I was delighted to be invited to chair this year’s Local Dental Committee (LDC) Officials’ Day – particularly as it marked a return to an in-person event for the first time since 2019 and allowed a focus on Integrated Care Board (ICB) engagement. It was also an opportunity to highlight the toolkit currently under development to support LDCs and BDA members. Bringing together LDC representatives from each region in England, ICBs, and commissioners, the event aimed to create a space for constructive engagement, dialogue, and facilitate shared learning from across the regions.
We know that that ICBs have taken responsibility for dental commissioning at a time when NHS dentistry faces a profound crisis. While the fundamental problems related to the contract are outside the control of ICBs, each Board has a statutory responsibility to meet their population’s oral health needs. Effective collaborations between LDCs and ICBs, have led to the design and delivery of successful local flexible commissioning schemes which help to both address the existing gaps in patient provision, and retain dentists providing NHS care.
Outlining the challenges
The day began with updates on the ongoing work at national level from the Chair of the BDA’s Board, Eddie Crouch and the Chair of the General Dental Practice Committee, Shawn Charlwood.
Speaking on prevention and tackling oral health inequalities, Eddie pointed out that we have led the argument for change, which resulted in the levy on sugary drinks, but further expansion of the sugar tax is required. He also spoke about the important role dentists play in detecting oral cancers, but how opportunities to pick these up have been hampered by the NHS crisis. The work of the BDA has been invaluable in highlighting the plight of NHS dentistry, with more references than ever before being made in Parliament.
Shawn spoke about the deep chasm between the Government’s stated promises on how it will reform NHS dentistry and improve access, and the reality. One by one, Shawn dispelled the myths being presented in the press and in Parliament this past year, revealing how NHS dentistry hasn’t bounced back since the pandemic, and how tweaks to the contract have failed to stem the exodus of dentists from the NHS. “What’s actually happened after the tweaks”, he said, “is that the number of NHS dentists fell to levels we’ve not seen since 2016.”
Far from NHS dentistry bouncing back to pre-pandemic levels as some government ministers suggest, Shawn said: “By almost every measure we’re a very long way from where we were when lockdown struck. If you tot up unmet need for NHS dentistry it amounted to 11m people – or 1 in 4 of England’s adult population. As I told the press, we are seeing scenes that belong in the old Soviet Bloc. Patients queuing from the crack of dawn to access care. These aren’t one offs.” The reason for this, Shawn explained, is that at the end of the day this access crisis is a workforce crisis.
Over half of dentists say they have cut back on NHS work since lockdown. And 75% planned to reduce - or further reduce – that commitment, in the year ahead. The public are seeing the reality. Jason Wong, Interim Chief Dental Officer, spoke about NHS dentistry in the context of the wider NHS, highlighting how vital the integration of oral health into general health was. The importance of local professional input into ICBs could not be underestimated. Jason and Eddie also highlighted the work that had been done internationally for the Minamata convention to negotiate a phase down, rather than a phase out, of amalgam by 2025.
Fostering collaboration and highlighting solutions
Interactive regional workshops designed to encourage collaboration within regions between ICBs and LDCs were a key feature of the event. I was struck by how actively attendees participated in discussions on breaking down communication barriers between primary care providers across the regions and their commissioners. The workshops fostered an environment of mutual learning and highlighted the significance of cooperation.
Numerous examples of effective collaboration between LDCs and ICBs were shared, including a presentation from LDC representatives in the North West setting out a case study of the engagement in that region. LDCs also heard a presentation on Practitioner Advice and Support and shared approaches developed in different areas.
There are no easy solutions, but engagement and shared learning from successes are an important part of how schemes can be developed. A key element of this success is keeping informed, and active local professional input. To support this, the BDA is developing an LDC-ICB engagement resource. This will be a toolkit, available next year, with case studies and templates to assist LDCs and BDA members in discussions with local commissioners.