Agenda item

The Committee considered a report of the Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB) which provided an update on dental services and future plans to improve dental access in LLR. A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes.

 

The Chairman welcomed to the meeting for this item Lewis Parker, Commissioning Manager – Pharmacy, Optometry and Dental East Midlands Primary Care Team, Dr Sulaxni Nainani, Deputy Chief Medical Officer, ICB, Jenny Oliver Consultant in Dental Public Health, and Catriona Peterson, Associate Medical Director (Dental).

 

Arising from discussions the following points were noted:

 

(i)           There were currently 133 general dental contracts across LLR over a similar amount of practices, though a small number of practices had more than one contract. Members raised concerns about whether this was enough contracts to cover the whole of LLR.

 

(ii)         Serious concerns were raised about the lack of access to dental services in Rutland specifically. The problem was compounded by the fact that Rutland residents would normally go to the Melton area as a second choice but Melton was also performing poorly in terms of dental access. Expressions of Interest to provide dental services in Rutland would be requested in September 2024 but the whole procurement process could take 3 months.

 

(iii)        Since February 2021, across LLR there had been 14 contract terminations though there had been no terminations since March 2024. Most of the contracts were terminated by the provider themselves and the most common reason was that the provider did not have the workforce to carry out the NHS contract. When a contract was terminated the patients from that practice were sent a letter signposting them to other practices that were able to take on new NHS patients. A member raised concerns that those patients were not being followed-up to ascertain whether they did in fact attend another practice. In response it was explained that this was not possible as patients did not register with dental practices like they did with GP practices.

 

(iv)       There were 5 out of hours dental contracts in LLR providing services from 8am to 8pm every single day of the year. In response to a question as to whether this was a sufficient number, it was explained that those services were actually underutilised therefore the provision of those services needed to be re-evaluated.

 

(v)         The provision of dental services was measured in Units of Dental Activity (UDAs). Each NHS dental provider was contracted to deliver a set number of units of dental activity (UDAs), for an agreed price, over the contractual year.  Each patient’s course of treatment was associated with a given number of UDAs, ranging from 1 UDA for a simple check up to 12 UDAs for a complex course of treatment, like dentures. There was some variation across LLR in terms of the % of UDAs delivered across NHS dental contracts. For example, contracts in Blaby delivered 94.31% whereas Charnwood contracts delivered 75.27%. This difference was believed to be due to differences in the way the practices managed the contracts and the availability of workforce. It was also noted that Charnwood had a high proportion of University students who tended to access dental services in the places they originally came from rather than where they were attending university.

 

(vi)       An Oral Health Needs Assessment (OHNA) for LLR had been drafted, which identified the oral health needs of the LLR population, highlighting inequalities in health and access to dental care for local groups of people, for example those who were at high risk of poor oral health. The Needs Assessment included the results of research carried out by Healthwatch. Members raised concerns that the publication of the Needs Assessment had been delayed which had led to improvements in access to dental services being delayed. In response it was explained that the document was going through governance processes and would be considered by the ICB at their meeting in August 2024. The Needs Assessment would not resolve all the issues by itself but was the start of a process to improve access to dental services. The contents of the Needs Assessment were already being used to set out commissioning intentions.

 

(vii)      Between July and December 2023 approximately 50% of 0-17 year olds in LLR accessed NHS Dental Services. In response to concerns raised by members that the other 50% might not be accessing dental services at all (not even private services), it was acknowledged that since the Covid-19 pandemic the amount of children accessing dental services had reduced. Some reassurance was given that the issue had been looked into as part of the Needs Assessment and when the document was published it would show the demographics of which children were and were not accessing Dental Services. Looked after children was one demographic that was not accessing dental services as well as they could and work was taking place to tackle this issue. A member requested a more detailed breakdown of the 0-17 year olds accessing dental services so as to understand exactly which ages of children were most affected by this issue. It was agreed that more detailed data would be provided after the meeting.

 

(viii)    Some children and families were hard to reach with dental campaigns. In response to a suggestion from a member that dentists should visit schools it was explained that this had been discussed at an ICB meeting. However, there was not the capacity of dentists available to carry out this work and there were not the facilities at schools to carry out dental procedures. In any case consent from parents would be required. Therefore, the work that did take place in schools tended to focus on encouraging children to brush their teeth properly. A member informed that some families in LLR could not afford toothpaste therefore the problem was a financial one and not just a matter of educating people.

 

(ix)       The causes of poor oral health, such as intake of sugar, were linked in with broader issues that were within the remit of public health departments such as diet and obesity. Therefore, the strategy to tackle oral health needed to be multi-layered and could not be addressed through access to dental care alone.

 

(x)         As an incentive to Dental Practices, a scheme had been put in place nationally where Practices would be paid for up to 110% over performance on their contract. ICBs in the East and West Midlands had originally decided not to implement the scheme.  For the 2023/24 year there had been an underspend in LLR for dental services but decisions had been made nationally on how that underspend was dealt with. It was hoped that going forward the scheme would be implemented in the East Midlands, subject to the NHS dentistry budget being protected at ICB level.

 

(xi)       None of the national initiatives that were being put in place to improve access to dental services in LLR came with any additional funding from NHS England so therefore they had to be funded from underspends locally.

 

(xii)      Both dentists and GPs could make a referral in relation to oral cancer.

 

(xiii)    Patients always had a choice on where they were referred to for specialist NHS dental treatment in hospital settings, though there were some complications arising from different systems being in place in different areas, for example the referral process was different in the East and West Midlands.

 

(xiv)    Water fluoridation had been shown to reduce the likelihood of tooth decay. Some parts of the UK were covered by water fluoridation schemes but LLR and Nottinghamshire were not. The upper-tier Councils in Nottinghamshire had submitted a letter to the Department of Health and Social Care seeking to have water fluoridation in Nottinghamshire. Members questioned whether similar representations to the Secretary of State could be made on behalf of LLR. In response it was confirmed that conversations between the local authorities in LLR had already begun taking place in this regard and an update could be brought to the next meeting of the Committee.

 

RESOLVED:

 

(a)        That the update on plans to improve access to dental practices in LLR be noted;

 

(b)        That officers be requested to provide further updates to future meetings of the Committee on progress with improving dental access, and water fluoridation in LLR.