Agenda item

(indicative timing: 11:20am – 12:20pm)

Attending for this Item were:

NHS England and NHS Improvement – Midlands Region (NHSE&I)

Terry Chikurunhe, Senior Commissioning Manager

Anna Lee Hunt, Consultant in Dental Public Health

Worcestershire County Council (the Council)

Kathryn Cobain, Director of Public Health

Elizabeth Griffiths, Public Health Consultant

Karen May, Cabinet Member with Responsibility for Health and Well Being

The Chairman introduced the Item by thanking those present for the very comprehensive Agenda Report.  The NHSE&I Senior Commissioning Manager highlighted some of the key points within, including:

·         Unlike a GP Practice, there was no system of registration with a Dental Practice.  Patients with open courses of treatment were Practice patients for the duration of their treatment, however, once complete, apart from repairs, the Practice had no ongoing responsibility.  However, it was not uncommon for Practices to recall patients for a regular check-up

·         Dentistry had been severely impacted by the COVID-19 pandemic due to infection control measures and priority was given to urgent care, children and vulnerable patients

·         It continued to operate at a reduced capacity, although levels of activity were slowly increasing.  In 2021, Dental Practices had been operating at 65% of normal capacity and as of January 2022, that had risen to 85%

·         As a consequence of the pandemic, Dentists were reporting that patients were presenting with more complex cases which in turn meant less time for routine check-ups  

·         There were 63 general Dental Practices in Worcestershire with a NHS Contract

·         Historically, Worcestershire had particular challenges around workforce, across Dentists, Dental Nurses and Receptionists, especially in the rural parts of the County

·         NHSE&I was aware of access issues and was working collaboratively with the Council to strengthen oral health promotion and prevention activities.  In addition, there was a campaign to ensure patients at risk of oral cancer were referred in a timely manner.

During the opportunity for discussion, the following points were raised:

·         A Member noted that although the Report provided a lot of detail, it would have been useful to have some data

·         A request was made for further information on Urgent Dental Care triage categories.  In response, NHSE&I was to undertake an Out of Hours needs assessment, which would incorporate NHS111 data and could be shared with the HOSC when available

·         A number of HOSC Members were concerned about Dental Practices ceasing to provide NHS dentistry and the way in which ‘going private’ was communicated to residents.  A Member highlighted a case whereby a resident was unable to schedule an NHS appointment but was informed they could be seen privately 

·         NHSE&I accepted that there was a significant problem and was currently mapping dental need across the region.  It was clarified that NHS Dental Practices had an obligation to adhere to NHS standards and residents should not be funnelled into becoming a private patient, unless the NHS contract was ending or had ended

·         In response to a Member suggestion that private patients were subsidising NHS dentistry, the HOSC learned that when NHS contracts began in 2006, the rates were set nationally on ‘units of dental activity’ with no provision of uplift.  The rate set was an issue of national concern and Contract reform was being considered by central Government, although the pandemic had stalled discussions

·         NHSE&I had done everything to try and deliver equitable access across the Midlands Region within the constraints of the NHS Contract

·         The Cabinet Member with Responsibility highlighted an upcoming Oral Health Steering Group meeting, reporting it would be keeping a watching brief of the unfolding data

·         Nationally, the Department of Health and Social Care was responsible for NHS Contracts, however, from April 2023, NHS Dentistry would move from NHSE&I to Integrated Care Systems

·         When asked why there was no patient registration process, it was reported that the way in which Dental Practices operated was there own decision, however in general, a Practice would know how many people they could manage during a year weighing up the NHS Contract awarded.  Dental Practices which reported that there were full, or had a waiting list, was an internal decision

·         NHSE&I hoped that from April, levels of activity could increase, however, acknowledged that this would unlikely be across all Practices

·         The Director of Public Health highlighted that preventative work was so important, for example as early as infant feeding.  Social Media was a tool for sharing key messages and raising awareness and Councillors were content to share information through their own networks

·         In relation to the cost of dental care and health inequalities, it was clarified that the payment exemption list was limited but would be shared with HOSC Members.

The Managing Director of Healthwatch Worcestershire was invited to comment on the discussion and made the following observations:

·         Healthwatch usually received around one complaint each week on Dental Services, which could be shared with NHSE&I

·         There was general concern about the impact on dental health inequalities

·         Awareness raising about Oral Cancers had appeared to have stalled

·         Positive feedback had been received about emergency dentistry.

The Chairman thanked everyone for their contribution and it was agreed to schedule a further Report at an appropriate time in the future.