Darrell Jackson, Senior Commissioning Manager, NHS England

Kate Taylor-Weetman Consultant in Dental Public Health, NHS England

The Board received the report of the Senior Commissioning Manager, NHS England - Midlands and the Consultant in Dental Public Health, NHS England – Midlands – copy attached to the signed Minutes – which provided an overview and scope of existing NHS Primary Care dental services in Shropshire.

The Senior Commissioning Manager and the Consultant in Dental Public Health introduced and amplified the report.  The Senior Commissioning Manager highlighted the challenges due to covid and what had been done to mitigate this and to get better access for patients.  The report set out the dental services that were available in Shropshire both primary care and secondary care provision and also set out examples of treatment for each treatment band and how many UDA’s (Unit of Dental Activity) that equated to, with a full-time experienced dentist expected to deliver around 7,000 per annum.

The Senior Commissioning Manager explained that during Covid there was a period where all dentistry was suspended due to infection control issues and social distancing, which led to the set up of urgent Dental Centres so that strategically urgent dental treatment could be delivered for patients.  He went on to explain how incrementally they had increased the delivery that dental practices should be providing (20% from 8 June 2020 to 31 December 2020 back up to 100% on 1 July 2022).  This had however led to a backlog which was why patients were now struggling to get access to a dental practice.

Prior to the pandemic, approximately 55.7% of the population of Shropshire, Telford & Wrekin accessed NHS dentistry and although now on the increase, had fallen to 48.3%.  The report set out how services were getting back into recovery and highlighted several initiatives that had been implemented to help restore dental access to pre-pandemic levels and the Senior Commissioning Manager drew attention, in particular, to the dental advice line and the new NHS practice in Oswestry.  Finally, he highlighted the current challenges which were around the workforce and in particular recruitment and retention.

The Consultant in Dental Public Health reported that although the population of Shropshire in general had good oral health, this was not the case in the more deprived communities and the Oral Health Network were focussing interventions on those communities to reduce inequalities.

A brief discussion ensued and the Senior Commissioning Manager and the Consultant in Dental Public Health answered a number of queries from members of the Board.  Lynn Cawley, Healthwatch Shropshire informed the Board that she had shared the Healthwatch report published in September 2021 with the Senior Commissioning Manager which had identified the limits of access to NHS Dentistry, particularly in Oswestry and Market Drayton and that Healthwatch had been pleased to assist in the re-procurement of the new practice in Oswestry. She highlighted issues around the accuracy of the NHS England website. 

The Senior Commissioning Manager shared the frustrations around the ‘Find a Dentist’ service on the NHS Website especially as services started to struggle to deliver services due to covid and were unable to accept new patients, however, this was slowly starting to open up again and the dental advice line were in constant contact with local practices and when they had the ability to take new patients they were letting the advice line know who in turn could signpost patients to the local practices.

The Assistant Director – Integration & Healthy People highlighted the work around young children and work within communities to ensure people had access to toothbrushes and toothpaste in order to develop really positive habits from an early age because one of the leading reasons why children were not in school and were in hospital was due to dental decay.  She also drew attention to the work of the RESET team working within the Ark focussing on the homeless and those with substance misuse issues and felt that there was an opportunity to join up this work.  In response, the Consultant in Dental Public Health reported that the local authority had been allocated £40,000 from NHS England to purchase toothbrushes and toothpaste which would be freely available and would be promoted through a range of avenues.

Concern was raised around the difficulty in finding a dentist in rural areas particularly for elderly patients if it involved having to travel to market towns as public transport was very sparse and a query was raised as to whether they could be co-located in GP surgeries.  In response, it was explained that there was a difference in the way in which rent was reimbursed for GP and dental practices, which was a barrier for dental practices however they could open a branch site in rural areas.

A brief discussion ensued in relation to support for those on a low income and how to raise awareness of this.  The Senior Commissioning Manager explained that dental practices should know how to direct patients as to whether they were exempt from payment or not and the dental advice line would also know how this worked however, more could be done to promote and support this. In response to support around promoting the dental health line, the Senior Commissioning Manager stated that any assistance would be greatly appreciated.

RESOLVED:

·           To note the contents of the report;

·           To consider how best to use the HWBB and its work around inequalities to look at
 the rurality challenge of dentistry along with how to ensure the commissioning of
 dentistry for the population and how to bring added value; 

·           To consider a more co-ordinated approach to communications in order to promote dentistry, the telephone helpline and other support;

·           To consider the future of NHS dentistry in terms of rurality, recruitment and
 retention and increased access.