Agenda item

Julie Dandridge (Strategic Lead for Primary Care across Oxfordshire, Thames Valley Integrated Care Board) has been invited to present a report providing an update on Dentistry Services in Oxfordshire.

 

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

 

Julie Dandridge (Associate Director – Pharmacy, Optometry and Dentistry, Thames Valley ICB) and Dan Leveson (Director for Places and Communities, Thames Valley ICB) were invited to present a report on dentistry services in Oxfordshire.

 

The Associate Director for Pharmacy, Optometry and Dentistry advised that since the previous scrutiny session in 2024, four new dental practices had opened across Oxfordshire, including in rural areas, and that the system had replaced more activity than had been lost following contract handbacks after the pandemic period. Additional urgent care capacity had been commissioned, with practices delivering thousands of additional urgent appointments in line with national policy objectives. She also highlighted the continuation of a flexible commissioning scheme, through which a significant number of vulnerable patients had accessed dental care, and described the introduction of oral health promotion initiatives aimed at children, including early engagement in schools and nurseries.

 

The Committee referred to data within the report indicating that approximately 46.5 per cent of the population had seen an NHS dentist within the previous two years, compared with over 51 per cent before the pandemic. The Committee asked what trajectory the Integrated Care Board expected for recovery and what interventions would be required to close that gap. The Associate Director for Pharmacy, Optometry and Dentistry acknowledged that returning to pre‑pandemic levels would be challenging, citing changes in public behaviour, growth in private provision, and workforce constraints. The reformed dental contract, including the requirement for a proportion of appointments to be made available for urgent care, was intended to improve access and reduce the number of practices closed to new patients. She also emphasised the importance of revising recall patterns in line with NICE guidance and strengthening public understanding of when and how to access dental care.

 

Members expressed concern that headline utilisation statistics did not capture unmet demand, particularly from individuals who had been unable to obtain NHS appointments at all. The Associate Director confirmed that there was currently no comprehensive dataset capturing unsuccessful attempts to access care, although proxy measures included complaints, Healthwatch intelligence, and 111 service contacts. It was noted that complaints relating to dentistry had reduced significantly in recent years, although Members cautioned that this might reflect reduced expectations rather than improved access.

 

The Committee explored urgent dental care pathways and their integration with NHS 111. Members raised concerns about the reliance on urgent care provision and the sustainability of delivering such care predominantly through general practice. The Associate Director explained that urgent care was provided through a combination of high‑street practices, commissioned urgent care slots, and the community dental service, including some out‑of‑hours provision. However, the new contract had only recently been introduced and that it would take time to assess its impact on access patterns, including weekend demand.

 

Members also examined health inequalities and rural access, noting significant variation between districts, and highlighted data showing lower contract delivery rates and reduced access in areas such as Cherwell and the Vale of White Horse. In response, the Associate Director confirmed that variation existed and identified recruitment difficulties, geographic factors, and historic contract arrangements as key drivers. The Integrated Care Board was seeking to rebalance activity through commissioning decisions and to target additional provision to areas of highest unmet need. The Director of Public Health emphasised that rural inequalities required particular attention, noting that traditional deprivation measures did not always capture rural access issues.

 

The Committee sought further clarity on how population need was assessed and how future changes to local government structures might affect the availability of granular data. The Associate Director explained that data was currently assembled at district level but could be analysed at different geographic scales, including neighbourhood level. The emerging neighbourhood health model would play a key role in identifying local need and shaping service provision going forward.

 

The Committee examined workforce challenges, particularly in recruiting dentists to underserved areas. The Associate Director explained that although financial incentives had been introduced to support recruitment, only a small number of practices had successfully recruited staff to date, reflecting wider workforce shortages. She referenced the lack of a dental school in the region as a structural challenge and noted ongoing discussions at regional level regarding training capacity.

 

Members queried how the Integrated Care Board defined vulnerable populations and how eligibility for the flexible commissioning scheme was determined. The Associate Director explained that the scheme was intended to support individuals facing barriers to access, including certain clinical groups and those with complex needs, and that it was flexible and evolving. She noted that the scheme had been adapted over time, with some groups removed where access had improved and others added where need had been identified, including individuals experiencing homelessness. Members suggested further groups for inclusion, including patients with epilepsy and those in institutional settings such as care homes and prisons.

 

The Committee also explored oral health as a wider public health issue, with Members emphasising the links between dental health and broader physical health outcomes, including cardiovascular disease, nutrition and cancer detection. The Associate Director acknowledged that this had not been fully articulated in the report and agreed that a broader framing of oral health would strengthen future reporting.

 

Significant discussion took place regarding water fluoridation. The Director of Public Health confirmed that the evidence base remained clear that fluoridation was the most effective population‑level intervention to reduce tooth decay, particularly among children. However, he explained that implementation was complex, involving legal, logistical and public acceptability challenges, including coordination with water companies and neighbouring regions. Members queried why, given the strength of the evidence, progress had been so slow. The Director of Public Health reiterated that while the public health case was strong, delivery was constrained by regulatory processes and infrastructure considerations, and suggested that progressing the issue at a wider Thames Valley level might be more effective.

 

The Committee considered contract performance and reinvestment of underspends, noting that some practices had delivered below contractual activity thresholds. Members asked how recovered funds were being reinvested to improve access. The Associate Director explained that dental funding was ring‑fenced and that underspends were reinvested into dentistry, including health promotion initiatives, services for vulnerable groups, and efforts to reduce secondary care waiting lists. Further, contract delivery reflected a complex interplay of workforce availability, patient demand and historic contract values, and the Integrated Care Board was seeking to rebalance provision to better reflect population need.

 

The Committee discussed the limitations of data available to commissioners, noting that unlike general practice, dental data was relatively restricted. The Associate Director confirmed that the Integrated Care Board had limited visibility beyond activity data and urgent versus routine classification, which constrained strategic planning. Members emphasised the need for improved data in order to support effective scrutiny and commissioning decisions.

 

The issue of access to specialist dental care, particularly for children requiring general anaesthetic, was also raised. The Associate Director explained that such services were delivered through community dental services but depended on access to theatre capacity, which was shared with acute providers. She confirmed that waiting times for some patients remained a concern but stated that work was ongoing to prioritise cases and explore alternative provision, including use of independent sector capacity.

 

The Committee AGREED to issue the following recommendations:

 

1. For system partners to pursue previously made requests to government by the JHOSC to support a local public consultation/engagement on fluoridating Oxfordshire’s water supply. It is recommended that system partners work with any future combined authority at the Thames Valley level to further support this.

 

2. For the Thames Valley ICB to launch a review of the local impacts of changes being made to the dental contract. It is recommended that there is stakeholder involvement in this review, including the JHOSC.

 

3. For system partners to take collective action to reduce the effects of rural inequalities on poor dental outcomes and on access to NHS dentistry; and to develop data indicators at all District and Neighbourhood levels to provide visibility to population need and other/rural health inequalities affecting oral health and dentistry access. It is also recommended that strong measures are taken, including through public/stakeholder engagements, to tackle broader inequalities around oral health, including amongst vulnerable population groups.

 

4. For NHS dentistry underspends to be reinvested in the areas of worst dentistry access in Oxfordshire to improve oral health outcomes within the County.

 

5. For system partners to continue to support oral health promotion, using neighbourhood health planning at community level as an opportunity to pursue this. It is recommended that system partners utilise parish and town councils and schools, as well as grassroots community organisations, to support this work.

 

6. For the ICB to continue to engage with the Dentistry Deanery to support the case for a local dentistry school to be established urgently.