NHS

BDA joins health unions to publish blueprint for the safe opening up of the NHS

Fast, comprehensive and accessible testing, and the ongoing, ample supply of protective kit are among measures that must be in place for the NHS to be opened up safely as the UK begins to ease the lockdown, say health unions today.

The 16 unions – including the British Dental Association, UNISON, the Royal College of Nursing, the Royal College of Midwives, the Chartered Society of Physiotherapy, Unite and GMB – have drawn up a nine-point blueprint, which also calls for salaried staff -including hospital and community dentists – to be paid properly for every hour worked. The unions want to ensure that – as out-patient clinics and operations resume – the NHS continues to operate a safety-first approach.

The unions represent more than a million staff working in the NHS across the UK – including dentists, porters, nurses, radiographers, physiotherapists, midwives, 999-call handlers, cleaners, healthcare assistants and paramedics. They all want to avoid a repeat of the personal protective equipment (PPE) supply problems experienced earlier in the pandemic. These shortages sapped staff confidence, causing widespread and unnecessary anxiety, say unions. Access to readily available PPE is especially important as employers in other parts of the economy begin to open up their workplaces and source protective kit for staff, say unions.

The blueprint also suggests that, over the next few months, trust managers deploy many of the 40,000 staff who’ve returned to the NHS to relieve areas experiencing staffing shortages. Their presence could allow overworked staff some much-needed time off, say unions. While the priority remains saving lives, and keeping health workers and patients safe, unions are calling on the government to ensure staff working through the pandemic get proper overtime and are paid for every hour they’re at work.

Unions want NHS employers to work with them so that the high value the public has placed on staff is reflected in pay talks, due to take place later this year. There can be no return to pay freezes and austerity, say the unions.

Chair of the BDA’s England Community Dental Services Committee (ECDSC) Charlotte Waite said: “Community dentists have been at the forefront of setting up Urgent Dental Care Centres in England and have often gone the extra mile working long hours, to ensure patients in need have the care they require. This blueprint offers a firm foundation for many overstretched colleagues who have stepped up admirably to support the national effort.

“All of my colleagues want the reassurance of a good supply of appropriate PPE, that reopening clinics will be safe for both patients and staff and that the efforts NHS dental staff have made and will be making during the COVID 19 crisis, is fully recognised in the coming pay round for doctors and dentists.”

Chair of the British Dental Association’s Central Committee for Hospital Dental Services (CCHDS) Peter Dyer said: “Hospital dentists have been fully engaged in the wider pandemic efforts across our trusts. Colleagues are either offering a skeleton dental service for those in need or have redeployed from ICU to geriatric wards. In March we wrote to the NHS offering the full support of employed dentists across hospital and community dental services and dental academia in the battle against Covid. We felt it was the right thing to do and are proud to have done so. This blueprint demonstrates what is important to dentists, ensuring safe working practices, full PPE and ensuring that a return to patient clinics means a safe return for all staff in hospital departments and their patients.”

Deliver consistency on NHS pensions, or open the floodgates to legal challenges

The British Dental Association (BDA) has called on the government to ensure all members of the NHS Pension scheme benefit from new pledges made to senior medics offering full flexibility over the amount they can put into their pension pots.  

The Association confirmed that dentists are also being hit with tax charges, which have been forcing colleagues to reduce their level of NHS dental activity in the face of growing access problems. Almost 1 in 4 new patients have tried and failed to secure an NHS dental appointment according to government surveys.

The BDA first raised this issue with the DHSC back in 2017 and has suggested pension flexibilities ever since. Dentist leaders have now written to Matt Hancock urging him to take a consistent approach and extend flexibilities to all NHS Pension Scheme members. They warn that targeting the availability of flexibilities would likely expose Government to challenge from groups that are prohibited from using them.

BDA Chair Mick Armstrong said: “Dentists hit by five-figure pension tax charges face exactly the same choices as medical colleagues. With access problems to NHS dentistry mounting, government should not be giving colleagues any reason to do less.  

“It’s great Ministers have recognised the need for flexibility, but no healthcare professionals should be left behind. Failure to take a consistent approach risks opening the floodgates to legal challenges.”

Dentists challenge Jeremy Hunt to prove his mettle by investing in prevention

The British Dental Association has challenged Jeremy Hunt to put prevention at the heart of government’s NHS ‘birthday funding’ pledge, as dentists warn that a rush to reduce political pressure on hospital targets will fail to tackle the pressures facing the wider service.

In an open letter to the Health Secretary the dentists’ union has demanded clarity on investment in primary care and public health services, which appear conspicuous by their absence, stating that any settlement geared purely around chasing targets for acute care stands entirely at odds with the preventive philosophy set out in the Five Year Forward View.

It has sought clarity on issues around the government’s successive manifesto commitments to reform dental primary care services, its increasing over-reliance on patient charges, threats to training budgets, and its unwillingness to engage meaningfully on public health programmes.

The BDA has stressed that a new prevention-focused NHS contract will only now be viable if ministerial contributions taken out of service since 2012 are restored, to boost quality, access and time spent with patients. Recent figures have shown spending per head has fallen £41 to £36 per person in just five years. Recent evaluation reports have demonstrated prototypes currently being tested are not financially sustainable.

Dentist leaders have also urged the government to engage with modelling from Public Health England on the huge returns of investment yielded by spending on prevention, and requested details on plans for public health budgets for cash strapped local authorities. £1 spent on early years prevention programmes of supervised brushing yield £3.06 in savings after just five years.

Tooth decay remains the number one reason for child hospital admissions in the UK, with a growing number of children facing more than six-month waiting lists. The BDA has documented the multi-million-pound costs hospitals are now facing for failure to tackle tooth decay, a wholly preventable disease, on GP services, emergency and secondary care.

BDA Chair, Mick Armstrong, said: “If Ministers fail to invest in prevention in primary care and public health services they will be on the wrong side of their own strategy for the health service.

“It is wrongheaded to focus on cure over prevention, treating the symptoms but not the causes of the pressure on our NHS. More and more children face six-month waits for tooth extractions in hospital, but the solution cannot be throwing cash at the surgical workforce.

“This is about targeted investment. Reform of the failed NHS contract has reached an impasse, and the government’s stated goals of improving both access and prevention simply cannot be delivered on a standstill budget. To make this work all we need is the cash Ministers have quietly siphoned out of the service since 2012.

“The government’s own figures show a pound spent on preventing decay can yield three back in savings. Reducing exposure on hospital and emergency targets is politically useful, but it isn’t a sustainable or cost-effective basis for a healthcare strategy.”

Dental neglect: Children falling through the cracks in “siloed health service”

The BDA has renewed its call for a joined-up strategy on children’s oral health, as new research reveals that GPs are not given the time or training to spot the tell-tale signs of dental neglect.1

The study, published in the British Dental Journal, surveyed all GPs in the Isle of Wight about their awareness and perceptions of dental health care in the identification of abuse. Among these family doctors, usually the first point of contact with the NHS, the majority had never liaised with a dentist. 96 per cent of respondents had never received any formal dental training and some did not perceive dental health to be important. Only five GPs mentioned a link between a lack of dental registration and childhood neglect and no GPs worked at clinics where child dental registration status was recorded.

Dental neglect is a marker of child neglect. It was defined in 2009 in the UK as “the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development.” The research demonstrates that GPs lack time, training and confidence to identify dental neglect during routine examination of the oropharynx, and lack awareness of dental neglect as a potential marker of wider systemic neglect.

The study also notes that the sheer ubiquity of dental neglect within the general population may have desensitised many health practitioners to its wider social and health consequences, and blurred the lines between neglect and economic deprivation.

Official data shows that 41.8 per cent of children in England had not been to see a dentist for a check-up in the 12 months up to June 2017. Tooth decay remains the number one reason for hospital admissions among children across the UK. The BDA believes that progress can only be achieved by breaking down silos across the health service, along with co-ordinated and properly funded public health interventions.

The BDA’s Chair of General Dental Practice, Henrik Overgaard-Nielsen, said: “Tooth decay can be a tell-tale sign of abuse or neglect, and many children are falling through the cracks in a siloed health service. GPs bear an enormous burden and it cannot fall to them to ‘multitask’, when government is failing to deal with the problem.

“Tooth decay is the number one reason for child hospital admissions, but dentists are not seeing those at most risk early enough to make a difference. Poverty, neglect or ignorance can be huge barriers to good oral health, and we desperately need joined-up policymaking to tackle them.

“Oral health has such a low profile that it is not surprising that awareness of its importance is low in other parts of the NHS. When we face an epidemic of decay, dentistry can’t be left in a corner. Without meaningful engagement in education, in media and across the health service we simply cannot expect progress.”

  1. See: Colgan, S.M et al (2018). ‘Bridging the gap’ – A survey of medical GPs’ awareness of child dental neglect as a marker of potential systemic child neglect, The British Dental Journal, published 11 May 2018

New BOS survey reveals a rise in the number of adults seeking orthodontic treatment in the UK

New figures released by The British Orthodontic Society (BOS) to coincide with National Smile Month, which kicked-off yesterday (14 May), has revealed the number of adults seeking orthodontic treatment in the UK continues to rise.

This survey, conducted in March 2018 among BOS members, was designed to gather new data about orthodontics and patient choices in the UK compared to two years ago.

Asked if they were seeing an increase in private adult treatment, 80 per cent said yes. This figure compares to 75 per cent in 2016. When asked what kind of braces they provide to their patients, orthodontists revealed a cross section of approaches:

  • Over 75 per cent supply fixed braces with clear aesthetic brackets
  • Over 35 per cent supply lingual braces (fixed behind the teeth)
  • Over 75 per cent supply clear aligners

The survey showed that adult patients are most likely to be female and in the 26 to 40 age bracket. However, the number of men seeking treatment appears to be on the rise. 19 per cent of the respondents to the survey estimate that half of their adult patients are male. This compares to 13 per cent in 2016.

The most popular system, provided by more than 98 per cent of orthodontists, is fixed braces on the front of the teeth, often referred to as ‘train tracks’. This figure reflects the high number of young people treated as NHS patients for whom fixed braces is the most appropriate option.

A quarter of BOS members responded to the survey. Of those who answered the survey, 27 per cent see only NHS patients while 67 per cent see both private and NHS patients.

Richard George, BOS Director of External Relations, commented: “It’s gratifying to see the number of adults interested in orthodontic treatment continuing to rise. If you are interested in treatment for yourself, it’s important to seek an opinion from a professional who has the training and skill to diagnose and treat a variety of orthodontic issues. Our members, specialists and dentists with a special interest, offer a range of options for adults, enabling them to provide a solution to any kind of orthodontic problem. The value of choice cannot be over-estimated.”

BDA heralds potential breakthrough on GDPR

Following months of lobbying the British Dental Association has welcomed news that Lib Dem MP Christine Jardine has tabled its suggested amendments [1] to the Data Protection Bill to save primary care providers from needless financial burdens.

The simple change would specifically exempt small NHS providers from the costly burden of appointing a dedicated Data Protection Officer (DPO). The BDA has been working closely with partners at the Optical Confederation, the National Pharmacy Association and the Pharmaceutical Services Negotiating Committee, urging both government and opposition MPs to exempt dentists, pharmacists and opticians from this expensive and unnecessary new requirement.

Primary care leaders have argued that the current draft Bill goes well beyond the requirements of the General Data Protection Regulation (GDPR), which does not require health providers to appoint a DPO unless they process healthcare data “on a large scale”.

Most high street NHS primary care providers do not process data on a large scale, but are set to be covered by this onerous new duty by virtue of being defined by UK legislation as “public bodies”. The BDA has estimated that outsourcing this service may well cost even the smallest practices in excess of £5,000, with some members reporting quotes from potential contractors of over £10,000 a year. Amendments will be considered at the Bill’s Report Stage, which is likely to take place in the second week of May [2].

News comes as primary care leaders have written again to the Department for Culture Media and Sport, urging Secretary of State Matt Hancock to change tack.

BDA Chair, Mick Armstrong, said: “We have been making the argument for a simple amendment that would protect small NHS providers who were never meant to be captured by these regulations.

“We want to thank Christine Jardine MP for her support. This common sense move wouldn’t cost taxpayers a penny, is non-controversial and nonpartisan, and remains entirely consistent with the stated intentions of the GDPR.

“This small change can make a big difference, saving hard-pressed high street health providers from needless pain. Together with our partners across primary care we urge parliamentarians on both sides of the house to offer their support.”

[1] https://publications.parliament.uk/pa/bills/cbill/2017-2019/0190/amend/data_rm_rep_0424.8-14.html

Clause 7, page 5, line 24, after “subsections” insert “(1A),”.                                                  

Clause 7, page 5, line 24, at end insert—

“(1A)

A primary care service provider is not a “public authority” or “public body” for the purposes of the GDPR merely by virtue of the fact that it is defined as a public authority by either—

(a) any of paragraphs 43A to 45A or paragraph 51 of Schedule 1 to the Freedom of Information Act 2000, or

(b) any of paragraphs 33 to 35 of Schedule 1 to the Freedom of Information (Scotland) Act 2002 (asp 13).”

[2] https://services.parliament.uk/Bills/2017-19/dataprotection.html

Devolution, evolution and revolution? Dentists to debate the issues at LDCs’ conference

The looming crisis in recruiting NHS dentists and the need for a level playing field for all dentists competing for NHS contracts, are among the topical issues that will be debated at this year’s annual conference of Local Dental Committees (LDCs) in Belfast on 7-8 June.

Some of the 200 delegates in attendance will also be calling on the government to commit a portion of the tax raised from sugary drinks to be spent on oral health schemes for children, and to improve funding of community dental services.

There will be a timely discussion on whether devolution improves dental care or takes the ‘N’ out of the NHS. This will include presentations from Michael Donaldson (responsible for commissioning health service dentistry in Northern Ireland) and Ben Squires (with similar responsibility for Greater Manchester). Ben will share his experience of DevoManc and where commissioning dentistry fits in the health and social care framework.

A Question Time debate will explore the benefits of devolved commissioning of dental care, and ask whether, in fact, this creates more barriers to healthcare. The panel will include all the chief dental officers in the UK: Sara Hurley (England), Colette Bridgeman (Wales), Margie Taylor (Scotland) and Simon Reid (Northern Ireland).

Professor Stephen Fayle, consultant in paediatric dentistry (Leeds Dental Institute), will discuss the importance of prevention for everyone, while general dental practitioner Claudia Peace will share her experience as an associate in a prototype practice in Wiltshire.

John Milne, the Care Quality Commission’s senior national dental adviser, will provide an update on developments around the Practitioners Advice and Support Scheme, which is also the subject of several motions.

Joe Hendron, Chair of the 2018 LDCs Annual Conference, said: “Since we’re having our annual conference in Belfast, it seems fitting to look at the impact of devolution on dentistry.

“This is no longer confined to countries, as the government continues to push its traditional responsibilities out to the regions, look at DevoManc.

“Is this a way of taking the ‘national’ out of our health service and blaming the ‘outposts’ if they’re poorly funded by central government, or genuinely the best way of addressing local differences?

“Whatever the answers, I am looking forward to hearing the debates and the first-hand accounts of our expert speakers in dental commissioning.”