Agenda item

NHS England and NHS Improvement South West Dental Reform Strategy

To receive an update on the NHS England and NHS Improvement South West Dental Reform Strategy presented by the Director of Commissioning Primary, Community and Mental Health Care NHS Devon; the Consultant in Restorative Dentistry, NHS Somerset Foundation Trust and the Programme Manager (Devon, Cornwall and the Isles of Scilly, Somerset, Dorset) Dental Team, South West Collaborative Commissioning Hub.




Jo Turl, Director of Commissioning, NHS Devon and Matthew Jerreat, a Consultant in Restorative Dentistry and Chair of the Local Dental Network provided Members with an update and presentation.


Members were informed that the commissioning of NHS Dentistry was transferred to ICB’s in April 2023 and that approximately 50% of the population were funded for NHS dentistry.  The NHS Contract had not been updated in some time and was seen as out of date and not fit for purpose.  The issues affecting Torbay were also national issues and the NHS had been trying to make improvements locally for some time now against the back-drop of the existing NHS Dentistry Contract.


It was explained that the NHS Contract was an ‘in perpetuity’ contract which meant that the contract could not be taken away from dental practices unless they under performed for three years consecutively.  Since Covid-19, some dental practices had found it hard to deliver to the expected level under the Contract and the NHS was currently working with those dentists and their teams to find out what they were doing to achieve the contractual level of activity.  In reality, a lot of practices had been adversely impacted by the loss of staff and dentists which had led to under performance and therefore workforce was a significant issue in some NHS dental practices being able to deliver against expected levels of performance.


High street dentistry practices were also independent businesses operating under contracts and some were finding it difficult to make the NHS Contract work for them and so offered private dentistry services instead or as well as.  It was recognised that, as independent businesses, they were responsible for the cost of employing their own staff and meeting the costs of their own premises.


It was explained that, under the NHS Contract, dental services were commissioned by Units of Dental Activity (UDA) which was a unit used to measure dentistry activity to ensure that the correct amount of patient charges were collected.  In the event of an underspend there was a clawback opportunity in the following year only.  It was confirmed that there was no ringfenced budget available for dentistry this year.


Currently the performance list indicated that there were enough dentists in Devon to meet demand but a lot of those dentists were doing private work because they could not make the NHS Contract work for them or they had chosen to work in private dentistry.  Since dental commissioning had been transferred to ICB’s, it had presented an opportunity for the ICB to work with the local dentists to encourage them back into the market of NHS work.


Members were informed that the South West Dental Reform Programme was set up in late 2020 to bring together NHS England Commissioners with key stakeholders with responsibility for oral health in the region.  The aim was to inform the strategy for the future of NHS dental services that would contribute to the overall improvement of oral health for people living in the South West.  An Oral Health Needs Assessment was completed in February 2021 which highlighted three key areas to prioritise:


·         Access;

·         Workforce; and

·         Oral Health.


The key business objectives for the NHS moving forward were:


·         digital dental referrals to improve referrals;

·         dental hub which would link with the regional NHS Long Term Workforce Plan to combine training and development for clinicians with access for people;

·         paediatric dental review which would cover primary, community and secondary care; and

·         stabilisation which provided sessional rates in high street practices to see patients in pain who do not have access to a regular dentist.


Members were informed that the stabilisation programme was underway and that throughout the Covid-19 pandemic there was a focus on urgent dental care and demand for that had increased and continued to increase.  There were a number of people who had dental issues which meant that they had to repeatedly access urgent care or people who did not meet the access criteria, but were still in dental pain.  The stabilisation pathway provided a solution to this by:


·         working with high street dental practices to offer sessions of stabilisation which people could access via 111 or directly via the dental practice; and

·         working with Public Health colleagues, high street dental practices and local charities to offer sessions and additional support to those requiring dental care who are in health inequalities groups.


The current focus of the programme related to the Under 18 age group and there were a number of areas of work connected:


·         starting well core – where practices commit to working with families and communities to promote oral health, focussing on 0-2 years;

·         First Dental Steps – pilot in progress and approval to expand across the South West with Health Visitors providing toothbrushing packs and referring vulnerable children to community dental services;

·         supervised toothbrushing – pilot in progress and approval to expand across the South West for 4 to 5 year olds;

·         child focussed dental practices – seven across the South West as part of a national pilot to take referrals for children from other practices; and

·         welfare checks – working with secondary care to do welfare checks on under 18’s waiting for a general anaesthetic to ensure they receive the best care possible.



Members were informed that the objectives of the Devon plan were:


·         to restore access rates to pre-pandemic levels;

·         to rebase the primary care contract;

·         the appointment of a Devon Dental Practice Advisor;

·         re-procurement of lost activity;

·         Population Health Commissioning (Flexible commissioning);

·         to address urgent care;

·         to bring forward stabilisation;

·         to provide child friendly dental practices;

·         to review the waiting list;

·         to promote oral health;

·         provision of digital; and

·         provision of a training hub.


It was explained that the National Team was working with Regional Teams on four main areas and one of those areas was flexible commissioning in respect of stabilisation and child friendly dental practices, for example, which were being used to help health and equality groups.


Although there were enough dentists in Devon to meet demand, there was no current data available which gave an indication as to what proportion of NHS work dentists may be undertaking in their usual working week.  The General Dental Council was looking to ask those extra questions in its annual review but it was stressed that the questionnaire was voluntary and so the data collected would be dependent upon how many dentists completed the questionnaire.  Currently the ICB was also looking at improving communication around dental access and the possibility of introducing a Dental Charter.