The urgent need for more dentists in South Dorset is a particular concern for Richard.
National Situation as of 24 May, 2023 (Debate in Westminster Hall)
News published Tuesday: Freedom of information requests from the NHS Business Services Authority undertaken by the British Dental Association indicate just 23,577 dentists performed NHS work in the 2022/23 financial year, down 695 on the previous year, and over 1,100 down on numbers pre-pandemic. The crash wipes out a decade of growth in the service, bringing figures to levels not seen since 2012/13.
These official figures are at odds with repeat claims that reforms have boosted dentist numbers.
South Dorset
• Only 10 dental practices registered in Swanage, Weymouth and Portland.
• Nine of them NHS, one now private and NONE accepting new NHS patients (when contacted by Healthwatch 6 months ago).
• Only two surgeries in Swanage
• NHS Dentistry left NHS England on April 1, 2023; South Dorset dentistry now delegated to NHS Dorset Integrated Care Board
• Just a few words from some letters from my constituents, received within the last 12 months, which spotlight the problem:
o “It’s impossible to find a dentist in Weymouth”…
o ”The nearest dentist accepting patients is 77 miles away”…
o “I haven’t had a dental checkup in person for two years due to covid”…
o “Our appointment has been cancelled again and now, our dentist is retiring early”…
o “After telephoning 14 practices ranging from Portland to Poole, Blandford, Sherborne and Wareham in Dorset through to Castle Cary in Somerset, I was met with 12 straight negative replies and 2 offers of being placed on very slow moving waiting lists or private treatment offers”…
o “There is only one dentist, who only sees his own clients”…
o “I am shocked and disappointed to find that I am unable to register with a dentist anywhere in Weymouth”…
o “After numerous cancellations during lockdown, our dentist has left the practice and now we are without a dentist at all”…
o “I’m new to the area and we really cannot get a dentist”…
o “As an ex-serviceman, I never lived anywhere for longer than 2 or 3 years. However, we were always covered by service medical and dental. It seems dentistry is not covered by this and no one seems able or willing to help”…
• I held a meeting with the SW Dental Team in November 2022, where I asked how many dentists there are in South Dorset, how long waiting lists are and how to improve recruitment. I am still awaiting answers
Situation in wider Dorset – Healthwatch Survey
Of 95 practices in Dorset, two have gone out of business, 13 did not reply, 78 responded. Of those:
• No dentists are taking on new, adult patients
• Two have closed since last year – 95 down to 93
• 17 now entirely private
• 18 accepting new child NHS patients (looking at map, only two in Weymouth, none in Swanage)
• 7 accepting patients with additional needs
• 23 have waiting lists; some didn’t know how long
• 50% have waiting lists longer than 12 months
• Purbeck particularly short of dentists
• 75% registered patients still receiving routine checkups
• Most private practices would accept urgent referral from NHS 111
British Dental Association
Current situation
• NHS Dentistry is facing an existential threat, hanging by a thread
• Predates the pandemic with only enough dentistry commissioned for half the population in England – service was already very poor
• Currently, an unprecedented lack of access to services
• 11 million (almost one in 4 adults) are not having their needs met
• 10% of the £3 billion budget is set to be returned to NHS this year - NOT because of lack of demand, but because practices are unable to fulfil contractual commitments
• Burnout/retention/recruitment problems due to chronic underfunding and current NHS contract (see below)
• Exodus of dentists – morale at all-time low. Urgent reform – or no staff left
• BUPA mass closure of 85 practices March 2023 – 38 immediately, 47 under review
NHS Dental Contract Reform so far
• Government November 2022 reform support package – marginal changes include:
o ‘Find a dentist’ website, showing availability – legally compelled to update (result: just shows scarcity)
o Reward for treating three or more teeth – dentist gets 5 UDA’s (instead of 3). But it’s a perverse incentive – no good for 20 fillings, for example – so dentists are punished for taking on patients with high needs
o Seven UDA’s for complex treatment (eg root canals). But diminishing reward as one tooth can take 3 hours
• Units of Dental Activity (UDA’s) – paid at £23 each.
• Quota for procedures each year per dentist imposed.
• Dentists are penalised if over perform (cap) – then dentists must pay out of own budget for extra materials, labs and overheads
• Dentists are penalised if underperform on quota – funds taken away
• Dentists are penalised if take on patients with high needs – less complex work remunerated at same rate as challenging treatments that take hours
What’s Needed (BDA)
• Reform contract. Scrap ‘units of dental activity’ – completely unrealistic activity targets. Prioritise prevention. Make NHS dentistry available to all
• BDA estimates £1.5 bn to restore NHS dentistry to 2010 budgets
• New integrated care systems must not treat NHS dentistry as an afterthought
• Build on historic prevention tactics; fluoride, early years’ brushing, sugar consumption, checkups
• Formal negotiations on contract yet to begin – STILL – though Government says ‘committed’
General Statistics
• 75% dentists thinking of reducing commitment next year (going private/early retirement/change of career)
• Though record number of dentists registered with GDC, they see no future with failed NHS contract, so going private
• 95% practices with high NHS commitments report difficulty in recruiting dentists and 90%, dental nurses.
• HoC Library: ‘dental deserts’ – some areas have 3,000 people for every dentist
• HoC Library: most dentists combine private and NHS work – BDA analysis show hundreds do only a single NHS checkup a year
• Officials have no idea of whole time equivalent NHS workforce. BDA says Government has never collected data on how much NHS work dentists do
• BBC: 91% of ALL dental practices in country unable to accept new adult patients, 80% not able to accept new child patients (Health and Social Care Select Committee has launched an enquiry as a result)
• BBC: No practices accepting new adult patients in 37% of all local authorities
• BDA poll: 45% of dentists in England have reduced NHS commitments since start of pandemic
• In 5 years before pandemic number of practices providing NHS dentistry fell by 1,253
• BDA estimates 40 million NHS dental appointments lost since start of pandemic (well over a year’s worth). Enormous and growing backlog
• 1 million new or expectant mothers have lost access to care since start of pandemic
• In real terms government spending cut by over a quarter between 2010 and 2020 – unparalleled cuts not seen elsewhere in NHS England
• England dental services spend significantly less per head of population than other parts of the UK. Per capita spend before the pandemic: £37 in England, £49 in Wales, £56 in NI, and £59 in Scotland.
• 79% unable to access timely dentistry (Healthwatch)
• Of £50m pledged for dentistry blitz in Jan 2022, only 30% was spent as practices overstretched trying to hit unrealistic activity targets. (Saw 64,456 extra people, instead of 350,000)
Patient Costs
• NHS dentistry charges increased by 8.5% on April 24 (ie not private)
• Bridges, crowns or dentures on NHS now cost £306.80 in England (£203 in Wales)
• YouGov: 1 in 4 delayed treatment due to cost before the increase; cost now increasingly the deciding factor in choice of treatment
NB Delegated commissioning from April 1, 2023 – NHS Dentistry leaving NHS England
David Freeman, Chief Commissioning Officer, NHS Dorset Integrated Care Board
• South West Dental Reform Programme includes: child-friendly dental pilot practice in Wareham, an additional 100 urgent care appointments every week across Dorset and a stabilisation programme, starting with 30 appointments weekly
• Getting more NHS dentists to come and work in Dorset a high priority.
• Working with Local Dental Committee and Healthwatch Dorset
Draft 10 point plan for Dorset
1. Sustainable investment in NHS dentistry
2.Strengthen the voice of dentistry in the integrated care system
3. Flexible commissioning
4. Oral health action
5. Invest in the future dental and oral health workforce
6. Work with dental owners to ensure the denti=try business model is sustainable
7. Establish an independent dental advisor role
8. Focus on prevention and addressing health inequality
9. Co-design pathways of care
10. Community dental services working with high street dentists