Agenda item

Purpose of the item: To advise the Committee of the current position regarding access to NHS Dental services in the county and actions being taken to improve access.

Witnesses:

Mark Nuti, Cabinet Member for Adults and Health

 

Liz Bruce, Joint Executive Director, Adult Social Care and Integrated Commissioning

Hugh O’Keeffe, Senior Commissioning Manager Dental

Lillian Nigrelli, Senior Delegated Commissioning Transition Manager, Dental Contracts Surrey Heartlands Integrated Care Systems (ICS)

Rachael Graham, Director of Non Acute and Primary Care Contracts, Surrey Heartlands Integrated Care Systems (ICS)

Nicola Airey, Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley Integrated Care Board (ICB)

Rachel Thompson, Associate Director Primary Care Transformation, Lead Commissioner Dentistry Frimley Integrated Care Board (ICB)

Key points raised during the discussion:

 

1. The Chairman asked what could be done to record information about residents who had tried and failed to access dental services. The Director of Commissioning and Assurance (SRO) explained that a consultation and engagement process with local communities had not yet taken place, however it was expected that the implementation of methods similar to those underway in other areas in addition to collaboration with partners with established links into communities would take place. The Director of Commissioning and Assurance (SRO) added that the link between deprivation and access to dental services required a commitment to engage with communities and welcomed any suggestions from Members regarding this.

 

2. The Chairman said that understanding the number of people that had failed to access dentistry was essential to recognise the size of the issue and asked why dentists were not required to record the number of people being turned away. The Chairman also suggested that the current opening hours of dental surgeries could result in some people not being able to access treatment. The Director of Commissioning and Assurance (SRO) explained that what could be mandated of dentists was influenced by the national dental contract. The Senior Commissioning Manager, Dental said that dentists were mandated to collect the data of patients treated to record the activities being delivered with no requirement to collect the data of those turned away, however the NHS contact centre did record and report on people that had made contact because of difficulties in accessing dentistry. Following a request from the Chairman, The Senior Commissioning Manager, Dental agreed to provide this data to the Select Committee including surveys of work being undertaken by partners in this area. Action – Senior Commissioning Manager, Dental/ Director of Commissioning and Assurance (SRO)

 

3. A Member, in referring to the new commissioning arrangements for dentistry outlined in the report, asked how effective the delegation agreement between NHS England and the Integrated Care Boards (ICB) was expected to be. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands Integrated Care System (ICS) explained that the agreement would define the roles and responsibilities of the ICB’s with NHS teams continuing to deliver services, impart experience to the ICB’s and afford the opportunity to bring commissioning closer to the patient, focusing on the provision and improvement of services for those in greatest need.

 

4. A Member asked how long it could be expected for NHS England officials to work with the ICB’s as referenced in the report. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS confirmed that the delegation agreement would be amended by July 2023 to reflect a single ICB host from the NHS team which would come down to the ICB at a local level. These ICB’s would continue to work together to continue to provide consistency.

 

5. A Member noted concerns about the NHS previously stamping on local initiatives and asked what extent the ICB’s would take charge with local initiatives. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS noted that immediate changes would not be possible, however, national contract boundaries in particular those with a level of inflexibility were being challenged.

 

6. A Member queried how the effectiveness of the new commissioning arrangements for dentistry would be assessed to allow improvements to be made accordingly. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB said that information measures currently in place had proven useful and were being developed adding that ICB and local authority data sources would expand on the information that could be used to measure improvements.

 

7. The Non-executive Director, Healthwatch Surrey asked if there were intentions to improve the complaints process. The Senior Commissioning Manager Dental said that dental practices were required to follow complaints standards as part of their contracts and asked Members to provide further details if that was not happening. The Chairman suggested that all relevant information documentation include Healthwatch details and clear guidance about the complaints process. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB agreed to follow up on the availability and provision of clear information regarding the complaints process. Action - Director of Commissioning and Assurance (SRO) Delegated Commissioning, Frimley Integrated Care Board (ICB)

 

8. A Member asked to what extent residents were made aware of the dental services available to them. The Associate Director Primary Care Transformation, Lead Commissioner Dentistry Frimley ICB explained that in addition to some practices having their own websites, a dental services section was available on the national NHS website where residents could find information about oral health services and how to access their local NHS dental practice. Under the dental contract reforms, practices had a contractual obligation to keep their information updated and state whether they were accepting new patients.

 

9. A Member queried the likelihood of residents being able to access dental services. The Associate Director Primary Care Transformation, Lead Commissioner Dentistry Frimley ICB explained that funding was based on 50 per cent of the population attending an NHS dental practice on a regular basis however the current figure was 40 per cent following a significant fall during the pandemic with challenges remaining in the short term. For patients finding it difficult to access dental services, additional access slots were provided at some practices via NHS 111 or through the practices directly. Access to dental services was under review and remained high on the agenda.

 

10. A Member queried the measures taken to ensure patients understanding of the appropriate charging exemptions for which they may qualify. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS said that the national NHS website dental services section included information about patient charges and eligibility relating to those charges. Another Member emphasised that patients should receive more guidance and advice on charging exemptions.

 

11. A Member queried how could residents find information regarding their nearest local dental practice and asked how digitally excluded patients could find information on dental services. The Chairman added that the 120,000 digitally excluded residents was in line with deprivation and queried what programmes would help in reaching these communities. The Associate Director Primary Care Transformation, Lead Commissioner Dentistry Frimley ICB said that an online search to find an NHS dentist would bring up the national website where residents could enter their postcode to show all local dentists, with the distance from that postcode and whether they were accepting NHS patients. Information was available from the Citizens Advice Bureau (CAB) and local libraries; however work was required to make the information available to the digitally excluded. The Senior Commissioning Manager Dental said that the information that organisations such as Healthwatch provided could be considered in the non-digital space and committed to follow this up. Action – Senior Commissioning Manager Dental

 

12. The Chairman asked if mobile dentistry had been considered to provide dental services in areas of need. The Senior Commissioning Manager Dental said that most NHS dental practices were in the most economically diverse and deprived areas to ensure the maximum NHS footfall.

 

13. The Chairman queried the success and process of identifying the need of dental services through annual health checks conducted on adults and people with learning disabilities.

 

14. The Chairman, in referencing report item 5.5 and the use of the 0-17 age group to obtain data as they would be more likely to use NHS dental services rather than private care, suggested that parents with private dentistry would include their children on their private policy and queried using this group to obtain the data.

 

15. The Chairman, in referring the mention of six lost NHS contracts in Surrey, said it would be useful to know their locations.

 

16. The Cabinet Member for Adults and Health said that prevention was key to avoid expensive treatment in the future and asked if there was scope for dental check-ups and oral health education in schools. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS explained that Surrey County Council (SCC) Public Health was responsible for oral health promotion and surveillance. Surrey Heartlands had reached out to SCC Public Health to ascertain what was happening in this area with the aim to work with teams to focus on initiatives and interventions. The Chairman requested an indication of timelines for rolling out prevention strategies and measures. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS said that there was no aligned budget and further formal work was required to understand the position and support local team initiatives. The Chairman asked if large companies could be approached to donate toothbrushes and related resources to foodbanks. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS agreed that that this was a good starting point in respect of sponsorship.

 

17. A Member asked what was being implemented to improving the diets of children living in poverty. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB said that this area would benefit from the dental commissioning coming to the ICS as dental care could be considered on a whole systems level.

 

18. The Vice Chair asked what measures were being taken to ensure that patients understood the appropriate charging exemptions that they may qualify for and how would this help to reduce fines for patients who have misunderstood their eligibility. The Senior Delegated Commissioning Transition Manager, Dental Contracts Surrey Heartlands ICS explained that dental charges were available on the NHS website which also included dental services and links to an advice tool on how to get help with the cost of dental treatment. Inquiries to better understand process of charges have been made to the NHS Business Services Authority (BSA), who manage NHS charges and a commitment was made to clarify this to Members if required. Work was required to ensure practices were aware that leaflets could be provided in specifically requested languages if required and that a translation service for patients was available.

 

19. A Member noted that Surrey Heartlands had been considering the accessibility of information since it began and the law said that people should have access to information in the format that they choose which was not the case with NHS England. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB agreed to take away an action to ensure the accessibility of dental services information and other elements were in consideration. Action - Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB

 

20. A Member, in reference to homeless communities noted in paragraph 2.10, page 41 of the report, asked what support would be provided to homeless people to help them access dental care and long-term treatments. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS said that whilst there were no specific services commissioned for homeless people, they were eligible to receive treatment through High Street dental services and homeless people with additional needs could also access community services and self-refer or be referred by support groups on their behalf. The Member asked if data regarding the number of people accessing these services was being collected. Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS advised that resident data was not routinely collected through general practice.

 

21. A Member asked if the need to see and treat patients was being balanced with the steps being taken to maintain infection control procedures within dental practices, as referred to in paragraph 5.1, page 49 of the report. The Associate Director Primary Care Transformation, Lead Commissioner Dentistry Frimley ICB said that infection control measures had become part of normal operations, resulting in a reduction of the impact on the time required to treat patients.

 

22. A Member asked what reassurances could be provided that backlogs because of the pandemic could be reduced, how would future backlogs be avoided and were there higher levels of acuity because of these backlogs. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB confirmed that these backlogs were being reduced because of the recent contract changes, however, dentists had reported higher levels of acuity because of the pandemic backlogs. Further contract changes would be expected to ease any future backlogs with the pace of the backlog reduction dependant on the workforce and ensuring that the offer for NHS dentists was attractive.

 

23. A Member asked if the acuity data was available to Members. Senior Commissioning Manager Dental said that the increase in acuity had been evidenced by contract delivery.

 

24. The Chairman, in referring to item 5.12, page 53 of the report, and dentists preferring to work fewer days for the NHS queried the possibility of making contract changes to include a minimum number of days for NHS provision. The Director of Non Acute and Primary Care Contracts, Surrey Heartlands ICS explained that the national contracts limited any changes to incorporate a minimum number of NHS working days. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB added that in addition to exploring the extent to which services were commissioned locally within the national framework and pushing the boundaries of these, there were opportunities to feedback to the national contracts process and committed to consider a way of collecting these views. Action - Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB

 

25. The Chairman, in noting the previously mentioned workforce issues, asked if more could be done to promote dental nursing and related roles as desirable careers and asked if there were apprenticeships or on the job training available. The Senior Delegated Commissioning Transition Manager, Dental Contracts Surrey Heartlands ICS confirmed that conversations regarding the promotion of dental nursing as a career had begun with Health Education England and any support they could provide to sign off competencies as part of apprenticeship training. The Senior Delegated Commissioning Transition Manager, Dental Contracts Surrey Heartlands ICS added that there were also issues around pay not being comparable to the responsibilities of the role.

 

26. A Member asked if patient satisfaction data was collected and if so, what were the causes of any dissatisfaction. The Associate Director Primary Care Transformation, Lead Commissioner Dentistry Frimley ICB said that information about levels of satisfaction had been obtained from letters to MPs and complaints and confirmed there was evidence of significant levels of patient dissatisfaction around access to NHS dental services were evident, adding that it was clear that that the level of satisfaction remained high when patients were successful in accessing services.

 

27. A Member questioned if exit interviews took place for dentists leaving NHS contracts. The Senior Commissioning Manager Dental confirmed that dentists were asked their reasons for leaving with the most common issues cited being delivering a contract with greater patient needs and difficulties in appointing staff to fulfil the contract.

 

28. The Chairman in referencing item 5.13 and the loss of six contracts, queried their locations and what had been done to try and replace them. The Senior Commissioning Manager Dental confirmed a total of nine closures at Addlestone, Banstead, Caterham, Cranleigh, Dorking, Epson, Guildford, Horley and Woking. The Senior Commissioning Manager Dental explained that closures were happening nationally and a national action on contract flexibility was required. Temporary activity to mitigate these closures in the short term included approaching a neighbouring practice to take on extra patients followed by the service replacing the activity lost through a procurement programme.

 

29. A Member asked of it was becoming more costly to run dental practices and if so, would NHS contracts take this into account. The Senior Commissioning Manager Dental confirmed that it had become significantly more expensive and although phase one of the contract would help the situation, phase two was urgently required.

 

30. The Deputy Cabinet Member for Children and Families questioned why residents were not being made aware of the reasons for the issues being raised. Director of Commissioning and Assurance (SRO) Delegated Commissioning, Frimley ICB agreed in the need for partners to collectively explain to residents the issues and solutions regarding dental access.

 

31. A Member suggested the consideration of people from overseas to take roles within the dental profession. The Senior Commissioning Manager Dental confirmed that many practices were already routinely recruiting from overseas.

 

Recommendations:

 

Dentistry Leads at Surrey Heartlands & Frimley ICSs

 

1. To improve access to dental care for vulnerable individuals; including the homeless, deprived communities, Domestic Abuse Victims, those suffering ill Mental Health, and residents with Learning Disabilities and Autism.

 

2. To reduce existing and future backlogs in dental care.

 

3. To improve communications, vehicles for communications, and work better with partners, to ensure that residents are aware of dental services available to them.

 

4. To urgently campaign for improvements to NHS Dental Contracts to maximise potential for patient access and to retain and attract dentists to perform NHS treatments.

 

5. To identify and implement strategies to work with schools to improve dental health.

 

6. In order to understand supply vs demand for appointments, it is recommended that a log is created, at all entry points into the system, of individuals denied dental appointments at NHS registered practices; and for this information to be centrally collated.

 

Actions/ requests for further information:

 

1. Dentistry Leads at Surrey Heartlands & Frimley Integrated Care Systems to look into developing mobile solutions for the provision of dental services in geographical areas underprovided for.

 

2. Dentistry Leads at Surrey Heartlands & Frimley Integrated Care Systems to look into receiving Corporate donations for toothbrushes and toothpastes for deprived communities.

 

3. Dentistry Leads at Surrey Heartlands & Frimley Integrated Care Systems to provide further details on the support available for homeless individuals on an area by area basis.

 

4. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB, to feedback to the national contracts process and commit to consider a way of collecting these views.

 

 

5. The Senior Commissioning Manager-Dental to provide the monthly reported NHS contact centre data regarding contact made by residents unable to access dentistry, including the survey work being undertaken by partners in this area.

 

6. The Director of Commissioning and Assurance, SRO Delegated Commissioning, Frimley ICB, to follow up on the availability and provision of clear information regarding the complaints process, including collation and analysis of Issues Of Concern.

 

7. The Senior Commissioning Manager-Dental to follow up and update the committee on resident’s ability to find information regarding their nearest dentist, including the digitally excluded.