4
The Chairman reminded the meeting that, in response
to the apparent concerns of many residents, the Committee agreed Councillor
Gooch’s Scoping Form in July 2021 to review the current
situation and challenges with regards to the access of National Health
Service (NHS) dental provision across the district. He
explained that a number of relevant people had been invited to speak,
each of whom had a
different perspective and hopefully this would give Members different
evidence and assessments. He stressed that the issue was not within the
Council’s remit so any gathered evidence and suggested actions would
be reported to the Suffolk Health Scrutiny Committee by East Suffolk
Council’s nominated representative Councillor Back. The
Chairman went on to explain the format for the meeting and introduced the
invited guest speakers.
Councillor Deacon stated that he was
pleased the Committee had the opportunity to scrutinise this appalling
situation where many constituents were not able to access a dentist. He
thanked all the guest speakers for agreeing to attend and clarified that this
review had not been informed or prompted by any pressure groups as the issue
had been informally discussed at the June Committee meeting and the Committee had
then formally agreed to conduct the review at the July meeting.
The Chairman invited each guest to
speak in turn as follows:
1.
Jason Stokes - Norfolk Local Dental Committee
Mr Stokes explained that he was the Secretary
of the Norfolk Local Dental Committee (LDC) and had worked in a primary high
street dental care for nearly 30 years and all that time had been an NHS performer. He continued that his role as LDC Secretary
meant he interacted with a wide range of primary care dentists, the majority of
whom were based in Norfolk.
Mr Stokes explained that the suspension
of routine care due to the pandemic restrictions meant that, across England,
30m appointments had been lost for dental patients, in Suffolk that amounted to
half a million courses of treatment or interactions of patients with their
dentists but it was clear that NHS dentistry was in crisis long before Covid. Recruitment and retention problems were
endemic and it was not unusual for practices in the region to have vacancies
for over two years. These problems had
caused some practices to hand back NHS contracts or close completely.
The Committee was informed that the NHS
national contract had a very negative impact on delivery of care across the region,
pushing talent out of the NHS and, in some cases, out of dentistry all together. The current NHS national contract came in to place
in 2006 and since then the dental profession no longer had the ability to set
up dental services in response to local need.
Before 2006, any dentist could set up an NHS practice where there was
need or perceived need and a business case could be made for viability of the
practice to whoever was going to loan them the finance. The funding would then be based on the level
of NHS dental work completed at the site.
Since 2006, however, the NHS itself directly controlled the placement
and size of dental contracts. Commissioning
of NHS dental contracts did not directly involve the dental profession. The amount of money spent on NHS dental
provision and the location of those services was a commissioning choice made
currently by NHS England. NHS England had
the option to conduct needs assessments to determine the areas of most dental
need. These assessments were not
regularly conducted. NHS dental funds
were not ringfenced so they could choose to spend more or less money depending
on the overall health needs of the population.
Mr Stokes reported that in all areas, in
every year, some NHS dental practices underperformed to the contracts they had,
usually completely unrelated to the demand for dental services in the area.
This underperformance related to several factors. Modern dental techniques and legal
requirements made it increasingly difficult to provide the same amount of
dentistry in the same amount of time.
This had not been reflected in any changes in the historic targets
associated with NHS contracts. Another
major factor related to underperformance was a practice’s inability to recruit
which was particularly difficult in coastal and rural areas such as Norfolk and
Suffolk. The money that would have been
spent on the delivery of services that went undelivered by these practices was
returned to NHS England in a process called clawback and they could then choose
to spend it elsewhere. East Anglia had seen
some extremely high levels of clawback in recent years. In 2019/20, almost £11.5m was returned by
dental practices to NHS England which was 9% of the total value of NHS dental
commissioning in the area, that was almost double the average clawback rate
across England. Practices currently able
to deliver more care could take up the slack in this situation but this required
NHS England to redirect the funding during the financial year. NHS dental practices were not able to overperform
significantly no matter what level of local shortages there were, without the express
permission of NHS England and if a practice had extra capacity to treat
patients and NHS England could not or would not agree to use the clawback monies
then practices could only provide extra care to patients privately.
Members noted that, over time, many
practices had found it increasingly difficult to meet their NHS targets. Initial targets were set in 2006 and since
then contracts had generally failed to keep pace with inflation and population growth
and some practices had had a permanent reduction in their NHS contract called
rebasing as they could not consistently hit the original targets set for them. Other practices had withdrawn from providing NHS
activity completely. The money released
by these changes to NHS contracts meant there was less commissioned dental
activity being delivered to patients but the money could be redirected to
patient care if NHS England wished to use the money in that way. In East Anglia, the commissioning of new
dental activity using money from clawback in the short term or rebasing money in
the long term, or even new money provided for the purpose, could occur but it was
not common. In the last few months,
however, the process for procuring seven new lots of dental services for the
Eastern Region had started with the aim of these extra services being available
to patients in early summer 2022. Any
new commissioned NHS activity had to be welcomed but the quality of the
procurement process would inevitably impact on the quality of the service commissioned
and delivered to patients. Mr Stokes
expressed concern that the current process for commissioning was flawed because
the contracts being offered were only for an initial period of four years and
nine months with the possible extension
of a further three years, but he felt that offering contracts of less than eight
years made it either unattractive or impossible for practices to finance over
the short timescale and patients might be surprised that they would only be in
existence for a relatively short time. The procurement asked that contractors deliver
services from 8am-8pm 365 days per year but whilst sounding like a boon for
patients this was an irrelevancy because it was impossible to deliver that type
of care in almost all practices.
Insisting on this level of provision would make recruiting and retaining
staff difficult and possibly impossible.
Mr Stokes stated that in relation to reducing
problems for patients, commissioners need to be encouraged to reinvest any
clawback monies direct into the NHS budget.
In Greater Manchester commissioners had been creative with allocating
funds for emergency care and producing a different type of contract through
flexible commissioning. He added that it
needed to be made clear to the Secretary of State for Health and Social Care
that the current contract was not fit for purpose, as discussed in Parliament the
previous evening, and if we continued down this line then these problems would only
escalate and even when we got past the acute problems of Covid and recruiting staff
from outside the country, the changes in place since 2006 would only develop
further.
The Chairman thanked Mr Stokes and
asked Members if they had any questions.
Councillor Goldson asked for
confirmation that if the units of activity were not reached, money would be taken
back but could be given to another dental practice that needed the extra
work. Mr Stokes confirmed that monies would
automatically be taken back by NHS England but then NHS England had to make the
decision to reallocate those resources to other practices. Cllr Goldson also asked if patients were
registered and if units of activity were based on what was required, how many dentists
undertook root canal treatments. Mr
Stokes explained that, under the 2006 dental contract, patients were not
registered with an NHS dental practice so did not have an ongoing contractual relationship
with the practice as far as the NHS was concerned. He added that, once a course of treatment had
been completed, the practice did not have a long-term relationship with the
patient, although most dentists would strive to develop and maintain a long-term
relationship even though there was no contractual obligation to do so under the
current NHS contract. In relation to
root canal treatments, he confirmed that it was an NHS band 2 course of
treatment but he was not aware of any practices that failed to deliver that
care, although there was a level of complexity for this particular treatment
and he suggested it might be that some practitioners were unable to deliver the
complexity of care that some patients required.
He added that there were moves to develop a wider range of services
called Level 2 provision where NHS dental practitioners with enhanced skills
could provide more complex treatment to patients but it was a process that was
within its early stages.
Councillor Goldson
clarified that he was aware of dentists that declined to undertake certain
treatments under the NHS but would do them privately. Mr Stokes responded that he was not aware
that this happened but if it did then it should be flagged with NHS England, especially
if the dentist said they had the skills to do it as he could not see how they
could then make a case for not doing it under their NHS contract unless they
had used up all their units of activity which could happen towards the end of
the year, although this reset itself in the new financial year.
Councillor Robinson queried if the shortness
and looseness of the contract affected investment for the long-term commitment
to invest in the area. Mr Stokes
responded that most dental practices had a General Dental Services Contract
which was open ended and as long as they met the contract provisions eg the
delivery of Units of Dental Activity (UDAs), they kept their contract in
perpetuity, but this was increasingly difficult. He added that the contract was actually very complex
rather than loose and stipulated an enormous number of requirements for NHS
dentists. The complexity of the contract
was often noted by practitioners leaving the NHS. In relation to patient registration, he
explained that not including this in the contract had been a deliberate decision
by the Government at the time and had not been changed since.
Councillor Topping queried if she had
not been a registered patient since 2006 and this was confirmed by Mr
Stokes. He added that there had not been
a contractual obligation for practices to see a patient since 2006 and he reiterated
that this was a Government decision. He
stressed, however, that most practices tried to maintain a relationship, but
this was not supported by the contract.
Councillor Topping stated that she had noticed her practice no longer
did a clean at the same time as her check-up appointment. Mr Stokes responded that this could be due to
Covid restrictions and was a decision for each individual practice as to how
and when to provide care in the most appropriate way.
Councillor Hedgley asked for further
clarification in relation to the difficulty of recruiting dentists. Mr Stokes stated that, whilst his practice
had not had to recruit for years, he was aware that other practices were
finding if very difficult to recruit dentists and further auxiliary staff. He added that when dentists were first
qualified they tended to remain close to the site where they obtained their
qualification and this region did not have a dental hospital nearby. Also, rural areas did not tend to attract or
retain dentists, especially younger ones.
Councillor Gooch queried if clawback
was happening systemically, especially across more than one year, if Mr Stokes
felt NHS England was not doing enough analysis of the issues as to why this
region was almost permanently in this clawback position. Mr Stokes responded that there could be short
term factors such as staff being ill, maternity/paternity leave etc that led practices
to struggle for a single year to hit their targets and undergo clawback. He explained that if they underwent clawback
for more than two years then they could rebase their contract to a lower
level. He added that he understood it
was difficult for NHS England because of the variable amount of clawback money
they had and it was difficult to change contracts quickly but when a contract
was rebased there was no reason to not re-use this money and he suggested that
the NHS representative later in the meeting might be able to provide some data
on this. Councillor Gooch asked how long
a contract would need to be to be attractive.
Mr Stokes responded that the issue with having short term contracts were
that it was either cash rich businesses or practices that were part of a corporate
provider that tended to be attracted to them.
He added that some of the practices that had left the region at
relatively short notice were those run by corporate providers and if the
business did not work they could be quite cut throat and simply withdraw. If a local dentist went to a bank for a long
term loan they would be keen to stay in the area so the shorter the procurement
timescale the more likelihood there was that it would be corporate providers
that were attracted to them rather than local dentists with a long term history
in the area. He was aware that corporate
providers had recently closed a number of practices in the region due to
problems with recruitment.
2. Paul Rolfe - Suffolk Local Dental
Committee
Mr Rolfe stated that he had been a
dentist in Ipswich for 22 years with a four surgery practice and that during most
of that time they had taken on NHS patients.
He added that he had been the Secretary of the Suffolk LDC for 18 years
and had a close relationship with other practitioners in Ipswich and the wider
Suffolk region.
The Committee was informed that, it
had been accepted for many years, the NHS dental contract was not fit for
purpose. Mr Rolfe stated that, over the
years, successive Governments had piloted various options for changing NHS
dentistry, and although these pilot options had come up with some very useful working
practices that would make dentists’ lives more easy and patients would be
helped along their care pathway, the changes would take twice as long at least and
would double the NHS dental budget, which he did not feel any Government would
agree to, so it was unlikely to ever get signed off. The current contract was very restrictive given
it was not possible to know what a dentist was facing until they had seen the
patient. The process for gaining UDAs
was points based eg 1 UDA point for a check-up, clean or x-ray; 3 points for 1
or any number of fillings, root canal treatments etc; and 12 units for
laboratory work including dentures and crowns etc and again it did not matter
how many crowns. He stressed, therefore,
that it was a risk ridden business model that was not attractive for many practices. It was also very difficult to understand why
some practices suffered from clawback because some of those practices might be
seeing high need patients so they might be providing a different type of work
for patients that did not tick over as many UDAs eg seeing more patients and
doing more work on them but that would not translate to more points. He added that, for a practice which had a
more stable patient list, it was easier to achieve the targets but it was a lot
harder for a practice with many very high needs patients. He stated that adding in staffing issues, made
it even harder to achieve the targets.
Mr Rolfe explained that 31 March was the
cut off day so if a practice hit 96% on 31 March the target would not be met
and it did not matter if there had been an issue recruiting staff etc there was
no scope to extend that timeframe. If the
NHS was minded to provide extra money in practices, the difficulty was often
that, by the time the decision was made that extra funding was available, it
was probably December and practices only had three months left which was their
busiest time of the year anyway as they were chasing their targets.
In relation to recruitment, which Mr Rolfe felt was the biggest issue, he pointed out that the East of England was about
the equivalent size of Wales with twice the population, but they had a dental
school and this region did not. He
explained that the difficulty with dentistry was that people tended to either
work where they qualified or where they were from and unfortunately there were
not many people from the East of England going to dental school because they
had to travel a long way and as a result there were not many people trained
from the region who were likely to want to come back. He added that previously a trainee dentist
could choose where they wanted to apply to spend their first year of vocational
training and they would get a job where they wanted to work. Now it was a national recruitment process and
dentists were sent to a location depending on where they were ranked from 1 to
however many had qualified that year, so there was no longer a pathway through
which vocational trainees, who might have previously chosen to come to Suffolk because
it was only an hour and a half from London, could decide where they wanted to
work and then they might have stayed. He
added that this change meant it was now much harder to recruit to this region.
Mr Rolfe explained that it was also
difficult for a foreign trained dentist who might live in the area to get on
the NHS Performer List eg he was aware of a trained dentist from New Zealand who
was looking to work in a private practice because even though she was
registered with the General Dental Council, she could not work at an NHS
dentist because she could not get on the Performer List.
The Chairman thanked Mr Rolfe and
asked Members if they had any questions.
Councillor Deacon asked if there were
any mobile dentist surgeries. Mr Rolfe
responded that there had been one previously but that he did not think they
would meet current CDC requirements so, although they did exist and had been used
in rural Wales in the past, it was not really a solution because there was now
a lot of add on requirements that had arrived in dentistry since 2006 for
example sterilisation now had to take place in a separate room. In relation to his statement that contracts were
not fit for purpose, Mr Rolfe confirmed that he had said this, adding that it had
also been stated in Parliament by politicians from both sides. Councillor Deacon queried if there was a
quick fix. Mr Rolfe stated that if the
money was doubled to fund the whole NHS so they could see half as many people again
then yes but he then pointed out that there would need to be four times the
number of dentists to see the whole population because currently only 50% of
people went to a dentist. He clarified
that the whole population only got 50% of funding it would need if everyone was
going to see a dentist and if the NHS wanted to do dentistry how the pilots had
shown dentistry could be done, it would need twice as much money. He stated that another difficulty was that it
took so long to train a dentist – five years training and one year vocational, so
although more dentists would come on stream 6/7 years down the line more
dentists were needed now. He added that
prior to Brexit dentists had come from the EU, prior to that they had come from
New Zealand, Australia and South Africa, but Britain had never trained enough
dentists for its own needs.
Councillor Beavan asked if Brexit had
affected the number of dentists and was there a problem with EU nationals working
in dental practices. Mr Rolfe confirmed
that it had affected things, he stated that he had lost three of his associates
at the same time because of the Brexit vote and they had worked for him for
about 11 years and it had taken about 2½ years to recruit them. He explained that prior to that, he had never
been short of applicants as long as EU dentists could apply and prior to that
the only hope was to go through the vocational training scheme and get young
dentists to work at the practice straight from University but it had become
apparent that they needed that training to be competent in carrying out
treatment.
Councillor Goldson stated that,
despite what had been said already about patients not being registered, it was
clear on several practices’ websites he had viewed that they had a register. He pointed out that if a dentist saw an NHS
patient needing Band 2 root canal treatment for example it was £65.20 but
privately it would cost about £700 and he queried if there was a simple answer
by saying dentists needed more money. Mr
Rolfe stated that it was not about increasing pay but was about increasing what
dentists needed to do to achieve their targets.
Councillor Goldson stated that if a dentist said they could not do work under
the NHS but could do privately and the NHS fee was increased it would be more
lucrative for practices to carry out more NHS work rather than private. Mr Rolfe stated that the difficulty was not
the fee per three UDAs but was that the three UDAs could be six root
fillings. He added that prior to 2006 it
used to be a fee per item and everyone understood that whereas now it was a fee
for an unlimited number of whatever items it was. Councillor Goldson agreed but suggested if
the contract was written in such a way that the money per unit was per
activity, dentists would be able to do more NHS work than private because the
fee would be the same.
Councillor Gooch queried how the
destinations for posting for vocational training worked. Mr Rolfe responded that it followed a similar
pattern to junior doctors, in that they had an interview, they were ranked one
to 500 say and the person who ranked number one got their first choice of where
they wanted to work and number 500 got their last choice. The training practices were also ranked one
to 500 and were approved year on year.
Councillor Topping asked what the
barriers were for joining the Performer List.
Mr Rolfe stated that foreign trained dentists had to jump through lots
of hoops to be able to undertake NHS dental work. He explained that to work in this country a
dentist had to be registered with the General Dental Council but then to work
for the NHS a dentist had to be on the Performer List which meant there was a
whole raft of paperwork eg records of experience, vaccinations etc including an
application process which was considered by a panel. A dentist could be included on the List with
limitations which meant that they could only work at a particular type of
practice, or they would have to do Performer List Validation by Experience which
meant they had to find a practice to work in with a mentor to help them
transition through the differences of working in general practice somewhere
else in the world to working here under the NHS. It was hard to find such
dentists who would provide that mentoring as there were no lists and it was not
the most efficient application process partly as the process only happened twice
per year.
3. Tom Norfolk - Dental Practitioner,
Joint Chairman of the Local Dental Network (East of England), Local Dental
Clinical Adviser (NHS England),Executive Member of the National Association of
Dental Advisers
Mr Norfolk explained that he was a
general dental practitioner who worked in the NHS some of the time but less so currently
as he also worked for NHS England advising, supporting and guiding them in the
process as a clinician. He confirmed
that workforce was a big issue and morale and retention and recruitment had
been made worse by Covid, particularly because this part of the region was very
reliant on an overseas workforce and a lot of European dentists had returned
home when Covid happened and had not returned.
In terms of solutions, the Committee
was informed that the national contract was not fit for purpose and Mr Norfolk
pointed out that the previous Minister had said this publicly and various other
politicians had said so for some time. He
suggested that the solution was to look at a combination of changing the
contract to make it more attractive, which local commissioners had the ability
to do to some degree, and also, when changing it, to use the wider dental
workforce.
Members were reminded that they had
already heard about the limitations of recruiting dentists to work in this
region who were able to work on the Performer List, so one solution for example
was to use dental nurses who were skilled.
Mr Norfolk explained that there would be a skills escalator from the
most junior dental nurse to the most senior consultant. At the moment, NHS dentistry was very reliant
on dentists on the Performer List but there were many skills and treatments
that the wider dental workforce could do.
For example, a dental nurse with extended duties could provide oral
hygiene instruction and prevention because most of the diseases such as dental
decay and gum disease were preventable eg decay was caused by large quantities of
refined sugar and gum disease was largely caused by inadequate oral hygiene,
and for the vast majority of patients this was preventable. He suggested, therefore, that there was a need
to have a big push on prevention, including to children many of whom had
decayed teeth by the age of three. He
pointed out that they were not born that way but had decayed teeth because of
their diet so prevention was key and the wider dental workforce could be used
to help address this. Similarly, gum
disease could be treated by the wider dental workforce eg hygienists had two
years additional training from a dental nurse, and therapists had three years
training from a dental nurse. Therapists
could do the basic types of dentistry that a dentist could such as examinations,
x-rays, simple fillings and extractions etc.
They could not do root fillings, dentures, crowns etc but could do a
fair amount of work that a dentist could, so he reiterated the need to widen the
dental workforce.
Mr Norfolk referred to the Dental
Strategy which had recently been written and it was noted that this was the
first in the country and could be used as a guide for the national document. The Strategy included a variety of Programmes
such as Programme 1A which looked at urgent access eg taking a General Dental Services
(GDS) contract and substituting 10% of the units of activity and prioritising
them towards urgent care, so patients who had not been to that practice before
and were not known to that practice could attend. Programme 1B looked at prevention and
stabilisation using the wider dental workforce and this might be another 5-10%
of the contract. Mr Norfolk stated that
these Programmes would start to address the need for increased access and look
at inequalities and prevention. Part of
the Strategy was also about linking with wider medical colleagues eg GPs, nurses,
pharmacists etc because poor general health was linked to poor dental
health. In addition, a variety of
programmes were being piloted to look at supporting care homes.
In relation to recruitment and
retention, Mr Norfolk explained that this region had the first dental academy
in the country which had recently begun and the academy would start to provide training
for a variety of skills sets. He added
that, whilst at the moment, the academy would not be able to train dentists because
of the structure, the academy could train a variety of skills to attract
dentists here and keep them, and also train the wider dental workforce. He clarified that it would be similar to how GP
surgeries worked in that patients did not always see a GP but could see a
nurse, clinical pharmacist etc so the aim was to have the same in dentistry and
move away from a reliance on dentists.
Mr Norfolk stated that there were urgent
dental centres across the country and this region had been the first to set
them up when Covid hit. He added that there
were still about 50 active centres across the region which would probably morph
into Programme 1A to see urgent patients.
He also explained that, due to Covid, throughput was restricted at the moment
to about 60-65% because of the generation of aerosols and social distancing, so
dentists were working at a slower throughput.
The Chairman thanked Mr Norfolk and
asked Members if they had any questions.
Councillor Deacon referred to British
Dental Association statistics that nearly half of dentists planned to stop NHS
services or reduce their NHS commitment, and over a quarter planned to move to
private practice. He queried if the NHS contracts
were improved would this position be reversed.
Mr Norfolk stated that he did not know about the accuracy of the
statistics but he felt a lot of young dentists wanted to do more and expand
their skills. He added that the Strategy
allowed dentists to do more than they were originally trained to do. He explained that one of the problems for
young dentists was that there was a pressure to de-skill very rapidly but the
Strategy included the upskilling programme and linking that with the Dental
Academy for example had allowed us to bring the world renowned Eastman Dental
Institute (EDI) from London into East Anglia, so there were programmes for
dentists to attract them to do more complex skills within the NHS. As part of the Strategy, dentists would also
be paid more eg Programme 1A paid them more than what they were currently paid
for what they were doing, so they were not financially disadvantaged. The Strategy also sought to make the work
more interesting and provide a link to the wider medical workforce. Mr Norfolk suggested, therefore, that there
was an opportunity to make NHS dentistry more interesting and attractive whilst
working within the limitations of the national contract because it was unlikely
that would be substantially changed. He
added that he did not expect it to be a simple journey but the aim was to make it
more attractive for dentists. He reported that 15 dentists were currently undergoing
an enhanced skills programme with the EDI to train them up and go through a
Level 2 accreditation so they would be able to practice their enhanced skills
on NHS patients in this region.
In response to Councillor Goldson’s
question about what two things he would change in the contract, Mr Norfolk
stated that the first would be, as mentioned earlier, to remove the not knowing
which caused fear for dentists, as they did not know if a patient required one
filling or 20. The second would be
giving greater flexibility to local NHS commissioners to move around money and
spend it differently. He added that the
national team excerpted a lot of authority and some areas were more
disadvantaged by having a national contract which was probably too orientated
towards cities. Councillor Goldson
queried if the extended training for normal dental surgeons who would not be
able to do impacted wisdom teeth for example, would be taken more locally than
referring them to a hospital. Mr Norfolk
stated that we were the first part of the country to develop Level 2
accreditation and this meant that they would take a normal general dentist, see
if they had the enhanced skills, encourage them and accredit them to do that
work in their practices. Some had
already worked in hospitals and others were young dentists who did not want to
specialise in hospital-based work but they wanted to work part time in general dental
practice because they liked the variety and part time doing things like
impacted wisdom teeth. Dentists were provided
with education, mentoring, showing them the standard, get them the training and
supervision, everything they needed.
They then had to show they could do it because it was a merit programme and
if they were accredited this allowed them to do the extra skills, and get remunerated
for them, within their practice. Mr
Norfolk concluded that this approach had now been developed to an advanced
level and now included gum and root treatments and it was planned to build that
out to develop the wider workforce.
Councillor Gooch queried firstly if
people knew about the emergency help available through community pharmacies,
where the new dental academy was and why was there more NHS capacity in
Essex. Mr Norfolk stated that
pharmacists had helped to supply temporary kits during Covid and signposted
patients when access to dentists was very difficult. He explained that the new academy was
currently virtual, adding that digital dentistry was already here. He reminded Members of his earlier comment that
one of the senior consultants from the Eastman Dental Institute was videoing
and coming up to this region and eventually, rather than a big hospital, most
skills would probably be developed in practices because that was where the
patients were. He referred to the new
guidance document from NHS England Advanced Dental Care which talked about
doing the training where it was needed especially in the rural areas. He pointed out that a lot of students said
the best training they had was when they were out in practice. He stated that this region was the first in
the country to have a dental academy but was not sure if it would have a
physical home. In relation to Essex, he
explained that the distance from London was probably a factor that put dentists
off from coming to this area but they were more likely to commute to
Essex. He added that there was a need to
get dentists to settle here and recruitment and retention was a lot worse the
further north you got and coastal areas were more problematic, although this
appeared to be far less of an issue in Essex.
4. Alex Stewart - CEO, Healthwatch
Norfolk
Mr Stewart stated that, even before
the pandemic, it was apparent that NHS dentistry provision in Norfolk was in
crisis. In October 2020, Healthwatch
Norfolk published a report collating the experience of residents relating to access
to emergency and non-emergency NHS dental care in Norfolk. The report highlighted the signposting
queries received since about January 2020 and detailed some reviews of
practices collected by their Engagement Team and other investigations into
accessing dentistry for patients that had never historically tried to join any
practice or received any treatment.
Healthwatch had raised concerns with
NHS England and Norfolk Health Scrutiny Committee as well as making frequent
briefings to the press. Mr Stewart
explained that the worse thing was public dissatisfaction and the perceived
gulf in provision of NHS dental care which was still palpable. He commented that, throughout the pandemic, the
issue had increasingly become a focus for national media outlets. In December 2020, HealthWatch England had released
a report detailing the experience of some 1300 people in relation to NHS
dentistry and the report found that seven in 10 people, approximately 73%, found
it difficult to access support when they needed it, compared to one in 10 that
could access other forms of care fairly easily. It was also found that even
those who were already registered with a practice or were aligned to a practice
were struggling to book routine or emergency appointments.
Mr Stewart stated that he had sympathy
with dentists but Healthwatch’s fear was that the industry was still facing
critical capacity issues. Many people had
spent extended periods on waiting lists and were not able to access dentists,
and dentists were not able to take on new NHS patients. Healthwatch were worried that vulnerable
people were missing out on treatment, especially those with learning
difficulties, autistic, or people in care homes. He stated that few practices had waiting
lists and people were frustrated about the situation.
Mr Stewart suggested that the nuances
from central Government had caused problems as they were signposting people to
Healthwatch to find a dentist and people did not understand the problem of virality
and people accessing services easily, or at least the possible barriers. He
confirmed that patients were being forced to go private and he commented that some
dentists did not keep their websites up to date, or they advertised that they
accepted NHS patients but, when contacted, people were told the lists were
closed. He stressed that, whilst the pandemic
had further restricted access to dental appointments, this was an ongoing
problem. He referred Members to some of
the solutions they had heard tonight to address the situation but suggested
there was also a need to explain to the public what the issues were and that
there was not a quick fix solution.
The Chairman thanked Mr Stewart and
asked Members if they had any questions.
Councillor Gooch asked what could be
done to improve communications with patients and possible patients, especially
about the registration process and duty of care. Mr Stewart responded that he felt there
should be a comprehensive media campaign to explain the registration process as
Healthwatch received many queries from people saying they had been de-registered
and dentists should keep their websites up to date as that would help.
Councillor Beavan asked if there were
any statistics on the number of children not going for routine preventative
care and Mr Stewart stated that he had no figures to hand but having spoken to
the Director of Public Health for Norfolk recently she had not been overly
concerned that children were being neglected.
Councillor Goldson asked if
Healthwatch included people with special needs when they surveyed patients eg
with dyslexia, mental health or physical disabilities etc. Mr Stewart confirmed that, during the pandemic,
they had changed their ways of working by using social media to access specific
communities of interest. All surveys were automatically translated to easy read
so people with learning difficulties could understand what they were being asked
and use was also made of reading newspapers for the blind and local deaf
organisations to hold specific focus groups for people unable to hear. Healthwatch also sought out asylum seekers
and people with mental health problems and staff would go into the acute and
Community Trusts and leave surveys or make use of any newsletters to include
hyperlinks to any surveys Healthwatch were running. Councillor Goldson also asked if it was fair
that a dentist seeing a patient with special needs, who might require more time,
would only get one unit of activity even though they might take up three
patients’ time. Mr Stewart confirmed
that he was sympathetic to the dentists as the contract was unfair on this and he
commented that people should not have to work for nothing.
Councillor Robinson commented that
dentists seemed to have changed their habits because previously if someone needed
more than one filling they would have them all done at the same time but now it
seemed only one was done and another appointment was made, and he queried if
this was a way of playing the points system.
Mr Stewart commented that he was not sure and would defer to the
dentists as he was not a practitioner.
5. Kerry Overton - Community
Development Officer, Healthwatch Suffolk
Ms Overton stated that it was helpful
for Healthwatch Suffolk to know what the challenges were for dental professionals
because they prided themselves on seeing the big picture not just hearing
things that were affecting individuals in a singular form. This approach had helped Healthwatch on signposting
which is where a lot of the evidence in the briefing report previously
circulated to Members came from. She
added that Healthwatch had also changed the way they worked in the last year
and now took a lot more phone calls, the majority of which, particularly in the
early part of the year, had been dental related. She explained that not every conversation had
been recorded but at least 222 people had called about access to dentistry,
partly down to people googling them and another reason was that NHS England had
kindly put on their website that people could contact Healthwatch to access a
dentist! This had put Healthwatch in a very
difficult position but with the information they had, they could inform people
of the situation, so whilst people did not get what they wanted, once they knew
the situation, they felt slightly differently about things. She suggested that communication was key
about many of the themes identified – over 200 people had said they had been de-registered
and she pointed out that the term was being used by clinicians too, so patients
were expecting just the same as they had with their GP practice, that they could
access a service who they considered themselves to be registered with, so better
communication, using the right terms, would be extremely helpful particularly about
registration and how dental services actually operated.
The Committee noted that where
patients had been able to access treatment, either by finding it themselves or by
calling 111, they were then told to get another dentist to carry on with the
treatment, which led them to think they had to go private and a lot of people
had said they were very worried about that especially as some practices had
said they could not do work under the NHS but could do privately and the briefing
report gave details of what some people had been quoted ranging from £400-£4K
for treatment. Another issue that had
not been spoken about was the impact on other parts of people’s health because
if someone had a problem with their mouth they were more likely to be self-conscious,
not want to go out, became isolated and it could affect their mental health which
had a knock-on effect. She added that Healthwatch was very aware of the need
for prevention.
Ms Overton stated that another issue
was how the contract for community dental was now commissioned because access to
it had changed and people now needed to be referred by a general dental
practitioner. She explained that people who
generally used community dental were those with disabilities who were averse to
going to a normal practice. She added
that community dental gave much more time to people which could not happen in a
general practice. She referred to an
example in the briefing report of a lady with a daughter in a wheelchair who
could not find a general practice that had wheelchair access.
The Chairman thanked Ms Overton for
her attendance and the briefing report circulated before the meeting and asked
Members if they had any questions.
Councillor Deacon referred to the 222
cases over the months from January to October and commented that on top of that
were the calls NHS111 had received and he suggested, therefore, that this was just
the tip of iceberg. Ms Overton agreed,
explaining that the figure did not take account of community meetings where
similar feedback was coming through, plus some calls would have been missed off
the system when they had so many coming through. She concluded that Healthwatch knew this was a
very big issue.
Councillor Goldson asked if
Healthwatch had a profile of patients who had been de-registered by age or
ethnicity etc. Ms Overton stated that
the organisation did not take down personal information under GDPR from calls but
if they were doing a specific project they would. She added that if people had been accessing community
dental, then Healthwatch were aware they likely had some issues. Similarly, the information in the briefing
report was from across the whole of Suffolk as Healthwatch did not take down a
postcode so could not provide data just on East Suffolk.
In response to Councillor Gooch’s
query, Ms Overton explained that this particular report had been collated for
the benefit of Healthwatch’s CEO who attended the Health Scrutiny Committee and
other meetings. She added that the
details might also be used for their Comms Team and published elsewhere but at
this stage she was unsure exactly who would receive it. Councillor Gooch queried if Healthwatch was
asked by NHS England to feedback annually about patient concerns and
experiences given it was very harrowing reading. Ms Overton responded that the CEO talked with
NHS England regularly but she would take the comment back and discuss where
else the information could be shared.
Councillor Beavan queried if access
for children and families was worse this year or if it had always been like
that. Ms Overton responded that, previous
to the pandemic, she was not aware of getting as many calls around dental so
she suggested the pandemic had thrown that into the spotlight more due to the
various restrictions dental practices had to work under and the figure had
increased due to the access limit. She
concluded that Healthwatch would continue to monitor this.
6. David Barter - Head of
Commissioning NHS England (East of England)
Mr Barter confirmed that he regularly
met Healthwatch colleagues with fortnightly meetings during the early days of
the pandemic. He added that he found
these meetings informative and hopefully passed information both ways.
The Committee was remined that the process
of restoring dentistry and dental access was ongoing because on 24 March 2020,
effectively high street dentistry ceased for a couple of months due to the
dangers of Covid. Mr Barter stated that,
following the announcement on 8 June that practices could see patients face to
face again, we were the first region in the country to successfully set up a
network of urgent dental centres to deal with the most urgent patients. Even from 8 June onwards, it was acknowledged
that, because of the fallow time, the need to let the aerosols settle before
the cleaning of the dental suite and the next patient coming in, this had dramatically
reduced the throughput of patients, and also the need to follow Infection Control
Protocol (ICP), meant dentists who would have seen 20-35 patients per day were
limited to seeing 4-6 per day. Dentists had,
therefore, been allowed to deliver as a minimum 20% of their throughput and that
stayed in place until the end of the year and then, in the first quarter of
this year, it was raised to 45%, then raised again to 60% and was currently at 65%. Mr Barter stressed that, over the last year, access
to dentistry had drastically reduced and was only now just over half what it
would have been in a normal year.
Mr Barter explained that the Dental Strategy
sought to increase access for patients, reduce health inequalities and improve the
oral health of the population through the ability this region had to flex the
national contract. Programme 1A of the
Strategy was to invite practices, to provide urgent sessions of treatment where
they could see patients with high oral needs eg those that presented with pain
and discomfort, rather than just delivering UDAs. Practices were then remunerated in the
contract at a higher rate so it made it clinically and physically more
worthwhile for them to see patients. He
added that this was the first region in the country to flex contracts. He stated that there was a need to move away
from patients expecting 6 monthly check ups and he highlighted the NICE
guidelines which outlined that it was quite appropriate to see a dentist every
year to 2 years where a patient’s oral health was good. He suggested that the profession needed to
move away from churning through orally healthy patients to seeing them at
greater periods of time, and this would then free up more of their contractual
activity to see patients of a higher need.
Mr Barter explained that the Strategy
had eight workstreams. Workstream 1B was
about oral health stabilisation so, whilst it was important to see a patient
who was in pain and get them out of it, dental disease was nearly entirely
preventable and usually those presenting in pain meant their oral health was
not good over a period of time.
Therefore, dentists needed to get patients out of pain and on a course
of oral health stabilisation to improve their oral health and reduce the risk
of other episodes of high need. This
approach would reduce the burden going forward for the NHS and also be a better
journey for the patient. Another workstream
included a dental check by the age of one so seeing children at a very early
age on their parent’s lap so they could get used to seeing the dentist and they
had better oral health through their entire life; he highlighted that a lot of
the Strategy was about prevention.
Mr Barter added that the commissioning
team had done a lot of work to flexibly commission the contract so it was more
fit for purpose and represented the region.
In terms of the procurement for the new contracts mentioned earlier, he confirmed
that, although those contracts were from 8am-8pm 365 days per year, providers were
being asked to provide healthcare in a slightly different way. He explained that, previously, it would only
have been the dentist that could deliver UDAs but the new contracts allowed all
dental clinical professionals in the team, overseen by the dentist, to provide
good oral care for patients. Similar to a
GP practice, within their clinical skillset and capacity, other dental clinical
professionals could be part of the clinical team delivering care to patients in
contracts that had many more hours in a day and at weekends, so that would
increase access for patients.
The Chairman thanked Mr Barter and
asked Members if they had any questions.
Councillor Mapey queried if there
would be an issue where dentists were hit by clawback at the end of the
financial year given the contracts had been adjusted in recognition that they
could not see the same number of patients per day. Mr Barter responded that the minimum delivery
targets acknowledged that the throughput of patients was much slower for the
dental team because of fallow times and ICP, but dentists providing NHS
contracts had their income guaranteed and were remunerated at their pre-Covid
level so they would get 100% of their contract paid to them even though it was
acknowledged they were not seeing the same level of patients. This was in
recognition that they were working very hard to deliver care to patients eg
having to wear full PPE, changing between patients, extra cleaning etc. Councillor Mapey clarified that he was seeking
assurances that practices would not have an issue at the end of the financial
year if they had a shortfall in the number of UDAs given the Covid situation was
exceptional. Mr Barter responded that
the minimum delivery targets had been agreed nationally and confirmed that, in
one particular month, a dentist might only deliver 20% but they would receive
100%. He added that pretty much every
practice in the region had met the thresholds and so it was unlikely there
would be any clawback issues next year.
Councillor Back expressed concern that
dentists would miss identifying patients with oral cancers etc due to the lack
of throughput. On behalf of Mr Barter, Mr
Norfolk responded that patients were risk assessed. He explained that the NICE guidelines, which determined
the recall interval, would look at a variety of things such as decay, gum
disease as well as cancer risk so the dentist would bring the patient back more
frequently according to that risk, so those coming in less frequently were of a
lower risk.
Councillor Topping queried if it was
feasible that the upskilled dental nurses could be used to carry out basic
dental check-ups in nurseries and school settings as this would allow more
children to be seen and help dentists to achieve their targets. Mr Barter responded that the Strategy
included upskilling dental professionals to provide outreach to schools and
also practices were being asked to buddy with care homes to teach the carers to
look after their residents’ oral health.
In response to Councillor Gooch’s
comment, Mr Barter stated that his team did not get to see who Freedom of
Information requests had originated from.
Councillor Gooch asked what was being done by whom to address the lack
of accurate information on the NHS website as so many registered practices did
not report if they were accepting NHS patients.
Mr Barter responded that there was not a contractual obligation for a
practice to update its details, however, the Dental Commissioning Team within the
Eastern Region worked with contract holders and the Local Dental Committee
(LDC), to try to highlight the importance of being able to keep their
information accurate and up to date.
Under part of the flexible commissioning 1A, where a practice would have
urgent slots of activity available for very high needs patients, part of the
process was that a practice would have to agree to update the Directory of
Services which informed NHS111 so when patients called 111 they would be
signposted to one of the practices that had the urgent slots. In relation to practice websites, Mr Barter
commented that it was up to them but his team tried to influence them to keep
them updated through the LDC and other channels.
Councillor Beavan referred to an NHS
England graph published in the EDP recently about the number of patients per
NHS dentist in Norfolk and Waveney from 2011-21 and he quoted that, in 2014-15,
the area had exceeded the average for England and since then had got even worse,
so the problem was ongoing and not just related to Covid. Mr Barter referred to earlier comments from
Mr Norfolk made about the Dental Academy, and his own comments regarding upskilling
dental clinical professionals. He reiterated
that there was a difficulty attracting dentists the further north a place was from
London and confirmed that NHS England were trying to attract good dentists to
the region and the Strategy acknowledged that there was a need for more
upskilled dental clinical professionals.
He explained that the University of Essex had the biggest cohort of
dental therapists currently being upskilled and trained so they could go into
practice. He added that other clinical
team members were more likely to be local recruits who were liable to stay in
the area which helped with retention and sustainability of practices.
7. Peter Aldous – MP
Mr Aldous reported that this had been
a problem for about 20 years which had reached melting point for several
reasons including the closure of 2 dental practices in Lowestoft and Leiston,
and Covid had drastically reduced throughput.
He referred to the following statistics relating to the Norfolk and
Waveney CCG area:
- Based on figures published in March 2020 before Covid, 38% of new patients could not get
access to an NHS dentist, compared to an average figure for England of 26%.
- Only 26%
of child patients were seen by a dentist as a percentage of the population in
the 12 months to June 2021 which was a decline from the previous year’s figure
of 50%.
- In August
2021, the CCG area had the lowest number of dentists per 100,000 population, at
38, which was the lowest in the East of England.
In relation to short term solutions,
Mr Aldous suggested that NHS dentists needed more throughput but he
acknowledged that this was a challenge because of Covid. More UDAs/funding needed to be provided for
NHS dentistry locally and he stated that this was happening thanks to the work of
Mr Barter and other colleagues but it was not the whole solution. He explained that additional resources had
been provided in the area for the period up to July 2022 and this was allowing
more patients to be seen. With regard to
the new four year, nine month contracts, Mr Aldous stated that he had found the
comments about needing longer term contracts interesting and had realised this
must be because the kit needed was very expensive. He reported that the main feedback he received
from NHS dentists was the problem with the 365 days per year from 8am-8pm because
of concerns about whether any tenders would be submitted on that basis as there
were challenges to get people to work then.
He explained that the preference was to have a normal working week with
bank holidays and weekends available for emergencies. Mr Aldous stated that his understanding was
that there would be tenders for the Lowestoft contract but Leiston was outside his
area so he did not know about that.
In terms of longer-term solutions, Mr
Aldous stated that the first was funding because over the last 15 years there
had not been the additional funding required to go into NHS dentistry and none
of the Governments since had provided the necessary funding. He referred to a letter which he believed had
been sent yesterday to the Chief Secretary to the Treasury, Mr Clarke, from Sir
Robert Frances, Chair of Healthwatch England and Eddie Crouch, Chair of British
Dental Association, highlighting that, of the additional £5.4bn funding coming
back from Covid, none was coming towards NHS dental services despite it being very
badly hit. This was likely to be
followed up in the next few days by a cross party letter from MPs highlighting
this problem to the Chancellor in advance of the comprehensive spending review
taking place shortly. Mr Aldous stated
that he would be signing this letter and he anticipated that a number of his
colleagues would do so as well.
In relation to the 2006 contract not
being fit for purpose, Mr Aldous explained that there had been a succession of
ministers over that period who all wanted to get it reformed and there was
supposed to be a new contract in April 2022.
Jo Churchill, who was the dentistry minister until the latest reshuffle,
had been determined to make sure that happened.
He concluded that whilst he was not sure if additional funding would be
provided, he pointed out that speakers today had outlined how the existing
contract could be improved.
With regard to increasing the
workforce capacity of NHS dentistry, Mr Aldous highlighted the following six suggested
actions made by the Association of Dental Groups:
- Increase the number of training places – a dentistry school in this area would help to
recruit and retain local people because it was challenging getting local people
back to this area but it would not be set up overnight.
- In the
meantime, need to recognise the role played by EU trained dentists and should
continue to provide access for EU trained professionals.
- It was
also important to recognise overseas qualifications from outside the EU and the
General Dental Council’s recognition of those qualifications through approved
schools should be extended.
- Speeding
up and simplifying the process to complete the Performer List Validation by
Examination - that needs to be improved.
- There were
a lot of professionals in a dental surgery and should look at a system, where
appropriate, that allows the whole team to initiate treatment.
- New dental
contract needs to include and embrace a strategy that retains workforce.
In addition, Mr Aldous referred to water
flouridation and explained that where this happened particularly in deprived
areas, it improved the overall dental health of an area, prevented dental decay
and was part of the wider prevention agenda.
Finally, Mr Aldous stated that there
needed to be greater accountability and possibly changes to the procurement
arrangements. He referred to the Health
and Social Care Bill which put Integrated Care Systems (ICS) on a statutory
footing and suggested that an ICS needed to have a greater role in terms of accountability
and possibly in commissioning.
The Chairman thanked Mr Aldous and
asked Members if they had any questions but, firstly, he wished to ask if the
experts and MPs all knew there was a problem with the contract, why were
Ministers not doing anything about it and scrapping it. Mr Aldous responded that the issue was always
down to money, although he thought it was possible it might be different this
time around because now it was critical and the industry was in crises, so much
so that a debate had been held in Parliament last night on NHS dentistry in
Lincolnshire, a similar debate had been held earlier in the summer on dentistry
in Waveney and there was a crisis in Cornwall and it tended to be there were
problems in rural areas. He concluded
that the problem now was that there was a crisis and he hoped the Government
would listen.
Councillor Deacon commented that there
were three other MPs representing East Suffolk and he explained that Felixstowe
was experiencing the same issue as people could not access a dentist. He referred to Dr Caroline Johnson who took
part in the Parliamentary debate last night and had secured a meeting with the Minister,
and he urged Mr Aldous and the other three MPs to meet with Dr Johnson and
explain the problems experienced in East Suffolk. He concluded that he had been very interested
in the remarks about EU dentists as he knew several professionals that had returned
to their own countries.
Councillor Gooch queried if Jo Churchill
MP had been invited to this review and it was confirmed that she had, although
no response had been received. In
response to a question about how widespread the all party group was, Mr Aldous
responded that he was not a member of the all party group but the letter was
being put forwarded by the British Dental Association and would be cross party
and have a wide geographical spread.
8. Mary Rudd -
East Suffolk Council Cabinet Member with responsibility for Community Health
& Nicole Rickard - Head of Communities
The
Head of Communities reported that her Team had worked with communities who had
lost dentists, particularly Leiston, over the last few months. Also, she and the Cabinet Member had recently
spoken to Messrs Barter and Norfolk about this issue.
In
relation to what East Suffolk Council was doing, the Head of Communities stated
that the Health Projects Officer and Integration Partnerships Manager were
undertaking a lot of work about prevention eg creating a pilot project with the
Integrated Neighbourhood Team working with children in the Aldeburgh, Leiston
and Saxmundham Community Partnership area to improve their diet and learn about
effective brushing, which could be expanded.
There were also opportunities to work with the Economic Development team
on a campaign to attract dentists and other sector professionals to live and work
in East Suffolk.
The
Head of Communities explained that a lot of work had been done already around rurality
through the Community Partnerships’ rural proofing work and she pointed out
that, whilst the Committee had heard about specific problems in rural
communities, there were also challenges for coastal communities. She suggested that communication was key and
East Suffolk could use its Residents magazine and social media to try and
ensure the right messages were being put across eg the debate about registration,
information about the frequency of check-ups and using networks to talk about
some of the things discussed this evening such as problems with the contracts,
ease of access to the Performer List etc.
The
Head of Communities stated that Mr Barter and Mr Norfolk had also raised the
issue of the planning process and opportunities for dentists to access town
centre locations where they were at the heart of the communities.
The
Cabinet Member stated that changing people’s minds about having six monthly
check-ups would help other people to access practices.
The
Chairman thanked the Cabinet Member and Head of Communities for their
attendance and asked if Members had any questions.
Councillor
Gooch referred to a review undertaken by Salford Health Scrutiny Committee in
May 2019 about dental health and in particular the education programme they had
put in place to ensure good practice for children, and she suggested that East
Suffolk might like to consider something similar. She concluded that prevention was key.
The
Chairman invited the guest speakers to make any final remarks.
Ms
Overton stated that Healthwatch’s ethos was about co-production and she stressed
that if everyone worked together then nothing was too big.
The
Chairman stated that the recurring message seemed to be about the contract and
he queried if the contract was such an insurmountable problem that if it was not
changed, then the situation would not really change. Mr Stokes responded that, personally, he felt
unless the contract changed fundamentally, the problems there had been over
many years would continue, even if the acute problems of a changing workforce
and Covid might improve, there would still be a downward trajectory.
Mr
Stokes continued that, every year, the cost to NHS patients if they paid, rose
and became an increasingly large percentage that funded NHS dentistry. He added that the contribution by patients was
growing and there should be an acknowledgement that, for some people, this might
be a barrier to accessing NHS care. He
queried, therefore, if fundamentally the NHS should be free at the point of
access or not.
Councillor
Topping queried who sat on the group that decided on the national
contract. Mr Aldous responded that he
did not know precisely, however, Ministers would look at it and making the
ultimate recommendations taking into account the views of a range of
organisations including NHS England.
Councillor
Goldson referred to the Integrated Care System (ICS) which would take on the
commissioning of some dental services and queried how the Norfolk and Suffolk approach
differed. Mr Barter responded that, if
the legislation passed, then the ICS Boards would come into existence from
April 2022. They would commission GPs
and in time dentistry, pharmacy and optical as well which Mr Barter suggested would
be really good because it allowed care pathways for patients through all
aspects of primary and secondary care, mental health and social services to be more
joined up. He added that part of the
legislation was to repeal S75 of the NHS Act which was the duty to follow
Public Contracting Regulations 2015 which meant that there was currently a long
arduous procurement process to bring in providers, but hopefully it would become
easier and more streamlined to engage with providers and bring them into place
in a swifter way.
Mr
Aldous clarified that the ICS legislation was going through parliament and
should come back to the House of Commons before Christmas. He assured Members that he would take on
board the points raised at this meeting and emphasise them. He explained that ICS in Norfolk and Suffolk was
currently in a state of flux but was recruiting a Chairman and Chief Executive and
when that process was out of the way, the process to map things out could begin. He agreed that the contract was of critical
importance and acknowledged that there was a worry about Ministers who were
committed to this, being reshuffled but he hoped the new Minister was on
board. He suggested that the Committee had
been given enough evidence that it might want to re-emphasise the importance of
contract reform to the new Minister, and he and other colleagues in Suffolk and
Norfolk could re-emphasise the point too.
He also agreed that there was a public health role as prevention was the
best solution long term. Mr Aldous
referred to the Head of Communities’ comment regarding the planning process and
stated that Jo Churchill had been concerned about obtaining planning permission
for facilities when she had been the Minister.
Mr
Rolfe referred to the earlier comment regarding fluoridation of water and clarified
that Suffolk had about half the optimum level naturally, so the benefits for
Suffolk might not be as all changing as it would be in other parts of the
country.
The
Chairman picked up on Mr Aldous’ suggestion and recommended that a letter be
sent to the Minister summarising the Committee’s findings and expressing the
wish that the contract be revisited as there was unlikely to be sufficient
progress if it was not.
In
response to Councillor Topping’s query, Mr Norfolk clarified that the Performer
List did not come under the contract but was under the Performer List
Regulations. The Chairman agreed that
this should be raised as a separate issue within the letter to the Minister.
Councillor
Gooch referred to the tenure and duration of the contracts mentioned earlier and
queried if it would be possible in the letter to ask for the contracts to be
extended to say 10 years. Mr Barter stated
that the procurement was already out for those contracts and he clarified that it
was not to enter into a General Dental Services contract but for a Personal
Dental Services Contract which under Regulations could be novated into a
General Dental Services contract which were in perpetuity, so effectively the
current procurement allowed for break clauses which was good for both sides,
but it did not mean that they could not be in perpetuity as they could then move
into a GDS contract.
The
Committee was reminded that, under the Council’s Constitution, a vote needed to
be taken to agree the meeting could go beyond three hours. It was proposed by Councillor Bird, seconded
by Councillor Beavan and unanimously
RESOLVED
That
the meeting be extended beyond three hours.
Councillor
Beavan referred to a proposed recommendation he had emailed to the Chairman and
the Chairman responded that it had not been intended that this Committee would
make any formal recommendations but the review findings would be passed by
Councillor Back to the Suffolk Health Scrutiny Committee. Councillor Beavan acknowledged this and
suggested instead that the Suffolk Health Scrutiny Committee call for an urgent
campaign to train hygienists and dental nurses to administer preventative
dental care to our children, funded by an increase in the sugar tax.
Councillor
Gooch stated it was also about what we could do as a District and suggested
that the Council should investigate an early years programme through the
Community Partnerships to safeguard the teeth of young children. She added that communication was key and also
suggested writing to local NHS practices to request that their information was
up to date on the NHS website so patients were not wasting valuable time and
money contacting practices who did not have any capacity despite what it said
on their website. The Cabinet Member
agreed to discuss how best to do this with the Head of Communities who added
that it might be better to talk to partners who had connections with dental
practices.
Councillor
Topping suggested that space should be unlocked in schools to enable dentists
or nurses to go in. Councillor Goldson
stated that the cost of taking dentists into schools was astronomical and was
not economically viable.
Councillor
Deacon referred to the fact that the Committee had heard about obesity of young
people and the impact on their oral health and he suggested that as obesity was
already a priority for the Community Partnerships, this could be something that
could be promoted.
Councillor
Gooch stated that the County Scrutiny Health Committees should explore the
possibility of the area having a dental school attached to one of the local
universities. Mr Norfolk suggested
writing to the universities about this.
Ms
Overton offered to send a website review of dental practices undertaken this
year which the Committee might find useful.
Councillor
Deacon thanked Councillor Gooch for all her hard work on the original scoping
form and the Chairman thanked all the guest speakers for their valuable
contribution to the review.
RESOLVED
1. That Councillor Back be asked to report
back to the Suffolk Health Scrutiny Committee on the findings of this review.
2. That a letter be sent to the Minister
emphasising the importance of creating a new national contract as soon as
possible.
3. That a letter be sent to the Universities
of East Anglia and Suffolk regarding the creation of a dental school in the
region which could be attached to the universities.
4. That the Cabinet Member and Head of
Communities discuss potential interventions the Council could make, possibly
through the Community Partnerships, including an early years programme to
improve oral health and contacting practices regarding better communication.
The Committee adjourned for a comfort
break at 9.30pm and reconvened at 9.40pm.