Ninth Report - NHS dentistry

The government's response

What the committee recommended 26

1. 1
   NHS dentistry faces a crisis of unequal access across different regions and groups. Conclusion · paragraph 13
2. 2
   Require Government to outline timeline and strategy for universal NHS dental access Recommendation · paragraph 14
3. 3
   Roll-out patient information campaign to clarify NHS dental services and entitlements Conclusion · paragraph 18
4. 4
   Mandate practices to adhere to NICE recall guidelines and prevent automatic patient removal Conclusion · paragraph 19
5. 5
   Permanently apply ringfence to prevent diversion of NHS dental funding by ICBs Recommendation · paragraph 38

See all 26 recommendations and conclusions

Sources

• Ninth Report - NHS dentistry ↗The committee's report, HC 964, parliament.uk
• First Special Report - NHS Dentistry: Government Response to the Committee’s Ninth Report of Session 2022–23 ↗The government's response, 13 December 2023, parliament.uk

Recommendations and conclusions 26

1. 1
   NHS dentistry faces a crisis of unequal access across different regions and groups. Conclusion · paragraph 13 · addressed to Department of Health and Social Care Conclusion (the committee's words)

   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.
2. 2
   Require Government to outline timeline and strategy for universal NHS dental access Recommendation · paragraph 14 · addressed to Department of Health and Social Care Recommendation (the committee's words)

   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.
3. 3
   Roll-out patient information campaign to clarify NHS dental services and entitlements Conclusion · paragraph 18 · addressed to Department of Health and Social Care Conclusion (the committee's words)

   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.
4. 4
   Mandate practices to adhere to NICE recall guidelines and prevent automatic patient removal Conclusion · paragraph 19 · addressed to Department of Health and Social Care Conclusion (the committee's words)

   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.
5. 5
   Permanently apply ringfence to prevent diversion of NHS dental funding by ICBs Recommendation · paragraph 38 · addressed to Department of Health and Social Care Recommendation (the committee's words)

   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.
6. 6
   NHS England's interventions on under-delivering providers welcomed; urgent flexible funding required Conclusion · paragraph 39 · addressed to Department of Health and Social Care Conclusion (the committee's words)

   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.
7. 7
   Urgently implement fundamental dental contract reform to address access crisis Recommendation · paragraph 50 · addressed to Department of Health and Social Care Recommendation (the committee's words)

   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.
8. 8
   Urgently implement fundamentally reformed dental contract, moving away from UDA system Recommendation · paragraph 51 · addressed to Department of Health and Social Care Recommendation (the committee's words)

   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.
9. 9
   Patient registration under capitation-based contract will improve dental access Conclusion · paragraph 54 · addressed to Department of Health and Social Care Conclusion (the committee's words)

   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.
10. 10
    Reinstate requirement for patients to be registered with an NHS dentist Conclusion · paragraph 55 · addressed to Department of Health and Social Care Conclusion (the committee's words)

    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.
11. 11
    NHS dentist headcount does not reflect actual NHS work or address access issues Conclusion · paragraph 67 · addressed to Department of Health and Social Care Conclusion (the committee's words)

    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.
12. 12
    Commission a comprehensive dental workforce survey on NHS staffing and activity levels. Recommendation · paragraph 68 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
13. 13
    Improve routine data collection on NHS dental workforce numbers, activity, and demand. Recommendation · paragraph 69 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
14. 14
    Introduce urgent incentives to attract and retain dentists for NHS work. Recommendation · paragraph 72 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
15. 15
    Ensure reformed dental contract fully utilises skills of the entire dental team. Recommendation · paragraph 73 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
16. 16
    Advancing Dental Care Review shows potential but immediate incentives needed for supply and demand. Conclusion · paragraph 79 · addressed to Department of Health and Social Care Conclusion (the committee's words)

    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.
17. 17
    Unacceptable backlog of Overseas Registration Exam applications hinders NHS dentist numbers. Conclusion · paragraph 85 · addressed to Department of Health and Social Care Conclusion (the committee's words)

    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.
18. 18
    Work with GDC to clear Overseas Registration Exam backlog and speed up international registration. Recommendation · paragraph 86 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
19. 19
    Absence of dental contract in Workforce Plan reflects lack of priority for reform. Conclusion · paragraph 90 · addressed to Department of Health and Social Care Conclusion (the committee's words)

    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.
20. 20
    Ensure full consultation with professionals on potential graduate NHS dental tie-in policy. Recommendation · paragraph 92 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
21. 21
    Ensure dental profession representation on Integrated Care Boards for informed decision-making. Recommendation · paragraph 106 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
22. 22
    Gather and review ICB membership data, assessing representation and policy effectiveness for NHS dental services. Recommendation · paragraph 107 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
23. 23
    Provide evidence on the effectiveness of initiatives for commissioning local dental services to ICBs. Recommendation · paragraph 115 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
24. 24
    Provide clarity to ICBs on commissioning flexibilities for NHS dental services and resource targeting. Recommendation · paragraph 116 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.
25. 25
    ICBs' delegated responsibility for dental services offers opportunities for local improvement. Conclusion · paragraph 121 · addressed to Department of Health and Social Care Conclusion (the committee's words)

    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.
26. 26
    Mandate all ICBs to complete oral health needs assessments by July 2024 with NHS England support. Recommendation · paragraph 122 · addressed to Department of Health and Social Care Recommendation (the committee's words)

    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.