Good & Bad News: Dentistry and the New Health Secretary
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- Published: Thursday, 03 November 2022 07:44
- Written by Peter Ingle
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After less than two months on the back benches, Steve Barclay is back as Health Minister. Appointed Secretary of State for Health and Social Care in the dying days of the Johnson administration, and then briefly displaced by Thérèse Coffey, he is now back at Victoria Street.
Amongst his briefing papers may well be the recent BDA letter to Chancellor Jeremy Hunt, intended to be a wake-up call about the plight of NHS dentistry. For some illustrated examples of the state of NHS dental care, a set of recent LDC minutes would make an excellent primer.
It should be pointed out that this LDC is very active, being one of the leaders in setting up and delivering urgent care during the pandemic, as well as being at the forefront of the campaign to improve trauma services. It has also maintained good relations with NHS bodies, and secondary care, indeed a senior NHS Commissioner and local hospital and CDS representatives were participating.
The meeting began with an apology from the NHS Commissioner for the BSA’s imposition of clawback. Concern was expressed that practices would not achieve targets. In particular those Urgent Dental Care hubs (UDCs) that were allocating time for the much vaunted NHS improvement programme 1a, were managing less than 80% compared to their traditional 96% or more. 1a was taking up 20 to 25% of their time but delivered only 1.2 UDA’s. The Commissioner’s response was that 1a/1b “hybrid” pilots were now being considered. In the meantime all contractors could do was “engage immediately with commissioners and provide contemporaneous notes”, and presumably hope for a sympathetic hearing.
Problems were then described with remote prescribing. Practices piloting 1a would need to have their contracts concluded for the handover to Integrated Care Boards (ICBs). There was an admission that some regional commissioning has not been supported by COMPASS, with a dentist replying that this needed to be dealt with as their function was to treat patients rather than collect data. There were also concerns over potential GDPR breaches following provision of the requested data, with an expert in the indemnity field confirming that it needed to be anonymised.
It was confirmed that ICB’s will be responsible for complaints handling, with the potential for disruption and their inevitable learning curve to be negotiated. The difficulties that workforce shortages were contributing to meeting targets was raised, once again the Commissioner advised early contact from practices in difficulty. He did hold out the workforce support coming from Health Education England (HEE), and that DCP’s could now open courses of treatment. Perhaps he had not yet seen the advice given to its members by the British Association of Dental Therapists warning members of the considerable risks that this could leave them open to.
The Commissioner expressed his confidence that the (then) Secretary of State was well aware of the current crisis in dentistry. The “mood music in central NHSE” was to find ways within Dental Contract Reform to improve dental provision.
There had been progress in developing trauma teams, however while they are funded for initial in or out of hours treatment, there is nothing for the often extensive aftercare required.
A consultant Maxillofacial surgeon reported on an ever increasing backlog of patients owing to staff shortages. 6 juniors had been taken away by HEE and the remaining ones were not allowed to be on call out of hours, following complaints that they were not achieving their curriculum requirements. There was also a general lack of equipment and supplies exacerbated by the prioritising of cancer treatment. To add to the difficulties, HR had then advertised for a Maxillofacial Consultant in an Anaesthetics journal. One area was trying to send orthognathic patients to another, but they could not be accommodated. There was no GA service available for children.
Regarding the CDS, there were different acceptance criteria for the service in different regions, and NHSE was not able to address this immediately for child patients. It was felt that the result of a previous needs assessment and the following procurement exercise, about 10 years ago, was a sharp increase in waiting times for the CDS.
There was then a, “very interesting discussion” about the problems that have beset UDCs and how Commissioners have failed to support them despite constantly requesting that dentists ‘do the right thing’ and promising that all cases will be reviewed favourably.
With so many of the current contractual changes focused on emergency patients, it was pointed out that there is a duty to patients who have been loyal to their dentists over many years, and that they should not be side-lined in order to treat the occasional patients who make all the damaging headlines in the media.
Another member commented that although the LDC feels that it has a good working relationship with the Commissioners, they have demonstrated little support for practitioners unless it suits them so to do.
Mr Barclay might care to remember that this all comes from a group that are still committed to, and taking an interest in, NHS dental care.
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