In 'From Delegation to Integration', the NHS Confederation explores lessons from early delegation of primary pharmacy, ophthalmology and dentistry commissioning to integrated care boards, and stresses that NHS dentistry poses the "greatest immediate challenge for systems."
On 1 April 2023, responsibility for commissioning pharmaceutical, general ophthalmic services, and dentistry (POD) was delegated to 42 integrated care boards (ICBs) with the aim of moving towards primary care services that are more joined up, locally led and locally responsive. On dentistry capacity, the report notes the issues, and the ongoing exodus from the service, stressing that "government must develop a clear approach to the dentistry workforce crisis." The report notes both the unpopularity and inflexibility of the NHS contract, and barriers this represents to drive improvement.
We have called on NHS England to ensure the lessons put forward by the NHS Confederation underpin negotiations on a reformed NHS contract. The report has also highlighted how the lack of data will prevent ICBs from taking high-quality commissioning decisions in the short term and to enable systems to tackle more entrenched oral health inequalities over the longer term. Dentist leaders stress that new systems will be required alongside fundamental changes to the contractual framework to make needed progress.
We strongly support calls for closer collaboration between the new bodies and frontline groups - such as Local Dental Committees – which can, as the report notes "be the single biggest driver to address local provision challenges."
BDA Chair Eddie Crouch said; "Integrated care is a sound idea that is going to collide with the reality of broken NHS dental system.
"The government need to heed these warnings. We can't leave local leaders to find 42 different ways to work around a failed contract made in Westminster."