Written evidence submitted by Healthwatch Worcestershire (DTY0037)
Inquiry question - How should inequalities in accessing NHS dental services be addressed?
Healthwatch Worcestershire gathers feedback from those who use local health and social care services, people contact us to share their experiences. This helps us to identify issues and concerns, decide what to focus on and tell those who run the services how they can improve.
Between April 2020 and 31st December 2022 150 people[i] have contacted us about NHS dental services. Last year feedback about NHS dentistry was the third most frequent topic that people contacted us about, after GP and hospital services.
Issues and Concerns
This was the most frequent reason for people contacting us. 96 of the 150 people who have contacted us since April 2020 did so because they had been unable to find a dentist that was currently taking on new NHS patients. Many had tried contacting several practices and were in need of routine checks and treatment.
These numbers include women who had been unable to access their free maternal dental treatment entitlement and parents of children who could not find them an NHS Dentist.
“I have been advised to contact you. I am desperately trying to register at an NHS dentist in Worcestershire, I must have called about 10 and they all say they are not taking on new patients. Do you know of any who are please? I am pregnant and I am entitled to free dental care.”
“I’m really struggling to find an NHS dentist in the Worcestershire area . My dental health is in very poor condition, and I need help as I get in a lot of pain. Can you suggest anything for me?”
We are hearing from people who have poor oral health who are unable to find a dentist for routine dental care.
“Person has lost all but 5 teeth, is diabetic and can no longer eat solid food. Cannot find a dentist to register with.”
“Person with history of oral cancer is having difficulty finding an NHS dentist. Person unable to wear their false teeth which has affected their ability to eat a normal diet. They are experiencing weight loss which they believe is linked to their lack of dentures.”
The issue of “registration” with a dentist is confusing. Many people believe that they are registered with a particular practice, as it has been their custom to attend there. The confusion is exacerbated by practices telling people that they have been placed on ‘waiting lists’, or that they have been ‘removed’ from a practice list. We have had examples of people being told they had been removed from practice lists due to non-attendance, even though they had notified the dentist of Covid-19 or other illness, or the appointments they did not attend had been cancelled by the dental practice.
“Person used to be at XX dental practice in Worcester, but did not go during Covid and then when they had appointment last year they could not go as they had Covid. They were told they had been removed from the list and were not able to re-join. They are in need of dental treatment as they say their teeth and gums are “in a bad way”, but they have been unable to find another NHS practice taking on patients.”
“Person needs treatment but has been told they are no longer registered with local dentist due to failure to attend 3 appointments. Person is frustrated as the appointments were cancelled by the dental practice. They are also diabetic and worried about not eating properly.”
Access to dentistry appears to be a problem in some places across Worcestershire, but particularly in the south of the County.
It is particularly acute in Evesham where there is currently under provision of NHS dentistry leading to extreme difficulty in finding a practice, and in Pershore where there are no NHS dentists taking on new patients at the current time.
“Persons previous NHS dental practice that they had been with for 20 years has changed to private practice. Person phoned about 10 dentists in Evesham and surrounding area as far as Chipping Camden and none were taking on NHS dental patients”
“Parent of four children is unable to find an NHS dentist in Evesham. One needs braces and a referral to an Orthodontist can only be made by a dentist. Parent is concerned for the oral health of their children.”
There is some evidence that access to NHS dental services is more challenging for people already experiencing health inequalities.
We have had feedback from people living in a homeless hostel of the difficulties that they have had accessing both routine and emergency dental care.
The lack of this provision led to one person “treating” themselves.
“Service user was unable to find an NHS dentist to treat them even though they were in pain. Rang NHS111 as per guidance and lengthy wait experienced for their call to be answered. NHS111 advised they would call person back with information, but no call was returned. Service user was in considerable pain and resorted to extracting their own tooth.”
We have also had feedback from providers of services to asylum seekers who have restricted finances. Some may not have access to free NHS dental services and are unable to afford the cost of NHS dental care even if they are able to access it.
As people are forced to travel further to visit an NHS dentist they are experiencing increased travel costs. This may have a particular impact on people with a low income. Older people have reported that they are struggling to travel to an NHS dentist and meet the additional costs involved.
“Person, 85 years old, unable to find an NHS dentist located near to them in Kidderminster. Currently using a dentist on Stourport Rd. Transport costs are £30 return which the person is struggling to pay”
We have had feedback that people are unable to find an NHS dentist and cannot afford private care, resulting in a deterioration of their oral health.
The struggle to find NHS dentists providing for children and young people raises issues about prevention, and potential for a future deterioration in population oral health.
In August 2022 we looked at the information on the NHS website about dental services in Worcestershire.
We found that of the 54 general dental practices listed in Worcestershire 17 had not recently updated their information, and 14 of these had not updated their information at any time in 2021 or 2022.
Only 9 practices in the County were accepting new adult (18+) NHS patients. 1 additional practice was accepting Under 18’s only. With the exception of one practice in Worcester City, these practices were all located in the north of the County.
9 practices specified that they were not accepting NHS patients who were eligible for free dental care, and 18 would only accept referrals for NHS patients.
This exercise highlights that finding information about practices who are accepting new NHS patients is not easy from a patient perspective, as the NHS website is not kept up to date. It also illustrates the shortage of practices accepting new NHS dental patients, particularly in the south of the County.
We have provided feedback to the NHSE West Midlands Commissioning Team about the difficulties with access to NHS dental services being experienced by people in Worcestershire.
The team are aware of the issues and have attended our Public Board Meeting on two occasions in 2022/23 to provide an update on the scale of the difficulties and their strategy for improving NHS dental provision in Worcestershire and across the Integrated Care System. The presentation delivered in September 2022 can be found here:
HWW meet with the NHSE/I Dental Commissioning team quarterly to provide feedback from patients and for progress updates from NHSE. This communication is valuable to our signposting function as it enable us to understand NHSE commissioning strategies in specific locations and the constraints and issues that are being experienced.
From a patient’s perspective, what is required is a clear national commitment that anybody who needs NHS dentistry can access it in a timely way, and the services in place, both generic and specialist, to make this commitment a reality.
Between 1 /4/2020 – 31/3/2021 44 people gave us feedback about Dentists.
Between 1/4/2021 – 31/03/2022 57 people gave us feedback about Dentists
Between 1/4/2022 – 31/12/2022 49 people gave us feedback about Dentists