Written evidence submitted by North Yorkshire County Council (DTY0046)

Re: Examining the struggle to access NHS dentistry services

I am writing to you on behalf of North Yorkshire County Council’s Scrutiny of Health Committee in relation to your call for evidence in support of the enquiry into dentistry.

For a number of years, the issues with being able to access an NHS dentist has been a high priority on the agenda for the Scrutiny of Health Committee.

Feedback has consistently been that of it being extremely problematic to find, access and retain an NHS dentist. Whilst everyone recognises this is an issue there seems to be very little evidence to support any form of rectifying or improving the problem.

• What steps should the Government and NHS England take to improve access to NHS dental services?

Healthwatch North Yorkshire recently canvassed public opinion on dentistry in North Yorkshire [1]. The results called for more public involvement in NHS dentistry allowing the public to play a greater role in shaping the service and ensuring it meets the needs of the local population. Healthwatch England’s recommendations on Dentistry are also endorsed by Healthwatch North Yorkshire. Increasingly, the Scrutiny of Health Committee hears examples of patients not being able to access a dentist. The overriding conclusion is that the only solution to this is a radical reform of dental commissioning as it currently stands, quickly and concisely.

Specific examples of the lack of access to dentistry are common, the Committee hears many, the solution is where we now need to be focussing attention.

• What role should ICSs play in improving dental services in their local area?

There is a huge opportunity with the recent implementation of the new Integrated Care Boards for them to undertake a greater role in commissioning NHS dentistry services. ICB’s can forge the start of a way forward that is consistent across the Country with place-based expertise and knowledge.

• How should inequalities in accessing NHS dental services be addressed?

Inequalities present a major problem in accessing dental services and these differ hugely, for example in North Yorkshire, Scarborough residents have a much greater challenge in accessing dentistry than Harrogate, due, in part, to the vast difference in demographics. This is particularly evident in Eastfield, the most deprived ward in North Yorkshire. Indeed, it is hugely concerning that “standardised incidence of oral cancer was highest in the North West, North East and Yorkshire and Humber regions” and “prevalence of tooth decay in 5-year-old children was highest in the North West and Yorkshire and Humber. This was repeated for 12-year-olds”.[2] There is more in terms of rectifying this, e.g., nutrition and education but the fact remains that accessing dentistry is problematic and a contributing factor in these issues.

• Does the NHS dental contract need further reform?

Absolutely, without question, yes, radical reform. The solution lies in the management of dental services. There could perhaps be enough dentists and enough practices. The logistical disparity is in the inability to accept enough NHS patients due to the dental practice not being a part of the NHS but in effect a private contractor. Whilst the first stage of dental reform 2021-2022 highlighted some initial changes[3] there is further work to be completed.

• What incentives should be offered by the NHS to recruit and retain dental professionals, and what is the role of training in this context?

Recruitment and retention remains difficult, dentists themselves are frustrated with the service they can provide.  The NHS has already lost around 3000 dentists, and around three-quarters of NHS dentists say they are now likely to reduce (or further reduce) their NHS commitment in the next 12 months.[4]

With at least 6 years to train and qualify as a dentist there is not a short-term solution. Perhaps an avenue to explore is to canvass leavers for first hand feedback, why did they leave the profession? What, if anything, could have tempted them to stay or prevent them from leaving in the first instance? The problem does not lie with recruiting dentists, the problem lies with a broken and dysfunctional dental contract with severe underfunding. Dentists themselves cannot rectify this and it is creating by default a two-tier system whereby those that can afford to go private do so and others struggle to access any kind of care.

Please find below for context a lived-in example from a local Councillor of the problems being faced:

In September 2020, many residents in the Ryedale area of North Yorkshire were left without dental care after the practice in Helmsley suddenly closed.
This quickly became a serious local concern as Helmsley and the surrounding villages have a higher-than-average population of elderly residents.  Because of the demographics in the area, the demand on health services, including dentistry, is significant.  Furthermore, many patients are not able to drive, so having local health and dental provisions is critical.

Comments from local residents at the time were published in the local paper.

A resident said: “What do we now do as all the local dentists around here have huge waiting lists...If you can’t drive how can you get to places like Great Ayton”. Another former patient said: “I moved to Helmsley last year and couldn’t find an NHS dentist. I have had problems with an upper denture to the extent that I can’t use it for eating, so for over a year now I’ve been on soft food.”  He said he had attended a private dentist but could not afford the treatment recommended.

This difficult situation lasted nearly two years when in the summer of 2022 dental services returned to Helmsley. We were very fortunate that Helmsley Smiles took on the clinic of the old dentist and made a significant investment to refurbish the premises, install new equipment and comply with all the regulations and guidance, including the Disability Discrimination Act.  The feedback that I have received about the new dentist has been very positive, however the extremely long delay between the closure of the old clinic and the opening of the new one was a serious problem for our community.  Furthermore, this has contributed to the increase in waiting list for treatment.

Helmsley's local MP, Kevin Hollinrake, who worked tirelessly immediately after the former dentist closed to ensure that dental care returned to Helmsley as soon as possible, highlighted that the delays to the recommissioning were principally due to extreme inefficiencies of action and process within the NHS.

In summary

• More dentists – recruit and retain
• Radical reform – the system is dysfunctional
• NHS control – dentists and ICB’s to be included in formulating the solution
• Education – nutrition and oral care
• More flexible access – allow more appointments later or at weekends

Jan 2023