NHS England – North (Yorkshire and Humber) will submit a report (Document “M”) which provides an update to the Committee since the last update in October 2015 on the current commissioning and commissioning plans for dental services in the Bradford and Airedale area encompassing:

• Access
• Performance
• Public Health
• Other Dental Updates

Recommended –

The Committee is asked to consider and comment upon the information presented within the report.

(Caroline Coombes – 01274 432313)

NHS England – North (Yorkshire and Humber) submitted a report (Document “M”) which provided an update to the Committee since the last update in October 2015 on the current commissioning and commissioning plans for dental services in the Bradford and Airedale area encompassing access, performance, Public Health and other dental updates.

The Senior Primary Care Manager, NHS England – North (Yorkshire and The Humber) outlined the report highlighting the constraints of the system in place and the limited scope to move funding within it to areas of higher need.  He stated that funding was constrained by the number of units of dental activity which dental practices were commissioned to deliver.  He explained that there was opportunity to claw back funding when practices under delivered on their commissioned units of dental activity (UDA).  He spoke of the increasing spend on unscheduled dental care which had risen from £3.93m in 2014/15 to £4.25m in 2015/16.  He outlined findings from the National GP survey which suggested that access was improving whilst recognising the challenges still being faced as outlined in the report from Healthwatch.

In response to the Healthwatch Manager’s concerns regarding the lack of progress on the pilot project, he informed the Committee that the Director Team of NHS England – North (Yorkshire and The Humber), in considering the proposals, had advised that the assessment be expanded across Yorkshire and The Humber and before any investment could be considered it was necessary to develop an evidence base to demonstrate priority areas.  This further work had commenced with support from colleagues across the region and would be discussed again with Directors in the future.  No timescales could be provided.

With regard to the NHS Choices website, Members were informed that the existing NHS dental contract encouraged practices to keep their information on the website up to date.  Due to current access issues, if a dentist was to advertise vacancies they would receive an overwhelming response.

It was reported that NHS England supported the development of a new national contract for 2018/19 and that there was a prototype practice in Bradford.  The timescales for the new dental contract were yet to be confirmed nationally.

In response to Members’ questions it was reported that:

·        The evidence originally presented to the Director Team had been constrained to Bradford and North Kirklees, not the Yorkshire and The Humber footprint for which NHS England – North was responsible for. 

·        Under delivered UDAs were not necessarily the fault of the practice.  It could mean that patients had not attended appointments which had hindered the ability of practices to plan.  Within the current contract, a practice was able to over deliver the following year by the percentage amount that they had under delivered the previous year.

·        In 2006 there were just over 1,000 A&E admissions in relation to dental care of which only three were serious conditions requiring hospital treatment; other patients were prescribed pain killers or advised to access dentistry care.  The cost of these admissions was £64 per patient.  It needed highlighting that A&E was not the place to go for dental issues.

·        There did not appear to be any difficulties in recruiting new NHS dentists.

A Member of the Local Dental Committee addressed the Committee to share his concerns about the lack of progress on increasing access to NHS dental care within Bradford.  He raised concerns about unspent funding in the region of £2m was being lost due to under delivered UDAs within dental contracts in West Yorkshire.  He considered that if work was undertaken to tackle the access issue in Bradford, even on a temporary basis, it would not hinder assessment work being undertaken across the wider region. 

Members commented that it was concerning if practices were not showing they had vacancies on the NHS Choices website for fear of being overwhelmed by people needing dental care and that this just highlighted the problem.  A suggestion was made to have an out of hours dentist service available at A&E.

Following a discussion about the constraints of the current system and the existing national dental contract, the Scrutiny Lead officer reminded Members that the Chair of the Committee had written to the Secretary of State for Health two years ago in relation to this; she agreed to re-circulate the response received from the Department of Health which acknowledged the problems being faced.

The Portfolio Holder for Health and Wellbeing spoke of the need to look at health needs in a whole system approach rather than in isolation.  It was evident that problems with access to dental care were putting pressures on other service areas such as GPs and A&E, which were more costly to the system as a whole. 

A Member raised concerns that there was a failure to understand the required model of dental care required for the district and considered that it should be looked at in conjunction with strategies for anti poverty and housing. 

The Consultant in Public Health gave an overview of the data relating to the oral health of children in the Bradford district, as provided in the report.  The Chair expressed concern at the high number (4.1) of decayed, missing and filled teeth (dmft) in 5 year olds from the Bowling and Barkerend ward in comparison with all other wards in the district.  It was reported that the dmft averages for 5 year olds for 2014/15 were 1.5 for the district, 1.0 regionally and 0.8 nationally.  The district average had decreased from 2.42 in 2007/08.  Whilst it was recognised that there was still a lot of work to do, the picture was improving.

A discussion took place about the training and retention of dentists within the NHS.  It was stated that there were no restrictions placed on dentists who were trained through the NHS on where they could seek employment.  Due to funding for NHS practices, it was stated there were fewer limitations for a practice to set up as a private practice than as an NHS practice.

Members acknowledged the need to discuss this issue on a regional basis.

Resolved –

(1)  That the Committee expresses its disappointment that no action has been taken by NHS England on progressing the pilot scheme in Bradford as put forward by the NHS Task and Finish Group.

(2)  That the Committee’s Members of the West Yorkshire Joint Health Overview and Scrutiny Committee raise the issue of access to NHS Dentistry to be considered on a sub-regional level.

ACTION:  Scrutiny Lead Officer