Source · Select Committees · Health and Social Care Committee
Ninth Report - NHS dentistry
Health and Social Care Committee
HC 964
Published 14 July 2023
Recommendations
2
Accepted
Para 14
Require Government to outline timeline and strategy for universal NHS dental access
Recommendation
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 …
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Government Response Summary
The government accepts the recommendation and highlights existing measures, such as NHS England's Patient and Public Voice group to improve patient understanding and the contractual requirement for dental practices to quarterly update their NHS website profiles. It also notes additional measures by NHS England to monitor and improve compliance with website updates.
Department of Health and Social Care
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5
Acknowledged
Para 38
Permanently apply ringfence to prevent diversion of NHS dental funding by ICBs
Recommendation
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 …
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Government Response Summary
The government partially accepts the recommendation, stating they need to build on existing contractual changes but do not commit to making the dental funding ringfence permanent. They are working on further reforms to the 2006 contract in discussion with the profession.
Department of Health and Social Care
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7
Accepted in Part
Urgently implement fundamental dental contract reform to address access crisis
Recommendation
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 …
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Government Response Summary
The government partially accepts the recommendation for fundamental reform, committing to build on existing contractual changes and work on further reforms to the 2006 contract, though they rejected a previously piloted capitation model due to its identified shortcomings.
Department of Health and Social Care
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8
Accepted in Part
Para 51
Urgently implement fundamentally reformed dental contract, moving away from UDA system
Recommendation
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 …
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Government Response Summary
The government partially accepts the recommendation for urgent reform, stating they will build on existing contractual changes and work on further reforms to the 2006 contract, but reject moving to a weighted capitation model based on previous pilot evaluations.
Department of Health and Social Care
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12
Accepted
Para 68
Commission a comprehensive dental workforce survey on NHS staffing and activity levels.
Recommendation
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 …
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Government Response Summary
The government accepts the recommendation, stating that NHS England introduced a new biannual dental workforce survey in October 2023, which will collect comprehensive data on the dental team and NHS activity, with initial data expected by early 2024.
Department of Health and Social Care
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13
Accepted
Para 69
Improve routine data collection on NHS dental workforce numbers, activity, and demand.
Recommendation
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 …
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Government Response Summary
The government accepts the recommendation, stating that NHS England introduced a new biannual dental workforce survey in October 2023 to improve data collection on the dental team and NHS activity, with initial data expected by early 2024. They also highlight existing monthly publications of NHS dental activity data.
Department of Health and Social Care
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14
Accepted in Part
Para 72
Introduce urgent incentives to attract and retain dentists for NHS work.
Recommendation
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 …
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Government Response Summary
The government partially accepts the recommendation, rejecting some specific incentives listed but committing to explore other measures, such as a tie-in for new graduates. It also agrees with the importance of a sustainable careers framework and is working with NHSE to develop a career pathway for dental professionals.
Department of Health and Social Care
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15
Accepted
Ensure reformed dental contract fully utilises skills of the entire dental team.
Recommendation
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
Government Response Summary
The government accepts the recommendation, having already published guidance in July 2022 to facilitate dental therapists and hygienists opening treatment courses, and completed a consultation on changes to human medicines regulations to expand their scope of practice, with a response due shortly.
Department of Health and Social Care
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18
Accepted
Para 86
Work with GDC to clear Overseas Registration Exam backlog and speed up international registration.
Recommendation
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 …
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Government Response Summary
The government accepts the recommendation, detailing GDC's increased ORE exam capacities from August 2023 and 2024, and listing specific measures already taken to streamline international registration processes for overseas-qualified dentists to work in the NHS.
Department of Health and Social Care
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20
Accepted in Part
Ensure full consultation with professionals on potential graduate NHS dental tie-in policy.
Recommendation
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 …
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Government Response Summary
The government partially accepts, committing to explore incentives like a tie-in as part of the NHS Long Term Workforce Plan and agreeing on the importance of a careers framework. They are working with NHSE to develop a career pathway and have implemented other dental system improvements and remuneration uplifts.
Department of Health and Social Care
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21
Accepted in Part
Para 106
Ensure dental profession representation on Integrated Care Boards for informed decision-making.
Recommendation
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 …
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Government Response Summary
The government partially accepts, stating that while they have not changed their stance on mandatory representation, existing legislation allows ICBs the discretion to appoint additional members, including dental professionals, where locally deemed necessary. DHSC will continue to work with NHS England and ICBs to ensure current arrangements are effective.
Department of Health and Social Care
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22
Accepted in Part
Para 107
Gather and review ICB membership data, assessing representation and policy effectiveness for NHS dental services.
Recommendation
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 …
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Government Response Summary
The government partially accepts, stating that NHS England has published guidance on effective clinical leadership and ICBs are asked to ensure diverse professional integration. However, the government has not changed its stance on centrally gathering and reviewing ICB membership information itself, noting that ICBs already publish this data and can appoint additional members as needed.
Department of Health and Social Care
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23
Accepted
Para 115
Provide evidence on the effectiveness of initiatives for commissioning local dental services to ICBs.
Recommendation
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 …
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Government Response Summary
The government accepts the recommendation, stating that NHS England published guidance in October 2023 with commissioning options for ICBs, and will release a further publication in 2024 providing practical examples of services and commissioning options to spread best practice.
Department of Health and Social Care
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24
Accepted
Para 116
Provide clarity to ICBs on commissioning flexibilities for NHS dental services and resource targeting.
Recommendation
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.
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Government Response Summary
The government accepts the recommendation, stating that NHS England published guidance in October 2023 to provide ICBs with clarity on commissioning flexibilities within the national dental contractual framework, and will issue further guidance with practical examples in 2024.
Department of Health and Social Care
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26
Accepted in Part
Mandate all ICBs to complete oral health needs assessments by July 2024 with NHS England support.
Recommendation
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 …
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Government Response Summary
The government partially accepts the recommendation, acknowledging that not all ICBs may complete oral health needs assessments by the July 2024 deadline due to varying maturity. However, it confirms that all ICBs are working towards having these assessments in place with support from NHS England.
Department of Health and Social Care
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Conclusions (11)
1
Conclusion
Accepted
Para 13
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 …
Government Response Summary
The government accepts the recommendation and outlined several reforms announced in July 2022, including allowing high-performing practices to take more patients, fairer payment for complex care, and requiring NHS dentists to update their availability online. It also states a forthcoming Dentistry Recovery Plan will continue efforts to improve patient access.
3
Conclusion
Accepted
Para 18
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 …
Government Response Summary
The government accepts the recommendation, clarifying that there is no formal patient registration system. It supports adherence to NICE recall guidelines and details existing measures from 2022 reforms for practices to provide urgent dental care and use risk-based recalls, with NHS England monitoring compliance and sharing data with ICBs.
4
Conclusion
Deferred
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 …
Government Response Summary
The government accepts the recommendation but responds by detailing measures unrelated to NICE recall guidelines or patient registration. The response outlines NHS England's guidance on ringfencing dental allocations for ICBs in 2023/24 and measures to address underperforming contractors by rebasing contracts and recommissioning activity.
6
Conclusion
Rejected
Para 39
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.
Government Response Summary
The government explicitly rejects a recommendation to introduce patient registration, which was not made in this conclusion. The response then outlines existing information on patient choice and practice availability, and commits to commissioning a dental workforce survey by early 2024 and publishing monthly data on local NHS dental activity.
9
Conclusion
Accepted
Para 54
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.
Government Response Summary
The government partially accepts, detailing existing and planned measures like a 5.13% uplift to NHS dental contracts and guidance for Integrated Care Boards on 'Flexible Commissioning' for local initiatives. They are also exploring tie-ins for new dentists and developing a career pathway including apprenticeships through the Advancing Dental Care review.
10
Conclusion
Deferred
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
Government Response Summary
The government reinterprets the recommendation to be about making best use of the wider dental team's skills, citing July 2022 guidance to enable dental therapists and hygienists to open treatment courses and a completed consultation on allowing them to supply/administer certain medicines without a prescription. They do not address the recommendation to reinstate patient registration.
11
Conclusion
Accepted
Para 67
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. …
Government Response Summary
The government accepts the importance of efficient processing for overseas dentists, confirming they are working with the GDC to clear the registration backlog. They highlight specific GDC actions to triple ORE Part 1 capacity and increase Part 2 sittings to address demand.
16
Conclusion
Accepted
Para 79
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 …
Government Response Summary
The government partially accepts, stating that Integrated Care Boards are responsible for undertaking oral health needs assessments to support commissioning priorities and are working towards having these assessments in place by July 2024.
17
Conclusion
Accepted
Para 85
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.
Government Response Summary
The government accepts the recommendation, detailing that it is working with the GDC to clear the backlog by tripling ORE Part 1 exam capacity and increasing Part 2 sittings for 2024. Additionally, it has streamlined processes for overseas-qualified dentists, including unilateral recognition of EEA qualifications and new regulations to reduce performers list application times.
19
Conclusion
Acknowledged
Para 90
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 …
Government Response Summary
The government acknowledged the committee's concern 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.
25
Conclusion
Acknowledged
Para 121
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.
Government Response Summary
The Government acknowledges that the transfer of responsibility for commissioning NHS dentistry services to ICBs provides a greater opportunity to tailor services around the needs of the local population.