New Dentistry Minister: ‘Committed To Driving Forward Long-Term Improvements’ – But No Money To Fund Ventilation In England
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- Published: Thursday, 21 October 2021 07:08
- Written by Chris Tapper
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The NHS dental crisis pushed the House of Commons into a late finish last night, as the East of England was the focus of debate for the second time in a week.
On Sunday, action group Toothless in Suffolk took their protests against a lack of NHS dental access to the streets, when they held a march and rally in Bury St Edmunds.
Last night, NHS dentistry in Lincolnshire was the subject of an adjournment debate brought to the Commons by Dr Caroline Johnson, MP for Sleaford and North Hykeham.
Dr Johnson, a consultant paediatrician, opened the debate with “Smiles are very important. When we smile, it makes us happier and it makes those around us happier, but unfortunately many of my constituents are struggling to smile because they have problems with their teeth and just cannot get an NHS dental appointment. That has left some of them in very significant pain and discomfort.”
She reiterated many of the points made by the Toothless in Suffolk campaign, namely patients are waiting ‘years’ to access NHS dental care and are only offered expensive private treatment as an alternative.
She also said youngsters in Lincolnshire were unable to access orthodontic care.
Dr Johnson said “Access to specialist treatment is even more limited. Lincolnshire has gone from having three full-time consultants in orthodontics, based in Boston, Grantham and Lincoln, to just one permanent consultant two days a week, based in Lincoln.”
“Unlike neighbouring counties in the east midlands, Lincolnshire has no specialist dental services either in paediatrics or in restorative dentistry, which means significant travel out of county for patients who require more specialist help.”
Minister for Patient Safety and Primary Care Maria Caulfield told the Chamber that NHS England Midlands and East had begun a procurement exercise to address some of the orthodontic backlog.
“Patients with a clinical need to start treatment quickly will be contacted. I reassure the House that any patient who was referred before they turned 18 but has not yet started treatment will still get free treatment, even after their 18th birthday, because the backlogs are not their fault.”
Dr Johnson’s opening remarks were echoed by Sir John Hayes, MP for South Holland and the Deepings.
Sir John said “Lincolnshire is the worst served of any midlands county, with the lowest proportion of dentists in the population. There are detrimental effects on children, as she said, and it is the poor who tend to suffer most.”
Dr Johnson said it was “Perhaps not surprising that 80% of Healthwatch complaints in Lincolnshire relate to problems with access to NHS dental services.”
The MP also asked the Minister what was being done to increase the number of dental students to meet the shortfall of NHS dentists in areas of low provision.
Dr Johnson said “The journey to being a dentist begins at university dental schools, which are heavily over-subscribed. The Government trained 21% more dentists in 2018-19 than in 2008-09. It was forward-thinking of them to increase the number of dentists; given the increase of only 7% in population, one would have expected it to result in more dental care.”
“However, that has not happened in practice, for two reasons: partly the increase in part-time working and flexible working, but particularly the dramatic increase in the number of dentists working in the private sector as opposed to the NHS.”
She asked Ms Caulfield “Does the Minister agree that, building on the success of the Government’s investment in opening a new medical school in Lincoln to train more doctors, we should build an east midlands dental school in Lincoln, creating a centre of excellence locally for specialist services and thereby increasing the number of local dentists being trained?”
‘There is already a precedent for opening dental schools in under-served areas: the last school was opened in Plymouth to serve a deficit in the south-west.”
Dr Johnson said a dental school in the area would boost training as well as help address routine dental care and specialist care for patients.
The Health Minister said she took the point made by Dr Johnson about a dental school in Lincolnshire and the East of the country. “I will look at that suggestion,” Ms Caulfield said. She acknowledged Dr Johnson’s point that newly qualified dentists often tend to practice near where they trained.
She added “I am pleased that we are being able to take specific action, both nationally and locally, to improve recruitment and retention, because that is key.”
“This includes widening access to dental careers and utilising the skill mix in dental practices. It is not always the dentists who need to be used and we need to upskill some of the dental workers in dentistry too, so that we can understand the oral health needs of patients in specific communities,” Ms Caulfield told the House.
“As part of that work, Health Education England is looking to address regional shortages by ensuring that training place numbers are better aligned with the needs of local populations and that we are targeting provision.”
Dr Johnson also pointed out one particular difficulty with finding new dentists for NHS practices.
She said “Newly qualified dentists need to work in a foundation job to get an NHS provider number, but they can work in a private practice without one.”
“That is something of a disincentive for people to work as NHS dentists.”
The MP also pointed out that at Grantham Hospital, there are currently six full-time dental training places.
“But this year it has been given only two new graduates to fill those places, Dr Johnson said.
“That is creating a reliance on temporary and overseas staff to deliver services, but it also means that there will be fewer dentists trained locally and therefore fewer dentists for the population.”
Dr Johnson outlined for the House, the problems with the current NHS General Dental Services contract.
She said the heart of the issue of NHS dentists moving into the private sector was the “Target-based dental contract that was introduced by the Labour Government in 2006.”
“It was widely considered unfit for purpose even before the pandemic, which has only served to highlight its flaws, and I am aware that the Government are rightly looking to replace it.”
Dr Johnson also said there is “A huge variation in the value of UDAs” across England. She said the average value of a UDA in Lincolnshire is £25.
The MP pointed out that in two NHS practices just over a mile apart, they are being paid £23 and £28 per UDA respectively, “A difference of more than 20% for the same work in the same town.”
“That illustrates how dysfunctional Labour’s dental contract has become, making it more difficult for practices with lower UDA rates to recruit because they cannot pay the dentists whom they hire as much for the same work.”
She concluded “When we compare this with private practice, where remuneration is based on actual work done, it is clear why this flawed contract has had a devastating impact on recruitment and retention among NHS dentists.”
Despite last week’s announcement that prototype practices were effectively being abandoned, Dr Johnson said “I am pleased that the Government have recognised the problems that this contract is creating and are piloting alternatives. It is crucial that they deliver on their commitment to roll out new contractual arrangements by April 2022.”
Answering Dr Johnson’s point about contract reform, the Health Minister told the House “I know that I have not answered all my honourable friend’s questions, but I hope she knows that we take this issue extremely seriously.”
“The provision of dentistry is a complex policy area for which there is no quick solution, so I shall not make promises tonight that we cannot deliver, but we are serious about trying to address the issues.”
“As the new Minister responsible for dentistry I am committed to playing my part in not only supporting the COVID recovery, but driving forward long-term improvements. We want to see a contract that is attractive for professionals and that ensures equality of access for all, across rural regions and coastal regions.”
Addressing the reduced capacity in the GDS due to fallow time restrictions, Dr Johnson said “The experience of my constituent Emma highlights this.”
“Her seven-year-old daughter is still waiting for a routine check-up from November 2019, and Emma is being told that the surgery is running at 50% capacity due to coronavirus prevention controls.”
“This fallow time can be reduced, and patient throughput increased, by installing high-capacity ventilation. However, this can cost a practice up to £10,000.”
“England does not currently invest in ventilation for dental practices, although the devolved nations of Wales, Scotland and Northern Ireland do. Capital funding for ventilation equipment would have a transformative effect on the throughput of patients, and would in effect pay for itself through increased patient charge revenues from paying NHS patients.”
The Health Minister failed to indicate there would be any funds made available for England’s dentists to fund ventilation provision.
Ms Caulfield said “My honourable friend will be pleased to know the UK Health Security Agency published new guidelines on 27th September that include three pragmatic changes to infection prevention and control measures, with a focus on elective care that allows providers to start making further safe changes to open up their services.
“I take her point, and I will consider what more support can be given for ventilation to help dentistry premises open up further still.”
The Minister continued “I feel that I have not specifically addressed the situation in Lincolnshire as a whole, which is the subject of the debate, so let me reassure my honourable friend that a number of measures are in place to address the issues there.”
We have introduced additional face-to-face weekend dental sessions from August this year through to March next year; there are dedicated urgent dental slots for 111 patients; and we are trying to address some specific local gaps in Mablethorpe by commissioning urgent NHS dental care sessions on a temporary basis.”
“We also want to improve recruitment and retention specifically in my honourable friend’s area.”
“Health Education England is working in Lincolnshire to recruit newly trained dentists but should perhaps look at a dental school to support that effort even further.”
MP for Cleethorpes Martin Vickers said “One of the problems, of course, is that rural villages and market towns are attracting increasing populations and we are seeing massive planning applications.”
“I cite Barton-upon-Humber in my constituency as one example. What work is the Department doing with local authorities to make sure that, where there are major planning applications, public services and particularly dentistry are sufficient to meet the need?”
Maria Caulfield said “Across Government Departments we are discussing the provision of both general practitioners and dentists for new developments. I am keen that dentistry is on a par with GP provision, because it is often an afterthought. I am keen that we push it up the agenda, and this debate helps.
Earlier in the week during a Commons debate on NHS capacity, Labour MP Yvette Cooper addressed Health Secretary Sajid Javid.
She said “NHS dentistry is facing a capacity crisis. There is a huge backlog of urgent care and treatment, which is leaving many dentists overwhelmed. Patients, including those in Pontefract and in towns across the country, are now unable to get routine check-ups, which is making the urgent care crisis worse and creating a vicious spiral.
“Will the Health Secretary ask his Ministers to meet dentist groups and patient groups in Yorkshire to hear about the urgent crisis they are facing and set out an urgent plan to deal with the huge capacity crisis in NHS dentistry?”
Mr Javid replied “Dentists have done a fantastic job faced with the challenges of the pandemic. We all knew that those were very real for dentists, who, of course, could not see their patients in the normal way, and they have done everything they can to help on that.”
“The measures that have recently been taken—the review by the United Kingdom Health Security Agency on infection prevention and control—will help. Reduced access has been a major cause of the backlog. We are also working with our colleagues in the NHS to see what more we can do.”
[UK Parliament Official Portrait of Dr Caroline Johnson Attribution 3.0 Unported (CC BY 3.0)]
[UK Parliament Official Portrait of Health Minister Maria Caulfield Attribution 3.0 Unported (CC BY 3.0)]
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