Agenda item

Over recent years there has been a steady fall in the number of patients in Dorset who have been able to access an NHS dentist.  The total number of adults seeing an NHS dentist in Dorset has decreased from 265,915 (42.0% of the population) in June 2021 to 231,948 (36.6% of the population) in June 2022.  This is a drop of 33,967 patients (5.4%) over this period. 

As at July 2023 there are 109 High Street Dental Contracts - these are in practices in Dorset who provide general dental services.  In 2022/23, NHS England (NHSE) commissioned 1,224,386 Units of Dental Activity (UDAs) from providers.  This figure has reduced from the previous year as a result of a number of recurrent and non-recurrent reductions which were made to contracts at the request of providers due largely to the number of vacancies for dentists in practices across the county. 

A key factor affecting access to NHS dentistry is workforce.  The lack of dentists in the area undermines the ability of High Street practices to meet their contracts.

The South West Dental Reform Programme was established in 2020 to improve access to oral health services, develop workforce initiatives to improve recruitment and retention of the dental workforce, and improve the oral health of the population.  The programme is run by NHSE and Health Education England, alongside our strategic Integrated Care Partnerships and Local Authority Public Health leads to bring together the NHSE Dental Commissioning Team and Transformation Team with key stakeholders with responsibility for oral health in the region (Public Health England, Health Education England, Local Dental Committees, the Local Dental Network, and Integrated Care System (ICS) representatives) as well as public and patient voice partners.  The purpose of the programme is to inform a roadmap/plan for the future of NHS dental services and oral health improvement in the South West.

Access to NHS dentistry in Dorset remains challenging.  Dorset ICB is working with local and regional Clinical and professional Dental leads to try and improve the situation for residents; engaging local dental clinicians, their representatives and partners, as well as Healthwatch, as part of the wider South West Dental Reform programme, to offer practical support to enable dental practices to take on more NHS dentistry in the area.

The Deputy Director Strategic Commissioning, NHS Dorset presented a report, a copy of which had been circulated to each Member and a copy of which appears as Appendix 'C' to these Minutes in the Minute Book.

Over recent years there had been a steady fall in the number of patients in Dorset who had been able to access an NHS dentist.  The total number of adults seeing an NHS dentist in Dorset has decreased from 265,915 (42.0% of the population) in June 2021 to 231,948 (36.6% of the population) in June 2022.  This was a drop of 33,967 patients (5.4%) over this period. 

As at July 2023 there were 109 High Street Dental Contracts - these were in practices in Dorset who provided general dental services.  In 2022/23, NHS England (NHSE) commissioned 1,224,386 Units of Dental Activity (UDAs) from providers.  This figure had reduced from the previous year as a result of a number of recurrent and non-recurrent reductions which were made to contracts at the request of providers, due largely to the number of vacancies for dentists in practices across the county. 

A key factor affecting access to NHS dentistry was workforce.  The lack of dentists in the area undermined the ability of High Street practices to meet their contracts.

The South West Dental Reform Programme was established in 2020 to improve access to oral health services, develop workforce initiatives to improve recruitment and retention of the dental workforce, and improve the oral health of the population.  The programme was run by NHSE and Health Education England, alongside the Integrated Care Partnerships and Local Authority Public Health leads to bring together the NHSE Dental Commissioning Team and Transformation Team with key stakeholders with responsibility for oral health in the region (Public Health England, Health Education England, Local Dental Committees, the Local Dental Network, and Integrated Care System (ICS) representatives) as well as public and patient voice partners.  The purpose of the programme was to inform a roadmap/plan for the future of NHS dental services and oral health improvement in the South West.

Access to NHS dentistry in Dorset remained challenging.  Dorset ICB was working with local and regional Clinical and professional Dental leads to try and improve the situation for residents; engaging local dental clinicians, their representatives and partners, as well as Healthwatch, as part of the wider South West Dental Reform programme, to offer practical support to enable dental practices to take on more NHS dentistry in the area.

The Manager of Healthwatch Dorset gave a short presentation which detailed the work they had undertaken regarding the lack of access to NHS dentistry in Dorset.

The Committee discussed the report and comments were made, including:

• In response to a query, the Committee was advised that dentists across Dorset were passionate about providing dental care on the NHS and were very concerned about the challenge in meeting the local populations dentistry needs.  It was also highlighted that the Government was in discussions with dentists about dental reform and the dental contracts which were not currently fit for purpose.
• The Committee was advised that the Government had recently introduced flexible commissioning which was explained to the Committee, including how the funding was provided and the challenges faced in providing a sustainable and targeted model.
• In response to a query regarding how many people locally wanted an NHS dentist and in turn, how many of those were accessing emergency care because of the lack of dental care, the Committee was advised how the data was collected through NHS dentistry and that NHS Dorset was unable to access data about levels of people accessing private dental provision. 
• The Committee was advised of the plan to progress patient participation groups around NHS dentistry to ensure the patients and publics voice was heard.
• In response to a query regarding the underperformance and under investment, the Committee was advised of the ongoing work to redirect the funding including child friendly dental practices, the supervised toothbrushing schemes, stabilisation pathways, creating additional theatre space for children who required anaesthetic and work around inequalities and increasing accessibility for the homeless to access provision.  The Committee was reassured that the Integrated Care Board would ensure all funding was utilised, however it was highlighted that it was early days in taking responsibility for dentistry provision.
• In response to a query regarding partnership working to improve services, the Committee was advised there were two key areas, one focusing on oral health which NHS Dorset was already working on with public health colleagues and the other was how partners could work together to attract more dentists to want to come and work in the BCP area, including the possibility of a Dorset Dentist School and other schemes to attract and retain dentists.
• In response to a query, the Committee was advised of the need to change practices of dentists and patients by increasing the length of time a patient would need between routine check ups, which would free up appointments for those with a more acute need.
• The Committee was advised accessibility was a very complex area of work, but NHS Dorset was trying to work through some of the issues and think about how the provision can work differently and to particularly target population needs in our most deprived or unequal access of care.
• The Committee was advised that investment had been made increasing sessions in the urgent care service and the route to access that was now via the 111 helpline.
• A new model of working was highlighted, which was being trialled in Essex and Suffolk to help increase provision and if successful, then the learning could be applied across the BCP area.
• In response to a query, the Committee was advised of the good community service for dentistry in BCP for people with additional needs.
• There was some further discussion around partnership working to make BCP an attractive offer for NHS dentists although the limitations of the national contract were highlighted, and it was acknowledged that none of the proposed solutions were short term fixes.
• In response to a query about dentists having capacity to take on patients privately but not with the NHS, the Committee was advised of the complexities and were struggling for NHS provision to be financially viable and how a sustainable NHS business model was urgently needed. 
• The Healthwatch Manager concluded by advising that they would feedback any changes to the Committee and if constituents needed any assistance, please direct them to Healthwatch.

RECOMMENDED that the Committee acknowledge the difficulties for dentistry as detailed in the report, in particular; access; returning to full contractual activity following the pandemic and workforce issues.  Also, to acknowledge progress of the Dental Reform Strategy bringing together key stakeholders with responsibility for oral health in the region as well as public and patient voice partners.  This programme is key for the future of NHS dental services and oral health improvement in the South West.

The Committee were also asked to note that improving access to primary care for people in Dorset would benefit from consideration on how the Council working in partnership can market Dorset to healthcare professionals.