Key Lines of Enquiry identified:

·         Is there sufficient NHS dentistry capacity in Torbay and what action is being taken to address long waiting lists to access urgent and non-urgent dentistry, especially for children and young people, the elderly or vulnerable patients?

·         Will the ICB consider using the annual claw-back of unspent Torbay specific UDA funding to design and develop innovative solutions to oral health improvement, prevention and access to dental services in Torbay (with Torbay Council and wider partners)?  This question also requires:

o   explanation of how Units of Dental Activity work.

o   budget lines for the last five years showing the amount of money contracted with high street dental practices in Torbay for areas TQ1, 2, 3, 4 and 5, whilst recognising that a percentage of TQ3, 4 and 5 are in the Devon County Council area); total UDA commissioned (number and value) and the amount of money unspent (percentage and amount).

Key Lines of Enquiry identified:

1.         Was there sufficient NHS dentistry capacity in Torbay and what action was being taken to address long waiting lists to access urgent and non-urgent dentistry, especially for children and young people, the elderly or vulnerable patients?

Members were informed that high street dentists were struggling to make the existing NHS Contract work for them, so either took the decision to provide private dental services or supplement NHS work with private dental work to meet costs.  This impacted NHS dentistry capacity to meet demand.  NHS England in the South West had been working on flexible commissioning for some time now and examples were the pilots on stabilisation and child friendly practices.  It was too early to measure the impact of these projects but the hope was that they would offer the opportunity for dental practices to focus on the patients in most need of dental care and to recruit additional staff, working towards retaining NHS dentists and bringing others into the market.  The focus of the pilots at present concentrated on assisting vulnerable groups first as a priority and it was confirmed that the urgent care list had been reduced as a result of stabilisation.

2.         Would the ICB consider using the annual claw-back of unspent Torbay specific UDA funding to design and develop innovative solutions to oral health improvement, prevention and access to dental services in Torbay (with Torbay Council and wider partners)? This question also requires:

(a)  explanation of how Units of Dental Activity work;

(b)  budget lines for the last five years showing the amount of money contracted with high street dental practices in Torbay for areas TQ1, 2, 3, 4 and 5, whilst recognising that a percentage of TQ3, 4 and 5 are in the Devon County Council area); total UDA commissioned (number and value) and the amount of money unspent (percentage and amount).

            It was explained that under the NHS Contract, dental services were commissioned by Units of Dental Activity (UDA) which was a unit used to measure dentistry activity to ensure that the correct amount of patient charges were collected.  In the event of an underspend there was a clawback opportunity in the following year only.  It was confirmed that there was no ringfenced budget available for dentistry this year.  Additional information regarding budget lines would be circulated to the Sub-Board.

Prior to the meeting, Members of the public had been encouraged, via a press release, to submit questions for consideration by the Sub-Board.  The questions were collated into subject headings and responses were provided as follows:

Wait times and numbers

·         It was explained that in terms of existing waiting times, figures had come down and that had been helped by the additional funding, but that there was further work to do in revalidating the list which was expected to naturally reduce the current waiting list.  ICB had spoken with providers recently and some individuals had been taken off the waiting list as they no longer required assistance; 

·         There was a mixture of people on the waiting list, some still requiring treatment and some who had decided to go privately and could be removed from the waiting list;

·         The waiting list in Devon and Cornwall was historic and was created a few years ago to help patients relocate from one practice to another; and

·         There was still backlog to deal with as a result of the Covid-19 pandemic.

Access

·         NHS dentistry was currently only funded for approximately 50% of the population;

·         The stabilisation work was key to improving access and at present the focus was on high needs individuals in vulnerable groups including looked after children, but it was recognised that getting routine care to those individuals who need it, was also important and best endeavours were being used to find the right balance;

·         Anyone could be referred through a secondary care route for urgent dental care; and

·         It was hoped that child friendly practices could be a way of encouraging dentists back into the NHS.

ICB Dental Contract

·         At present there was a standard rate of UDA but there was some flexibility to vary that rate for specific reasons, for example, a dental practice located in a place that was hard to reach, which resulted in the dentist struggling to make the NHS Contract work coupled with the fact that dental services were generally more expensive to provide in certain locations;

·         There was an opportunity to review the UDA rates now to understand what would be sustainable for NHS dentists.  Enhancing the rates to meet inequality groups and treat patients could present a way forward in encouraging more dentists to take up NHS work again.  Currently, some dentists could not make the NHS Contract work for them and had to take on private work to supplement costs.  It was hoped that flexible commissioning could help in terms of attracting more dentists back to NHS work;

·         The ICB teams were working with dental providers to understand what the pressures were so that provision of NHS dentistry could be improved and sustained;

·         It was hoped that flexible commissioning and incentivising would encourage existing NHS providers to keep their provision and attract new providers to NHS work to also cover an increasing population; and

·         The NHS Contract is being looked at nationally and a white paper was due to be put before the House of Commons.

ICB Community Dental Contract

·         The ICB was working with community dentists to work out how to increase capacity to meet demand because of the way the Contract was currently funded.

Mouth Cancer screening

·         If patients were screened sooner, the treatment was easier to manage and survival rates better, so ideas were being explored as to how access to screening could be improved.  Ideas included utilising different workforces such as nursing, hygiene and oral health workers who might be able to assist and access different environments and flexible commissioning could help with this.  Cancer screening ‘drop in’ centres could also provide support. 

Resolved (unanimously):

1.            that the Integrated Care Board (“ICB”) be requested to continue to provide an annual update to the Torbay Adult Social Care and Health Overview and Scrutiny Sub-Board on improvements in dental access and planned oral health improvement initiatives;

2.            that the ICB and Director of Public Health, and Director Adult and Community Services, Torbay Council be requested to explore and deliver joint communications to raise awareness of and promote access to dental provision, how to maintain good oral health and what to do if urgent dental care is required within Torbay;

3.            that the ICB and Director of Public Health and Director Adult and Community Services be requested to develop communication resources for use by frontline services and supporting web content to raise awareness of how to maintain good oral health, how to access routine dentistry and what to do if urgent dental care is required within Torbay;

4.          that the ICB and Director of Public Health and Director Adult and Community Services be requested to explore additional funding opportunities for mitigating oral health initiatives in Torbay; and

5.            that the ICB and Director of Public Health and Director Adult and Community Services be requested to explore how to improve and expand access to screening to address the escalating rate of mouth cancer registrations and mortality.