Meeting documents

Members will receive:         

i.)    An overview of NHS provision in Buckinghamshire

ii.)   An overview quality of NHS dentistry provision and types of dental work NHS funding excludes.

iii.) An overview of contractual performance in Bucks.

iv.) A dentists perspective on the provision of dentistry in Buckinghamshire

Contributors:

Hugh O’Keefe - Contract Manager – Dental, NHS England South (South Central)

Nilesh Patel – Chair of Bucks Local Dental Committee

Hugh O’Keeffe the Dental Contract Manager at NHS England South and Nilesh Patel, Chair of Bucks Local Dental Committee updated the committee on NHS dental commissioning and provision. 

During the discussions the following areas were covered:

NHS England

·         NHS England is responsible for commissioning all NHS dental services. Bucks comes within the Thames Valley region

·         10% of all 111 calls are dental.

·         Oxford University Hospitals NHS Foundation Trust are the providers for Maxillofacial Surgery.

·         Bucks Healthcare NHS Foundation Trust provides, (mainly at Stoke Mandeville Hospital) Oral Surgery, Orthodontics and Restorative Dentistry and is clinically linked to the Oxford University Hospital.

·         Community Dental Services are provided by Central and North-West London NHS Foundation Trust

·         Currently there are 75 NHS Dental Practices in Buckinghamshire, of this 30 practices only provide NHS dentistry for children and exempt patients. 95% of dental activity is delivered through the 45 practices delivering NHS dentistry to all.

·         Dentistry is a banded treatment system, which attract different charges. There are exemptions such as for children and people receiving benefits.

·         All NHS practices are measured in units of dental activity relating to the bandings. Practices are expected to deliver 92% of their activity targets set in their contracts. The level of activity commissioned in the Chiltern area has fallen due to some practices being unable to deliver their contracted activity.  (In Chiltern dental practices there is a higher rate of delivery below the targets. This money is recovered by NHS England.)

·         In 2009 there was a big push to invest in NHS dentistry. In Bucks there was a problem with investment going in not being utilised. South Bucks has the highest level of access in Thames Valley and Chiltern the lowest.

·         Some of the key challenges are:  population growth/new housing: impact on primary and secondary care services, financial pressures across NHS.

From a LDC perspective:

·         Buckinghamshire had a lower dental commissioned budget in 14/15, than Oxfordshire and Buckinghamshire. £14.6 million in Bucks, compared to £24 million in Oxon and £28.7 million in Berks. The outcome is lower units of dental activity in Buckinghamshire.

·         Bucks has a spend of £28.81 annually per head of population, compared to Oxon at £36.65 and Berks at £33.23. Bucks has 79% of the spend per person of Oxon and 87% of the spend of Berks.

·         Bucks has on average only 1,2 units of activity per person commissioned a lot lower than Oxon and Berks. NHS Commissioners need to look at this.

·         There was an issue with the way in which the 2008 Needs Assessment was conducted and this informed the 2009 spread of practices.

·         Most of Bucks underspend is getting re-distributed outside of Bucks.

·         There are two Prisons in Grendon and one in Aylesbury who now have new national dental provider which was appointed by a larger healthcare organisation. Dentistry only formed 1% of the questions. Not enough care is taken of providing dentistry for inmates. Previously the service was provided by local dental services who provided support for the inmates as they left the prisons

In response to questions from Members the following areas were discussed:

·         Getting an appointment with a NHS dentist is still challenging. Dentists may be struggling to cope with growth of population their areas.

·         Dentists feel constrained by a lack of funding and see dentistry as a personal service.

·         The way the budget is apportioned in Bucks needs re-looking at as Bucks may not be getting a fair proportion.

·         Historically Bucks have had the lowest levels of delivery. Issues of whether the resource is going to the right place is something Commissioners need to look at.

·         LDC felt Bucks has a serious issue of over provision in some areas matched with severe under-provision in other areas. Money being taken out of Bucks for dentistry is just exacerbating the inequality where there is under provision. The needs of the region need to be re-assessed.

Actions

The Chairman write to NHS England to:

·         Seek an explanation for the different levels of funding Bucks receives compared to its neighbours and work ongoing to assess access disparities across the region.

·         Ask about any plans to re-dress the funding anomalies identified by the LDC in Bucks.

·         Highlight the need for commissioners to have links with local planning authorities so they are aware of growth and provide links to Local Plan Development

·         Highlight to Commissioners the need to create greater awareness in communities of where NHS dental practices are.