Select Committee on Health Written Evidence


APPENDIX 1

NHS DENTISTRY IN DEVON

Report to the Devon County Council Health Overview and Scrutiny Committee

INTRODUCTION

  In April 2006, the new NHS dental contract was implemented across England, replacing the national General Dental Services contract which had been in place largely unaltered since 1948. The new regulatory framework for primary care dental services, introduced a number of important changes which included, new contract arrangements which were based upon moving away from the item of service system, the removal of the registration system, devolvement of the national dental budget to Primary Care Trusts, a new simpler system of patient charges, new National Institute of Clinical excellence (NICE) guidelines on recall intervals for patients.

  The new contract arrangements were successfully implemented across the six PCTs that constituted the area now covered by Devon PCT. In line with the national position approximately 4% of dentists across the county chose not to accept the offer of a new contract. In addition to contracts for general dental services to be provided, agreements were also in place for the provision of orthodontic services, sedation, domiciliary visits and urgent dental services.

DENTISTRY SPEND

  During the first three years of the dental contract the funding for NHS dentistry is separately allocated to PCTs and does not form part of the PCTs unified budget. This enables the Department of Health to ensure the spending commitments to NHS dentistry are delivered and can be demonstrated. The table below sets out the PCT allocation for NHS dentistry. The dental budget is made up of two separate elements, being the allocation received from central government and the income received through patients charges.


Allocation from
DoH £000s
Patient Charge
Expectation £000s

2006-07
24,055
8,452
2007-08
25,517
8,817


  Whilst the allocation from the Department of Health is a known sum, the patient charge income was unknown and based upon the assumptions made by the Department of Health's figures and had not been tested under the new system. In the first year of the contract the actual income received from patient charges was £6,578,000 representing a significant shortfall against the funding anticipated within forecasts. Significant patient charge income shortfalls have been reported across many PCTs and has reduced the overall level of funding available for dental services.

DENTAL MANPOWER

  The table below shows the number of dentists who are currently working under open contracts within the PCT area.


June 2006
September 2006
December 2006
March 2007

Number of Dentists on Open Contracts
330
341
342
360
Dentists per 100,000 population
45.1
46.6
46.8
49

Source: The Information Centre for Health and Social Care.


  Whilst the statistics show an increase in the number of dentists under contract within Devon PCT it does not take account of the amount of time each dentist devotes to treating patients under NHS arrangements. A whole time equivalent figure is not available for the amount of time spent undertaking NHS dentistry.

PATIENTS ACCESSING NHS DENTISTRY

  Prior to April 2006, patients were registered with a specific dentist for NHS treatment and dentists NHS list sizes were used to indicate the number of patients who were regularly accessing NHS dental care. Patient registration was removed with the introduction of the new contract and has been replaced by a measurement of the number of patients who access NHS dentistry in any 24 month period. The table below provides the number of patients registered at 31st march 2006 and the new patients treated measure:


March 2006
June 2006
September 2006
December 2006
March 2007

Patients Registered
344,962
n/a
n/a
n/a
n/a
Children Treated
101,197
101,113
101,552
101,629
102,167
Adults Treated
263,533
262,960
263,576
265,876
269,394
Total Patients treated in Previous 24 month period
364,730
364,073
365,128
367,504
372,011

Source: The Information Centre for Health and Social Care.


  The PCT has consolidated the differing arrangements which existed for patients to access an NHS dentist into a single contact point which can be accessed by telephone, letter or by e-mail. This central contact point enables patients to register their name with the PCT and be allocated to a local dental practice as further NHS spaces become available. During the first year of the new contract improvements in access have been achieved through additional investment which has supported new dentists in practices, in Torrington, Barnstaple, and Chulmleigh, new practices have been established in Exeter and in Salcombe. This has allowed the PCT to be able to offer patients who have been on the waiting list a NHS dental service. Whilst information is available through the NHS website, NHS Choices and through NHS Direct, there is more work which needs to done in this area, particularly regarding the accessibility, and accuracy of information to the public about dental services.

  In addition to routine dental care there are established arrangements in place to provide access to urgent dental care. During normal hours, patients can gain access to urgent dental care through their own dental practice, all practices have daily emergency appointments available and are usually able to see a patient on the same day or within 24 hours of making contact. For those patients who do not have access to a regular dentist there are Dental Access Centres or salaried dental services provided by the PCT providing urgent care. Services are available in Exeter, Barnstaple, and Newton Abbot within Devon.

  An Out of Hours dental service is provided by Devon Doctors, providing call handling and advice on managing a dental condition on weekday evenings and access to an emergency dentist in Exeter, Barnstaple, Newton Abbot and Plymouth at weekends.

DEVELOPMENTS DURING 2007-08

  The first year of the new contract has seen significant change for patients, the NHS and for dentists. The PCT has continued to work with dental practices to review performance under their contract to ensure the best use of public funds is achieved and to further improve access for the public. In June 2007, new practices were opened in Exmouth and Okehampton with a total of four extra dentists. Further improvements in access are being planned for Exeter and Crediton, with existing practices increasing their NHS workload. Another new dental practice has been approved for Tavistock and this is expected to open by the end of 2007.

  Since June 2007, 6,435 patients have been allocated an NHS dentist, with access being secured in Exeter, Crediton, Newton Abbot, Exmouth, Okehampton, Torrington, Chulmleigh, Barnstaple, South Brent, Kingsbridge and Salcombe.

  There are now 7,700 patients on the PCT waiting list and the PCT will continue working with dentists to ensure those patients can be offered a NHS dental service as more spaces become available through the planned developments mentioned above.

ORAL HEALTH STRATEGY

  The development of an oral health strategy for Devon is viewed as a key requirement to take forward and inform the commissioning of oral health services in Devon. The strategy will contribute to the strategic review of Health Services across Devon. The strategy is in the early stage of development which is being led by the PCT Oral Health Advisory and will be shared with stakeholders as part of a consultation process.

Andrew Harris

Primary Care Manager

Devon Primary Care Trust

22 October 2007





 
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Prepared 4 February 2008