Item 4a – Dentistry & the Impact of Covid 19 Cover Report
Item 4b – Dentistry report provided by NHS England & Improvement
Item 4c – Dentistry in Barnsley – A Position Statement from Healthwatch Barnsley
The following witnesses were welcomed to the meeting:
Deborah Pattinson, Dental Commissioning Lead – Yorkshire & the Humber, NHS England and NHS Improvement
Michael Speakman, Secretary, Barnsley Local Dental Committee
Margaret Naylor, Chair of the Local Dental Network South Yorkshire and Bassetlaw
Deborah Pattinson introduced this item and provided the Overview & Scrutiny Committee (OSC) with an update from NHS England and NHS Improvement on dentistry, including dental provision in Barnsley; the impact of Covid 19; and the key challenges faced. A position statement was also provided by Healthwatch Barnsley to demonstrate what they are hearing from Barnsley residents, the work they have done and the next steps they plan to take to help improve dentistry services for residents across the borough.
In the ensuing discussion, and in response to detailed questioning and challenge the following matters were highlighted:
The Chief Dental Officer instructed all dentists to close at the start of the Covid-19 pandemic in March 2020 whilst at the same time establishing an emergency urgent dental care network, with a view to practices reopening in June. Practices have been delivering a much reduced dental service because of the measures which had to be put in place to keep staff and patients safe, with urgent care prioritised. This has led to a growing backlog of non-urgent work. Nationally there is also a contract restriction in place, managed locally and regionally. All finances are allocated within the dental contract in perpetuity and include orthodontics and community surgery. Flexible commissioning has been paused during the pandemic and a different type of contracting approach may be needed.
The tremendous difficulties facing dentistry at the moment were highlighted, including the increased need for PPE; the impact of social distancing requirements and stringent infection control measures which mean that following a dental procedure with a drill the surgery has to be left fallow for a significant period of time, which in turn limits the capacity of the dentist to do other routine and non-urgent work, including orthodontics referrals and oral surgery. However, it was reiterated that all patients in pain and/or vulnerable are seen as a priority and many of Barnsley's dentists have stepped up and volunteered to become urgent dental practices. There have also been difficulties in finding dentists and nurses to work in Barnsley, which will remain as a challenge when things return to normal.
Barnsley has no stand-alone urgent dental care centre but patients can access urgent dental care via a call centre and will be offered emergency dental care close to their address - although it seems that in practice patients are usually asked to travel to Sheffield. Each practice should act as an urgent dental care centre and should see patients regardless of their home address. Barnsley dentists have all worked extremely hard to continue to provide services. A separate 'hub' would require staffing with additional dentists and this would be difficult to do, given local and national recruitment difficulties. It is unclear why this is, although dentists from abroad have been lost due to Brexit (particularly from Spain and Portugal) and it will be a problem for the next 5/10 years. Training numbers remain fairly stable. It is a very long process to recruit dentists from overseas.
It is not possible to give a geographical breakdown of the areas of highest demand for urgent dental care as each dental practice records Units of Dental Activity (UDAs) delivered, not the geographical location of patients, although it may be possible to obtain this information through calls to the 111 service.
According to Healthwatch Barnsley, over 70% of calls received by them were in respect of patients being unable to access routine dental appointments. It was explained that routine active care appointments within 1-2 months. However, this does not include check-ups and this may mean that more dental work will be required in the future. This can't be helped, as urgent care must be prioritised.
It is not possible to determine how many dentists Barnsley needs, as practices keep their own staff records and some will be fully NHS and/or part private. Practices are currently putting in place new infection control measures in order to recommence routine work, with a 65% activity target. Private dental practices are subject to the same decontamination procedures and must provide their own PPE. Where practices are able to they are already offering regular appointments and many Members had personal experience of receiving dental care during the pandemic and spoke very positively of the services received. Dental contracts are measured by Units of Dental Activity (UDAs), not how many full or part time staff are employed or the size of population they serve.
A member reported that there are 55 registered NHS dental practices in Barnsley. Some of these will provide services in other areas outside of Barnsley. GP contracts are based on population numbers and patient lists, but dental contracts work to a different delivery model and don't cater for 100% of the population. This model of contracting started in 2006, with no end date, and does not take account of population growth or the need for additional dentists in the area over time.
Remote working (as in primary care) for dentists is problematic as patients have to be physically present. As yet there is no technology available to assist with remote triaging. Ventilation systems have been installed in some practices, with tools which don't require aerosols - this will help to avoid cross contamination.
Elderly patients in care homes are usually brought into the surgery, although some dentists who have a contract to deliver services in care homes will visit the homes in full PPE if needed. However, many homes don't want people going in at the moment.
(i) Witnesses be thanked for their attendance and contribution;
(ii) Thanks be expressed to the dental practices in Barnsley who have strived to deliver services throughout the pandemic; and
(iii) Through local MPs, the delivery model for dental contracts should be reviewed nationally through Parliament, to look at both contract perpetuity and also financial provision for areas affected by population growth
(iv) The possibility of Barnsley having a 111 walk-in UDC service should be investigated.