NHS

BDA: No answers from NHS England on targets

The British Dental Association has lamented confirmation of delays from NHS England on arrangements for the NHS contractual year starting today (Friday April 1).

In a short message, sent to regional teams on 31 March, NHS England stated: “Confirmation of the 2021/22 year end reconciliation guidance and contractual performance requirements for 2022/23 are being finalised and we will share with commissioners and the profession as soon as possible. We appreciate your patience, and thank you for your continuing work.”

Chair of the BDA’s General Dental Practice Committee Shawn Charlwood said:

“NHS dentists will head to work in the morning – the first day of the financial year – with no sense of what’s expected of them.  

“We’re now told details on new contractual arrangements will come ‘as soon as possible’. We have demanded clarity for months, so these delays are frankly unacceptable.
 
“While NHS England has widely signalled intentions to return to 100% of pre-Covid activity, we have continued to press for a reality check, given the huge challenges practices have and continue to face in this quarter. 
 
“It beggars belief that we are now in this situation. Covid infection rates are at near record highs, and thousands of practices are on track to fall short of the current target as it is.

“At the bare minimum practices need the ability to plan. Instead of answers, all colleagues have been offered is a holding message.”

New dental statistics confirm access to NHS dentistry still in crisis

Official figures published today show that patients are still struggling for NHS dental appointments due to the workforce crisis in dentistry.

15.8m adults were seen by an NHS Dentist in the 24-months up to 31 December 2021 which equates to 35.5% of the adult population.  This is a decrease on the number of adults seen by an NHS Dentist in the 24-months up to 31 December 2020, which was 19.7m.

There was an increase in the number of child appointments in the same period, rising from 3.6m to 5.1m children which equates to 42.5% of the child population reflecting the priority the profession has given to children over the past year.

Neil Carmichael, Chair of the ADG, said: “The dental profession is doing what it can to try to meet the needs of patients, especially children across the country. They have stepped up to the challenge of providing treatment in a pandemic.

But behind this data there is a clear problem – we cannot offer more people NHS treatment without more dentists.

In the year to March 2021 the NHS lost a record 951 NHS dentists in England.  Our estimates are that we could be seeing a similar exodus this year.  The number of NHS dentists working in England is set to reach a decade low. 

More must be done to attract people into the profession from home and abroad otherwise we are going to see more serious gaps in access to treatment across England and we will never recover the backlog of patient care from the past two years.”

Pressure mounts on failed NHS contract: amendments tabled to Health Bill

MPs are continuing to join our call to break from the discredited NHS contract, with amendments now tabled to the landmark Health and Care Bill currently before parliament. 
 
Building on the momentum of the British Dental Association’s joint letter with Healthwatch England and the cross-party letter from over 40 MPs to the Treasury about the crisis in the system, the Labour frontbench has tabled a proposed New Clause to the Bill calling for measures to ensure universal access to NHS dentistry.
 
Introducing this amendment, Labour’s Shadow Health Minister Alex Norris MP attacked the Government’s record on NHS dentistry. Quoting BDA research, he highlighted the savage cuts to dental budgets and called for a proportion of the recently pledged funding for NHS recovery to be earmarked for dentistry. He stressed the crisis in morale amongst the dental workforce, and urged the Minister to get on with the critical work of contract reform.
 
“There is consensus that UDAs are long out of date and that after 15 years it’s time to move away from them. We really need to get on with this, because there are lots of dentists waiting on that before making a judgement as to whether NHS dentistry is in their future or not” he argued, adding “it is not a hyperbole when the BDA talk about “last chance saloon”, it is not a hyperbole to say that we will not have NHS dentistry in the medium term if we don’t have a course check”.
 
The SNP health spokesperson Dr Philippa Whitford echoed his points on the chronic underfunding of dentistry in England, calling for capital investment in ventilation for dental practices and oral health prevention schemes. She lamented the return of the UDA system post-pandemic, calling it “an enormous missed opportunity to improve NHS dental access for everyone”.
 
In his response the Health Minister Edward Argar reiterated the Government’s commitment to contract reform, saying “transformation in NHS dentistry is essential” and stressing they wanted “to see a contract that is attractive for professionals”, but offered no specifics on when changes might be implemented.
 
BDA Chair Eddie Crouch said: “Both dentists and patients will thank MPs for not letting up after the missed opportunities in last week’s budget. It’s time for answers on what meaningful support is going to be offered to ensure this service can have a future. Ministers are offering boilerplate responses when we need a plan and ambition to rebuild services millions depend on.”

As the Bill continues its passage through Parliament the BDA is speaking to and providing targeted briefings to the Government, MPs and Peers and fighting for the interests of dentists and patients, as well as trying to strengthen the public health measures included in the Bill.

CDO England: Many members of the NHS dental team are eligible for a booster

In the latest NHS dentistry and oral health update, Chief Dental Officer, England, Sara Hurley, and Ed Waller, director of primary care for NHS England, have confirmed that ‘Many members of the NHS dental team are eligible for a booster.’

In addition to urging everyone to ‘book yours if you haven’t already,’ noting that it’s ‘one of our best ways of keeping the virus under control,’ they also encourage you to ‘book your free NHS flu vaccine, too’.

‘The NHS booster roll out continues to go from strength to strength, with nearly 1.6 million lifesaving booster jabs delivered over the last week, higher than last week’s record numbers, and with over half of eligible over 50s now protected. There are more clinics delivering vaccines now than at any other point in the programme.’

Get your Covid-19 booster jab as a frontline health worker

The NHS is vaccinating in line with guidance set by the JCVI which says that eligible groups can have a booster shot, a minimum of six months on from their second jab for maximum protection.

The NHS will contact you to offer you a booster vaccine if you are eligible and it has been at least six months (182 days) since the date of your second vaccine dose. Anyone receiving an invite should come forward as soon as possible to get crucial protection.

Anyone eligible for a booster who is 190 days on from their second dose can go online and book through the National Booking Service or call 119 if they need extra support with their booking.

The booster programme is being delivered through existing sites including pharmacies, hospital hubs, GP practices and vaccination centres.

Staff employed by an NHS Trust should follow their Trust’s guidance on booking a booster vaccination in the first instance.

Book your free NHS flu jab

For this flu season frontline NHS dental teams are entitled to a free flu vaccination – paid for by the NHS. 

BDA: “Budget leaves NHS dentistry in last chance saloon”

The British Dental Association has lamented the budget’s failure to recognise the challenges facing dental services across England. It follows calls from both the BDA and Healthwatch England to provide vital funding for the recovery and rebuild of services, which was backed yesterday by over 40 cross-party MPs.

Reform of the widely discredited model the service operates to was pledged by April 2022. Dentist leaders have expressed disbelief that no commitments have been made to provide the necessary resources to deal with the backlogs and underpin a transition to a new and sustainable model of care. 

Over 35 million appointments have been lost in England since lockdown, and even before Covid funding was sufficient to cover barely half the population.

The BDA had joined with public health leaders in early October for reversal of savage cuts to local public health budgets. There is no indications the Treasury appears willing to change tack.

The 50% business rates discount extended to the retail and hospitality sectors once again leaves dentists as among the only businesses on the high street not receiving needed support.

British Dental Association Chair Eddie Crouch said: “MPs have recognised NHS dentistry is in the last chance saloon. Sadly the Chancellor has offered this service no help clearing the backlogs, no support for the rebuild and recovery, and no boost for public health. Covid busted an already failed system, but any reform plan is doomed without new investment. Any credible ‘levelling up’ agenda cannot ignore millions of patients with no hope of securing needed care.”

BDA Scotland: Scottish Government plans set to decimate NHS dentistry

The British Dental Association Scotland has warned plans to return NHS practices to pre-Covid models of work will devastate dental services across the country.

Cabinet Secretary Humza Yousaf has written today to every NHS dental team in Scotland, indicating that all emergency support will be withdrawn by 1 April 2022. Since the first lockdown, NHS practices have operated under a COVID support package, reflecting pandemic pressures and tight restrictions that continue to limit capacity across the service.

A return to delivering a low margin/high volume model of care is, BDA Scotland contends, simply unsustainable under current conditions. While some restrictions may ease in the coming months, there are no indications the service is likely to return to anything resembling ‘business as usual’.

With a growing number of staff facing abuse from frustrated patients unable to secure appointments, the BDA has warned the move will only raise patient expectations, while pushing NHS colleagues into the private sector or out of dentistry altogether.

Yousaf has signalled minor changes to the payment system for dentists that will take effect from 1 February 2022, largely covering the treatment of children. While welcome, these reforms will have a negligible impact on capacity within the service and will not ease the pressure on practice finances once the Covid support payments are withdrawn.

The SNP committed to delivering free NHS care for all in Scotland in the recent election. The BDA has stressed this approach runs counter to that vision, and that real focus and energy must be applied to developing a new, sustainable model for delivering care.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “The Scottish Government seems set to pull the rug out from under every dedicated NHS dentist. If Ministers had an objective to decimate NHS dentistry, this approach would offer a great starting point. To signal the return of a ‘business as usual’ model when the country is still in the grip of a pandemic is utterly reckless. The net result will be to push colleagues out of the NHS and to leave this profession altogether.

“Ministers put NHS dentistry front and centre in their pitch for government. To deliver on their promises we need real commitment to find a new and better way for delivering for the patients that need us.”

Healthwatch and BDA urge Chancellor to reverse a decade of NHS dentistry cuts

In a joint message Healthwatch England and the British Dental Association have urged Rishi Sunak to use the coming Spending Review to guarantee the future of NHS dentistry.

With over 30 million appointments lost since the first lockdown, the two organisations have pressed the Chancellor to ensure resources are in place for the recovery and promised reform of the service.

The two organisations say: 

  • The crisis in the service continues to grow. Dentistry has risen to be the number one issue raised with Healthwatch over the pandemic, and the volume of feedback continues to grow.  From April to June 2021 feedback was up 55% on the previous three months, and 794% higher when compared with the same period in 2020.  Nearly 4 in 5 people (79%) of those sharing their stories said they had found it difficult to access timely care. 
  • The two bodies are pushing for the reversal of a decade of cuts With no attempt to keep pace with both inflation and population growth, the BDA have said it would take an additional £879m from the Treasury to restore resources to 2010 levels. With £0.6 billion lost in NHS patient charge revenues since lockdown – which the Government appears anxious to retrieve – both bodies have said Ministers must guarantee adequate funding to deliver NHS dentistry to all who need it and rule out both inflation-busting patient charge hikes and cuts to front line services.
  • Invest in the fundamentals. The future of national child and adult dental health surveys – vital for setting strategy – has remained in doubt owing to financial uncertainty. Without this data there is no basis to effectively plan oral health services. 

Sir Robert Francis QC, chair of Healthwatch England, said: “Lack of access to NHS dentistry has exploded as an issue for people over the last year, with both the volume of feedback and negative sentiment going through the roof. We’ve heard from patients up and down the country unable to find care, leaving them in pain and taking matters into their own hands. We’ve also heard from parents unable to register their children with an NHS dentist, as local dental practices weren’t taking on new patients, had gone private or had closed down.

“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void. The Government needs to use the forthcoming Spending Review to provide vital investment in services like dentistry that help keep us all healthy and ensure we build back better for current and future generations.” 

BDA Chair Eddie Crouch said: “In the last Spending Review Ministers chose to make patients pay more into NHS dentistry, so they could pay less. These charges are now a substitute for decent state investment, with no attempt to even try and keep pace with demand or inflation. Ministers have pledged reform. Simply telling dentists to do more with less will not provide the care our patients desperately need.”

A decade of cuts 

As England emerges from the pandemic NHS dental services will confront increased demand, an unprecedented backlog and widening oral health inequality.     

Yet primary care dentistry went into the pandemic receiving less direct support from the Treasury than it did in 2010, a unique status in the NHS. Following the 2015 Spending Review commitments patient charges have formed an ever-greater share of NHS budget. The net result is that in real terms government contributions fell by nearly a third between 2010 and 2019.   

Ministers have pledged wide-ranging reform to the widely discredited system NHS dentistry operates to in England. Sustained cuts will make any attempts to rebuild the service an uphill struggle, with a growing number of NHS dentists already reconsidering their future.  

The Funding Gap

Practices are set to face higher demand but remain forced to do more with less, with no attempt made to keep pace with inflation or population growth.    

  • While the population of England grew by 7.42% between 2010 and 2020, the amount of dentistry commissioned by NHS England was cut by more than 2 million units of dental activity (UDAs). UDAs commissioned per head of population fell from 1.70 to 1.56, while government contributions per head fell from £41.79 to £34.53 in the same period.
  • In 2010/11 the gross budget for high street NHS services was £2.81bn, of which £614m was drawn from patient charges, £2.2bn from direct government contributions. In 2019/20 while the gross budget reached £2.96bn, net government contributions had fallen in cash terms to £2.1bn.
  • To restore the resourcing in NHS General Dental Services to 2010 levels, simply reflecting RPI inflation would require a total budget of £3.6bn for NHS General Dental Services. In order to also reflect population growth in the intervening period would require a budget of £3.9bn.  
  • Should overall patient charge levels remain unchanged an additional allocation of £879m from government contributions, per annum, is required to restore levels of resource seen in 2010. 

The Tax on Teeth 

The 2015 Spending Review committed the Government to annual above-inflation 5% increases in dental charges, which form an ever-growing share of the NHS budget.   

The Government has operated a support scheme during the pandemic, maintaining funding for NHS practices while capacity has been reduced by the suspension of routine care and ongoing restrictions.

Consequently, patient charge revenue fell by £0.6 billion from 2019/20 to 2020/21, a gap which has been filled by the Treasury, which the Government is anxious to retrieve. 

The Government must now write off existing and any ongoing losses from patient charge revenue as a result of COVID and make no effort to reclaim them via above inflation patient charge increases or cuts to frontline services.

BDA weighs in NHS activity target rise

The British Dental Association has criticised the NHS England approach to the latest hike in NHS activity targets, imposed with minutes to spare, and ahead of any meaningful relaxation of Covid restrictions.  

From Friday 1 October practices will be obliged to meet 65% of their pre-Covid activity levels, or face financial penalties. Around a third of practices were incapable of achieving these levels in recent months. The ‘cliff edge’ – the level below which practices face returning a substantial proportion of their NHS funding – will also rise to 52%, leaving hundreds of already struggling practices at risk. 1 in 6 practices were delivering below this level in August.  The target will remain in place until 1 January 2022.

Practices are still facing major limits on capacity owing to standard operating procedures designed during the first wave of the pandemic.  In response to BDA calls to commission a roadmap to ease Covid restrictions, all four UK Chief Dental Officers issued a rare joint statement in June, committing to a review.  Approaches to ease restrictions are set to be consulted on, but there is no clarity when any changes will take effect, or indeed what levels of additional capacity this may unlock. Increases in thresholds at this point therefore remain premature.

The BDA has pressed for restraint on targets, underlining that any significant increase will further undermine the long term sustainability of services in England. It has said clear ambition is also required from government to honour pledges to reform the widely discredited NHS contract. In recent BDA surveys nearly half (47%) of dentists indicated they were likely to change career or seek early retirement in the next 12 months should current Covid restrictions remain in place. The same proportion stated they were likely to reduce their NHS commitment.

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee, said: “The timing of this new target is simply unacceptable. Dentists are at their wits end, and many are already reconsidering their futures. We need a roadmap to meaningfully ease Covid restrictions, not further hikes when plans are still on the drawing board. This service was in crisis long before COVID struck. We have pressed for restraint on targets, but we need to see real ambition on reform if this service is going to have a future.”  

BDA presses Sajid Javid for support as PM pledges to ‘make NHS dentistry a better place for profession’

With Health Secretary Sajid Javid now confirmed to be staying in post following the reshuffle, the British Dental Association have issued an open letter, seeking assurances on how the £36 billion recently committed to the NHS will be used to support the recovery of dental services across primary and secondary care.

The boost, funded by the new Health and Social Care Levy, was described by the Prime Minister as the “biggest catch-up programme in the NHS’s history”.

Yesterday the Prime Minister told the House of Commons he recognised the need to ‘fix’ NHS dentistry, stating that “we want the NHS to be a better place for the dental profession.” In the letter, the BDA stress their commitment to work with Ministers to achieve the PM’s objective.

Dental leaders are seeking clarity on the proportion of new money will be allocated to help tackle the unprecedented backlog of dental care, and enable dentists to continue to provide NHS care in the years ahead. England remains the only UK nation not to commit any capital funding for ventilation improvements to enable a safe increase in patient numbers.

Oral health inequalities are now set to widen owing to the suspension of public health programmes, and ongoing access problems. Over 30 million appointments have been lost in high street services since the first lockdown in England alone. Recently published NHS Dental Statistics indicate the proportion of children seen by an NHS dentist in the last 12 months fell from 59% in March 2020 to just 23% in March 2021.
 
Copies of the message have been sent to the dentistry Minister Jo Churchill MP, as well Sir James Mackey, who has recently been appointed to advise on clearing the enormous backlog of elective surgery that has built up over the past 18 months –  including dental procedures under general anaesthetic, where patients already faced year-long waiting times prior to COVID. 

The letter is available here: https://bda.org/advice/Coronavirus/Documents/letter-from-bda-to-sajid-javid-sep-21.pdf

SNOMED disruption: urgent statement now required

The British Dental Association has urged NHSX and the Office of the Chief Dental Officer to issue an urgent statement on the status of SNOMED CT, following updates instructing practices to implement the system from 1 September 2021.

SNOMED aims to ensure better interoperability between health services for patients, by ensuring clinical notes are coded in a standardised way. The planned implementation was postponed from 1 April 2021. The BDA had previously expressed grave concerns that the systems in place for its use in dental practices are not sufficiently robust at present to ensure patient safety and a smooth rollout that would not impact on time spent with patients.  

The recent announcement came as a surprise to GDPs and many major software suppliers. 

Shawn Charlwood, Chair of the BDA General Dental Practice Committee, said: “Since March, we have been engaging with NHSX, as advised by the Minister Jo Churchill, to resolve the outstanding issues with implementation of SNOMED CT. In our meetings, NHSX has been clear that it did not regard it as necessary for dental practices to implement SNOMED from 1 September 2021 and that instead it wished to take the time to work with BDA to develop a subset of dental-specific SNOMED codes that would be appropriate for use.

“It was therefore unexpected that NHS England and the Office of the Chief Dental Officer announced on 31 August that practices were expected to begin using SNOMED from 1 September.

“As a result, we sought urgent clarification from NHSX, as the NHS body responsible for SNOMED, as to what practices were required to do and we demanded a joint statement from NHSX and the OCDO today to clarify matters. It is disappointing that there have been conflicting views from the two organisations.

“The BDA has been engaging with various NHS bodies including NHS England, the Office of the Chief Dental Officer, the NHS BSA and NHSX since it was announced in 2016 that storage of records using SNOMED CT would become a requirement.

“Our objective throughout this was to ensure that there was clear information about what implementation would entail and that the process for doing so would not disrupt practices’ operation. It is regrettable that, despite our efforts, the various NHS bodies have not provided dentists, their practices, and software suppliers with the clarity needed to implement SNOMED without such disruption. We will continue to press for an urgent statement from NHSX and the OCDO.”