Agenda item - Dentistry

Report of NHS Sussex (copy attached).

24.1    The item was presented by Garry Money, NHS Sussex Director of Primary Care Commissioning, and by Ellie Coleman, NHS Sussex Senior Manager, Primary Care Commissioning. They were joined online by local dental practitioners Nish Suchak, Chair of East Sussex Dental Committee; Ali Mubarak, Practice Principal Dentist at Eaton Road Dental Practice; and Aisha Asghar, Dental Contract Holder at Goodwood Court Dental Practice. Dr Nicola Lang, Director of Public Health, was also present.

24.2    Mr Money told members that there had been considerable changes since dentistry was last reported to HOSC in January 2024. These included reform to the national dental contract which have improved incentives for dentists to take on NHS work, particularly in terms of complex and urgent care. There has also been more focus on prevention. There are currently 43 NHS dental contracts in Brighton & Hove and there has been an increase in the Units of Dental Activity (UDA) delivered since the last report to HOSC. Ms Coleman added that an Urgent Care Stabilisation Pilot had been run locally. This was successful, with 5 local practices signing up and the pilot has now been extended to non-urgent unscheduled care. Lots of work is ongoing to support the most vulnerable patients, including children in care and care leavers and clinically vulnerable patients. Ms Coleman also outlined preventative work that NHS Sussex has undertaken with the council’s Public Health (PH) teams, targeting the more deprived areas of the city to encourage good oral hygiene including supervised tooth-brushing.

Mr Money told members that a ‘golden hello’ scheme had also been introduced to try and attract new dentists to the city. To date this had not been successful, but additional rounds are planned. In summary, dentistry remains a Sussex strategic priority. There has been positive progress in recent months but much more needs to be done.

Mr Suchak told members that NHS Sussex (ICB) commissioners have been much better than the NHS England commissioners who previously had responsibility for dentistry, being particularly open to appreciating the value of prevention. However, it is important to recognise that there has been no additional funding for dentistry and that a new national contract has not been trialled. The increase in urgent care capacity is positive, but to be successful it needs to be accompanied by an increase in routine UDAs. Mr Mubarak added that dentists will not ultimately be able to take on more NHS patients without an increase in funding.

24.3    Cllr Simon asked about consistency of NHS contracting across dental practices, about monitoring of dental lists, and about how NHS capacity is advertised. Mr Money replied that the focus of commissioners is to ensure that the highest possible percentage of Sussex UDA is actually delivered by dental practices. NHS Sussex does not monitor dental lists; how much dental activity practices actually deliver compared to the UDA they are commissioned to deliver is closely monitored by the ICB. If practices have capacity to take on additional NHS patients, this is advertised via the NHS website. However, commissioners recognise that public feedback on the accessibility of the website is mixed.

24.4    Geoffrey Bowden commented that dentistry remains one of the most common issues that people contact Healthwatch about. Access may have improved but it is still far from adequate, and only wealthy people who can afford to pay private fees really have proper access to dental services. Mr Money responded that these were valid points, but it does need to be recognised that the ICB has to work with the budget it has. Mr Suchak added that he would love to treat more NHS patients, but this has to be paid for – or preventative services that reduce demand for treatment need to be funded.

24.5    Cllr Goldsmith asked why the golden handshake scheme had not proven successful. Mr Money replied that it was unclear, but the high cost of living in the city and the often poor condition of dental estates were likely to be factors. Mr Suchak added that young dentists have very high student debt and need to earn decent money; even with golden hellos, private practice is more attractive than NHS work.

24.6    Mary Davies commented that the Older People’s Council hears stories of older people struggling to register with or being de-listed by dentists. Mr Money replied that he acknowledged the issue of registration. This may be particularly confusing for older people who remember a time when dentists ran true dental lists. The current contract does not support dental lists, but recent tweaks to incentivise dentists to offer more lengthy courses of treatment which may provide some continuity of care. Ms Coleman added that there is a care home pilot which supports dentists to visit care homes. This is something that dentists used to do some years ago, but this type of activity is not supported by the current contract.

24.7    Cllr Evans asked how urgent care was defined as she was aware of instances where people with seemingly urgent issues such as constant tooth pain were denied access to urgent dental care, sometimes being rejected by non-qualified reception staff. Cllr Evans also noted that many dentists are very difficult to contact. Mr Money responded that clinicians should determine what is an urgent, unscheduled or routine case. The NHS dental helpline should be able to help with contacting services. Mr Suchak added that, in his practice all patients are triaged by dentists.

24.8    Cllr Evans asked whether there were statistics on how much preventable disease is linked to poor oral hygiene. Dr Lang responded that there are huge savings to be made through preventative care. This is so, even just looking at the costs of preventing dental procedures such as tooth extractions and root canals, without factoring in the potential to prevent physical health problems or identify them at an early and treatable stage. Glasgow has been undertaking excellent work in terms of oral health prevention. Mr Money added that there is an ongoing discussion across primary care on developing prevention programmes; the ICB endeavours to use its funding is the most efficient way possible. Mr Suchak commented that he was very much in favour of prevention. There is also the potential for dentists to deliver basic physical health tests such as taking blood pressure and blood glucose. However, dentists would have to be paid for delivering this type of preventative service.

24.9    Nora Mzaoui commented that it was good to see a focus on prevention for young people, but it was important that other ages were not neglected, particularly people from the most deprived communities. Mr Money agreed, noting that there are a number of initiatives supporting more vulnerable people, and that dental commissioners are working actively with family hubs.

24.10  Cllr Parrott asked questions about services for people with multiple compound needs (MCN), about renovating dental infrastructure, and about co-production with people with lived experience. Mr Money responded that there are various workstreams supporting people with additional vulnerabilities, including those with MCN. The ICB is also committed to using co-production more. Capital funding is very limited but improving dental infrastructure is part of the conversation around use of capital.

24.11  Cllr Mackey asked a question about dental services for people in SEND residential places. Ms Coleman confirmed that sight tests and dental checks are offered to residential schools.

24.12  Cllr Mackey asked about support for challenged providers. Mr Money replied that dentists have not traditionally been supported to the same extent as GPs but that commissioners are seeking to develop better long term relationships with dental practices.

24.13  Cllr Simon asked whether there were any areas of the city particularly poorly served in terms of dental access. Mr Money responded that commissioners are at an early stage of having granular data on this. The ICB wants to better match provision to demand across geographies.

24.14  The Chair asked whether there was a risk that urgent dentistry would effectively replace routine care. Mr Money acknowledged that this is a risk. National policy is currently pushing urgent care, but locally the ICB is committed to improving access to all types of treatments.

24.15  The Chair asked what local data shows about the balance between local demand and activity. Mr Money agreed to take this away for consideration. There is currently no dental equivalent to the Pharmaceutical Needs Assessment which maps pharmaceutical needs and assets across local areas. The ICB is keen to explore the concept of an oral health needs assessment.

24.16  Ms Asghar commented that her practice runs urgent sessions, but these are often not fully booked. She also stressed how difficult it could be for dental practices that wanted to do more work to negotiate increased UDA. Mr Suchak added that everyone concerned about the state of NHS dentistry should consider lobbying for more funding. Without additional funding there will be no sustainable improvement in services.

24.17  RESOLVED – that the report be noted.