Agenda item

Wavell Vere and Jenny Bowker gave a presentation on this item and made the following points:

·       The NHS Dentistry Service is now accountable for decision-making and budgets in dentistry involving the commissioning of work

·       Dentistry primary care, high street care, community care and secondary care are all delivered by our service

·       The local context for NHS Dentistry was explained to the Board

·       In common with the situation nationally, access to dentistry was a real challenge

·       National reforms were part of an attempt to ease these problems. Wherever possible local solutions were preferred by developing a local approach

·       The main focus of the presentation related to primary dental care which was significantly different to other care services. Dentists in this area operated as independent businesses, tendering for contracts and delivering both NHS and private dentistry

·       Whilst they provided their own staff and premises, there was some reimbursement for the latter

·       Dental contracts were procured on dental activity but there remained a huge variation in contracts which creates pressures on staff retention

·       The cost of living had created a huge impact on providers. The number of adults requiring the service was increasing and whilst it had dropped, this remained in line with the national average

·       In Bristol, there were 57 practices equating to approximately 235,000 patients which was just above 50% of adults

·       Orthodontic activity requires aesthetic appliances and operated on a national basis so did not allow for much variation.

·       Mandatory care provided cover for patients that participated with 64 patients a week being seen within Bristol. The contract had been extended to March 2024 and it was hoped to extend by a further 36 months to assist with retention of staff to provide a pathway to stabilise oral health

·       Access to 111 enabled an urgent provider for temporary treatment (such as fillings) and then further requisite treatment. 8 practices operated to provide stabilisation treatment with approximately 3.5 hours per session. On average there were about 6 patients per session. Further work was required to address regional concerns and take into account regional priorities

In response to Board Members’ questions, they made the following points:

·       People were sometimes not accessing dental care due to the difficulty in accessing it. There was a need to prioritise what is available for local communities as NHS Dentistry was not being provided

·       St Paul’s surgery has closed by the end of June 2023. Whilst the service had attempted to offer out other activity to dentists to keep it open, there had been some uptake but not enough. The service had received offers from the local Community Action Group and Housing Association in relation to this

·       The service would use and emergency procurement arrangement for the St Pauls Replacement Surgery Service.

·       BUPA was advised that they could not continue. NHS dentistry was no longer competitive in the market as opposed to private dentistry

·       Private and High Street Dentistry were the first dental services to re-appear after the pandemic. Whilst the service was trying to make the delivery of contracts feasible, these were not long-term solutions and a larger reform programme was required

·       It was acknowledged that a national approach was required. It was noted that health visitors cannot get treatment for certain groups such as refugees. There were strong campaigns locally but no delivery from successive governments

·       It was also noted that some people were having to provide their own dental care, including pulling out their own teeth. Local people were taking toothbrushes to school. Whilst there was anew provider for Southmead, this was a very bad state of affairs in the long term. Toothbrush procurement for children was being organised to assist the situation. There was also an attempt to understand national priorities. In the meantime, the profession was lobbying very hard for reform via the Dental Association

·        There was a long process to register a dentist

·       In September 2023, there was a planned HWBB Development Session on dentistry

ACTION:

(1)  Lobby Central Government for a more effective NHS Dental Service and continuing work on local schemes such as the one operating in Southmead

(2)  In the meantime, NHS Dental Services to work with Locality Partnerships to consider ways to improve dental services throughout communities in the region

(3) Provide an updated version of the map of NHS Dental Services on the Live Link

NHS Dental Services – Wavell Vere and Jenny Bowker