Evidence submitted by the Newcastle University School of Dental Sciences (DTY0066)

 

The following report draws together research from across Newcastle University’s School of Dental Sciences. The school has academic staff whose research interests include access to dental services across general dental practice and hospital services, for a wide range of patient groups. These groups include the general public, regular and irregular dental attenders and under-represented groups such as those from the most deprived areas and requiring special care dentistry. Furthermore, we have researchers specifically interested in dental contract reform and the impact of the contract on oral health inequalities. Finally, many of our academic staff have clinical backgrounds, meaning they have in-depth knowledge of the demands of clinical practice.

Before discussing the questions posed to us, it is important to acknowledge that research in this area is difficult for a multitude of reasons and can make the problems outlined challenging to address. The government can change this and provide the urgently needed contemporaneous data about the nation's oral health. Currently, data is provided decennially through the Adult Oral Health Survey (AOHS) and the Child Dental Health Survey (CDHS). The CDHS is due this year but has yet to be commissioned. These surveys are both vital resources and need to be continued. Accessibility to annual data obtained by the Business Services Authority (BSA) also needs to be improved to give a clearer picture of who is being treated in dental practices to identify the extent of oral health inequalities, and issues affecting access and utilisation of dental services. Furthermore, hospital data relating to dentistry (including dental hospitals) is known to have numerous deficiencies and inaccuracies which, unless addressed, will continue to limit our understanding of the care provided to patients in this setting.1


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

 

There is a shortage of NHS dental services, causing widespread problems with access. This problem can be addressed in at least two ways:

1)      Increase the number of NHS dental staff

2)      Reduce the need for dental care

1) Increasing the number of NHS dental staff

There are three ways the government and NHS England could increase the number of people willing and able to work in NHS dentistry without needing to train more people – and therefore improve availability of appointments and access quickly. These are to:


2) Reducing need for dental care

There are two potential ways in which the need for dental appointments can be reduced:


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

ICSs have a huge potential in impacting the oral health of their populations. They are uniquely placed to know what the needs of their local populations are. However, in order for them to be effective in dentistry, we need to learn from the difficulties experienced by NHS regional commissioning teams.

In research to explore how priority setting for dentistry happened NHS regional teams, we identified that there was no capacity to plan resources strategically. The following key issues were:7

How should inequalities in accessing NHS dental services be addressed? 

We need to ensure correct incentives are in place for dental teams to provide care for patients with complex oral health needs, and for individuals to use the services before their oral health starts to decline.

For dental practices and the primary care network, there are several changes which will improve their ability to supply care to high-needs individuals:


At the individual level, (i.e. changes would directly impact the people who use dental care and improve their use of services), we have the following suggestions:


Does the NHS dental contract need further reform?

The reforms announced in July 2022 show a measure of goodwill from the Department of Health and Social Care.14 However, the reforms do not offer a significant change to a lot of practices. There are still several reforms which need to happen. The following section will discuss the key issues with the contract specifically relating to the payment mechanism (Units of Dental Activity – UDAs) which have been raised by members of the dental team in ongoing research.


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

There needs to be increased efforts to ensure there is diversity within the student dental population. Ensuring diversity across ethnicity, class, disability and other protected characteristics means that the workforce will reflect the population. Recruitment of dental students from rural areas also has the potential to increase workforce in these areas.

Retention

Reforming the dental contract will be key to retaining more dental graduates within NHS dentistry. Concerns about irregular pay, stress, and lack of professional development in the NHS all make providing private care more appealing to young dental graduates.

Training

Any professional development which happens for dental professionals working in general dental practices is self-funded. Granting professional bursaries where people can both pay for training and have an income while they are undertaking their training for extended courses will help prevent those providing care within the NHS from de-skilling.


Concluding remarks

To address all the issues raised by this Inquiry further reforms to the NHS dental contract are required. We need reforms which will:

  1. Fairly renumerate dental practices
  2. Focus on prevention
  3. Make NHS dental services more accessible for vulnerable populations and those with the worst oral health
  4. Value the workforce

From a research perspective, it is difficult to examine the current status and change, therefore, to help with this researchers/reformers need:

a)      Continued funding of the Adult Oral Health Survey and Child Dental Health Survey

b)      More detailed routine data collection by the Business Services Authority to incorporate information regarding each course of treatment provided

c)       Information about the utilisation of dental services according to the Index of Multiple Deprivation to be readily available from the Business Services Authority

d)      Improved data quality from hospital dental services

 


References

 

1.              Getting It Right First Time. Hospital Dentistry: GIRFT Programme National Speciality Report. In:2021.

2.              Association of Dental Groups. England’s Dental Deserts: The urgent need to “level up” access to dentistry. 2022.

3.              NHS England. Building dental teams: Supporting the use of skill mix in NHS general dental practice. 2023.

4.              Holmes RD, Burford B, Vance G. Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England. BMC Health Serv Res. 2020;20(1):255.

5.              Morris J, Chenery V, Douglas G, Treasure E. Service considerations–a report from the Adult Dental Health Survey 2009. London: Information Centre for Health and Social Care. 2011:1-19.

6.              Currie C. Investigating problem-orientated patient pathways: toothache to treatment: School of Dental Sciences, Newcastle University; 2022.

7.              Vernazza CR, Taylor G, Donaldson C, et al. How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners. BMJ open. 2019;9(3):e024995-e024995.

 

8.              Currie CC, Stone SJ, Brocklehurst P, Slade G, Durham J, Pearce MS. Dental Attendances to General Medical Practitioners in Wales: A 44 Year-Analysis. J Dent Res. 2022;101(4):407-413.

9.              Currie CC, Stone SJ, Connolly J, Durham J. Dental pain in the medical emergency department: a cross-sectional study. Journal of Oral Rehabilitation. 2017;44(2):105-111.

10.              Currie CC, Stone SJ, Durham J. Pain and problems: a prospective cross-sectional study of the impact of dental emergencies. J Oral Rehabil. 2015;42(12):883-889.11.               Steele, J. NHS dental services in England. London Depertment of Health. 2009;5:6.

12.              Citizens Advice. Check if you can take time off work. https://www.citizensadvice.org.uk/work/time-off-work/time-off-work-overview/. Published 2022. Accessed 24th January, 2023.

13.              Health and Social Care Information Centre. Report 1: Attitudes, Behaviours and Children's Dental Health. 2015.

14.              Sparke A HS. Outcome of 2022/23 Dental Contract Negotiations In: England ADPi, ed: NHS England; 2022.

Jan 2023