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Improving NHS dentistry: giving dental patients better access and outcomes

Blog Author Tom King

Blog Date 05/11/2018



Marking the NHS' 70th Birthday, the Government is set to invest £20.5 billion into the NHS in England in exchange for a long-term plan for the health service's future.
We feel that dentistry is often forgotten when it comes to getting a share of NHS funding, so in our response to NHS England's consultation we've set out to Government why we feel committing more resources to NHS dentistry can massively improve oral (and general) health outcomes for patients. 


Here's a summary of some of our key asks:


1. Reform the dental contract

Delivering on a reformed and better resourced NHS primary care dental contract that is based on a preventive care pathway must be a top priority for transforming NHS dental care and putting prevention front and centre.

It is also vital if NHS dentistry is going to be able to attract the workforce needed to meet the oral health needs of the population and reduce health inequalities.


2. Invest in a preventive approach

Prevention, not treatment, must be at the heart of NHS dental services.


The lack of resources and the failure to adopt well-evidenced and cost-effective preventive strategies are a key barrier to improving care and health outcomes. 


Public health initiatives such as smoking cessation and drug and alcohol services are being cut by local authorities under severe financial pressure. 


There needs to be a whole-system approach to improving health which includes social care and prevention. 


For dentistry, toothbrushing schemes for young children have been shown to be an effective and cost-effective means to reduce dental decay in children, which will have lifelong benefits to the oral health of the children and the general population.


An England-wide supervised brushing programme to the most deprived children could be delivered for less than £5 million a year. This is set against an annual NHS spend of £3.4 billion on dentistry. Public Health England's return on investment tool indicates a return of £2 for every £1 spent on a supervised toothbrushing scheme. 


3. Deal with the recruitment crisis

NHS dentistry is facing severe and growing recruitment and retention challenges.  


Our research has found that, in 2016, 49 per cent of dental practices in England that had tried to recruit reported difficulties in doing so and in 2017 this had increased to 66 per cent.


It is clear that NHS England needs to act to be able to encourage dentists to want to work within the NHS by improving working conditions, boosting morale and delivering fair pay.


4. End the hostile environment on patient fines

The number of fines issued increased more than 100-fold in the last few years, going from 4,120 in 2009-10 to 427,240 in 2017-18, with well over one million penalty charge notices sent in the last four years alone.


The impact of this has fallen disproportionately on vulnerable patient groups. Many of these are just innocent mistakes with patients not understanding the complexity of the forms. 


These fines, combined with the NHS campaign #dontruntherisk, deter patients from seeking care.


Official figures show a fall of two million treatments delivered to patients exempt from NHS charges since 2013-14 – a fall of 23 per cent in four years. 


NHS England needs to end this hostile environment that is deterring low income patients and punishing the most vulnerable. 


We need a common-sense approach to checking that patients are entitled to free dental care, rather than issuing fines first and asking questions later. 


5. Ensure access to services for vulnerable groups

Many of the most vulnerable groups in our society are struggling to access routine dental care.


Given the ageing population there are challenges ensuring high quality oral health care and attention for all those living in care homes or requiring care in other domiciliary settings. 


It is also crucial that we ensure improved access for people experiencing homelessness, who are likely to have significant levels of unmet dental need. 


Appropriately commissioned domiciliary and community services are vital to ensure that sectors of the population are not unnecessarily disadvantaged. 


6. Take action on oral cancer

Rates of oral cancer are rising fast – and Cancer Research UK estimates that incidence of oral cancer will rise by 33 per cent in the UK by 2035.


Dentists are often the first health professionals to detect early signs of oral cancer, during either a routine or emergency appointment, as they see otherwise "healthy" patients.


We want the barriers to accessing dental services removed, so oral cancers can be detected earlier by dentists – early detection results in a roughly 90 per cent survival rate, compared to 50 per cent, for delayed diagnosis.


There must also be a focus on preventable risk factors that are common to a range of cancers including oral cancer such as tobacco, alcohol and diet. 


We've called for the HPV vaccination programme for boys must be implemented without delay, along with a catch-up programme for those over the age for vaccination who would otherwise miss out. 


7. Give dentists access to Summary Care Records 

Digital innovation is a key priority for the new Secretary of State for Health and Social Care, but we feel dentistry is often forgotten in these conversations.


Even giving dentists access to the Summary Care Records would be an important step forward. This would help safeguard patient safety, ensuring that dentists have access to accurate details of patients' medical history. 


This is of growing importance with an ageing population, as patients increasingly live with several long-term conditions and are taking a combination of medications. 


It would also help dentists to minimise antibiotic prescribing and help to tackle anti-microbial resistance.


8. Recognise that oral health is important for hospital patients

Better integration and collaboration between different parts of the NHS could improve patient care, and a recognition that oral health is important, could make a big difference.

Some of the risks of potentially life-threatening diseases could be reduced by simple oral hygiene measures.

This is particularly the case for hospital in-patients, for whom neglecting basic oral hygiene can lead to under- and malnourishment and increase recovery times and hospital stays.

Poor oral health can also increase the risk of hospital-acquired pneumonia and ventilator-associated pneumonia, and lead to higher mortality rates.

We want all health professionals to recognise the importance of oral health, and to  implement simple oral hygiene routines on hospital wards, helping to improve patient care and outcomes.


9. Secure the future of dental education and research

In order to increase the pioneering research in dentistry and oral health, we want there to be a recognition of the problems in clinical academic staffing in regards to recruitment and retention.


Low staffing levels among this group have a profound influence on the quality of the education received by dental undergraduate students. There are fewer academics available to do the research needed for future oral health innovations.


We call for a steady intake of, and career progression for, dental academics, to ensure the UK remains a world leader.


Tom King, BDA Policy Adviser


Working for you

We will continue to campaign for more resources for NHS dentistry to improve oral health across the UK. If you'd like to be kept up to date with our progress:


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