NHS Sussex paper to East Sussex Health Overview Scrutiny Committee (HOSC) on Dentistry
1. Introduction
1.1 An NHS Sussex report on Dentistry was shared with the East Sussex Health Overview Scrutiny Committee (HOSC) in November 2022, and an update was provided in October 2024. These reports set out the position of the delegated commissioning responsibility for Dentistry, provided an overview of how dental services are delivered, and described how the NHS Sussex Dental Recovery and Transformation Plan (DRTP) is supporting the development of NHS dental services across Sussex
1.2 This brief update report, following our more comprehensive reports, provides an overview of developments across East Sussex since October 2024 to support patients to access NHS dentistry and includes details of the NHS Planning and Operating Guidance 2025/26.
1.3 To recap, enhancing access to dental services is a national and local priority. The NHS Planning and Operating Guidance 2024/25 included a national objective to increase dental activity by implementing the national plan to recover and reform NHS dentistry, improving units of dental activity (UDA) towards pre-pandemic levels. The NHS Planning and Operational Guidance 2025/26 includes a national priority to improve access to urgent dental care, providing 700,000 additional urgent dental appointments. Across Sussex this equates to approximately 26,500 appointments.
2. The National Dental Rescue Plan
2.1 Following the General Election last year, the new government committed to delivering their manifesto pledges published on 24 June 2024, which included their Dentistry Rescue Plan and provide 700,000 new appointments, with four areas of focus, to:
o Reform the dental contract, to rebuild NHS dentistry and make sure everyone who needs a dentist can get one.
o Roll out supervised toothbrushing for 3 to 5-year-olds, to prevent children forced to hospital to have their rotting teeth pulled out.
o Fill the gap of appointments with an extra 700,000 urgent and emergency dental appointments a year.
o Flood ‘dental deserts’ with new dentistry graduates, with ‘golden hellos’ of £20,000 for those who spend at least three years working in underserved areas.
2.2 We are awaiting further guidance on the first three of these focus areas. However, NHS Sussex has started to deliver additional urgent dental appointments from the dental “ringfence” budget. We have also offered 17 “golden hellos” across Sussex. Further details of these schemes are provided below.
3. How are dental providers delivering contracted activity across East Sussex?
3.1 Dental access is reduced when NHS dental providers under-perform against their contracted activity. Sussex dental performance data showed a steady decline in delivery of UDAs after the Covid-19 pandemic, decreasing from 94% in 2018/19 to 65% in 2021/22. This trend was mirrored at a regional and national level. There was a significant improvement in 2023/24 with 86% of UDAs being delivered across East Sussex, (84% in Sussex).
3.2 Our latest dental performance data for 2024/25 indicates improvements across Sussex. At of 31 December 2024 our local target delivery UDA count was 1,293,195 UDAs. Providers in Sussex delivered 1,464,694 UDAs.
3.3 Table 1 shows delivery against contracted activity for each district borough area in 2023/24 and for the nine months to 31 December 2024. We would expect providers to deliver at least 50% of their contracted activity as of 31 December 2024. The 50% target allows for the fact that claims can be submitted up to 31 May. Historically this and the 30% mid-year target have been a good predictor of year end outcome.
3.4 As the table shows, all district borough areas in East Sussex delivered over 50% of activity in the first nine months of 2024/25 with the East Sussex average being 63%.
Table 1 – UDA delivery by District Borough area
|
District |
FULL YEAR % of contracted activity delivered 2023/24 |
9 MONTHS % of contracted activity delivered as of 31 Dec 24 |
|
Eastbourne |
81% |
65% |
|
Hastings |
100% |
73% |
|
Lewes |
91% |
63% |
|
Rother |
70% |
53% |
|
Wealden |
82% |
58% |
|
East Sussex Total |
84% |
63% |
3.5 The area in East Sussex with the lowest percentage of activity delivered as of 31 December 24 is Rother at 53%. We recently met with a provider in Rother who is struggling to deliver their NHS contracted activity. We have agreed that they will temporarily reduce their contracted activity in 2025/26. We can then offer that activity to other providers in Rother which will help to increase NHS dental access in that area.
4. How have NHS dental contract hand backs affected East Sussex and the wider system?
4.1 Since the last report to HOSC in October 2024 there have been some small contract hand backs as follows:
- One in the Eastbourne locality, totalling 1,800 UDAs
- Four small contracts (with one provider) in the Lewes area, equating to 3,491 UDAs.
4.2 We are developing our plans for 2025/26, and hand backs will be reviewed as part of the planning process.
5. What actions has NHS Sussex taken to enhance dental access in East Sussex?
5.1 Overperformance
As reported previously, nineteen dental contracts in East Sussex were originally approved to ‘overperform’ by up to 10% in 2024/25. Since the last report we have agreed “overperformance” for a further two providers in East Sussex (in Northiam and Hailsham). This represents delivery of up to 25,946 additional UDA in East Sussex and up to 81 additional sedation courses of treatment.
5.2 Lewes procurement
Lewes was identified as a locality that had experienced a loss in activity falling below the average Sussex UDA per head of population (PHP) rate for an area with similar levels of deprivation according to Index of Multiple Deprivation (IMD) rankings.
5.3 NHS Sussex in conjunction with Local Authority colleagues hosted a dental provider listening event in Lewes on 7 November 2024. This event was well attended and enabled us to hear from providers and to work with them to identify opportunities to increase commissioned activity and improve contractual performance in Lewes.
5.4 Following this event, we reviewed feedback and decided to “rapidly” procure additional UDAs across the Lewes District. Our aim is to commission at least 16,500 permanent UDAs (equivalent of 2.4 whole time equivalent dentists). We have reviewed expressions of interest and are currently working with providers to mobile this additional activity from April 2025.
5.5 Once this activity is commissioned, UDAs per head of population (PHP) in the Lewes district would increase to 1.43 UDAs PHP, which is above the Sussex average of 1.41 UDAs PHP.
5.6 Dentist Recruitment Incentive Scheme
Lewes and Hastings were identified as target areas to offer ‘golden hellos’ under the Dentist Recruitment Incentive Scheme (DRIS) in 2024/25. This scheme was described in the previous paper to HOSC in October 2024. Three ‘golden hello’ posts were originally agreed for practices in these areas. One further application was approved in December 2025. When recruited these new dentists will be delivering approximately 14,000 UDAs each year (depending on their previous experience). We are working with providers to support them with recruiting to longstanding vacancies and are hosting a workforce session to assist providers.
5.7 Additional Hours Scheme
We have continued to fund the Additional Hours Scheme in 2024/25 which offers additional capacity for new patients and supports access for vulnerable patient cohorts. Three practices in Hastings deliver that scheme, offering up to13 sessions per week.
5.8 Urgent Dental Care & Stabilisation Programme
We have expanded our Urgent Dental Care & Stabilisation (UDCS) Programme. This follows a successful 12-week pilot last year. The programme is designed to improve access to urgent dental services for people without a regular dentist and to vulnerable patient groups. It provides urgent care appointments and also offers courses of treatment to stabilise oral health, reducing the need for recurring visits.
Patients in need of urgent dental care who do not have a regular dentist can access the service by calling the Sussex Dental Helpline on 0300 123 1663 or emailing kcht.dentalhelpdesk@nhs.net. The Helpline team have the latest information on the availability of appointments and can book patients into appointment slots directly.
5.9 Sessions are now available in four district council areas across East Sussex (Eastbourne, Hastings, Wealden and Lewes). We are currently working with providers in Rother to try to ensure the service is available in that area however people living in Rother can still access appointments in other nearby locations, including Hastings, Eastbourne and Wadhurst.
5.10 Providers in East Sussex are currently delivering 9 sessions per week under this programme. This equates to approximately 63 extra appointments per week. The team is reviewing capacity on a weekly basis and if needed can quickly mobilise additional sessions.
5.11 Additional Urgent Appointments
In line with the Planning & Operational guidance for 2025/26 NHS Sussex is developing a plan to deliver its share of the 700,000 additional urgent appointments across Sussex. This equates to approximately 26,500 extra appointments across Sussex.
5.12 Our providers are currently delivering around 217 extra appointments per week (11,284 per annum) via our UDCS programme across Sussex. We regularly review capacity and demand and are assessing how this can be scaled up in the areas of need to achieve the appointments required.
6. Continuous improvement priorities
We continue to take actions, as detailed below, to support continuous improvement:
· Review contracted dental activity, performance and population health management data on a quarterly basis to inform commissioning decisions to help address variation and health inequalities. This enabled us to identify a commissioning need in the Lewes area.
· Support practices by using the South East resilience framework to assess applications from dental practices experiencing challenges due to exceptional circumstances. This has included supporting two dental providers in East Sussex and ensuring they can continue to provide NHS services.
· Working with our local authority colleagues to promote oral health to children. We recently set up a Sussex task and finish group to develop options for enhancing services to support children. We shared our proposal and are now working with our local authority colleagues to plan options for delivery.
· We have updated the pathway for UDCS to include children who are identified by a qualified professional as requiring a full dental assessment.
· We are undertaking a service review for five dental specialty areas (Special Care and Paediatrics, Unscheduled Care, Sedation, Restorative and Oral Surgery). This includes working with our secondary care colleagues at East Sussex Healthcare NHS Trust to ensure services are available for children and adults with additional needs who are unable to have treatment at a general dental practice. These services are a referral-only service, providing a range of dental treatments for children and adults with additional needs, including physical or learning disabilities, or where they have a need for additional support to receive treatment.
· A domiciliary dental care pilot for elderly care home residents in a care service has been mobilised in Crawley to test a new delivery model. As part of our planning for 2025/26 we are reviewing the data and considering whether this can be extended to other areas including East Sussex.
· We have undertaken a survey to better understand the local dental workforce in line with the forthcoming data from the national dental workforce data collection and inform the Sussex Primary Care Workforce Development Plan. The survey is still open. This data will inform our collaborative workforce initiatives aimed at improving access, enhancing service delivery, support for children and vulnerable groups and cultivating a positive experience for dental professionals of NHS service delivery
· We are implementing a dental clinical leadership initiative to lead and support projects in our local programme.
· We are reviewing the recent pan Sussex Healthwatch survey on dentistry which sought people’s experiences of NHS Dentistry. A poll was previously carried out in January 2023 and Healthwatch wanted to see if there had been any changes over the past two years. The poll found that more than half of respondents (52%) indicated it is a struggle to access a dentist able to offer NHS treatment, which is higher than in 2023 (41%). However, it saw an increase in the proportion of respondents who said they were able to access NHS dentistry without any issues in 2025 (44%), compared to 2023 (26%).
7. Conclusion
7.1 This report details some of the actions NHS Sussex has taken over the last six months to enhance routine and urgent care dental access for people across East Sussex. It also outlines our plans to deliver additional urgent appointments required as part of the NHS Planning and Operating Guidance 2025/26.
7.2 It sets out how we have improved patient access to NHS dentistry, and our actions to prevent poor oral health. The actions we have taken include initiatives to enhance access to routine and urgent dental care via the rapid commissioning of permanent UDAs in Lewes, the expansion of the UDCS pilot and an oral health improvement pilot supporting patients in care home settings. In East Sussex, we now have seven dental practices delivering the UDCS programme and three practices who participate in the additional hours scheme. We are also supporting providers to recruit new dentists who will offer NHS activity. Additionally approved “overperformance” will deliver up to 25,946 additional UDAs in East Sussex and up to 81 additional sedation courses of treatment. All of these initiatives support patients in East Sussex to access NHS dentistry.