Local dental committees call on government to tackle dental crisis

Local dental committees (LDCs) are warning that the survival of NHS dentistry is at risk. Their second online annual conference takes place on Saturday 12 June, and dentists will be looking for answers. Key speakers at the conference will be Ed Waller – director for primary care strategy and NHS contracts at NHS England and Improvement – and England’s chief dental officer, Sara Hurley. 

LDCs want to know how the government and respective NHS bodies are going to tackle the recruitment and retention crisis as a damning report from Healthwatch England reveals that some dental patients within the NHS are being put on a three-year waiting list.  At the same time,  a BDA survey reveals that nearly half of dentists are likely to change career or seek early retirement in the next 12 months if the current Covid restrictions remain in place.  

Motions at the conference will also raise a plethora of workforce issues that are crucial to delivering NHS dentistry.  These range from seeking clarity on the admission of new EEA graduates onto the GDC list of registrants to a call for urgent action by the government and commissioning bodies to tackle the additional recruitment challenges faced by rural communities and those far from dental schools.

Conference will hear that dentists are exhausted from having to wear enhanced personal protective equipment and will be wondering if this is still necessary as lockdown restrictions ease, and as an evolving evidence base calls this into question.  A motion will say that this adds to the strain of working for a relentless target-driven NHS system that demands back-to-back aerosol generating procedures.

LDCs will iterate support for the development of properly funded robust and effective programmes to support the delivery of oral health services to the homeless and socially marginalised groups in society.  In keeping with this, a motion will be urging policy makers to develop programme frameworks that enable sustainable care for these groups. These are just a few of the topical issues, among the anticipated 32 motions, that will be aired at conference.

In a shift of gear, guest speaker Steve Mulligan, GDP, clinical tutor, will share some of his insights into sustainable dentistry. Steve will draw from his experience as a GDP at the coal face, and his research at Sheffield University into the emerging challenges of single use waste and dental material-based environmental issues.

Shawn Charlwood, Chair of the BDA’s General Dental Practice Committee said: “Just about everyone – dentists, MPs and Healthwatch England – are calling on the government to take action over the dental care crisis which has worsened throughout the pandemic.

“It’s unacceptable that patients are being told they have to wait for years before they can be treated. We need a well-trained, highly motivated workforce to deliver this care but the government is driving dentists away from the NHS in their droves.

“After a decade tinkering around the edges a contract that isn’t fit for purpose, we need reform that offers dentists a supportive environment where they actually want to work. And it needs to be in place by April.

“If NHS dentistry is to survive in more than name, the government has to grasp the nettle and invest in dentistry now.”

Chair of this year’s LDC conference, Stuart Allan, said: “Once again the LDC annual conference will drive home what we know already – that the long-term sustainability of NHS dentistry is in question.  A chief executive from Healthwatch who was recently interviewed on the BBC said the government must heed the dental professionals and patients because they have the answers to fixing a broken system.  We’ll certainly have some of those at our conference.  We hope the government is listening?”

NHS England informs dental practices of contractual arrangements over next six months

NHS England has, today, informed dental practices of the contractual arrangements over the next six months in a letter from Ian Dodge, Executive Director of Primary Care, Community Services and Strategy, and Jo Churchill, Parliamentary Under Secretary of State Prevention, Public Health, and Primary Care.

An electronic copy of this letter, and all other relevant guidance from NHS England and NHS Improvement can be found online here.

The letter, which can be read in full here, states that, ‘in December 2020, following discussion with the Department of Health and Social Care (DHSC) and NHS England, the return to usual pre-pandemic NHS contract arrangements was confirmed, ending income protection as rapidly as proves practicable.’

However, it also states that DHSC and NHS England are  mindful that:

  1. current IPC arrangements will continue to act as a brake on full recovery
  2. practices want as much stability as possible, and the ability to plan ahead; and
  3. the profession seeks faster progress on reform of the current UDA contract.

In addition, DHSC has asked NHS England to lead the next stage of dental contract reform, working with the BDA and government to develop a revised reform process focused on designing implementable proposals that ‘address the key challenges facing the delivery of NHS dentistry, leverage changes in the wider primary care system and meet the key tests described below’. DHSC will work to gain cross government agreement to any proposals and expedite any necessary legislative change that is required as part of this necessary reform process. 

It is noted that for national contract reform to be viable, six aims apply. They are that contract changes must:

  1. Be designed with the support of the profession
  2. Improve oral health outcomes (or, where sufficient data are not yet available, credibly be on track to do so)
  3. Increase incentives to undertake preventive dentistry, prioritise evidence-based care for patients with the most needs and reduce incentives to deliver care that is of low clinical value
  4. Improve patient access to NHS care, with a specific focus on addressing inequalities, particularly deprivation and ethnicity
  5. Demonstrate that patients are not having to pay privately for dental care that was previously commissioned NHS dental care
  6. Be affordable within NHS resources made available by Government, including taking account of dental charge income.

The letter also states that, in February, mean performance was 59% of contracted Units of Dental Activity (UDAs) and that contracts will continue to be in place for 100% of normal volumes, and ‘our
expectation is that all NHS funded capacity is used to deliver the maximum possible volume of safe care for patients. In recognition of the ongoing constraints to practice capacity due to Covid-19 there will be ongoing contractual protection for practices unable to deliver normal contracted activity for the first six months of 2021/22. During this period clawback will not be applied to practices delivering at least 60%1 of contracted UDAs and 80%2 of contracted UOAs (Units of Orthodontic Activity). The rate of clawback will then reduce linearly down to the existing lower threshold of 36% UDAs and 56% UOAs. Below these levels normal clawback will apply. The payment for activity not delivered, exempt from clawback by these arrangements, will continue to be adjusted by 16.75% to take account of variable costs not incurred.’

Read the letter in full here.

The latest NHS dentistry and oral health bulletin update from Sara Hurley and Gabi Darby, meanwhile, focuses on the next steps for dental contract reform.

New figures show ‘’collapse in children’s dental visits as a consequence of the pandemic”

The Association of Dental Groups has responded to this morning’s publication of the latest NHS Dental Statistics Biannual report for England 2020-2021.

The statistics reveal that overall, 3.6 million children were seen by an NHS dentist in the 12 months up to 31st December 2020, which equates to 29.8% of the child population.

This compares to 7 million children seen by an NHS dentist in the 12 months up to 31st December 2019, which was 58.4% of the child population in the previous report demonstrating the dramatic effect of the pandemic on oral healthcare for children during 2020.

Neil Carmichael, Chair of the ADG, said: “Before lockdown, just under 60% of children had visited an NHS dentist in the 12 months to December 2019. The 1st lockdown when dentists were closed and subsequent constraints on activity has resulted in a dramatic collapse in child visits to their NHS dentist. “The fear is that dentists will now have their work cut out dealing with tooth decay among children and I know that many dentists have already raised their concerns about the future of children’s oral health. I would call on the Government to focus on addressing the backlog of oral healthcare for children as a priority in the year ahead. We need to take action now to prevent this unmet need translating into more hospital operations than ever to remove children’s teeth.”

The latest NHS dental statistics are available here.

NHS reforms set to deliver on BSPD’s key campaigning aims

The government’s plan to reform the NHS has been welcomed by BSPD which believes that joined-up care in the interests of children is now on the horizon. Claire Stevens, BSPD’s spokesperson, says the proposed legislation set out in the White Paper has the potential to make a significant difference to children’s oral health.

“There are three reforms which are most relevant to paediatric dentistry – reducing barriers to community water fluoridation, a reduction in advertising of high sugar products and an emphasis on joined up care.”

Claire said: “ BSPD supports water fluoridation as a highly effective measure for preventing dental disease. Only 10% of the UK has access to fluoridated water yet this public health measure can reduce general anaesthetics for the extractions of decayed teeth in young children by as much as 68% in the most deprived areas. “

“For some time BSPD has been pressing for improved food labelling and for a restriction on the advertising of products high in fat, sugar and salt (HFSS). According to the plans, the government will proceed with both, which we welcome.”

Claire continued: “Once enacted, the proposed new legislation should ensure that dental leaders  are working collaboratively with medical, public health and commissioning teams to make decisions about health provision in the best interests of their local population.”

Nationally, Claire is already briefing medical leads on dental issues. “They are beginning to understand that good oral health is critical to the overall health and wellbeing of young patients. Paediatric dentistry is recognised as a national priority and this will allow us to work with the developing Integrated Care Systems to reduce the unacceptably long waiting times for dental treatment under general anaesthesia. 

“A perfect example of greater integration would be that services recognise the links between obesity and caries and collaborate so children who are at risk of both get the care and support they need. This is already happening in some places but needs to be developed.”

She added: “There is a long way to go but I have genuine hope that we are on the cusp of significant and positive change.”

BSPD’s position statements on water fluoridation and dental caries and obesity can be found here: https://www.bspd.co.uk/Professionals/Resources/Position-Statements

Eric Rooney, Deputy Chief Dental Officer England, bids farewell

England’s Deputy Chief Dental Officer, Eric Rooney, is retiring at the end of this month. In the latest NHS dentistry and oral health update, he bids farewell to the sector while reflecting on the last 12 months and his career as a whole.

“It hardly seems a year since I was working on minimising the disruption to the supply of our normal and routine dental face masks. All due to a new novel virus affecting China,” says Rooney. “As the year goes by, so come birthdays and anniversaries, and this week it’s my birthday. That’s the same, but it’s different. Not just because of social distancing and the impact of Coronavirus, but because I have reached the normal NHS retirement age!

“Just like last year, I can hardly believe how time has flown, from being a fresh faced 17 year-old entering Dundee Dental School, to this last tumultuous year. Throughout that time, the dental profession, it’s institutions, and the wider NHS have been a massive part of my work life. For the support and camaraderie of colleagues across dentistry, health and beyond, I will always be grateful, as I will for the longstanding support of my wife and family throughout my career.

“There is still much to be done to improve our NHS services, for the good of patients, the profession and the taxpayer and there will continue to be difficult times ahead, but I have every confidence in our profession and in the wider health system that together they can build a better future.”

Paying tribute to Rooney, CDO England Sara Hurley states: “It has been an incredible honour and a real pleasure to work alongside Eric Rooney as Deputy Chief Dental Officer for England. His wry, dry, humour and his humility and humanity have shaped not just the office of CDO but in the genuine warmth of his sharing of knowledge he inspires all those that have the good fortune to work alongside him. He truly cares and his quiet deliberate passion to do the right thing sets a benchmark that many aspire to, but few can claim to have achieved. Eric’s impressive CV, including an MBE for services to Dentistry in the 2015 New Year’s Honours and the plethora of national and regional achievements underline his clarity in advocacy for oral health and ensuring that patients receive the most effective dental care.  His contribution as co-author of the 2009 review of NHS Dentistry, known as “the Steele Report” and his clear thinking and evaluation of the Government’s Dental Contract Reform programme have shaped the intent for future service provision with an improved offer for patients and professionals alike.”

Eric Rooney’s career in dentistry began in 1983 and, in the words of the CDO, has seen him go from “clinical practice to public health, designing and delivering regional and national initiatives, shaping contract and commissioning policy in conjunction with the British Dental Association, Department of Health and latterly NHS England.”

New ADG report shows at least 8 million people will be waiting for an NHS dentist this Christmas

A new report from the Association of Dental Groups (ADG), published today, projects that around 8 million people will be waiting for NHS dental treatment this Christmas, but unable to access a dentist to perform it.

The findings point to an unprecedented proportion of people being unable to access the NHS at any one time – 8 million people represents around 14% of the English population, or around one in seven people.

The fear among dentists is that record numbers of mouth cancer cases are going undiagnosed while more than a million fillings may have been missed this year.

The analysis is published today by the Association of Dental Groups, who commissioned Matt Hancock’s former aide to conduct an independent ‘state of the nation’ report on access to dentistry.

The work shows London to be the worst region in the country to access a dentist, with around 1.5m people in the capital waiting at Christmas – equivalent to around 17% of its population, or one in six people. The Midlands will have 1.3m waiting; around one in eight people.

Region Patients waiting at Christmas

  • London 1,500,000
  • Midlands 1,300,000
  • North East and Yorkshire 1,200,000
  • South East 1,200,000
  • North West 1,000,000
  • East of England 950,000
  • South West 800,000

In the report, titled “30 years of hurt”, Mr Sloggett notes that restrictions on the flow of people that can be seen in dental surgeries due to the pandemic are quickly making access a huge problem. He points out that the root cause is that the system has been underfunded and neglected for decades.

“For 30 years, dentistry in England has been the forgotten service of the NHS. It is time for that to change.”

The report suggests there is no way at present to tackle the backlog due to a crippling lack of NHS dentists and proposes several urgent recommendations for boosting dentistry recruitment, including by:

  • Boosting training: increasing the number of placements in England along with incentives to work in areas with acute staff shortages;
  • Routes for overseas professionals to fill short term gaps: because it takes five years to train a dentist, for the short term, automatic recognition of EU dentistry qualifications should be maintained after Brexit and recognition of dental qualifications from good schools outside the EEA should be extended.
  • Boosting retention of NHS dentists: Many dentists are leaving the sector or moving from the NHS to private practice due to dissatisfaction with the current NHS dental contract. Government needs to look into this urgently and open up a process of reform.

Commenting on the report, Neil Carmichael, Chair of the Association of Dental Groups and former Conservative MP for Stroud said: “These figures represent real suffering, with hundreds of thousands – potentially over a million – fillings going unperformed, plus a host of other treatments piling up, as well as undiagnosed cases of mouth cancer. Even when the Covid restrictions are lifted, dealing with this will take months. We need urgent action now to draft in more dental professionals to tackle the crisis.”

The report can be found at https://www.theadg.co.uk/.

How NHS dental staff can join the Covid-19 vaccine team

Understanding that many NHS dental practitioners and dental healthcare staff want to support the Covid-19 Vaccination Programme, the Office of the Chief Dental Officer, England and NHSE have prepared an FAQ document to help clarify how indemnity arrangements will work with regards to participation in the COVID-19 vaccination programme.

Further guidance on recruitment into the Covid-19 vaccination programme is available at Join the Vaccine Team

New Covid-19 infection prevention and control dental guidance published

The Department of Health and Social Care (DHSC), along with Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS), Public Health Scotland, Public Health England and NHS England, has released new Covid-19 infection prevention and control dental guidance.

This newly published UK IPC Guidance has been developed for dental settings, and has been considered and incorporated into the latest revision of the office of CDO’s SOPs, which will be published imminently.

Whilst this guidance seeks to ensure a consistent and resilient UK wide approach, some differences in operational details and organisational responsibilities may apply in Northern Ireland, England, Wales and Scotland.

It is also noted that this guidance is of a general nature and that an employer should consider the specific conditions of each individual place of work and comply with all applicable legislation, including the Health and Safety at Work etc. Act 1974.

The guidance is available to read here.

NHS England: Contract uplifts confirmed

Following consultation with the BDA, the Department of Health and Social Care has confirmed that contracts will be uplifted by 2.5% in England. The uplift will be paid in November and backdated to 1 April.

The BDA stressed, when the Chancellor announced his deal back in July, that an above inflation award represents a bare minimum any government can offer NHS workers’, adding that the ‘uplift does not begin to cover the huge increases in expenses practices have faced with PPE and meeting new cross-infection guidelines’.

Foundation Dentist salaries will be updated by 2.8%, as will Educational Supervisors’ grants. FD service costs have been frozen, which the BDA has strongly objected to.

This is the second consecutive year of above-inflation pay awards for dentists. The BDA remains clear that this must now be built on, as part of wider plans to maintain the long-term integrity of the service.

The BDA continues to campaign on behalf of NHS dentists.

NHS pension discrimination case update

In April 2015, public sector pension schemes were reformed, with most members moved from what have become known as ‘legacy schemes’ into new, ‘reformed’ schemes. Transitional protections were put in place to protect those within 10 years of their normal retirement age, allowing them to remain on legacy schemes, rather than be moved automatically.

In December 2018, the Court of Appeal found that these transitional protections unlawfully discriminated against younger members of the judicial and firefighters’ schemes as transitional protection was only offered to older scheme members. In July 2019, the government accepted that the judgement applied to all public sector pension schemes, and is taking action to remedy the discrimination.

On 16 July 2020, the government launched a consultation seeking views on its suggested remediation measures.

The government has proposed giving public sector scheme members a choice on which pension scheme they accrue benefits in for what is being called the ‘remedy period’ – the time between the 1 April 2015 and 31 March 2022. For this period, affected members can choose to have their benefits accrue in a legacy scheme or a post-2015 reformed scheme.

It has also proposed two possible methods for making this decision – members will either have to decide on their scheme within 12 or 24 months after 31 March 2022, or they will be asked to decide when they access their benefits.

In either case, those who have already drawn on their pensions will be asked to choose as soon as possible after 31 March 2022 – their choice will then be applied to their pensions retroactively. The government is also proposing that all active members are moved into the reformed schemes on 1 April 2022.

Wesleyan is a specialist financial mutual for dentists, and therefore has considerable experience advising people on public sector pensions.

Parminder Gill, advice policy consultant at Wesleyan, said: “Sunday saw the closure of the government’s consultation into its suggested approach to remedying discrimination in public sector pension schemes. This is shaping up to be the biggest change to public sector pensions in the past five years.

“Affected members are now eagerly awaiting further information on the government’s next steps.

“The proposed measures will have an impact on the retirement savings of millions – with potential implications for the size of their pensions pots and the amount of tax they will need to pay.

“Under the government’s proposed solution, members will be asked to choose on how they want their pension accruals to be calculated.  The ‘right’ answer will very much depend on the individual, but almost everyone affected will have a complex decision to make factoring in projected pension benefits, planned retirement age, their life expectancy and any impact on their Lifetime Allowance or Annual Allowance of moving from one scheme to another.

“The process of resolving this will take some time, and the final proposal to members could look very different. However, an update on the government’s intended way forward will provide those affected with more clarity around what this will mean for them and enable them to start factoring it into their retirement plans.”