Agenda item

To receive an update on dental services in NCL.

The Committee then received an update on NCL access to dental care, introduced by Mark Eaton and Jeremy Wallman. Previous committee meetings had expressed concerns about funding, NHS contracts, and access for children’s dental health services.

The report is summarised as below.

·                     The Dental, Optometry and Community Pharmacy Services were brought under ICB management in 2023 and had undergone a transformation programme.

·                     An extra £600k has been allocated to dental services that offer support to more vulnerable residents such as asylum seekers, rough sleepers, and those in residential care. It also went toward reducing waiting times for children and young people who need more specialist care.

·                     Patients in acute pain can access urgent appointments through NHS 111. A commitment has been given by the ICB to support Looked After Children and the development of Child Friendly Practices in dentistry.

·                     Additional investment has been made in preventative work and in supporting children with SEND.

·                     Community Dental Services have been used to reduce the number of patients needing to be treated in more specialist centres. Only 8% of patients referred for specialist care resulted in treatment in a hospital setting.

·                     The main focus for the ICB since delegation has been on expanding access to Primary Dental Services including helping practices to develop new skills, increasing workforce capacity, and reducing the number of practices handing back their contracts.

·                     Future work includes improving oral health for those with diabetes (who are particularly vulnerable to loss of teeth), and piloting work to identify illnesses such as cardiovascular disease in patients with oral health issues. Also, a new cross-agency pediatrics pathway will lead to improved outcomes for children and young people.

Mr. Eaton explained that the ICB could not change the contract it held with Primary Care Dentists. It was not a statutory requirement for dentists to take on NHS patients, or to deliver any NHS activity against their contracts, with some practices actively blocking NHS patients. Substantially more could be earned by dentists taking on private patients than those on the NHS. However, it was noted that better access to NHS services exist within London than in rural areas.

Cllr White asked whether there could be some incentives for dentists to take on NHS patients. Mr. Eaton responded that for an NHS patient a dentist would earn around £28 for each unit of dental activity, but for the same work the dentist could earn anywhere between £30 and £300+ privately. This acted as a disincentive for many to see NHS patients.  Mr. Wallman also reiterated that dentists were not obliged to see patients under the NHS, indeed registration was very informal in some practices. However, this was a national policy issue and cannot be addressed locally by ICBs.

Cllr Clarke commented that although dentists were not getting paid more for seeing NHS patients, £28 was still expensive for most residents. For those on the breadline there were still questions as to whether they were receiving any dentistry at all. This was acknowledged by Mr. Eaton and Mr. Wallman as an area of concern.

Cllr Clarke then requested more in-depth detail around the delivery of dental treatment to the most vulnerable. Mr. Eaton and Mr. Wallman clarified that access by rough sleepers and asylum seekers was achieved through link workers. Children and young people in Looked After Care had statutory health checks. Cllr Clarke suggested that perhaps this could be linked to dental health services.

It was agreed that another update specifically on access to dental care services for vulnerable groups would be given to the committee.(ACTION)

Cllr Connor then asked for written responses to questions from the Committee.

·         Cllr Revah requested more information on the definition of ‘exempt’ also what special provision there was for those with Diabetes.(ACTION)

·         Cllr Chakraborty requested the ICB view on the opportunities to roll out preventative schemes in the community – such as supervised brushing amongst children. (ACTION)

·         In reaction to the 111 dental services item in the report, Committee requests for a list of dentists taking NHS patients, as well as those skilled in child friendly practices - Cllr Connor highlighted that this information needed to be common knowledge amongst residents. There was a strong recommendation from the Committee that the ICB should investigate a Communications budget to start looking at making these pathways more accessible to residents.(ACTION)

·         She also expressed concern at the state of dentistry. Some residents did not access dental services because of the cost, and this would have big implications on long term health.(ACTION)