Agenda item - NHS dental services in Brighton & Hove

Report of the Executive Director, Governance, People & Resources on dental services in Brighton & Hove (copy attached).

27.1    This item was presented by Charlotte Keeble, Pharmacy, Optometry and Dental Lead, NHS Sussex. Also present were Becky Woodiwiss, BHCC Public Health, and Nish Suchak, Chair of the East Sussex Brighton & Hove Local Dental Committee (LDC).

27.2    Ms Keeble told the committee that responsibility for dental commissioning had recently passed to NHS Sussex (previously it was the responsibility of NHS England area teams). NHS Sussex has done a deep dive on dental access. There has been underperformance against the contract since around 2016, with not all NHS activity being delivered. There has also been a rise in recent years of dental practices handing back NHS contracts; this is a particular issue in West Sussex, but there have been 3 practices to do this in Brighton & Hove. Recruitment and retention is a national problem, but the situation in Sussex is better than the national average in terms of dentist to patient ratio.

27.3    Ms Keeble outlined actions being taken to address problems in dentistry. These include:

·         Working closely with the Local Dental Committee (LDC) – this is inevitably a provider-led environment

·         Contacting all dental practices doing NHS work to see if they want to do more

·         Contacting dental practices to see if they are willing to outperform their NHS contracts

·         A focus on the geographical areas with the highest levels of need – this is typically West Sussex, which has the highest dentist to patient ratio

·         Opening a new dental service in Brighton (however the preferred provider has encountered problems)

·         Putting pressure on dental practices to keep their websites up to date, including details of whether they are taking new NHS patients (there are currently 5 practices in Brighton & Hove open to new NHS patients)

·         Working in improving access to dentistry for children in care

·         Focusing on providing services to care homes

27.4    Mr Suchak spoke to the committee about his experiences as a dentist in East Sussex and Chair of the LDC. Mr Suchak told members that:

·         He had started practicing dentistry in East Sussex in 1988, and is now treating his third generation of patients

·         He is a foundation trainer, and the training of new dentists is key

·         The transfer of commissioning to NHS Sussex has been a positive move – they actually consult dentists

·         Historically, dentists got paid for everything they did for NHS patients. However, the dental contract was revised in 2006, and subsequently, under the Units of Dental Activity (UDA) scheme, dentists have often been paid for only a proportion of the NHS work they actually perform. This makes undertaking NHS work a much less attractive and much less profitable proposition

·         The NHS issues breach notices to dental practices that don’t deliver at least 96% of their contracted NHS activity; but practices are not permitted to exceed their contracted activity by more than 2% and don’t get paid for additional work they do deliver. This is unworkable

·         Since 2006, dentists’ NHS pay has risen by much less than their costs. Dentists have had to use private income to subsidise their NHS work

·         This is not a sustainable situation and it has become very difficult to recruit staff for NHS work – Mr Suchak has been unsuccessfully advertising for an associate dentist for 3 years

·         In consequence, 50% of dentists have scaled back NHS work and 75% plan to make further reductions

·         NHS spend on dentistry has reduced by 25% in real terms since 2010

·         The Health Select Committee has called for a new NHS dental contract, with a patient-centred focus

·         There will be no additional dental training places until 2028/29, meaning that there will be no additional qualified dentists until 2034/35.

27.5    Mr Suchak suggested some solutions to the current problems. One option would be to ring-fence NHS resources to provide care for all vulnerable groups, using NHS-employed dentists. All other dentistry would be market based. It is also essential that the failed UDA system is ditched and that dentists are paid for the work they deliver.

27.6    In response to a question from Cllr Asaduzzaman on how to make it clear to local people that they are not registered on a formal dental practice list, Ms Keeble told the committee that there is more that can be done in terms of working with communities, particularly in terms of co-designing a new dental plan. Improvements have already been made to the NHS Sussex dentistry web pages.

27.7    In reply to a question from Cllr Asaduzzaman on what can be done to encourage private dentists to take on NHS work, Mr Suchak told members that this is difficult as all practices have a large backlog of activity arising from Covid. These backlogs will need to be cleared before most practices are in a position to consider taking on new patients. More thought needs to be given to managing dental demand – for example by paying dentists to undertake preventative work. Thought also needs to be given to positioning dentists as part of a holistic health system – for example, dentists could check patient blood pressure as part of routine appointments.

27.8    Cllr Wilkinson welcomed the report, noting that tooth decay is now one of the major causes of hospital admissions for young people. Does the decline in NHS dental services mean that there is no longer universal care in the city?  Ms Keeble replied that there may be some flex to do more preventative work on tooth decay, but the national targets are around delivering UDAs not around prevention. Mr Suchak added that there has been a pilot scheme targeting those most in need. This works, but it is expensive and would require national funding to be extended.

27.9    In response to a question from Cllr Baghoth on work in schools, Ms Woodiwiss told members that the Sussex Community NHS Foundation Trust has a health promotion team tat works with schools and with other groups (people with a learning disability, older people etc.). There is limited capacity within the service, but it does great work, focusing on the most derived areas where needs are highest.

27.10  Cllr Baghoth has a query about an individual constituent which Ms Keeble agreed to take up outside the meeting.

27.11  Nora Mzaoui noted that preventative work is important, but sometimes it is a challenge to engage with parents who don’t understand how to promote oral health to their children. Ms Woodiwiss agreed that this is an issue, and needs to be addressed as part of a holistic approach to supporting families, e.g. via Family Hubs. Ms Keeble offered to come to a later meeting to talk about prevention work. Members welcomed this offer.

27.12  The Chair thanked the presenters for their time.

27.13 RESOLVED – that the report be noted.