Presentation by NHS England and NHS Improvement

The Committee received a presentation on NHS dental services for children and young people in Gateshead.

It was reported that all practices operate in a highly regulated environment, however these regulations do not allow for patient registration. This means that any resident can access dental care from any NHS dentist.  NHS dentistry contracts are demand led and contracts are measured in units of dental activity (UDAs).  Each practice is therefore contracted for a certain level of access across the year.

It was noted that there are 24 NHS dental practices across Gateshead, contracted to provide general dental service, commissioned for 364,347 UDAs. Pre-Covid approximately 98.3% of the commissioned capacity in Gateshead was utilised. Covid has had an impact on access to dental care and work is ongoing to increase access for patients locally.

Challenges in the dental service is also around recruitment and retention of dentists and dental nurses, although the position in Gateshead is better than in other parts of the region.  The service was put under pressure with the emergence of Covid-19, because this was an airborne virus it was important to keep staff safe. A small number of urgent care centres were set up, however there were issues in terms of accessing PPE for staff and further training, which meant that these did not open until June 2020.  Due to the majority of dentist accommodation being previously residential, this led to an impact on the number of patients these practices could safely see.  In view of the reduced capacity dentists were required to prioritise patients based on clinical need, children were within these priority groups.

There remains a large backlog and dental practices are still being advised to keep priority groups and increase gradually.  National guidance has been set to increase capacity to 85% from January to December 2022.

In order to improve access incentives for all NHS dental practices are in place to prioritise those patients who have not been seen within 12 months for children, and 24 months for adults.  There has been further investment into clinical triage through the 111 service to ensure those with the greatest need are being prioritised.

It was reported that expressions of interest are being sought from practices who have capacity to deliver additional in-hours access until the end of March 2022, with a focus on the priority groups.  All practices have also been requested to maintain short notice cancellation lists in order to reduce clinical downtime as missed appointments remain an issue as it was pre-Covid.

It was questioned whether there are any records kept of those children not accessing any dental care.  It was acknowledged that because there is no registration requirements it is difficult to know, however there is data to show who has accessed. It was noted that smaller geographies could be analysed to identify where there is a low uptake of children accessing appointments.  It was also noted that there is links with the authority around looked after children and ensuring they are accessing dental appointments. It was confirmed that once a child becomes looked after, Children’s Services ensure the child or young person has regular routine dental checks, however this was a challenge throughout the pandemic. 

It was questioned whether there is any help for those young people who are getting to the threshold of having to pay for treatment.  It was confirmed that there is no flexibility around payment as this is set by NHS England, however there is constant dialogue between practitioners and NHS England around the cost of care being an inhibiting factor.

It was questioned what has happened to dental practices as a result of them not achieving UDAs during Covid.  It was confirmed that practices had to meet minimum expectations and these expectations on patient numbers were lowered during Covid to a level that was safe. The practices remained open the same hours and although usual UDAs were not met they were still fulfilling NHS expectations. 

The point was made that more needs to be done to look at children and young people accessing dental provision as there are a lot of adults who do not use dental services and therefore their children do not access it either. It was noted that the full extent of the problem is not known and therefore it was suggested that further work should be taken up with Public Health around this and how we work together to ensure people are using the services. It was proposed that this be included in the work programme for next year.

It was also suggested that there remains gaps to be filled to provide a more joined up system between GPs and Dentists, for example to encourage pregnant women to access check ups and therefore stop potential future problems for them and their children.

The point was made that dental appointments are unaffordable for a lot of families at the moment and that this will have a long-term effect on dental health as choices are prioritised elsewhere.  It was noted that this is a topic for lobbying for a different system because this does not work for a proportion of the population.

It was questioned what service is in place for specialist dental care.  It was confirmed that this service is not monitored on UDAs as they have longer appointments and are referred through GPs, dentists as well as self-referrals. There is a limited criteria around who can access this service as it works with specific groups, will visit Special Schools and has strong links with the rest of the care system.

RESOLVED    -           That the information be noted.