Agenda item

The Committee will hear from representatives from the NHS Dental Services Commissioning team and the Local Dental Committee on how dental services are currently commissioned in Buckinghamshire, how services have been accessed during the pandemic and some of the challenges faced by dentists over the last few months.

Presenters:

Mr H O’Keeffe, Senior Commissioning Manager Dental, NHS England and NHS Improvement – South East

Mr S Moonga, Clinical Director, Senior Dentist, Local Dental Committee

Papers:

·       Cover report

·       Profiles – information to health systems

·       Dental profiles for Buckinghamshire, Oxfordshire and Berkshire West

·       Delivery of Urgent Dental Care briefing paper – November 2020

·       Delivery of Urgent Dental Care briefing paper – December 2020

The Chairman welcomed Mr Hugh O’Keeffe, Senior Dental Commissioning Manager,

NHS England and NHS Improvement (South East) and Mr Satnam Moonga, Clinical Director and Senior Dentist from the Local Dental Committee. Mr O’Keeffe outlined that NHS England were responsible for commissioning all dental services. 70% of its investment was in primary care services (high street dentists) and 30% was in referrals to other services. Primary dental care services were commissioned under the General Dental Services and Personal Dental Services Regulations 2005 which meant that the dental practices had the same contractual relationship as the GPs to deliver NHS services. Patients were not registered to a single practice and could attend any practice of their choice. Across Buckinghamshire, Oxfordshire and Berkshire West, 52% of the population normally attended a dental practice in a two year period. The frequency of dental attendance was often governed by each individual’s oral health and clinical need. There were 71 dental practices in Buckinghamshire, 28 of which provided only NHS services for children and charge exempt adults.

Dental practices had to cease routine dentistry and orthodontics on 25 March 2020 due to the pandemic. Practices could only offer dental advice, analgaesia and antibiotics at this time. There had initially been two urgent care dental hubs set-up in Buckinghamshire to support priority care during the lockdown. There had been a high threshold to access these hubs and between March – June 2020, 808 referrals had been made to them. Dental practices were able to re-open from 8 June 2020 for all treatments and had been open ever since. Operating capacity in June 2020 was around one fifth compared to normal due to Covid-19 restraints. There was also a national operating procedure that focussed on high needs which limited patient access to practices. Dental practices had also been required to adapt their surgeries to operate in a safe Covid environment as well as source PPE.

The situation had eased since January 2021 with dental practices operating safely and able to access appropriate PPE however operating capacity was at nearly 50%. Further guidance was expected in April 2021 but it was recognised that there was no quick way to work through the backlog. Additionally, the NHS England dental budget was based on dental attendance so may be problematic in future due to the reduced capacity. Mr Moonga highlighted the difficulties that the lower capacity created and gave the example that Aerosol Generating Procedures (AGPs) needed considerable planning due to the current regulations.

Following the update, Members had further questions and were advised that:-

·         The geographical coverage of dental practices in Buckinghamshire was considered good. The Dental Access Programme had expanded access to dentistry in more densely populated areas such as High Wycombe and Aylesbury.

·         Capacity for NHS dentistry provision had increased by 30% since 2009. Due to a decrease in NHS access at the time, the Government’s response had focussed on increasing uptake and ring fenced funding.

·         Charges for patients was based on a national fee. There was no local influence on this.

·         There was no data to indicate NHS hours were being lost to private work. An indicator of this would be contract handbacks which was rare in Buckinghamshire. Dental practices having an NHS contract had assured a level of funding and the pandemic had put private dental practices at risk. Dental practices were contracted to provide an agreed number of NHS hours throughout the year but may also offer private treatment. They should not offer NHS work privately.

·         The best way to find a local dentist was via www.nhs.uk/service-search/find-a-dentist and this website was used by NHS 111 if someone enquired for a local dentist. Prior to the pandemic, NHS 111 had a list of 40 dental practices in the Thames Valley area that could see patients the same day for urgent care or assessment.

·         The impact of the pandemic on dental care would be picked up by national oral health surveys conducted by Public Health England. Disrupted access to dental services would likely cause issues in future.

·         Healthwatch Bucks had highlighted some issues with information on dental practice websites not being up-to-date, particularly during the pandemic. Healthwatch Bucks had also found that the NHS website had outdated information such as whether or not a practice was accepting NHS patients. The findings from the Healthwatch report had been communicated to the practices.  This was under review as part of contractual arrangements in future.

·         Each practice’s ability to hit the Units of Dental Activity (UDA) target depended on the set-up of each practice and any additional measures they had put in place to increase capacity. The further challenge would depend on the outcome of contract negotiations in April 2021.

·         Maintaining morale amongst dentists was difficult in the current situation. Dentists had expressed concerns about communications from the Government and NHS England, and future targets may lead to practices not reaching them due to capacity issues.

·         The UDA was determined nationally and based on activity in a reference year in 2004/05 that was then introduced to dentistry in 2006. Alternative contract models had been considered since 2010 with some pilots taking place however the issue was how the system would transition to an updated arrangement. The introduction of the Quality and Outcome Framework for doctors had a discrepancy between estimated costs and actual costs which then had to be met locally. The April 2021 contract review may be a suitable time to implement any changes.

·         Dental care for residents of care homes and nursing homes was through the community dental service. If the resident could not leave the care home then the service could visit them. A June 2019 CQC report had highlighted oral health issues in care homes and that oral care and wellbeing did need support from care home staff. Pilots had been run to enhance dental care support in care homes.

·         Community dental service providers also assisted individuals with mental health needs. The staff were trained to support these patients and appointments were allocated more time for treatments to meet the individual’s needs.

·         Most hospital dental treatment could be carried out at Stoke Mandeville however the most technically complex procedures would be carried out in Oxford.

·         800,000 people nationally were awaiting hospital surgical procedures. 600,000 of these had gone through the Royal College of Surgeons prioritisation service. 24,000 of these patients are awaiting treatment for Oral and Maxillofacial Surgery.

During the discussion, the Committee made the following comments:-

·         One Member felt there was a shortage of dentists in Buckinghamshire when compared to other local authority areas. NHS access was important for en-masse, preventative and minimally-evasive treatment. This would detect oral cancer earlier and reduce expensive hospitalised tooth extractions.

·         One Member recommended that a grant was given to dental practices to allow them to keep a rolling stock of level 3 PPE.

·         The Committee did express concern that the funds delivered per Unit of Dental Activity (UDA) could differ considerably which could have a detrimental impact on the morale of practitioners.

·         Members would raise any further specific concerns, such as NHS access in local areas and the discrepancies in the costs surrounding UDAs, with Mr O’Keeffe after the meeting.

·         Mr O’Keeffe would supply the Committee with information regarding community dental service providers for wider circulation.

Action: Mr O’Keeffe

The Chairman thanked Mr O’Keeffe and Mr Moonga for attending the meeting and providing an update. The Chairman advised that any further Member questions would be circulated to Mr O’Keeffe and Mr Moonga after the meeting.