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What’s the long-term plan for community dentistry? Three things you need to know...

Blog Author Charlotte Waite

Blog Date 26/02/2019

Charlotte Waite community dentist with patient

 

​​Launching the NHS Long Term Plan earlier this month, Matt Hancock tweeted that there needs to be a 'personal responsibility' for health.

Many of our patients rely on others to help with their oral care, 'personal responsibility' is a bit of a non-starter – for those patients, the provision of the right support is essential, along with an understanding of their needs and the funding to provide it.

Buzz words such as 'prevention' and 'promoting good oral health' is also nothing new to those working in community dentistry.

It's a shame then, that workforce planning seems conspicuous by its absence in the NHS Long Term Plan, as does any mention of dentistry, and certainly none of the challenges facing community dentistry specifically.

 

But the plan engages on the challenges facing children and vulnerable adults that we have to make our own. We must embrace this opportunity and make sure our voice is heard.

 

Positive words must be transformed with positive actions and outcomes for our patients.

 

BDA Chair Mick Armstrong responded on behalf of the profession, pointing out what is needed for general dentistry, to really deliver on the plan. 

And here's what I hope it will mean for the community dental service:


1. Tackling oral health inequalities

The words "community dentistry" didn't feature anywhere in the NHS 10 Year Plan. However, the issues we are facing in the CDS on a daily basis, did.

The plan says it will tackle health inequalities and the funding allocations to local areas will be based on a more accurate assessment of health inequalities and unmet need.

Could this lead to a postcode lottery of services or is this a real opportunity to direct funding and resource to those who need it most?

If the NHS is to get this right, then the CDS needs to be involved, and commissioners engaging with the profession will be key to its delivery.

We will continue to call on commissioners to consult with us, to listen to what we have to say and to ensure our patients' needs come first, ensuring oral health inequalities are really being tackled.

 

2. Improving the provision of oral care in care homes

One million people will have dementia in the UK by 2025. We know from Healthwatch reports that some of their very basic oral health needs are not being met.

BDA research also shows that care home owners and managers are reporting that the current commissioning of domiciliary care is incredibly patchy.

And those of us working in the CDS, have seen the evidence first hand: the residents with dentures that are never taken out; the staff rushed off their feet; the policies still at the 'to do list' stage.

The result is people left in pain, experiencing dehydration or malnutrition, difficulties in eating, communicating, and with it can come loneliness and isolation.

It feels like there is light at the end of the tunnel though. The NHS England Enhanced Health in Care Homes framework appears to be making inroads: it sets out to ensure every resident's hydration, nutrition and oral health is reviewed regularly and is up front in their care plan.

 

In areas where it's undergoing trials, there are reports of 29% fewer A&E attendances and 23% fewer emergency admissions in areas where it's undergoing trials.

That model is set to be applied to oral health of care home residents by 2023/24, with staffing and funding attached. A consistent team of professionals is pledged to be on hand to address needs – with oral health part of the package.

This is an opportunity to ensure all care home residents have access to regular mouth care and dental services. But again, there needs to be appropriate structures and funding for this to work and we need to be consulted on the way forward.

 

3. Ensuring children with learning disabilities' oral health needs are met

Over 1.4 million people in England have a learning disability and 700,00 people have autism. If this group of children and young people access the CDS for ongoing care, which is often the case, then the cohort of adult people being cared for is also likely to increase.

Investment has been promised to ensure that children with learning disabilities have their needs met by dental services. Dental services are to be included within reviews, as part of general screening services, which will be supported by easily accessible ongoing care.

A pledge is also included to bring dental checks to children based in special residential schools. There is a promise to work with partners, to deliver these checks. These children and young people are usually cared for within the CDS.

The NHS must work with us during the implementation of this part of the plan, so that we can ensure these checks are developed appropriately, to deliver the best outcomes for our patients.

 

Turning the promises into a reality

And with all these promises must come real action.

A new NHS Assembly is set to emerge in early 2019 dentistry and clinicians must have a seat at the table. There must be an understanding of the issues that affect dentistry and its delivery and engagement with the profession will be key.

 

Services must be properly funded and commissioned to an appropriate level, which will meet the needs of the population. Appropriate training will be required, for those involved with the screening processes, as well as dental input into the pathway development.

At the heart of this there must be appropriate commissioning of community dental services, to meet the needs of the population.

Delivery of all the above will depend on real investment in the CDS workforce.

 

Fifty-eight percent of the CDS is now over the half way point of their careers with over a quarter of the workforce in the likely final stages of their careers.

We believe there is a need for increased specialist input in both paediatric and special care dentistry, and the development and funding of specialist training pathways in both primary and secondary care.

So, there is hope for our patients and for those working in the CDS: plans, pledges and promises are one thing, but we will continue to fight for the appropriate investment and the commissioning to make it a reality.

Charlotte WaiteCharlotte Waite, Chair

England Community Dental Services Committee


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