Agenda item

To receive the presentation of a report on Dentistry provision within Oxfordshire by Sue Whiting, Deputy Director of Integration & Delegation of Direct Commissioning, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB), Nilesh Patel, Chair-Thames Valley Local Dental Network, Hugh O’Keeffe, Senior Commissioning Manager Dental, NHS England and NHS Improvement – South East, and Dr David Chapman, System Clinical Lead for Pharmacy Optometry & Dental Services.

The Chair welcomed Hugh O’Keeffe, Senior Commissioning Manager Dental, NHS England NHS Improvement – South East, and Dr David Chapman, System Clinical Lead for Pharmacy, Optometry, and Dental Services, to the Committee.  The Committee noted apologies from Sue Whiting and Nilesh Patel.

The Chair expressed the Committee’s appreciation to Mr O’Keeffe for the detailed report with significant amounts of Oxfordshire data and analysis which had been submitted to the Committee and also noted the Committee had received the NHS Confederation Report on Dentistry, including Integrated Care Boards (ICBs). 

The Chair explained that the Committee would begin by focusing on national questions before turning to more local questions.  The Committee recognised, as set out in the NHS Confederation Report, that there were no quick fixes to the national problems regarding NHS Dentistry provision but wanted to explore what could be achieved, in both the short- and long-term, and what could be communicated to the public and to particular stakeholders.

In response to questions, the Committee noted the following:

·       There was consensus that adding fluoride to water in Oxfordshire, as it was in many other areas of the country, would be beneficial as an effective intervention to prevent poor dental outcomes.  Whilst using fluoride toothpaste had benefits, it inevitably had less of an impact than adding fluoride to the water supply. 

·       The Health and Social Care Bill permitted the Secretary of State to consult with local stakeholders and residents about introducing such a supply to the network.  There was recognition that there was likely to be some opposition, in a similar way to there being opposition to immunisations and vaccinations, but that a consultation would be an opportunity for different views to be expressed and for the Secretary of State to make a reasoned decision.

·       That the NHS Dentistry contract dated from 2006 and had changed very little in that time.  Minor changes to the contract had achieved little in terms of increasing access to services or in improving the recruitment and retention rate.  The ICB did not have responsibility for the contract but was able to introduce flexible commissioning which it sought to introduce in Oxfordshire and which it hoped would combat health inequalities particularly amongst migrants and other vulnerable groups. 

·       There had been attempts to review the contract since 2010 and pilots and prototypes sought to improve oral health protection and there had been attempts to design a contract which focused on working in partnership with patients.  The current contract worked on a basis of incentivising pre-agreed planned levels of activity known as Units of Dental Activity (UDAs) and the prototypes sought to mix quality, capitation, and activity.  These pilots and prototypes ceased in March 2022. It was hoped that any new contract would recognise the importance of an outcome based approach.

·       There was a national concern relating to access (more time being spent with individual patients had led to fewer patients being able to be seen) and reductions in patient charge revenue (fewer patients being seen led to less money being received).  The Committee noted that approximately 30% of the NHS dental budget was based on an assumed level of patient charge collection based on historic data that was not necessarily reflective of contemporary circumstances.

·       The contract was a national contract rather than a local one but there was some flexibility within it which enabled flexible commissioning.  This was understood to enable considerable improvement to the system locally but was dependent on expressions of interest received.

·       It took approximately six months for new dental trainees to be placed on the NHS Dental Register whereas they could register for private practice immediately.  This was partly due to the requirements for ensuring that overseas qualifications are comparable to the NHS requirements.  A request to speed that up significantly had been made at a national level and there was a recognition that the process was overly bureaucratic and cumbersome.  There was a recognition that a delay to beginning work for the NHS could lead to some trainees not returning to the NHS at all.

·       That there can be a significant disparity between NHS charges and those made by private dentists.  Whilst some private dentists do have DenPlan arrangements to make private care more affordable, there was nonetheless a problem when substantial treatment was needed.  There was a recognition that there needed to be sufficient treatment available on the NHS so that all those who needed it could access it.  This was a national issue compounded by the results of the COVID-19 pandemic.

·       There were specialist pathways into community dental services for patients with anxiety and that service also worked with those with other mental health issues and could make referrals.

·       Prior to COVID-19, slightly over 55% of Oxfordshire residents had attended a dentist in the previous two years which was higher than the national average.  The figure was currently 43%.  Historically, Oxfordshire had seen the highest access to dental care across the Thames Valley with Oxford City and Cherwell District having the highest rates along with Reading, at 60%.  The current position was lower than that but access was lower across the country.

·       The dire effects of COVID-19 on children’s oral health and dental hygiene in particular was set out as a major concern.  The number of dentists in Oxfordshire returning their NHS contracts was the highest across Buckinghamshire, Oxfordshire, and Berkshire West and was higher than the national average.  Oxfordshire was an expensive place to live and there were similar challenges recruiting nurses and teachers.  Costs of running practices increased each year and that was compounded by the difficulties of recruitment.  The UDA rate was based on a reference year of activity in the early 2000s.

·       There could be localised nuance in plans for Oxfordshire itself but working across BOB was more likely to see positive results, given that dentistry was a service commissioned at scale.

·       The Committee was keen that the underspends in the system should be reinvested in Oxfordshire and sought clarity about how that could be done.  The Committee was reminded that dentists were individual contractors and that it was up to individuals as to whether to accept the offer made to practices.  It was confirmed that funding remains with the ICB when it is clawed back and that traditionally only a small amount had been requested back by Oxfordshire practices. 

·       The information provided on Find My Dentist page on the NHS website was dependent on practices inputting their information.  Whilst practices were required to ensure up to date information was entered on a regular basis, the Committee questioned what was being done to ensure they did so. 

·       There had been significant backlogs in treatment which had seen significant investment and community-based alternatives to hospitals had been a crucial part of this.  Given the importance of prevention, questions had been raised as to whether therapists could be used for prevention work and that this was to be tested during the flexible commissioning approach.  The flexible commissioning scheme was being designed to remodel how contracting for the service was done.  There had also been significant amounts of training for healthcare professionals and for SEND staff.  Simularly, over 400 professionals working with adults, including mental health nurses and adult learning disability specialists, were trained to provide advice and support.  It was important to look holistically and to recognise that what was good for oral health was good for all health.

·       The Committee explored the idea of a baseline dataset and how far the ICB was from having something that could be monitored so that improvements could be tracked more readily.  Oxfordshire County Council was commended for continuing to undertake a childhood survey of oral health, in contrast to some other local authorities.  It was emphasised that this provided key data which was of use.  It was noted that ICB staff were moving away from being NHS England employees and would be transferred to the ICB in an hosted model and there would be discussions about operating models going forwards.  There were significant resourcing implications going forward but it was agreed that good and useful data was key.

·       The Committee was reminded that the Health and Social Care Select Committee was conducting an inquiry into NHS dentistry.

The Committee discussed making recommendations over writing to the Secretary of State regarding fluoridation, the use of Oxfordshire underspends, and ensuring the fullest data were made use of. It was AGREED that the Scrutiny Manager would draft wording around these recommendations to bring back to the Committee for full agreement at its following meeting.