Contract reform and addressing the challenges from COVID-19 and a poorly funded NHS service, were among the topics debated at the second online local dental committees (LDCs) conference last weekend.
The majority of around 280 dentists who attended voted in favour of a motion from Birmingham LDC calling for additional NHS funding to support practices to extend capacity. Delegates said that waiting lists have escalated during the pandemic, and patients were now presenting with much greater clinical need that required more time to treat. It was argued that additional funding is needed for practices to extend opening hours beyond those contracted so that more patients can be treated safely under current restrictions. Delegates also heard that while the Government had recently announced a £7 billion package for health and care services in England to support the next phase of the NHS response to the pandemic, this was not earmarked to give a funding boost to NHS dental services.
Delegates also supported a call from West Sussex LDC that abatement clawbacks must be urgently reviewed and removed to reflect the fact that ‘variable costs’ have actually increased not decreased despite a ‘reduced’ level of NHS service. It was heard that this could push more dentists into private practice.
Dental funding was the focus of discussions between Sara Hurley, England’s chief dental officer, Ed Waller, NHS director for primary care and Shawn Charlwood, chair of the BDA General Dental Practice Committee (GDPC). The trio discussed oral health inequalities and how contract reform could work to reduce gaps in oral health outcomes, with Shawn Charlwood highlighting that 20% of 3-year-olds in Blackpool have active decay, whereas the corresponding figure for Cambridgeshire is less than 2%.
There were clear calls in delegates’ questions to the panel for more funding to address the impact of the pandemic, reduce inequalities, expand access and make up for long-term under-resourcing of NHS dentistry. Both Sara Hurley and Ed Waller said there was a need to demonstrate that the current funding was spent effectively and efficiently before a case for new investment could be made. They also suggested that commissioners make use of flexible commissioning to address patient backlogs.
Shawn Charlwood pointed out that the current NHS dental budget only provides care for just over half the population and there was a need for NHS decision-makers to admit to this reality. He said that nearly 30 million appointments in England have been lost since the first lockdown. The Chair of GDPC said that dental charges are a barrier to dental care for the most vulnerable in our community and doesn’t fit in with ubiquitous promises to attain "equality" in access. He asked how above inflation increases in patient charges fit with the soundbite that we hear all too often, and questioned why there is a charge for dental examinations.
Commenting on the need for a roadmap out of the pandemic and the relative lack of support for dental practices in England, the GDPC chair said the government should provide funding support to invest in ventilation systems. He said: "Support for dentists in the other nations have contrasted greatly with England in terms of ventilation support as one-off payments.”
On contract reform, Shawn Charlwood said a new dental system needs to be in place for April. He said: “I know that's ambitious, but time is running out. The decade of delay and repeatedly kicking of the can down the road needs to stop.”
Delegates from LDCs also discussed and passed motions on the ongoing contract reform process, with motions proposing that the new system allows for more career development and progression opportunities and that it should facilitate dentists spending more time with patients. The conference also said that the reformed contract must not replace one ‘treadmill’ of targets with another and must have prevention as a central feature.
There was an extensive discussion of the impact that the current infection prevention control (IPC) requirements were having on dentists and their teams. The conference passed a motion from Nottinghamshire LDC calling for an urgent review into the need for enhanced PPE that took into consideration the impact on dental team’s burnout and fatigue and the devastating environmental impact of such measures.
The conference called for NHS England to address the failings in domiciliary dental services. Jason Stokes of Norfolk LDC speaking for the motion said that dental provision for care home residents and those requiring treatment in their own homes was treated as an “afterthought”, setting out the need for a bespoke contractual framework for these services and a comprehensive needs assessment. The BDA has previously highlighted that there is only enough domiciliary care commissioned to cover under 1.3% of the population whose activity is significantly limited by disability or ill health. The CQC’s Smiling Matters report found that 52% of care homes did not even have an oral health plan for residents and 47% of staff never receive training in dental care.
LDCs also backed calls for new programmes to expand access to dentistry to the more than 300,000 homeless people in the UK. While charities in some areas made up for the fragmented NHS provision, Ian Wilson, Leeds LDC, said there needed to be properly commissioned services to meet the needs of this patient group. Research by homelessness charity Groundswell found that people experiencing homelessness have much higher dental need, but that only 23% had attended the dentist in the last six months.
Despite planned NHS reforms marking a move away from competitive procurements, commissioners in South East England were proceeding with a competitive process for special care and paediatric dentistry services. Delegates feared that similar problems would emerge in this process to those that have plagued the competitive procurement of orthodontic services. Instead, the conference urged a more collaborative approach to the arrangement of services as proposed by NHS England’s new provider selection regime.
The conference also gave unanimous backing to a motion asserting that “all forms of discrimination have no place in dentistry”, which was moved by Eddie Crouch, BDA chair. For the fifth year running, conference reaffirmed its support for fluoridation, with this year’s focus on supporting the proposals in the Health & Social Care White Paper to remove funding barriers to the implementation of water fluoridation schemes.