To receive Report No. 145/2022 from Rose Lynch, Pharmacy, Optometry, Dental Services – Midlands (East), NHS England – Midlands.

Report No. 145/2022 was received from Rose Lynch, Pharmacy, Optometry, Dental Services – Midlands (East), NHS England – Midlands.  The report was presented by Caroline Goulding, Interim Deputy Director of Primary Care and Public Health, NHS England – Midlands, Adam Morby, Regional Chief Dentist for NHS England in the Midlands and Steven Claydon, Local Dental Network (LDN) Chair for Northamptonshire and Leicester, Leicestershire and Rutland.  During the discussion, the following points were noted:

·       The key issue for dental services currently was the lack of a qualified and skilled workforce i.e. dentists, dental nurses etc.  The General Dental Council was reviewing the process for registering dentists and NHS England was considering supporting dental providers with workforce recruitment through the ‘Golden Hello’ scheme.

·       Following the pandemic, dental services in the East Midlands were operating at 82%.  Dental services in Rutland were operating at 75%.

·       The national contract was impacting on improving access to dental services across the country.

·       NHS England was working with Local Authorities on prevention initiatives such as making toothbrush kits available in foodbanks and providing toothbrush kits for distribution by healthcare workers.

·       Work would also commence in the future with schools, families etc. with communication about good oral health and the benefits of visiting the dentist. Members requested that NHS England’s communication strategy be distributed with the minutes.

ACTION: NHS England 

·       The committee noted that there was currently no water fluoridation scheme in Rutland.  Rutland had a naturally occurring fluoride level of 0.27 mg/l; the UK/EU limit was 1.5 mg/l.  Adding 1.0 mg/l of fluoride to the water would benefit residents’ teeth and bones and help reduce the high level of dental decay in children.  NHS England confirmed that it was the responsibility of the local health authority to ask the water authority to add fluoride to the water.  NHS England agreed to send data to Governance (governance@rutland.gov.uk) on the benefits of fluoridisation.

ACTION: NHS England 

·       NHS England confirmed that the re-form of the national contract started on the 1^st October 2022 and would take 18 months to fully implement.  In the next 6 months, Rutland would see the implementation of ‘Skills Mix’.  This would be the development of roles and responsibilities within dentistry as a way of providing better access to services alongside more efficient and effective patient care.

·       As part of the transition strategy, NHS England would continue to work closely with the Integrated Care System so that the financial allocation for the commissioning of NHS dental services would be transferred to the LLR ICB (Integrated Care Board) on the 1st April 2023.

·       NHS England confirmed that work had begun on Rutland’s oral health needs assessment. This was planned for completion by early 2023 and would include a dental service consultation across Rutland.

·       Members were informed that a large amount of dental activity required commissioning in Rutland – approximately 15,000 to 20,000 Units of Dental Activity.  1 check-up = 1 unit of dental activity.  1-2 fillings = 3 units of dental activity.  3 or more fillings = 5 units of dental activity.  This would include the commissioning of another dental surgery in Rutland within the next 12 to 18 months.

·       The cancelled contract in Rutland had provided 20,000 (25%) of the units of dental activity in Rutland.  The dental service provider had moved to new premises and NHS England confirmed that each provider had to be checked, to ensure that the premises were safe for NHS dental patients to access.  There had been a delay in this process and BUPA had taken the business decision to terminate the NHS services contract. BUPA were asked to re-consider their decision but they had confirmed that they wanted to continue in a private format.  NHS England acknowledged that there had been issues with this premises checking process but that improvements had been made to prevent such situations from happening again. 

·       It was confirmed that future contracts would be designed to support dental providers in the provision of NHS dental services but that the main problem was the recruitment of NHS dental workers.

·       Patients whose oral care needs could not be met through NHS primary dental care due to their complex medical, physical, or behavioural needs should be referred to the Community (Special Care) Dental Service.  Any issues with this service should be addressed directly with the service provider.

Community (Special Care) Dental Service Head Office: Telephone 0333 207 5992 / Email: info@cds-cic.nhs.uk

·       NHS England confirmed that they did commission children’s NHS dental services in Rutland and that details of the NHS dentists in Rutland accepting children as patients would be circulated with the minutes.

ACTION: NHS England

·       It was noted that the NHS Dentists website did not list which dentists were accepting NHS patients.  Residents were contacting dental practices directly only to be informed that the waiting list for new patients in Rutland was approximately 800. Adam Morby informed members that providers would be contractually obliged to state on the website if they were accepting NHS patients.  

·       NHS England requested that residents with issues regarding dental services in Rutland including the Community (Special Care) Dental Service, notified NHS England so that the matter could be investigated. 

NHS England Customer Contact Centre: Telephone: 0300 311 22 33 / Email: england.contactus@nhs.net

RESOLVED

That the Committee:

a)    NOTED that dental practitioners were independent contractors to the NHS. Many dental practices operated a mixed private/NHS model of care and all patients were free to choose what option of dental care they would prefer to receive.

b)    NOTED that the commissioning responsibility for all NHS dental services would transfer from NHSE to the Leicester, Leicestershire & Rutland (LLR) Integrated Care Board on the 1^st April 2023 and that the statutory responsibility for oral health improvement would remain with the local authority public health team.

c)     AGREED that NHS England – Midlands would return in a year to provide the Strategic Overview and Scrutiny Committee with an update regarding access to NHS dental services within Rutland.

d)    AGREED that the Committee would write to MP for Rutland and/or the Secretary of State for Health and Social Care regarding:

• The fluoridation of Rutland’s water.
• The issues with the process of implementing new NHS dental premises.
• The review of contract provision to encourage NHS dental workers and service providers
• The possible use of Rutland Memorial Hospital to provide additional NHS dental services

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Caroline Goulding, Adam Morby, Steven Claydon, Debra Mitchell and Adrian Allen left the meeting at 8.25 p.m.

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