Agenda item

Purpose: To understand how NHS Dentistry services are performing, how they have been affected by the Covid-19 pandemic and how services will be developed in order to respond to patients’ needs.

Hugh O’Keefe gave a presentation on NHS Dentistry Services (Agenda Item 7). The key points from the presentation were as follows:

·         Dental services were running at 65% of capacity due to Covid safety requirements.

·         Patients were prioritised according to need using criteria set at the national level.

·         Capacity allocated to NHS treatment was determined by each practice, resulting in variations in availability of appointments.

·         Action was being taken locally, with additional sessions offered to practices for patients who didn’t visit a dentist on a regular basis.

·         NHS patients were not ‘registered’ with a particular dentist.

·         Around 50% of the population attended an NHS dentist regularly, with the remainder going private or attending when they had a problem.

·         A pilot programme was being run for looked after children.

·         Significant investment was being made in community based referrals for out-of-hospital specialist oral surgery for the period to 31 March 2023.

·         The additional investment was intended to keep the system as open as possible, or at least stabilise waiting times for treatment, but while dentists continued to operate at reduced capacity, there would continue to be a backlog.

·         Feedback from dentists suggested that some patients failed to attend booked appointments, which was causing issues, since dentists had to set aside long time slots to allow for disinfection between patients.

·         There were some challenges with the workforce – the pandemic had resulted in challenging working conditions, and more dentists wanted to work part-time on the NHS – this meant that more dentists were required to keep up with demand.

·         The 65% capacity limit was scheduled to be reviewed in January 2022.

·         There would also be a national review in April 2022 to see what incentives and systems should be incorporated into contracts.

·         It was anticipated that there would be issues with availability of NHS dentistry appointments for some time.

Councillor Tony Linden asked if the dentistry workforce was facing similar issues to GPs with significant numbers due to retire in the near future.  Mr O’Keefe suggested that this was less of an issue with dentists. Contracts for dental services were instigated in 2006, which were accompanied by significant national investment. As a result of this additional capacity, there had been a 30% growth in patients attending the dentist across the Buckinghamshire, Oxfordshire and Berkshire West area. Mr O’Keefe confirmed that the workforce was relatively young and suggested that the issue was more related to the heavier case mix, making it a tougher environment – this was prompting some dentists to move to the private sector. However, this was more of an issue in other areas.

Council Alan Macro noted that a high proportion of children treated in hospital were there for dental problems. He suggested that many of these issues could have been identified earlier by a dentist and asked how this could be addressed. Mr O’Keefe highlighted the strong correlation between socio-economic factors and dental extractions in hospitals for children, with 40% of the community dental extractions in Berkshire coming from four postcodes. He highlighted the ‘starting well’ initiative to promote oral health within local communities. He suggested that prototype contracts had been trialled for about 10 years, which had a greater focus on preventative measures, but there were challenges in terms of striking a balance between access and prevention. He suggested that there would be more opportunity to engage in preventative work once the peak of the pandemic had passed.

The Chairman asked about the role of dental hygienists. Mr O’Keefe noted that those involved in preventative work may not need the same level of qualifications as dentists and so resources could be targeted appropriately.  He highlighted work being done on training pathways (e.g. dental nurses training to become hygienists and eventually dentists). He also highlighted a new course run by Health Education England on oral health promotion, which could be done outside the dental surgery. He noted that community dental services had done much of this work to date and suggested that more needed to be done through high street dentists.

The Committee agreed to suspend standing orders to allow Andrew Sharp to speak on this issue. Andrew Sharp stated that NHS dentistry was the issue that the public most contacted Healthwatch about. He suggested that waiting lists would continue to increase while restrictions remained in force to limit capacity to 65%. He noted that acute hospital services were now working to 110% of capacity to address backlogs, and asked when normal access to dentistry would return. To illustrate the point, he highlighted a recent letter from a patient who was unable to get an appointment until March 2022. He also asked about NHS resources for emergency dental treatment in West Berkshire. Finally, he asked if the integration of NHS dentistry within the ICS would be a positive development. Mr O’Keefe indicated that NHS dentistry would be a high profile issue for the ICS and discussions had already started. He indicated that there would be investment to address the issues mentioned, and highlighted success in community dental and referral services, with good take-up by providers to address waiting lists. He highlighted that if dentists hit the 65% threshold, then they would retain 100% of their funding. This represented additional investment into the system.

Councillor Andy Moore sought confirmation that all dental practices offering NHS treatment also offered private treatment. Mr O’Keefe indicated that some practices were 100% private, while some only offered NHS treatment to children and exempt patients. Even practices that had substantial contracts with the NHS also offered private treatments.

Councillor Moore asked what measures were in place to prevent dentists from offering NHS patients private appointments. Mr O’Keefe stressed that it was important for the patient to make an informed decision, with options clearly explained to them. Instances of patients being pushed towards private treatment when they had a clear preference for NHS treatment would be reviewed and followed up. He explained that practices set aside a particular amount of time for NHS work and if that was full, then patients may be offered private appointments, but they would need to ensure that patients were making informed choices.

The Chairman thanked Mr O’Keefe for attending and for his presentation.