Ninth Report - NHS dentistry
- HC No.
- HC 964
- Published
- 14 Jul 2023
- Items
- 26
- Response
- Response document linked Read government response ↗
Select Committee · Health and Social Care Committee
NHS dentistry
Status: Closed
Opened: 7 Dec 2022
Closed: 30 May 2024
15 recommendations
11 conclusions
1 report
Inquiry scope
The Health and Social Care Committee has launched an inquiry into dentistry following a survey that showed 90% of practices across the UK were not accepting new adult NHS patients. MPs will consider to what extent the current NHS dental contract disincentivises dentists from taking on new patients. They will look at what incentives can be offered by the NHS to recruit and retain dental professionals, also explore the role of training. They will also explore the possible impact of changes to be introduced next April to make new Integrate Care Systems and Integrated Care Boards responsible for the provision of dental services.Reports
Recommendations & Conclusions
NHS dentistry faces a crisis of unequal access across different regions and groups.
Conclusion · source text
We believe there is a crisis of access in NHS dentistry. Many people are unable to access an NHS dentist or are travelling significant distances to get to one. Access varies across the country and is being experienced unequally by different groups. We believe everyone should be able to access an NHS dentist when they need one, wherever they live.
Department of Health and Social Care
Require Government to outline timeline and strategy for universal NHS dental access
Recommendation · source text
We welcome the Government’s ambition for everyone who needs an NHS dentist to be able to access one. This ambition must ensure access within a reasonable timeframe and a reasonable distance. The Government must set out how they intend to realise this ambition and what the timeline will be for delivery. It is vital that this ambition is the central tenet of the Government’s forthcoming dental recovery plan. Once the plan has been published, we will revisit the recommendations in this report to assess it against this criteria.
Department of Health and Social Care
Roll-out patient information campaign to clarify NHS dental services and entitlements
Conclusion · source text
A lack of public awareness about NHS dental services and how practices operate is contributing to access issues. The Government and NHS England should roll-out a patient information campaign with the aim of improving awareness of how NHS dentistry will work and ensure the public are better informed about what they are entitled to. This should clarify common misconceptions, for example, about patient registration, recall periods, and NHS dental charges and exemptions.
Department of Health and Social Care
Mandate practices to adhere to NICE recall guidelines and prevent automatic patient removal
Conclusion · source text
Practices should abide by NICE recall guidelines of up to two years for most adult patients, recognising the need for more regular recall for some, but people should not automatically be removed from dentists’ registers of NHS patients without good reason. This should be monitored by NHS England to ensure it is being carried out. (Paragraph 19) The Dental Contract
Department of Health and Social Care
Permanently apply ringfence to prevent diversion of NHS dental funding by ICBs
Recommendation · source text
We welcome the fact that to try and address the underspend, NHS England is applying a ringfence for 2023/24, to ensure that no ICB can divert funding away from NHS dentistry. We recommend that this ringfence applies permanently, and NHS England puts in place transparent scrutiny to ensure compliance.
Department of Health and Social Care
NHS England's interventions on under-delivering providers welcomed; urgent flexible funding required
Conclusion · source text
We also welcome measures by NHS England to intervene on providers who are under-delivering on contracted NHS activity. We look forward to an update on how this work is progressing. We welcome this funding being used flexibly, however there cannot be further delays in doing so.
Department of Health and Social Care
Urgently implement fundamental dental contract reform to address access crisis
Recommendation · source text
Fundamental reform of the dental contract is essential and must be urgently implemented, not only to address the crisis of access in the short-term, but to ensure a more sustainable, equitable and prevention-focussed system for the future. We are concerned that any further delay will lead to more dentists leaving the NHS and exacerbate the issues patients are experiencing with accessing services. (Paragraph 50) 34 NHS dentistry
Department of Health and Social Care
Urgently implement fundamentally reformed dental contract, moving away from UDA system
Recommendation · source text
We welcome the Government’s recognition of the need for dental contract reform. The Department and NHS England must urgently implement a fundamentally reformed dental contract, characterised by a move away from the current UDA system, in favour of a system with a weighted capitation element, which emphasises prevention and person-centred care. This should be based on the learnings from the Dental Contract Reform Programme and in full consultation with the dental profession.
Department of Health and Social Care
Patient registration under capitation-based contract will improve dental access
Conclusion · source text
We believe patient registration under a reformed capitation-based contract will better enable those patients who currently can’t access a dentist to be able to do so.
Department of Health and Social Care
Reinstate requirement for patients to be registered with an NHS dentist
Conclusion · source text
We uphold the recommendation from our predecessors’ 2008 report into Dental Services, that the Department should reinstate the requirement for patients to be registered with an NHS dentist. (Paragraph 55) Workforce
Department of Health and Social Care
NHS dentist headcount does not reflect actual NHS work or address access issues
Conclusion · source text
The Government states that the number of NHS dentists has increased over the past year. However, while the headcount has gone up over the past year, it has gone down over the past three years, and moreover headcount alone does not reflect how much NHS work these dentists are undertaking. We heard repeatedly that a lack of dentists and dental care professionals undertaking NHS work is the main driver behind both lack of access to appointments for patients, and the underspend in primary care dentistry.
Department of Health and Social Care
Commission a comprehensive dental workforce survey on NHS staffing and activity levels.
Recommendation · source text
The Government and NHS England should commission a dental workforce survey to understand how many full-time and part-time-equivalent dentists, dental nurses, therapists and hygienists are working in the NHS, and how much NHS and private activity they are undertaking, alongside demographic data such as age and location.
Department of Health and Social Care
Improve routine data collection on NHS dental workforce numbers, activity, and demand.
Recommendation · source text
The Government and NHS England must improve the routine data that is collected on the number of NHS dentists and the wider dental team, and the levels of NHS activity they undertake, as well as data on demand, to assist with workforce planning and identifying gaps in provision. This must be addressed in the forthcoming dental recovery plan. Until such a time, the Government should focus on statistics which show the levels of NHS dental activity.
Department of Health and Social Care
Introduce urgent incentives to attract and retain dentists for NHS work.
Recommendation · source text
Any contract reform now will almost certainly be too late for those dentists who have already left the NHS or are considering doing so in the near future. The Government must urgently introduce incentives to attract and retain dentists to undertake NHS work. These should include, but not be limited to, the reintroduction of NHS commitment payments, incentive payments for audit and peer review, and the introduction of late career retention payments. The development of a careers framework should be considered, including on-going education, supervision and support. This should form part of a wider package, accompanied by a communications drive, to entice professionals to return to NHS dentistry.
Department of Health and Social Care
Ensure reformed dental contract fully utilises skills of the entire dental team.
Recommendation · source text
The Government, NHS England and ICBs must ensure that the reformed contract ensures that full use is made of the skills of the whole dental team. (Paragraph 73) NHS dentistry 35
Department of Health and Social Care
Advancing Dental Care Review shows potential but immediate incentives needed for supply and demand.
Conclusion · source text
We support the implementation of the work of the Advancing Dental Care Review. Centres for Dental Development could have the potential to change how we approach training dentists in the UK to meet the needs of the populations who most require care. However, these are in their early stages and their outputs will need to be assessed. We also recognise that incentives are required in the short-term to address the immediate challenges with supply and demand.
Department of Health and Social Care
Unacceptable backlog of Overseas Registration Exam applications hinders NHS dentist numbers.
Conclusion · source text
The backlog of applications for the Overseas Registration Exam is unacceptable and resolving this represents an opportunity in the short term to increase the number of dentists working in the NHS, and therefore create more appointments to enable patients to access much-needed services.
Department of Health and Social Care
Work with GDC to clear Overseas Registration Exam backlog and speed up international registration.
Recommendation · source text
The Government must work with the General Dental Council to ensure the backlog of applications for the Overseas Registration Exam is cleared in a timely manner, and to speed up changes to the process of international registration for new applicants seeking to work in the NHS.
Department of Health and Social Care
Absence of dental contract in Workforce Plan reflects lack of priority for reform.
Conclusion · source text
We are concerned that the absence of explicit mention of the dental contract in the Long Term Workforce Plan reflects the lack of priority given by the Government and NHS England to contract reform. We believe it indicates a lack of recognition of the urgent need for reform before any other workforce initiatives can be implemented.
Department of Health and Social Care
Ensure full consultation with professionals on potential graduate NHS dental tie-in policy.
Recommendation · source text
Given the varying views expressed regarding a tie-in for new graduates into NHS dentistry, we urge NHS England and the Government to ensure full consultation with professionals and representative bodies, as they seek to explore the potential merit of such a policy, although its success depends on fundamental contract reform, and should be accompanied with a careers framework. (Paragraph 92) Integrated Care Systems
Department of Health and Social Care
Ensure dental profession representation on Integrated Care Boards for informed decision-making.
Recommendation · source text
The dental profession should be represented on Integrated Care Boards to ensure they have the necessary expertise to inform decision-making around contracting and flexible commissioning. This should include wider engagement with the profession locally, for example through Local Dental Committees and Local Dental Networks.
Department of Health and Social Care
Gather and review ICB membership data, assessing representation and policy effectiveness for NHS dental services.
Recommendation · source text
We contest the Department’s rejection of the recommendation in our ‘Integrated Care Systems: autonomy and accountability’ report, and reiterate that they should centrally gather information relating to the membership of ICBs, including the specific role of members and their area of expertise. We also recommended the Department should review that information with a view to understanding whether the policy of keeping mandated representation to a minimum is the right one and whether any specialties are especially under-represented. We believe this is particularly relevant in the case of NHS dental services.
Department of Health and Social Care
Provide evidence on the effectiveness of initiatives for commissioning local dental services to ICBs.
Recommendation · source text
We welcome the initiatives outlined by the Chief Dental Officer to help ICBs commission dental services in a way that best meets the needs of their local populations. NHS 36 NHS dentistry England should provide evidence of the effectiveness of these initiatives, so that ICBs can see for themselves which options they could most usefully pursue and best practice is spread.
Department of Health and Social Care
Provide clarity to ICBs on commissioning flexibilities for NHS dental services and resource targeting.
Recommendation · source text
In light of the current national contracting arrangements, NHS England must provide clarity to ICBs about what flexibilities they have with regard to commissioning NHS dental services and targeting resources according to the needs of their populations.
Department of Health and Social Care
ICBs' delegated responsibility for dental services offers opportunities for local improvement.
Conclusion · source text
ICBs have been delegated responsibility for commissioning dental services by NHS England. They offer an opportunity to improve access locally, better integrate services around patients and address inequalities.
Department of Health and Social Care
Mandate all ICBs to complete oral health needs assessments by July 2024 with NHS England support.
Recommendation · source text
By the end of July 2024, every ICB should have undertaken an oral health needs assessment, in consultation with service users, patient organisations and the profession. NHS England should provide support to ICBs to undertake this, including sharing examples of best practice and learnings from other ICBs. NHS England must also ensure each assessment is sufficient to meet its intended purpose. (Paragraph 122) NHS dentistry 37
Department of Health and Social Care
Oral evidence sessions
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| Date | Session and witnesses | Source |
|---|---|---|
| 19 Mar 2024 | Dr Amanda Doyle OBE · NHS England, Jason Wong MBE · NHS England, Rebecca Curtayne · Healthwatch England, Rt Hon Andrea Leadsom MP · Department of Health and Social Care, Shawn Charlwood · British Dental Association (BDA) General Dental Practice Committee, Thea Stein · Nuffield Trust | View ↗ |
| 25 Apr 2023 | Chris McCann · Healthwatch England, Dr Amanda Doyle · NHS England, Jo York · Hampshire and Isle of Wight Integrated Care Board, Neil O'Brien MP · Department of Health and Social Care, Sarah Fletcher · Healthwatch Lincolnshire, Sara Hurley · NHS England | View ↗ |
| 21 Mar 2023 | Dr Abhi Pal · College of General Dentisty, Dr Sandra White · Association of Dental Groups, Ian Brack · General Dental Council, Malcolm Smith · Health Education England North East, Professor Nick Barker · University of Essex, Shawn Charlwood · British Dental Association (BDA) General Dental Practice Committee | View ↗ |
Written evidence
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| Reference | Date | Submitter |
|---|---|---|
| DTY0106 | 26 Mar 2024 | Department for Health and Social Care |
| DTY0105 | 26 Mar 2024 | Healthwatch England |
| DTY0104 | 11 Jul 2023 | Department of Health and Social Care |
| DTY0103 | 19 Apr 2023 | National Audit Office |
| DTY0034 | 14 Mar 2023 | Mr Michael Furminger |
| DTY0074 | 10 Mar 2023 | Professor Paul Batchelor, UCLan |
| DTY0072 | 10 Mar 2023 | Healthwatch Bolton |
| DTY0071 | 10 Mar 2023 | Denplan (Simplyhealth - WA Communications) |
| DTY0070 | 10 Mar 2023 | Healthwatch Lincolnshire |
| DTY0069 | 10 Mar 2023 | Plymouth Community Dental Services Ltd |
| DTY0068 | 10 Mar 2023 | Healthwatch Richmond |
| DTY0067 | 10 Mar 2023 | Healthwatch Isle of Wight |
| DTY0066 | 10 Mar 2023 | Newcastle University School of Dental Sciences |
| DTY0065 | 10 Mar 2023 | Oral Health Foundation |
| DTY0064 | 10 Mar 2023 | The Challenging Behaviour Foundation |
| DTY0063 | 10 Mar 2023 | Faculty of Dental Surgery, Royal College of Surgeons of England |
| DTY0073 | 9 Mar 2023 | LDC Confederation |
| DTY0015 | 7 Mar 2023 | Healthwatch East Riding of Yorkshire |
| DTY0014 | 7 Mar 2023 | Mr Vijay Sudra, Shard End Dental Pactice |
| DTY0009 | 7 Mar 2023 | Mr Martin Turver, Licensee |
| DTY0008 | 7 Mar 2023 | Mr Philip Martin, Whitehouse Dental Surgery |
| DTY0005 | 7 Mar 2023 | Robert Barker, Private |
| DTY0002 | 7 Mar 2023 | Dr Eurico Martins, Self employed |
| DTY0003 | 7 Mar 2023 | Anonymised |
| DTY0006 | 7 Mar 2023 | Anonymous |
| DTY0030 | 7 Mar 2023 | Healthwatch Hertfordshire |
| DTY0029 | 7 Mar 2023 | The Dental Defence Union (DDU) |
| DTY0028 | 7 Mar 2023 | Gill Furniss, UK Parliament |
| DTY0027 | 7 Mar 2023 | Healthwatch Liverpool |
| DTY0024 | 7 Mar 2023 | Bupa Global & UK |
| DTY0023 | 7 Mar 2023 | Birmingham Local Dental Committee |
| DTY0021 | 7 Mar 2023 | Healthwatch Northumberland |
| DTY0020 | 7 Mar 2023 | Mr R Bannister, Swan Dental Practice |
| DTY0016 | 7 Mar 2023 | Healthwatch Middlesbrough & Healthwatch Redcar and Cleveland (Healthwatch South Tees) |
| DTY0045 | 7 Mar 2023 | West Yorkshire Joint Health Scrutiny Committee |
| DTY0043 | 7 Mar 2023 | Dr Andrew Bell, John G Plummer and Associates |
| DTY0041 | 7 Mar 2023 | Healthwatch Derbyshire |
| DTY0040 | 7 Mar 2023 | Parliamentary and Health Service Ombudsman |
| DTY0039 | 7 Mar 2023 | Healthwatch Southend |
| DTY0038 | 7 Mar 2023 | Association of Dental Groups |
| DTY0037 | 7 Mar 2023 | Healthwatch Worcestershire |
| DTY0036 | 7 Mar 2023 | Jan Cuerden |
| DTY0033 | 7 Mar 2023 | Dental Protection |
| DTY0032 | 7 Mar 2023 | Healthwatch Cambridgeshire and Peterborough |
| DTY0031 | 7 Mar 2023 | Healthwatch Staffordshire |
| DTY0058 | 7 Mar 2023 | Hertfordshire Local Dental Committee (LDC) |
| DTY0057 | 7 Mar 2023 | Healthwatch North Lincolnshire |
| DTY0055 | 7 Mar 2023 | Healthwatch Norfolk |
| DTY0053 | 7 Mar 2023 | Healthwatch Sheffield |
| DTY0052 | 7 Mar 2023 | Healthwatch North East Lincolnshire |
Who gave evidence
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| Witness | Organisation | Sessions |
|---|---|---|
| Shawn Charlwood · Chair | British Dental Association (BDA) General Dental Practice Committee | 2 |
| Chris McCann · Director of Communications, Insight and Campaigns | Healthwatch England | 1 |
| Dr Abhi Pal · President | College of General Dentisty | 1 |
| Dr Amanda Doyle · National Director for Primary Care and Community Services | NHS England | 1 |
| Dr Amanda Doyle OBE · National Director for Primary Care and Community Services | NHS England | 1 |
| Dr Sandra White · Clinical Director | Association of Dental Groups | 1 |
| Ian Brack · Chief Executive and Registrar | General Dental Council | 1 |
| Jason Wong MBE · Interim Chief Dental Officer | NHS England | 1 |
| Jo York · Managing Director | Hampshire and Isle of Wight Integrated Care Board | 1 |
| Malcolm Smith · Chair, HEE's Advancing Dental Care Review and Dental Education Reform Programme, and Postgraduate Dental Dean | Health Education England North East | 1 |
| Neil O'Brien MP · Parliamentary Under-Secretary of State for Primary Care and Public Health | Department of Health and Social Care | 1 |
| Professor Nick Barker · General Dental Practitioner and Professor of Oral Health Science | University of Essex | 1 |
| Rebecca Curtayne · External Affairs Manager | Healthwatch England | 1 |
| Rt Hon Andrea Leadsom MP · Parliamentary Under-Secretary of State (Minister for Public Health, Start for Life and Primary Care) | Department of Health and Social Care | 1 |
| Sara Hurley · Chief Dental Officer | NHS England | 1 |
| Sarah Fletcher · Chief Executive Officer | Healthwatch Lincolnshire | 1 |
| Thea Stein · Chief Executive | Nuffield Trust | 1 |
Correspondence
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