Select Committee on Health Written Evidence


Memorandum by the Oral Health Task Group of Lancashire County Council's Adult Social Care and Health Overview and Scrutiny Committee (DS 21)

DENTAL SERVICES

1.  EXECUTIVE SUMMARY

  1.1  Lancashire County Council's Adult Social Care and Health Overview and Scrutiny Committee considered submissions on the subject of "Access to NHS Dentistry" at its meeting on 4 September 2007. The submissions included a report from a consultant representing the three Primary Care Trusts in Lancashire on the implementation of the new NHS Dental Contract, a contribution from a practising NHS dentist, and public consultation outputs from the Life in Lancashire Citizen Panel and responses to media requests for public experiences and perceptions.[43]

  1.2  Members of the Scrutiny Committee were concerned that the reports they received indicated there was cause for concern about oral health standards in Lancashire. To further investigate the subject a Task Group of elected members was established who made the decision to provide a submission to the Health Select Committee regarding oral health in Lancashire, in order to contribute to the national debate.

  1.3  This memorandum represents the views of the Oral Health Task Group which includes County Councillors Terry Aldridge, Miles Parkinson, Mike Calvert and Stephen Sutcliffe and Wyre District Councillor Ramesh Gandhi.

2.  RECOMMENDATIONS

  2.1  The NHS Dental Contract should be re-examined in light of the potential limiting effect of Units of Dental Activity on delivering preventative care and advice.

  2.2  A public education campaign should be delivered on the benefits of good oral hygiene from an early age, particularly targeting children and young people, and to promote accessing dental care for preventative rather than remedial treatment.

  2.3  PCT commissioning should deliver investment into preventative treatment and advice to deliver good oral health.

  2.4  The new system of dental charge bands should be publicised to address the public perception of free dental care for all.

  2.5  PCT commissioning should provides appropriate and equitable service provision taking into account urban and rural needs and barriers to access such as deprivation which can limit mobility and travel horizons.

  2.6  The NHS should ensure that enough trainees enter the system to sustain and raise the number of Dentists.

3.  INTRODUCTION

  3.1  Lancashire has a population of 1.1 million people experiencing on average lower levels of oral health than nationally.

  3.2  Lancashire County Council's Adult Social Care and Health Overview and Scrutiny Committee comprises fifteen county councillors and 12 co-opted councillors representing the district councils of Lancashire, and enables closer two tier working to consider social care and healthcare developments across the county.

  3.3  Members of the Scrutiny Committee were concerned that the reports they received indicated there was cause for concern about oral health standards in Lancashire. To further investigate the subject a Task Group of elected members was established who made the decision to provide a submission to the Health Select Committee regarding oral health in Lancashire, in order to contribute to the national debate.

  3.4  The following information comprises evidence considered by the Oral Health Task Group with concern and recommendations for the attention of the Health Select Committee.

4.  THE ROLE OF PCTS IN COMMISSIONING DENTAL SERVICES

  4.1  The PCTs in Lancashire have begun the process of developing Oral Health Strategies. The strategies include oral health assessments, actions to improve oral health and actions to improve services. Central Lancashire PCT has published its Oral Health Strategy, whilst North and East Lancashire PCTs are in the process of developing theirs.

5.  NUMBERS OF NHS DENTISTS AND THE NUMBERS OF PATIENTS REGISTERED WITH THEM

  5.1  It is the understanding of the task group that dentists no longer hold "registers" of patients following the implementation of the 2006 reforms. This may have led to confusion amongst patients and longer waiting times for appointments.

  5.2  As part of their investigation, the Overview & Scrutiny Committee commissioned a survey. The survey was distributed to the "Life in Lancashire" Citizen Panel, which is demographically representative of the population in the county. Results are weighted to reflect this. The public perception as identified through the Life in Lancashire Citizen Panel shows that more than three-quarters of all respondents (78%) think it is difficult to register with an NHS dentist, nearly half (47%) are dissatisfied with the availability of NHS dental services, half of respondents (52%) said they are registered as NHS dental patients.

6.  NUMBERS OF PRIVATE SECTOR DENTISTS AND THE NUMBERS OF PATIENTS REGISTERED WITH THEM

  6.1  The Life in Lancashire Citizen Panel found one in three people were private patients. These people were most likely to be from the AB socio-economic groups. The majority of people who are registered privately said it was because their dentist stopped providing NHS cover (72%).

7.  THE WORK OF ALLIED PROFESSIONS

  7.1  The Task Group was concerned that patients recommended for a protracted period of care with an allied professional such as a hygienist or orthodontist would be deterred by the cost.

8.  PATIENTS' ACCESS TO NHS DENTAL CARE

  8.1  The Life in Lancashire Citizen Panel found that one in five people don't have a dentist at all. One in 12 respondents has tried to register with an NHS dentist in the last year, going up to 21% for those without a dentist. Half of the respondents who have tried to register with an NHS dentist in the last year are still unregistered with a dentist (48%) with the main problem experienced being that there were no NHS places available locally (70%). NHS patients have to travel shorter distances than private patients with half of those from socio-economic group DE living within a mile of their practice.

  8.2  The Task Group noted that patients were not prepared to travel very far for a dentist and that this was affected considerably by the level of deprivation experienced by the individual.

  8.3  Many patients use Dental Access Centres for remedial treatment as they do not have a regular dentist. Such treatment would not take into account general oral health concerns or provide preventative advice or treatment. It is unclear whether those who use Dental Access Centres are satisfied with being able to have emergency treatment when necessary or whether they would prefer to access a general dental practice for preventative treatment and advice.

  8.4  There is a concern about the accuracy of the waiting lists for dental practitioners as to whether they reflect the true number of patients or individuals representing families without a dentist.

  8.5  The task group felt that further consideration should also be given to the needs of vulnerable population groups and more accessible service provision appropriate to their needs.

9.  THE QUALITY OF CARE PROVIDED TO PATIENTS

  9.1  The Task Group considers that NHS dentists provide a good remedial service to patients. However there is not enough effort put into preventative advice for good oral health.

10.  THE EXTENT TO WHICH DENTISTS ARE ENCOURAGED TO PROVIDE PREVENTATIVE CARE AND ADVICE

  10.1  The Units of Dental Activity are not considered to allow for preventative care and advice to be administered. There were particular concerns that in areas of deprivation and poor levels of oral health, UDAs did not allow NICE guidance on dental recalls to be followed as there was insufficient time to work with more complex cases and in areas of poor oral health.

11.  DENTIST WORKLOADS AND INCOMES

  11.1  An individual General Dental Practitioner raised concerns with the Committee about the Units of Dental Activity allocated within a NHS Dental Contract and their potential to limit capacity. The case was presented that the number of UDAs within the specific practitioner's contract were not sufficient to fill their normal working week and that the dentist effectively had spare capacity to treat patients that was not contracted by the PCT. It was noted that patients with poor oral health would take up large portions of UDAs thereby reducing the overall number of patients that could be seen by a particular Dentist. It was of concern that this could potentially be a disincentive to treating patients with poor oral health. As there was no further funding available from the PCT to commission the additional capacity, effectively this individual dentist only worked part-time and could not treat additional NHS patients.

  11.2  There was a perception that some NHS Dentists experienced considerable workloads leading to lengthy waiting times for patient appointments. This delay could contribute to the perception that NHS Dentists are hard to access in an emergency.

12.  THE RECRUITMENT AND RETENTION OF NHS DENTAL PRACTITIONERS

  12.1  The Task Group was concerned NHS dental practitioners were becoming private practitioners as a result of the new NHS contract, and that this was chiefly due to a combination of the financial constraints and a reduced ability to provide care offered by the contract.

  12.2  There was additional concern that dental practitioners recruited from outside of the UK were only staying short term and that trainee dentists did not intend to stay within the NHS due to the financial constraints of the contract and the burden of study costs.

13.  RECOMMENDATIONS FOR ACTION

  13.1  The NHS Dental Contract should be re-examined in light of the potential limiting effect of Units of Dental Activity on delivering preventative care and advice.

  13.2  A public education campaign should be delivered on the benefits of good oral hygiene from an early age, particularly targeting children and young people, and to promote accessing dental care for preventative rather than remedial treatment.

  13.3  PCT commissioning should deliver investment into preventative treatment and advice to deliver good oral health.

  13.4  The new system of dental charge bands should be publicised to address the public perception of free dental care for all.

  13.5  PCT commissioning should provide appropriate and equitable service provision taking into account urban and rural needs and barriers to access such as deprivation which can limit mobility and travel horizons.

  13.6  The NHS should ensure that enough trainees enter the system to sustain and raise the number of Dentists.

December 2007






43   Life in Lancashire Wave 19-Dentistry in Lancashire (2007) Corporate Research and Intelligence Team, Lancashire County Council. NHS Dentistry Consultation (2007) Corporate Research and Intelligence Team, Lancashire County Council Back


 
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