Agenda item

To consider an update on NHS primary care dental services and dental access recovery developments.

Further to a presentation given to the Committee in March 2023, Members received an update on NHS primary care dental services and dental access recovery developments. The North East and North Cumbria Integrated Care Board (NENC ICB) Director of Place Based Delivery provided information on:

Ø  Summary Overview of NHS Dentistry

Ø  Context

Ø  Commissioned Capacity

Ø  Other Primary and Community Dental Services

Ø  Urgent Dental Care Services

Ø  Challenges to Access

Ø  Our Approach to Tackling These Challenges – Three Phases

Ø  Immediate Actions Undertaken

Ø  Dental Access Recommissioning (UDAs)

Ø  Further Action and Next Steps

Ø  Advice for Patients with an Urgent Dental Treatment Need

NHS England delegated responsibility to the North East and North Cumbria Integrated Care Board (NENC ICB) for commissioning dental services from 1 April 2023 (with professionals who had previously led on this transferring to the ICB). Whilst private dental services were not commissioned, regulations did not prohibit the provision of private dentistry by NHS dental practices. From a purely NHS perspective, although patients could contact any practice to access care, the issue remained that not all practices could meet demand, and the backlog of treatment needs (involving increased complexity) arising as a result of the COVID-19 pandemic remained high.

It was emphasised that whilst the relevant NHS webpage may indicate a practice was not taking on new patients for NHS treatment, individuals were encouraged to contact a practice to confirm this was the latest position as the website was not always up-to-date and availability was often changing. Given the existing pressures, practices were being encouraged to prioritise patients for treatment based on clinical need and urgency, therefore appointments for some routine treatments (such as dental check-ups) may still be delayed. That said, if teeth and gums were healthy, a check-up or scale and polish may not be needed every six months.

Regarding NHS dental contracts, commissioned capacity for 2023-2024 was just under 1.3 million units of dental activity (UDAs) across the Tees Valley – this should be sufficient if it could be accessed. In addition to routine general dental practice, other commissioned provision included urgent dental care services (in-hours and out-of-hours appointments via NHS 111), community dental services (CDS – for vulnerable patients with additional needs that cannot be met within high street practices), advanced mandatory (minor oral surgery services), and domiciliary care, sedation and orthodontic services.

Access challenges were outlined, including the pandemic legacy and ensuing backlog, recruitment and retention of dentists remaining an issue (particularly for NHS provision) which inhibits a practice’s ability to deliver full commissioned capacity, and the ongoing need for national contract reform (the NENC ICB cannot control this but would welcome change). A significant factor (replicated across the UK) was the handing back of contracts, a number of which had been returned since the ICB took over commissioning responsibilities from April 2023 – this had created difficulties in accessing NHS dentists across many areas of the North East (including, from a Tees Valley perspective, Darlington).

Three distinct streams were being pursued to tackle these challenges – immediate actions to stabilise services, a more strategic approach to workforce and service delivery, and developing a strategy (linked to the previous water fluoridation item) to improve oral health and reduce the pressure on dentistry. A number of immediate actions undertaken were noted (though were restricted by the number of dentists available), including the recommissioning of UDAs resulting in a significant uplift in non-recurrent capacity across the ICB footprint.

Further proposed actions and steps to continue addressing existing NHS dentistry issues were referenced, a key part of which was anticipated work alongside Healthwatch to update patient and stakeholder communications – this was reflected within the final presentation slide which provided advice for patients with an urgent dental treatment need. It was acknowledged that the current situation was not ideal, but the ICB was trying to do the best with the resources available, and within the confines of overarching national challenges linked to this sector.

The Committee expressed frustration that concerns over the state of NHS dentistry had been flagged for some time now, yet effective action from those in authority continued to be slow. In contrast to the apparent decline of NHS provision, private dentistry appeared to be flourishing, and it seemed clear that payments for NHS work (UDAs) was insufficient to cover costs. Previous discussions on the reasons for challenges in finding / accessing NHS services had indicated that contracts were being handed back by dentists because of frustrations over personal development opportunities (not, as was often thought, for financial motives). Officers agreed that there was a need to sell the broader offer for individual dentists as part of recruitment and retention efforts – as was the case with GPs, a system-wide approach to make the region more attractive for prospective professionals was required (this was not purely an NHS issue).

Discussion continued around the provision of an appropriate workforce within dentistry, with Members being informed of recruitment / employment offers which combined working in practices with career development (this had been done in other parts of the UK). It was felt that helping dentists acquire specialist skills could aid in efforts to keep them within the NHS, and that once someone moved to private provision, it was rare that they returned. Similarly, career development of dental nurses was being explored in order to keep them in the NHS system.

Referencing the use of the NHS 111 service following a recent poor dental care experience (which worked well but led to the need to travel further for treatment), officers were asked to clarify how a UDA was defined. Members heard that this was a payment measure which involved different treatment bands (e.g. a check-up was one UDA for all practices; a filling (requiring more time) would be classed as three UDAs). Essentially, the more complex the treatment, the more payment units received.

With regards the commissioned NHS capacity for 2023-2024, the Committee raised the point that this would provide approximately two UDAs per head of the Tees Valley population – the equivalent of only two check-ups. Observing that only around half the population access dentists, officers acknowledged that there was a need for greater capacity given the existing issues previously highlighted and that it would take some time before demand for services returned to what could be deemed ‘normal’. Members added that it would be helpful if the status of practices on the NHS website was updated more regularly (the lack of a distinction between those taking on routine and / or urgent care was also noted).

Returning to recruitment and retention matters, the Committee wondered if an increasing number of professionals were sharing the perception that it was no longer financially viable to work in the NHS system. Officers recognised that practices were under pressure and that payments for treatment were not keeping up with inflation – indeed, many of those who stayed within the NHS did so by supplementing their incomes with private activity. Work was ongoing around ensuring the sustainability of practices.

AGREED that the NHS dentistry update be noted.