Agenda item

- Update and discussion on dental access for children and adults in Bristol.

- Dr Lou Farbus, Head of Stakeholder Engagement for NHS England South West and Melanie Smoker, Senior Dental Programme Manager for NHSE SW will present the enclosed briefing paper.

The Committee received and discussed a report providing an overview and update on dental access for adults and children in Bristol.

Summary of main points raised:

1. The report was presented by Melanie Smoker, Senior Dental Programme Manager for NHS England South West and Dr Lou Farbus, Head of Stakeholder Engagement for NHS England South West.

Key points highlighted in the presentation of the report included:

a. Over recent years, there had been a steady fall in the number of patients in Bristol able to access an NHS dentist. The percentage of adults seeing an NHS dentist in Bristol had decreased from 43.5% to 37.3% in the last 12 months (data available from June 2021 to June 2022). This was a drop of 6.2% although the access rate for the adult population of Bristol (37.3%) was in line with the access rate for England as a whole (37.4%).  The number of children who had seen a dentist in Bristol in the last 12 months (from June 2021 to June 2022) had though increased from 36.3% to 52%. This was an increase of 15.7% and was higher than the access rate for England which was 46.9%.

b. A key area of current work was an 18 month stabilisation programme for NHS dentistry; throughout the pandemic, there had been a focus on urgent dental care and demand for this had continued to increase.  There were a number of people with dental issues meaning they must repeatedly access urgent care, or who did not meet the access criteria, but were still in dental pain.  The stabilisation pathway was being taken forward as the solution to this issue.

c. The key issue affecting access to NHS dentistry on a national basis was workforce related. In Bristol, a shortage of dentists in Bristol impacted on the ability of practices to deliver their contracts. 

d. NHS England was engaged in a number of activities to increase access to primary NHS dental services, including:

- Running a South West recruitment day supported by the British Dental Association

and dental providers to try and attract practitioners to move into the region.

- Working with dental providers to ensure existing contracts were delivering to their

maximum potential.

- Reviewing under and over performance of dental contracts on a regular basis and addressing with those contractors with the most variance what they were doing to address under-performance.

- Developing plans to commission dental services in areas where there was inequality in

access.

e. As documented in the report, under the South West Dental Reform Programme (established in 2020), a series of specific actions were being taken forward to improve access to dental services, develop workforce initiatives to improve recruitment and retention of the dental workforce and improve the oral health of the population.

2. In response to points raised by Cllr Hathway, it was noted that on a national basis, changes were being made to the commissioning of dental work to secure increased Unit of Dental Activity rates from practices.  New reforms to the dental contract also meant that NHS dentists would be paid more for treating more complex cases.

In terms of workforce planning and recruitment, it was also important to improve capacity by training up and maximising the use of dental therapists and hygienists; dental therapists could also accept patients for certain NHS treatments, e.g. providing fillings and preventative care, which would free up dentists’ time to deal with more complex and urgent cases.

3. It was noted that a number of initiatives were being taken to try to increase the rate of retention of dentists in the region who were trained in the south west.

4. It was noted that NHS England had no jurisdiction over private dental practices.

5. In response to a question from Cllr Clark, it was noted that dental access for young children was considered to be important as a public health initiative as this could help lay the foundation for good oral health, e.g. providing guidance for parents on healthy foods for mouth and gums, and instilling the importance of good oral hygiene from a young age.

6. Whilst noting that it was not an issue within the control of NHS England, Cllr Francis expressed a general concern about the impact for the NHS resulting from dentists leaving the service for private practice.

7. It was noted that from 1 April 2023, the BNSSG ICB would be taking over the delegated responsibility for the commissioning of dental services.  David Jarrett advised that a key focus of the commissioning approach moving forwards would be to improve access to NHS dental services as part of the strategy and commitment to tackle health inequalities in the city, linking in and potentially integrating this work with the locality partnership approach.  In discussion, it was agreed that it would be appropriate for a progress update to be submitted to the committee in a year’s time.

At the conclusion, of the discussion, the Chair thanked Melanie Smoker, Lou Farbus and David Jarrett for attending for this item.

The Committee RESOLVED:

- To note the report and the above update and information.