Agenda item

The Committee considered a presentation of the Senior Primary Care Manager (Dental Commissioning Lead – North East and Cumbria), NHS England and NHS Improvement with regards to an update on NHS Dental Access (for copy see file of minutes).

P Fletcher, Senior Primary Care Manager, NHS England, North East and North Cumbria advised Members with regards to the operation of general dental practice in the NHS and private dental practice regulations.  If an NHS appointment was unavailable, patients could be offered private appointments, but they did not have to take up that offer and were able to contact other practices to access NHS appointments.

Dr T Robson, Chair of Durham, Darlington and Tees, Local Dental Committee addressed the Committee and advised of the issues impacting general dental services.

Prior to the pandemic there was already a workforce recruitment retention problem that impacted on dental nurse recruitment and although there were more registered dentists in the country than ever before, there were fewer whole time equivalent years worked by graduates than that of the cohort that were approaching retirement.  COVID-19 had impacted further by becoming the trigger for those due to step down, and there had been an impact on training for dentists coming into profession.

In addition, the peculiar nature of dentistry meant that employees were operating in a high-risk environment and although the clinical team wore PPE, the mist generated in a treatment room, if infected, was a risk to the next patient.  In order to treat patients, the room would need to be left for an hour before entering and every horizontal surface would need cleaning and of course this had a huge impact on the treatment that dentists were able to provide.

The Chair of Durham, Darlington and Tees, Local Dental Committee continued that delays were exacerbated after face to face dental care was stood down between April and August 2020, and when general dentistry resumed, the operating procedures meant that the number of patients that were able to be treated had reduced to 20% of pre-pandemic numbers.   Improved procedures and filters had allowed fallow time to be reduced so the number of patients treated had been increased, however it had gone to 45% in December 2020 and then up to 60% and at the time of the meeting was operating at 65%.

New infection protection guidance was under consultation but dental practices were still trying to cover two years of loss and still having to prioritise patients until they could return to normal activity.

The Senior Primary Care Manager, NHS England, North East and North Cumbria advised of local measures and actions taken, which included incentives, additional capacity for NHS appointments, investment in triage via the 111 service and work to commission additional NHS capacity for over 4000 patients.

Councillor Earley asked whether there was any way that the Council could assist in making the County more appealing for Dentist’s to want to come live, whether there was anything that could be done within schools to encourage more people to take up the profession or better provision for premises.  The Chair of Durham, Darlington and Tees, Local Dental Committee advised that primary care dentistry was network of businesses and a more attractive business environment, it generated more profit and it was easier to recruit.  There was ongoing work with ICS to incentivise provision in otherwise non business economic locations; premises was one factor but there were other ways to enhance the areas and the focus was on trying to increase recruitment.

Councillor Howey acknowledged the pressure that Dentist’s were under and although they had to run private businesses, she asked whether there was any way that they could be convinced to use private appointments for NHS patients in order to catch up.  There were a lot of people who were unable to get appointments due to being unregistered.  The Senior Primary Care Manager, NHS England, North East and North Cumbria advised that some were already prioritising NHS appointments but were independent businesses that had to ensure financial viability, but there were some with additional capacity or part time employees, and expressions of interest had been sent out confirming that additional services could be commissioned.

Councillor Gunn had been concerned that over last 12-18 months, vulnerable families in particular were potentially not accessing dental treatment.  When families were struggling to provide food and fuel over winter dental treatment was not an absolute priority, but check-ups were preventative of emergency treatment and she asked what was available for these patients that were already registered, if assistance was communicated.  Some families would be unable to afford public transport costs.

The Primary Care Manager, NHS England, North East and North Cumbria advised that the communication team were trying to get messages out through the use of social media to confirm that services were able to access services and this had been shared with local authorities to share on social media.  For those with financial difficulty, they may be exempt from dental charges.  Prior to the pandemic only 91% of commissioned capacity was utilised and the objective was to see the whole of it utilised in future.

The Director of Public Health advised that with regards to prevention, there was a broader Oral Health Strategy which had been impacted on during the pandemic, the toothbrushing scheme, the healthy weight alliance, the work on community water fluoridation and the reduction of sugary drinks and this work was hoped to be continued and revisited through the Health  and Wellbeing Board and Members would be kept up to date as that went through.

Councillor Townsend advised that her family dentist in Shildon had done fantastic job done with her children but when dealing with public, they often found themselves in a dental crisis and nobody would take on as an NHS patient.  In that circumstance they would phone 111 and she asked if there was held back capacity for 111 and whether there was a database that people could find spare NHS capacity to save them ringing around 100 practices. 

The Primary Care Manager, NHS England, North East and North Cumbria advised that there was no formal registration, however she acknowledged that people were ringing around to ask to register with a practive but it was really important that if there was a dental problem, that it be shared up front and there was an expectation that the patient would be triaged and if there was no availability they should be sign posted to another practice that could meet that dental need.  If someone had need that could not wait, then they would be expected to call 111 and patients would be prioritised in some capacity, but it was important that patients expressed the need.

The Chair of Durham, Darlington and Tees, Local Dental Committee confirmed that there was a difference between express clinical need and patient demand, the need was constant but the express demand varied considerably, for example on a Monday there was four times the activity than that of a Wednesday and he highlighted that patients assumed they had a need but it was not necessarily a clinically assessed need.  If they called 111 with a clinically assessed need, there was a network of practices commissioned across County Durham – UHND operated out of hours and four other County Durham based commissioned centres that were fed by assessed 111 health advisors.

Resolved

That the presentation be noted.