Wales: Mouth Care in Hospitals for nursing care 
• MDT Prevention: South East Wales, South West Wales for Haemophilia, Dysphagia, MRONJ clinics 
• safeguarding: Training and development of "Was not Brought" pathways 
• access: Virtual clinics, Easy read leaflets 
• IT Transformation: Swansea Bay Consultant Connect

NHS Wales Dental Epidemiological Programme’s inspection of school year one (5-year-old) children undertaken across Wales in 2024 to 2025 has recently been published and is available at Public Health Wales.

Overall, there was a statistically significant reduction in the prevalence and severity of dental caries across from 2022 to 2023 to 2024 to 2025.

Oral health inequalities remain (for example, those from poorer backgrounds experience more disease).

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has recently published new editions of two of its resources. 

The updated SDCEP Antibiotic Prophylaxis Against Infective Endocarditis implementation advice supports dental teams to identify and manage the dental care of patients at increased risk of infective endocarditis, with a focus on shared decision-making. The implementation advice is presented within a dedicated website, with supporting tools also provided, and is endorsed by several UK cardiac societies.

The updated SDCEP Management of Acute Dental Problems guidance provides decision support to identify any immediate advice or attention to give a patient presenting with an acute dental problem, and to determine the appropriate provider of subsequent care. The guidance is intended for use by a range of healthcare staff such as general medical practice, emergency department and pharmacy staff, as well as members of the dental team. The updated guidance is available via a dedicated website.

Both resources are acknowledged by the National Institute for Health and Care Excellence (NICE) and the 4 UK Chief Dental Officers as having UK-wide relevance. The dental faculties of the UK Royal Surgical Colleges also endorse these resources as providing reliable, high quality professional advice.

If you have any queries or thoughts about the work of the Welsh Dental Committee, please contact:

• Chair, Adam Porter: adam.porter2@wales.nhs.uk
• Vice Chair, Jonathan Carter: chairgwentldc@gmail.com
• Secretary, Rebecca Evans: rebecca.evans034@gov.wales