Agenda item

Report of the Director of Public Health

The Committee received a presentation from Stuart Youngman, Primary Care Contract Manager for NHS England . The presentation aimed to clarify the position in terms of commissioning and highlight the current arrangements.

It was reported that since 2012 the local authority has become responsible for oral health improvement, and NHS England is responsible for primary and secondary dental care.  General dental services are commissioned by the primary care dental commissioners, the service can be accessed through NHS 111, NHS Choices, self-directed contact and professional sign-posting.  That general service may not be able to meet all the needs for each individual and therefore referrals can be made to special care dental services. This special care can offer discreet community dental service where high street services cannot meet needs, for example for people with learning difficulties or bariatric patients, and can be accessed through professional sign-posting.  Specialist dentistry, including orthodontics, minor oral surgery and sedation services is commissioned by the primary care dental specialist referral service. This service supports the general high street dental practices.  In terms of the secondary care services this is consultant led and commissioned by secondary care commissioners.  Overarching all of these services is Public Health’s oral health improvement programmes commissioned by Local Authority Commissioners.

It was noted that patient preference dictates that a number of patients will choose to access private dental care rather than NHS services. In addition a number of patients will be unscheduled dental health seekers who will only access services when they have a specific need. It was noted that private dental care regulation is undertaken by the Care Quality Commission and the General Dental Council.

Primary Care Dental Services must operate in accordance with National Dental Regulation. This stipulates what should be provided, there is no requirement for patients to be registered, it is a demand led system and the practice has direct responsibility for patients only during the course of treatment. It was acknowledged that patients will perceive that they are registered with a particular practice, although practices only send out appointment reminders etc in order to manage their system.  Secondary Care Dental Services do not fall under the same regulation and are commissioned under separate Standard NHS Contracting arrangements and funded through Payment by Result tariffs.

It was reported that the regulations set the contract currency and is measured in units of dental activity (UDA’s) and ‘banded’ to courses of treatment.  Band 1 equates to one UDA and is for a routine visit, scale and polish, Band 2 is for fillings and extractions and is 3 UDA’s, Band 3 is 12 UDA’s and is for laboratory work. The regulations require the collection of patient charges, which are nationally derived charges which vary year on year.  It was noted that there are certain groups of people who are exempt from paying for treatment, it was acknowledged that there are gaps in terms of getting this message out to those who are exempt.

In terms of national statistics it was reported that the percentage of Gateshead residents accessing NHS dental care is very high. Within the previous 24 months 61.9% of the Gateshead population accessed a dentist, compared to the North East number of 61.1% and the national figure of 55.1%. It was acknowledged therefore that there is the capacity in Gateshead to meet demand, although it would be unlikely to ever reach 100% because some people will access private practices or are irregular attenders.

It was noted that the spread of primary dental care provision is good in Gateshead. During the period April 2015 to March 2016 over 374,000 Units of Dental Activity (UDA) were funded to support general patient access across Gateshead to 104,000 patients. Of that number 26% were children and young people aged between 0-18. 93% of practices in Gateshead could offer a routine appointment within two weeks and 7% within three weeks. It was also reported that 100% of the practices stated they would prioritise child patients in pain.

It was also noted that there is a Community Dental Service that provides services to children, young people and families with special care needs. This service is provided by the South Tyneside Foundation Trust and is located at the Queen Elizabeth Hospital, Wrekenton Health Centre and Blaydon Primary Care Centre. During the period April 2015 to March 2016 the Community Dental Service provided primary dental care to approximately 1200 patients with special care needs, of this number 41% were children and young people aged 0-18.

It was reported that the National Dental Contract Reform Programme is looking at a remuneration model. The development of National Paediatric Dentistry Pathway Guidance will be published in early 2017, this will set expectations for how paediatric dentistry should be provided to ensure high quality care into the future.

Committee was advised that NHS England is keen to work with partners to improve oral health and connect with local communities.

The point was made that oral health is linked to other health problems, for example heart problems, tonsillitis and ear nose and throat problems. It was noted that conversations are being held with dental leads nationally around broadening the role of dentists to look at other issues in order to offer a more holistic approach. Committee agreed that this would be a positive direction of travel and should be highlighted in the recommendations within the final report of its review into child oral health.

It was queried why there is no primary dental practice in Chopwell and High Spen, it was pointed out that there is a poor population in the area and the lack of a dental practice is a local concern. It was questioned whether the demographic of poor dental health is mapped.  It was confirmed that it is the job of all Commissioners to collect information about what is happening in the community. Under the reforms a local dental network has been established which covers Northumberland and Tyne and Wear, the group will look at all information including general access to determine if and where there are any gaps.

RESOLVED    -           That the comments of the Committee and the content of the

presentation be noted.