Agenda item

Purpose: To receive a presentation on the provisions of dental services in West Berkshire.

Hugh O’Keeffe, Senior Commissioning Manager, Dental NHS England (BOB and Frimley) gave an overview of the report on Dental Services. He advised the report included an overview of the systems and services, primary and secondary dental care, patients’ access to services and information on practices and referrals in West Berkshire. Hugh O’Keeffe explained that it also included information on the impact of Covid which had hit dental services hard and they had been running services at below 100% capacity for about two years. They had only been working at full capacity since July 2022. Hugh O’Keeffe highlighted that the number of patients accessing dental services was improving but it was still below pre-pandemic levels. Practices had called people back in, but it was challenging with those who had not been attending regularly, some of whom used private dental services and others only went to the dentist when necessary. Additional access sessions had been provided. They were also looking to bring down the numbers of long waiters so that no one was waiting for secondary care for more than two years.

Hugh O’Keeffe highlighted that recovery was still at an early stage. Treatment needs were higher due to gaps in treatment and there were workforce issues including morale, recruitment and retention. Across the South East NHS dentists were handing back NHS contracts and going fully private, although this was not a significant issue in the West Berkshire area yet. There were national contract changes as well as a flexing of local contracts to increase capacity. Hugh O’Keefe summarised that the overall picture was very difficult over the last few years but it was improving and they were working on a number of schemes to address it.

David Chapman, System Clinical Lead for Pharmacy, Optometry and Dental Services, added that there was a new way of commissioning for dentistry. It was now the BOB ICB and it was in its first year phase. There were slight difficulties in how quickly things could be changed at the time. They were looking to address health inequalities and highlighted that some of the most deprived areas suffered the most. Some of the schemes might address some aspects of that.

The Chairman noted awareness of difficulties in the waiting times for orthodontic work. Hugh O’Keefe advised that there was a backlog built up for orthodontics but they were not concerned about the delays in terms of risk to patients. They wanted though to look at the variations in waiting lists between practices and for there to be more joint working as some had shorter waiting lists that others.

Councillor Alan Macro asked for further detail on the national contract changes of November 2022. Hugh O’Keefe advised that they would allow dentists to perform more activity under their contracts. It would require practices to provide up to date information on NHS Find a Dentist webpage. There were also contractual powers to redistribute the resources allocated to the practices in relation to the level of activity. There were new powers being brought in for the commissioner to address that. There was a push to ensure Dentists clearly followed NICE guidance on recall intervals to be clinically appropriate. Finally one of the treatment bands meant an increased payment could be made for more complex treatment.

Councillor Tony Linden asked for more information on the digital gap and those not accessing dentistry services. Councillor Linden also noted that the private sector was a major part of the system. Councillor Linden asked whether Nilesh Patel represented both private and NHS dentists highlighting it was important to work holistically as accessing NHS dentists was a concern. Nilesh Patel, Chair of the Thames Valley Local Dental Network, advised that his role was to focus on NHS provisions, however most practices had a mix of private and NHS services. There was a benefit of private services in helping the community in reducing demand on NHS services. Hugh O’Keefe highlighted that the flexing of the contracts would be picking up on the health inequality agenda. Contracts were target driven and so dentists would respond to patients coming in and so there was a challenge to enable access into those services. They were trying to set aside capacity within the contracts for dentists to work more proactively to bring people into the system, especially younger children. For example there was a Starting Well scheme in Slough to encourage children in the community into dental practices at a very early age. They were trying to see what more they could do within the contracts they had. There were certain patient groups, particularly children from deprived backgrounds who were accessing hospital treatment for extractions for example. Also the older population being able to access services was a concern. The flexing of contracts was at an early stage but they were looking to focus on those whose oral health needs were greater.

Councillor Andy Moore noted the statistic in the report that 52% of the population attended an NHS dentist but that people were not signed up to an NHS dentist in the same way you were signed up to a GP surgery. He asked whether there was any intention to change that. Hugh O’Keefe confirmed that the 52% was a 30% growth on the ten years before which was a significant increase. He explained that for patients who were not registered, they were still on the dentist’s books if they went regularly and called in for check-ups. This was more difficult since the pandemic. Councillor Moore noted that dentistry practiced prevention rather than treatment in a way that did not occur with GP services. He asked if the balance was right and were people having too many check-ups? Hugh O’Keefe advised that there was guidance around recall intervals that was more frequent for those with lots of fillings such as the older generation. The younger generation did not have to go in as often as they had fluoride in toothpaste at a young age. Dentists were conscious of recall intervals but the contract had a built in incentive to get recalls through. In addition patients were creatures of habit and liked to have six month check-ups if they were used to them. David Chapman highlighted that prevention started before visiting the dentist. Children and patients learned to look after their own teeth, how to brush and use fluoride toothpaste. There was a whole range of lower priced toothpastes that people could have been directed towards that did an adequate job. Councils, through their public health teams, had responsibilities for health promotion and for doing a survey of dental hygiene in children. He noted that some councils in BOB had opted not to do that. The Chairman noted the comments made. He highlighted that health promotion and dental hygiene should be part of the school curriculum.

Sarah Deason, Healthwatch West Berkshire, noted in the report that people were not registered and asked if any engagement had been done locally to understand more about why people were not registering. She explained that across Healthwatch in Berkshire West one of the top questions asked was ‘where can we get a dentist?’ and asked whether available appointments and GP surgeries were going to be advertised. Hugh O’Keefe referred to the NHS website as the place to look for local dentists but noted that it was difficult for anyone at that point to find a practice open to new patients. That was related to catching up with backlog and delivering contract targets for the year. He stated that there would be a communications plan along with the flexing programme to ensure other agencies were aware who was taking part in the scheme and promoting access in those communities. The reasons people did not attend were well known. One was money and paying for patient charges. Another was anxiety about going to the dentist. There were high street sedation services available. By people going early and regularly it helped with that fear.

Councillor Linden highlighted the next steps and review section in the report. It was agreed that dentistry would be revisited in the future. Councillor Moore requested an action to know more about public health’s role at West Berkshire Council. Nilesh Patel highlighted that dental prevention was also about diet and its larger part in general health. Dental appointments included advice around dental care and diet and in particular reducing sugary snacks.