Written evidence submitted by Healthwatch Lincolnshire (DTY0077)
During March 2022, Healthwatch Lincolnshire conducted a survey to gain insight into the accessibility of NHS dental services and the ability to seek NHS treatment in Lincolnshire in the past 12 months. 45% of respondents had no access to an NHS dentist and 45% had not had an NHS dental check-up in the past 2 years. The picture for those needing emergency treatment was also very bleak. Not being able to access emergency treatment has left individuals in pain, discomfort and distress, in many cases, for months and has caused them to try and find help from elsewhere. 40% contacted an alternative NHS service when unable to see an NHS dentist but 28% ended up paying to see a private dentist. Paying for private treatment is not feasible for the majority and is likely to worsen health inequalities.
The results from this survey reinforced to us the concerns both we and residents have about the decline in access to NHS dentistry in Lincolnshire.
Since as far back as 2015, due to the number of poor experiences shared with us by residents, Healthwatch Lincolnshire has been raising concerns about the decline in access to NHS Dentists in our county. During this time, we have consistently worked closely to raise our concerns with NHS England Midlands Dental Commissioning Team, media, Healthwatch England, as well as with local and regional dental networks.
We all recognise many of the problems with dental services in Lincolnshire, such as commissioning, workforce and our counties geography, however, what we see is little or no improvements being actioned. For example, in our county we have seen increasing numbers of dental practices making the decision to ‘hand-back’ NHS contracts and move to being fully private.
Healthwatch Lincolnshire’s ‘An NHS Dentist 4 all - Improving Dental Services across Lincolnshire’ campaign will run from 1 October 2022 until 31 March 2023. During this time, we will be raising our concerns both locally and nationally so we need all the help we can get to bring to the attention of as many people as possible, the need for more NHS Dentists in Lincolnshire.
In just over a week, over 150 individuals have shared both their experiences of NHS Dental Services in Lincolnshire and views of how services should be improved.
So, what have you told us so far?
Experiences of NHS Dental Care in Lincolnshire
After reviewing the experiences shared, several key themes became clear.
1.The lack of NHS dental care is having a negative impact on peoples' immediate and future health
Many Lincolnshire residents are unable to access both preventative and emergency NHS dental treatment. The lack of preventative treatment is likely to result in many oral health issues going untreated and as a result the issues are likely to continue to deteriorate to the point where patients then need emergency treatment. Several respondents 'hoped' that nothing went wrong with their oral health, as they knew they would not be able to get any NHS treatment, nor could they, like so many, afford private treatment. This additional worry of knowing that you most likely will not be able to find NHS dental treatment causes extra distress on top of the pain patients are already in due to untreated dental issues.
Indeed, not being able to access remedial NHS dental care is leaving people in severe pain for months, with teeth that need filling or removing, braces that need changing and untreated suspected dental abscesses. This lack of access to urgent treatment is again causing considerable distress, having an additional immediate negative impact on peoples' physical and mental health. As a result of this, people are taking matters into their own hands, removing their own teeth which is incredibly dangerous and could cause a severe infection.
Story 1
"I broke a tooth in February 2022 and contacted my dentist only to be told I had been taken off the books because I hadn't been since December 2019. Obviously covid and the fact I was shielding didn't make a difference!! Since then I have phoned around dental practices on and off throughout the past 7 months, but no joy. 2 weeks ago I started getting pain and swelling...abscess? Went on the 111 website and was given 2 dentists to ring in Lincoln. One of which didn't answer the phone at all, despite ringing 3 days running and the other one, having been held in a queue for 35 minutes asked me to leave an answer phone message, which I did. Nobody called me back. I have self-medicated and thankfully the pain and swelling has stopped."
Story 2
"I cannot get a dentist, I cannot afford private, I had to pull a problem tooth out myself with pliers."
Story 3
"I have a dentist but my son, his wife and 3 children have been told that their dentist is removing all NHS patients so they will be without a dentist. Explain that to a child who is in pain from dental problems."
2. Existing NHS patients are finding their NHS practice is now solely private
Another common experience of NHS dental services in Lincolnshire is that many NHS practices are now handing back their NHS contract and only offering private treatment for both adults and children. Patients at these practices are given little to no notice of this change. They are then left with the difficult decision of either having to pay for private treatment or try to find an alternative NHS practice, which they already know is virtually impossible.
Story 1
"This week with no warning I received a letter stating my dentist was going private and we had to now pay £25 a month. Cannot switch to another dentist within the practice and they will only continue to see my children under NHS if I pay private monthly fee which is complete opposite of what it says on NHS website! I now have to find money to see a private dentist at a time when money is super tight."
3. Other patients throughout the county have never had the opportunity to have an NHS dentist due to lack of services
In contrast to point 2, some individuals in the county have never had (or at least not for several years now) access to an NHS dentist. This appears to be a problem throughout the county but especially in Mablethorpe and Grantham. Furthermore, whilst everyone is struggling to access NHS dental care, those who are children, pregnant and/or have a disability are finding it especially challenging. Also, individuals who have recently had chemo or radiotherapy are struggling to find NHS dental services.
Story 1
"Pretty much non existent. We pay for NHS services including dental care as part of our National Insurance but despite trying with at least 6 dentists over a 4 years period I am unable to get any NHS dental care. they are all happy to offer private care though."
Story 2
"I have found it impossible to register myself or my children with an NHS dentist despite frequently trying numerous (more than 10) different practices repeatedly over the last 2.5 years including at a time I was pregnant. I have even found it difficult to find a private practice with space although have succeeded but in order to get an appointment I have to pay 3 months fees before being allowed to book the first appointment. This means my 4.5 year old son has not seen a dentist since he was a baby when we lived in a different city."
Story 3
"I need 5 teeth extracting. My NHS dentist will not remove them due to a risk as I've had radiotherapy in the past. I was referred to Lincoln hospital in December 2021. 10 months later I have not even had a first consultation. The teeth cause me pain all the time."
4. Patients are being left with no alternative but to pay for private treatment
For many in the county, the only way to access dental services is by paying for private treatment. However, for many, particularly for families, those relying on pensions, benefits and low incomes, this is simply not a feasible option. Furthermore, as people have now gone extended periods of time without seeing a dentist the amount and type of treatment, they now need is more complex which can be costly on the NHS, yet alone private.
Story 1
"Unfortunately forced to go private due to no NHS taking on and seeing ‘new’ patients."
Story 2
"We have been forced to pay money we can ill afford for necessary dental treatment at a private dental clinic, this has to be a one off for us as we simply cannot afford that sort of money for dental treatment."
This issue is likely to widen health inequalities. Those who are unable to pay for private dental treatment are likely to see their oral health decline further, meaning they need more treatment and if only private dental services are available, people will not be able to afford to get treatment. This creates a vicious cycle and, in the meantime, has an additional negative impact on mental and physical health. It could also cause people to get into debt and having to making difficult decisions around whether they use their money to pay for dental treatment or to heat their houses. Indeed, several respondents who were currently paying for private treatment because they had been left with no other alternative, shared that as the cost-of-living increases, they may not be able to continue paying for private treatment.
Story 3
"Private dentistry from BUPA is good but it costs me £600 a year and with the cost of living increase this may be something I have to stop."
Story 4
"My front tooth crown fell out last week and it took FOUR days to get to see an emergency dentist ! Then to be told I would need a denture /bridge but I can’t get a NHS dentist ! So I am being forced to private and having to pay for it monthly so now council tax payment will not be met because I don’t have enough money with all the ludicrous rise in cost of living!"
5. Individuals are routinely travelling to other counties for NHS dental services
As a result of not being able to access NHS dental care in Lincolnshire, some patients are accessing care in other counties. For example, some patients in Grantham are travelling to Nottinghamshire for NHS dental care. Notably, this has not been a recent development, several individuals shared that they had been doing this for over 5 years. Additionally, we frequently heard from people who had recently moved to the county, but due to the lack of NHS dental services in Lincolnshire were travelling back to the dentist they had prior to moving. This often results in 100-mile round trips, which is both costly and time consuming. One individual shared that the lack of dental services in Lincolnshire means that when they travel back to their home country of Poland, they seek treatment there.
Story 1
"I moved to Lincolnshire in 2021 and have been unable to find a NHS dentist for myself and 2 children. We have to travel to Bedfordshire to see a dentist which is a 5hr round trip."
What have health or social care professionals told us?
Dentists have reported that there is an issue with the current NHS contract as not being fit for purpose.
UDAs are the value given to a course of treatment. For example, band 1, which includes examination, X-ray, scaling and polishing and preventative care has a UDA of 1 whereas band 2, which includes treatment such as fillings, root canal, extractions and denture additions, has a value of 3 UDAs.
In July 2022, as part of the reforms to the NHS dental contract, a minimum monetary value for a UDA was set to £23.00 and the UDA value assigned to some treatments increased. However, there is concern that this minimum value is not high enough and will not result in a real positive change in recruitment of NHS dentists or encourage dental practices to offer NHS treatment. Indeed, the healthcare professional who shared their views through our campaign said the following:
"It is pretty much impossible to recruit due to the abysmally low UDA rate most dental practices receive. My practice UDA rate is set at £24
At this level I am losing money when providing NHS dental care. Our county has some of the lowest UDA rates in the whole country. The UDA rate has to be set at £30 as a minimum for Lincolnshire. The patients in the region are lovely and deserve so much better.”
What would you like to see improved?
Improvements are listed in no particular order.
More NHS dentists and practices throughout the county
This increase in provision should be throughout the county, not just in more urban areas. Public transport links are often poor and costly to use, so more dentists are needed in the rural areas of the county too especially areas such as Mablethorpe.
Improve NHS dental provision for children
Whilst there should be more NHS dental services in the county for everyone, there should be a specific focus on children. Many were concerned about the lack of NHS practices taking on new child patients, with some children in the county having never seen a dentist, and the impact this would have on their current and future oral, physical and mental health.
NHS practices should not be able to become solely private
Repeatedly individuals shared their experience of once being an NHS patient at a practice, only to find out (often with no prior warning) that their practice had 'handed back their NHS contract' and were becoming a practice that only offers private treatment. Many commented that practices should not be able to be solely private and should all have at least one dentist offering NHS treatment.
Better pay and contracts for NHS dentists
Many acknowledged the fact that the reason some dentists are no longer providing NHS care is due to their pay and contract for NHS treatment. Therefore, both should be improved.
Private patients at NHS practices should not be prioritised over NHS patients
Other individuals who are registered with dental practices which hold an NHS contract but also accepts private patients, felt that private patients were given priority over NHS patients. In some cases, NHS patients felt as if they were a 'burden' or 'problem'.
More money should be spent on prevention
A common suggestion to improve NHS dental services in Lincolnshire was to spend more time, effort and money on preventative measures. These preventative measures should especially focus on children.
Greater transparency on the cost of NHS treatment and the introduction of payment instalments
There was also a call for treatment bands (what treatment is included in each band) and prices to be more clearly explained. Individuals also expressed concern over the cost of the higher bands of treatment and wished they were able to pay for their treatment in instalments.
Greater transparency on waiting and practice lists
Respondents called for greater transparency on what being on a practice or waiting list and not being able to join a waiting list means. There also needs to be clarification on how many times a year a patient needs to attend the dentist, so they are not removed off the practice list.
We frequently heard from individuals who had been removed from their practice list as they had not had an appointment for example in 18 months. This was despite the fact that many had tried to make an appointment during this time but were told the practice was too busy or only seeing emergency cases during the pandemic.
A local dental teaching hospital
To improve NHS dental services in Lincolnshire a local dental teaching hospital was suggested. This would hopefully encourage more dentists to practice in the area.
What works well? Share your positive experiences.
Sadly, the most frequent answer to this question was ‘nothing’. Indeed, many responded by saying they had no experience of NHS Dental Care in Lincolnshire so could not comment.
For the handful of individuals who did share their positive experiences, they highlighted the benefits of text reminders for appointments and practices having extended opening hours – offering appointments in the evening and at weekends. Regular appointments and timely, affordable, localised good quality care were common themes in the few positive experiences shared.
What is Healthwatch Lincolnshire doing to improve access to NHS dental services in the county?
Healthwatch Lincolnshire continue to raise dental access concerns both locally and nationally. The findings of this report will be shared and directly influence the Lincolnshire Dental strategy 2023-2026 that is currently being put together. This strategy will set out what needs to be done over the next three years to improve NHS oral health services and drive improvements in oral health across the county. We have also been asked to provide patient participation at the Lincolnshire Dental Strategy face to face stakeholders’ workshop and as a result of overwhelming interest we are now setting up our own focus group to record even more patient experiences.
Our campaign will next look at feedback from seldom-heard groups: those who are living in deprived and rurally isolated areas, cancer patients, wheelchair users, pregnant women, parents, those with sensory loss as well as the dental workforce themselves.
Jan 2023