Agenda item

NHS England and NHS Improvement

To receive a presentation from NHS England and NHS Improvement (copy enclosed).


The Committee received a presentation from NHS England and NHS Improvement on NHS Dentistry in North Cumbria which informed members that primary care dental services operated in accordance with the National Dental Regulations and must evidence compliance with General Dental Services Regulations and Dental Charge Regulations.  Officers highlighted that the Regulations, unlike those for General Medical Practice, did not allow for Patient Registration.


Members were informed that NHS Dentistry contracts and provision was activity and demand led with the expectation that practices delivered and managed their available commissioned activity to best meet the immediate needs of any patient presenting by entering into an agreed and formal signed course of treatment.  Officers explained that they tried to keep equity with regards to commissioning, therefore, this was reviewed on a yearly basis.


The Committee was informed that NHS England did not commission private dental services, this was regulated by the Care Quality Commission and dentist regulation was undertaken by the General Dental Council.  It was explained that National NHS Dentistry Regulation and Contracts did not prohibit the provision of Private Dentistry by Dental Practices.


Members received an explanation as to the current commissioned capacity, noting there were 39 NHS practices throughout North Cumbria.


The Committee was informed that the NHS dentistry pressures and challenges included the recruitment and retention of the dental workforce due to a number of reasons including a preference for dentists to work in city regions to avoid travel, particularly to remote and rural locations.


Officers highlighted the national problem due to the impact of COVID 19 and explained this was creating significant pressures in an increasing number of local North Cumbria and North East localities with North Cumbria being of particular concern. 


Members were informed that a revised set of contractual targets had been introduced from April 2021 with a requirement to deliver at least 60% of normal activity volumes in return for income protection.  It was noted that whilst restoration of NHS dental activity continued, a return to full capacity would be dependent on the further easing of COVID 19 infection prevention control measures.


The Committee drew attention to the anxiety which patients may have been experienced during COVID and asked how people were being reassured that it was now safe to attend the dental appointments.  It was explained that work was being undertaken with local authorities to promote oral health and the measures being taken to ensure dentists were working in a safe environment.


A discussion took place regarding the local measures and actions to date which included the establishment of a small number of urgent dental care centres accepting referrals from dental practices and NHS 111.  Officers explained this supplemented the existing urgent/unscheduled care services delivered from Cleator Moor, Carlisle Dental Access Centres and the supporting practices with commissioned urgent dental care slots.  It was emphasised that there were incentives for all North Cumbria NHS dental practice to prioritise patients who had not secured an appointment in the practice within the previous 24 months (adults) and 12 months (children) who required urgent dental care.


A concern was raised regarding the closure of a dental practice in Maryport and the additional on?costs such as travel that patients incurred in this instance and in remote areas generally.  Officers explained that discussions had taken place with the provider but unfortunately the contract was handed back due to issues regarding recruitment and retention of the workforce.


During the course of discussion concerns were raised about the longstanding issue regarding lack of NHS dentistry services in Copeland and a suggestion that there was a need to promote dentistry as a career.  Members were informed that dentistry courses were oversubscribed, highlighting the need for more student places to be made available to help to alleviate workforce problems.


The Committee was informed there was investment in additional clinical triage capacity within the out of hours integrated NHS111 North East and North Cumbria Dental Clinical Assessment Service; increased investment into the new Dental Out of Hours Service contract to ensure there was sustainable capacity available.


A discussion took place regarding next steps and members were informed that plans were being finalised to re?commission the NHS dental capacity that had disappeared since the start of the COVID pandemic as well as starting to address some of the historic capacity gaps.  It was explained that subject to a successful outcome of the procurement process this would provide general access capacity in 2022-23 which was in excess of the contract hand back capacity.


Members were informed there were ongoing discussions to finalise the additional capacity that was likely to be required to fully address the historic gaps in provision identified by the North Cumbria Access Review.  Officers explained that work would continue to engage with Health Education England and their delivery partners in the development of initiatives/opportunities to improve recruitment and retention of dentists and dental team staff in North Cumbria.


Officers concluded and summarised that all NHS dental practices were still operating at a significantly reduced capacity due to the requirement to continue to adhere to national infection control guidance.  It was explained that it was, therefore, necessary for dental practices to triage patients to ensure that those with the greatest clinical need were prioritised which could, therefore, lead to delays for patients seeking non clinically urgent and more routine dental care.


The Committee was informed that progression to resume the full range of routine dental care was being risk managed by individual practices and that this position was likely to continue until at least end of March 2022.  Officers highlighted that plans were urgently being progressed to increase the clinical treatment capacity available.


RESOLVED,   that an update on the improvements made to dentistry provision in West Cumbria be considered at a future meeting of the Committee.

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