Agenda item

To receive information from NHS England on the availability of dentistry services in North Tyneside.

Pauline Fletcher, Senior Primary Care Manager, NHS England, and Simon Taylor, Local Dental Network Chair for the Northumberland and Tyne and Wear, attended the meeting to provide a presentation on Provision of NHS General Dental Services in North Tyneside.

The presentation set out background information on the commissioning of NHS dental services which is activity and demand led.  It was noted that pre-Covid, in 2019-20, around 91% of the total commissioned capacity in North Tyneside was utilised, demonstrating that at that time practices were meeting the expressed demand of the local population.  The COVID-19 pandemic, and the requirement to follow strict infection prevention control guidance, has seen a significant impact on access to dental care over the last 2 years, with demand for dental care remaining high across all NHS dental practices.

The presentation set out the current pressures and challenges for the commissioning of dental services.  These include the impact of COVID-19,  NHS dental contract and dental system reform, and workforce recruitment and retention.

It was noted that Covid had caused a large backlog of unmet need and patients requiring more complex and lengthier treatment.  This has made it more difficult for patients with low priority to get an appointment, such as those seeking check up appointments.  In addition, there were issues in relation to dental professionals choosing to retire early, move to private practice, or move away from dentistry all together. There have also been overseas recruitment difficulties and constraints in attracting trainees to rural and other areas that may have a greater need, and this was impacting on the ability to deliver commissioned levels of service or additional access for patients.

It was noted that a package of initial reforms to the NHS dental contract had been published by NHS England in July 2022.  These included:

-        Prioritising care for patients with high needs by increasing the remuneration practices receive for more complex treatments.

-        National minimum UDA value - £23 from 1 October 2022 (although rates in North Tyneside are above this).

-        Greater flexibility in how dental funding can be used by enabling practices who can deliver more to do so and to release funding locked into practices who are unable to deliver the commissioned activity so that it can be moved to those who can deliver.

-        Personalisation of recall intervals - move away from the default position of patients attending every 6 months to intervals that are clinically appropriate based on the oral health of the patient – create capacity for practices to take on new care.

-        Making it easier for practices to introduce skill mix - utilising the skills of the wider dental care professionals (dental therapists and hygienists) to work within their full scope of practise thereby freeing up dentist time to focus on more complex treatments.

-        Improving information for patients - requirement for dentists to update the NHS.

The Sub-committee was advised that all dental practices are able to safely provide a full range of treatments, however demand for care remains extremely high, with dental practices having to balance addressing the backlog of care with managing new patient demand.  Practices are being incentivised to prioritise patients with the greatest clinical need, ie those requiring urgent dental care and delayed treatments including patients not known to the practice, as well as vulnerable/high risk groups such as children.  Opportunities are being explored to increase the clinical capacity available and improve access for patients.

Members asked about the national minimum UDA value and why North Tyneside was above this level.  It was noted that this was due to legacy arrangements and variations across contracts and this will be addressed through procurement going forward.  The average UDA rate in North Tyneside was currently £27.

Members asked about any backlog prior to Covid.  It was noted that pre-covid there were some waiting lists but the current backlog is a result of Covid and the need for additional treatment per patient which has lead to non-priority patients having to wait.

There was some discussion about Foundation Dentists and the way that Health Education England appoints Foundation Trainers to mentor newly qualified dentists.  It was noted that many Foundations Trainers are currently in more affluent areas and these areas attract more trainees but there is a need for more trainers in areas with higher need.

Members asked whether there had been a reduction in dentists in training.  It was noted that access problems are not related to the number of dentists training and more dentists are currently on the register than in the past.  However, there has been a change in the way dentists want to work, with a shift in expectations around work life balance, more dentists working part time and a shift towards private dentistry.

An issue was raised about difficulties for residents in knowing where to go for dental treatment, especially as the dental hospital walk in service is not available.  It was noted that more information was needed to assist people in accessing services and for organisations such as 111 to play a greater role in signposting people to services.

The Chair thanked the officers from NHS England for the informative presentation.