Agenda item

14.1     The Committee considered a report from NHS Sussex providing a progress update on work underway to enhance routine and urgent dental care access for people across the county.

14.2     The Chair requested that future reports from all NHS organisations should reference data that covered East Sussex only and avoid Sussex-wide data wherever possible.

14.3     The Committee commented that the current levels of provision were unacceptably low and asked how NHS Sussex were working to increase the number of units of dental activity (UDA) across the county.

14.4     Charlotte Keeble, NHS SussexDirector of Primary, Community and Urgent Care Commissioning outlined that nationally the Government had committed to review the NHS dental contract and address known challenges with it which currently presented issues for dental professionals. Locally, there were challenges attracting new NHS dentists to the area, and NHS Sussex was undertaking targeted action to address this. This included uplifting the minimum UDA rate and engaging with local dental providers to encourage them to overdeliver on their NHS contracts, which they were able to do by up to 10%. Providers had also been encouraged to take on temporary UDA, as sometimes they did not want to take these on permanently. An urgent dental care ‘test and learn’ pilot approach, which combined UDA and sessional payments, encouraging providers to take on more complex patients, had proven popular and been extended for the rest of the year. Given there had been five dental contract hand backs in East Sussex, there were plans to hold a market engagement event in Lewes in November to both procure new contracts and understand what would encourage greater take up from providers.

14.5     Nish Suchak, General Dental Practitioner and Chair of the East Sussex Local Dental Committee outlined that the current national contract meant that where practices failed to deliver their number of UDA in a year, they were required to make these up the following year, and the contract was not fit for purpose. There was insufficient funding for the system to meet the level of need and the national contract did not provide sufficient funding to support dentistry practices’ costs, including staff.

14.6     Cllr Turner suggested that dentists should be required to accept new patients onto their books even if they were full, just as GPs were required to do. Nish Suchak commented that dentists were unable to take on more patients because the funding they received from the NHS was ringfenced and cannot afford to do any more NHS work.

14.7     The Committee commented that some people struggled to pay for certain treatments and asked how these people could be better supported.

14.8     Charlotte Keeble commented that NHS Sussex supported there being reforms made to the national contract. The feedback from dental professionals had identified three key drivers causing contract hand backs, which were the low UDA rate, the NHS dental contract and workforce recruitment and retention. NHS Sussex had tried to address these challenges where it was able to, but there were structural issues with the national contract, and there was no dental training school in the entire South East which meant trainees were not being attracted to the region or county.

14.9     Nish Suchak commented that patient charges for NHS dental work went up every April, and working in an area of high deprivation he noted that many patients asked for the minimum level of treatment to avoid higher costs. There was high level of tooth decay within children and prevention work in schools would be important in addressing this.

14.10   The Committee asked how NHS Sussex collaborated with ESCC to deliver a preventative approach to dental health in schools.

14.11   Charlotte Keeble explained that the NHS Sussex Dental Plan had been developed in partnership, including with Public Health teams in ESCC. There had also been discrete pieces of work, including working with ESCC to review the Looked After Children pathway, given the specific complexities related to their dental health. The new Government had committed in its manifesto to a toothbrushing campaign for 3-5 year olds, and public health consultants would be working on that campaign. Prevention was also embedded into the urgent dental care pilot, which was ringfenced for children, young people and clinically vulnerable people who had difficulties accessing dental services and needed longer appointments.

14.12   The Committee asked what the time delay until the workforce benefits were realised from the work with the NHSE Workforce Dental Deanery.

14.13   Charlotte Keeble explained that she had recently met with the Dental Deanery and Chichester College to explore the viability of a proposal for a dental school with the Deanery, as well as to test out the costs of such a development. A fully costed business case would need to be developed and discussions on this were ongoing. Nish Suchak added that it took five years to train a dentist followed by an additional year, which meant it took six years for newly qualified dentists to come onstream.

14.14   The Committee asked whether there were plans to increase the number of ‘golden hellos’.

14.15   Charlote Keeble explained that there was a national allocation to each region for golden hello posts. Twenty eight were allocated to the South East and NHS Sussex took eleven, three of which were allocated to East Sussex. As this was centrally administered there was nothing NHS Sussex could do to increase the number of golden hello posts in East Sussex. Dental providers also needed to be willing to take on the golden hello posts, which required support and training and there were three providers in East Sussex which came forward to accept. Nish Suchak, added that the golden hellos required practitioners to stay for a minimum of three years, and if they did not stay for that length of time the money would be clawed back from practices, which many were not willing to risk.

14.16   The Committee asked when the issues in East Sussex would be in less of a crisis situation.

14.17   Charlotte Keeble explained that performance in East Sussex had been improving due to the programmes and interventions outlined in the report. A lot of progress was still required but it would never be the case that 100% of activity for dental contracts was delivered, and this had been the case prior to the pandemic. Despite work done locally, changes made at a national level were required for there to be the level of improvement that people were hoping for.

14.18   The Committee noted that there was a gap in appointment availability and the needs of patients and how this was managed.

14.19   Charlotte Keeble explained that NHS Sussex monitored all activity it commissioned, so every practice was being monitored to ensure they delivered the expected amount of activity, and the dental contract allowed for reviews to take place to address underperformance. If a dental provider chose not to deliver its NHS activity there was very little that commissioners could do in-year to address this, beyond working with the provider to develop an action plan for it to deliver its expected activity. Commissioners had very few contractual sanctions to enforce delivery of activity, particularly in the early part of the year. NHS Sussex also monitored availability of appointments, and where these did not change then NHS Sussex would make direct contact to confirm when providers would next be making new appointments available.

14.20   The Committee asked whether a national requirement for newly qualified dentists to be required to do a minimum amount of NHS work before they could go into private practice would be helpful.

14.21   Charlotte Keeble responded that she would be very supportive of such a change, and that any way to recruit and retain more dentists locally was vital for implementing the workforce plan.

14.22   The Committee asked for clarification at Figure 1 of the report to whether the numbers shown were only providers that delivered NHS contracts, as there were currently no NHS providers accepting patients in Seaford.

14.23   Charlotte Keeble explained that the map on Figure 1 showed all NHS service contracts. There were five NHS dental contracts in Seaford, but this did not mean there were five separate providers. Some providers held more than one NHS dental contract for different services. NHS Sussex was widely advertising its market engagement event in November where it hoped to attract new providers to the area, recognising that there were some gaps in provision across the county.

14.24   The Committee asked what the proportion of NHS to private activity was for the average dental provider.

14.25   Charlotte Keeble said that this was not data that NHS Sussex had available and would only been known by individual providers themselves. There was no national data on this, but most providers delivering NHS activity would deliver a level of private activity as well.

14.26   The Committee asked how NHS Sussex ensure there was sufficient provision in more deprived areas of the county.

14.27   Charlotte Keeble explained that comparative data was considered as part of the allocation of dental provision across the county, including indices of deprivation. The number of currently commissioned UDA were RAG rated against the number that would be expected to meet the level of need in an area based on indices of deprivation to assess whether this was higher or lower than required. Commissioning on this basis then meant that activity could be targeted at the areas with the most need, such as the commissioning of temporary activity or overactivity on dental contracts in areas where there had been dental contract hand backs. Charlotte agreed to share the commissioning methodology with the Committee.

14.28   The Committee asked whether it was possible to pay dentists to overperform and deliver more NHS activity.

14.29   Charlotte Keeble explained that NHS Sussex commissioned for its allocated dental budget in a year. Where providers underperformed on their commissioned activity, funding was then clawed back and used to pay for overperformance on contracts by other providers. The way NHS Sussex commissioned its services were within the confines of the national contract which the new Government had committed to reform. Margaret Case explained that the funding allocated is based on the amount of work that was actually delivered, which meant if patients did not attend then dentists would not be paid for it. The UK did not train enough dentists to meet the level of demand which meant the country was reliant on dentists coming from abroad, which was a protracted process for those arriving. Often these dentists found working within the NHS system difficult and would more likely than not go private.

14.30   The Committee asked whether it was possible to require dentists arriving from abroad to work for the NHS for a longer period of time.

14.31   Margaret Case explained that she was a clinical dental advisor for the South East and worked to onboard foreign dentists into the area. Foreign dentists mostly funded their own training, including the required conversion courses to work in the UK, and they also faced long delays to entering the system and found working with the NHS difficult to navigate. These things created barriers for foreign dentists staying in the NHS for an extended period of time. Paying some of their costs upfront and treating them as salaried workers might help but that would require national change.

14.32   The Committee RESOLVED to:

1)    Note the report and recognise greater levels of funding were required from national government to improve NHS dental services in East Sussex;

2)    Receive a further report in March 2025.