Agenda item

NHS England and NHS Improvement will provide an update on the position of dental services.

Nuala Woodman with support from Alison Lee and Claire Walters of NHS England and NHS Improvement (NHSE/I) provided an update on the position of dental services in Warwickshire. This comprised a written briefing as background and a presentation with high level information. The briefing included the following sections:

• Introduction
• Dental charges
• Impact of the pandemic
• Restoration of services and recovery initiatives
• Vulnerable groups
• Oral health and inequalities
• Children’s access
• Out of hospital provision (including urgent dental care, domiciliary care, dentures, secondary and community care)
• Staffing issues (including collaborative working with local dentists, PPE / Fit testing and Covid & outbreaks in dental settings)
• Opportunities for innovation including digital

The presentation highlighted key areas from the circulated briefing. It also updated with more recent data on general dental activity in the midlands and the local position compared to normal levels of service. Due to the restricted services during the pandemic, a year’s worth of activity had been lost access over the last 20 months.

Questions and comments were submitted, with responses provided as indicated:

• Councillor Roodhouse advised that this item was discussed at HWW board. The British Dental Association (BDA) and others were critical of the unrealistic targets imposed given the challenges around cleaning and changing the air between patients, making those targets unachievable. HWW was receiving a lot of enquiries about access to NHS dentists. It was understood that around one in ten dentists were likely to cease providing NHS services this year. HWW would write formally to the Chair of this Board to set out its concerns and was considering writing to NHSE too. There was a perception that the safety requirements weren’t recognised by central government in setting the service targets.
• The Chair acknowledged the points raised, adding that private patients were still able to receive six-monthly check-ups and routine treatments where NHS patients were not.
• Councillor Matecki asked if the 85% of the normal service level was the optimum, given the cleaning requirements. Moving forwards, he asked if there would be a lessons learnt at some point and whether the aim was to achieve previous service levels fully. Nuala Woodman confirmed that this was the safe minimum level. There were exception arrangements and each practice was considered individually, with monitoring of how they were managing. Support was being provided to practices for example where there had been a Covid outbreak amongst staff. The aim was to return to the full provision by April 2022. However, there were unknowns about the pandemic.
• Nigel Minns asked if the treatment of private patients at the expense of NHS patients was the issue of registration and not having the same obligation as a GP doctor. He asked about the treatment backlog for dentistry and how long the measures proposed would take to address the backlog. Nuala Woodman confirmed there was data for secondary care and further community dental service waiting times. This was not about money, but having staff and available premises. The solutions included longer working hours and weekend appointments. However, the backlog was significant. Reference to missed check-ups which could lead to people presenting with more serious oral issues.
• The points raised on private patients were acknowledged. This was about the national contract. Dentists were required to provide the same level of NHS activity as previously and the payment protection initiative aimed to keep dentists providing NHS services. Reference to the BDA representations and some practices were prioritising private patients, not undertaking NHS work but still being funded for it.
• An outline was given of the investment some practices were making to improve ventilation, the provision of free personal protective equipment to practices, and specialist masks. Warwickshire practices were working well and there was an active local dental committee providing mutual support. She outlined the initiatives being used to address the backlog with additional capacity at some practices being utilised, weekend access and the launch of a community dental service support scheme. NHSE/I welcomed feedback about patient concerns from Healthwatch and others.
• Sarah Raistrick asked about services for very young children and novel ways of accessing dental care, in non-healthcare settings to provide a basic dental check. There had been a slump in attendance by children since early in the pandemic and it had taken a while to educate and encourage them to return. Children were a priority group, but dentistry was a highly regulated service in terms of who could undertake each function.
• Reference to use of technology and digital options. Patients had to be seen face-to face, but treatment patterns had been adjusted to make them as efficient as possible. Locally, there was praise for the urgent care system, put in place in a very timely manner and this had been replicated across the Midlands and possibly beyond.
• The data on the proportion of private and NHS dentists in Warwickshire was reflective of the demography and made it hard to provide NHS services in some rural areas. Rural affluence and poverty were two of the hardest things to address and they were prevalent in the county, with the example of Stratford mentioned. Missed appointments was a further issue.
• The Chair asked whether the crisis in dental services had prompted NHSE/I to consider the reconfiguration of services. It was understood that dental services would transfer to the new ICS and was considered the current situation should be addressed ahead of this handover. On Covid, it was endemic now and there had always been airborne viruses. A need to think how best to address the protection aspects.
• Nuala Woodman spoke of the unsuccessful attempt at dental contract reform which needed to be revisited. The model was not like that for GP services. There was recognition of the crisis, the workforce issues and low morale amongst staff. There were significant recruitment issues in some parts of the midlands, with similar issues to those raised during the earlier provider workforce update. An outline was given of the work underway to transfer dental services to the ICS locally alongside other services and within the national framework. On the pandemic, a comparison was drawn to the adjustments made in response to HIV previously.
• Sarah Raistrick asked if the current resources for dentistry would transfer to the ICB. This was confirmed and work was underway to identify the split of resources. There had been substantial investment locally to address the backlog. An issue was that funding usually transferred to the CCG and dental services were often omitted. An outline was given of the endeavours being made to remedy this and access recovery monies as well as further impacts for dentistry services.
• The Chair thanked the representatives of NHSE/I for their presentation and for answering the Board’s questions.

Resolved

That the Board notes the briefing and presentation from NHS England and NHS Improvement.