To provide the Committee with information on NHS dentistry provision in the District, and the wider Suffolk and North East Essex Integrated Care Board geography. This report will support the enquiry by the Committee into NHS dentistry provision to be undertaken at this meeting of the Committee.

The Committee heard that on 1 April 2023, Suffolk and North East Essex Integrated Care Board (SNEE ICB) received delegated responsibility from NHS England (NHSE) to commission dental services.

There were longstanding issues with NHS dental access including NHS routine dental care and urgent dental care. This problem had been amplified by the current COVID-19 pandemic. Treating oral diseases cost the NHS £3.4 billion per year.

The pain experienced with dental problems such as toothache or abscess could be considerable, intractable, and distressing, and might have led sufferers to extreme measures to address pain if urgent dental care was not available. Examples included DIY dentistry and overdoses of paracetamol, which in turn increased pressure on urgent and emergency care. There were also wider societal impacts and costs that arose when people could not access urgent care, such as increased demands and pressures placed on the wider health care system such as accident and emergency and primary care services, as well as costs to employers and reduced productivity due to time off work.

Commissioning, Legislation, and Dental Fees

The report outlined that Suffolk and North East Essex ICB directly commissioned all NHS dental services at primary, community, secondary, and tertiary settings depending on the care and treatment required.

Currently, almost all dentists in north-east Essex (and Suffolk), were paid by commissioners for the Courses of Treatment (CoT) they provided, each CoT was allocated a Unit of Dental Activity (UDA). A UDA was the technical term used in the NHS dental contract system regulations to describe weighted CoTs. The ICB piloted a primary care contract that did not use CoT or UDA but was based on the availability of appointments.

Members heard that UDAs were developed as part of the 2006 NHS dental contract. Under the old NHS contract, dentists were paid for every item of treatment they provided: examination, filling, crown, or denture. Under the 2006 system, they were paid per course of treatment, irrespective of how many items were provided within it. Thus, a course of treatment involving one filling (3 UDAs) attracted the same fee as one containing five fillings, a root treatment, and an extraction (also 3 UDAs). This factor was behind much of the resentment against this system.

Members also head that in March 2021, NHS England was asked by the government to lead on the next stages of NHS dental system reform. At the outset, six aims were agreed upon when considering what a reformed dental system should bring. They were:

·         Be designed with the support of the profession

·         Improve oral health outcomes

·         Increase incentives to undertake preventative dentistry, prioritize evidence-based care for patients with the most needs and reduce incentives to deliver care that is of low clinical value

·         Improve patient access to NHS care, with a specific focus on addressing inequalities, particularly deprivation and ethnicity

·         Demonstrate that patients are not having to pay privately for dental care that was previously commissioned NHS dental care

·         Be affordable within NHS resources made available by the Government, including taking account of dental charge income.

·         In July 2022, NHS England announced the first new reforms to the dental contract; these were the first in 16 years. The announcement included the following key points:

o   NHS dentists would be paid more for treating more complex cases, such as people who needed three fillings or more.

o   Dental therapists would also be able to accept patients for NHS treatments, providing fillings, sealants, preventative care for adults and children, which would free up dentists’ time for urgent and complex cases.

o   To make services more accessible for people, dentists had to update the NHS website and directory of services so patients could easily find the availability of dentists in their local area.

o   High-performing dental practices would have the opportunity to increase their activity by a further 10% and to see as many patients as possible.

The Committee heard that these reforms represented the first significant change to the contract since its introduction in 2006.

Dental Fees

It was reported to the Committee that adult patients paid a subsidized fee for receiving care unless they were exempt. The NHS operated a three-band fixed charge primary care treatment package and payment from adult patients depended on the treatment received. The bandings were:

Emergency dental treatment – £26.80 This covered emergency care in a primary care NHS dental practice such as pain relief or a temporary filling.

·         Band 1 course of treatment – £26.80 This covered an examination, diagnosis (including X-rays), advice on how to prevent future problems, a scale and polish if clinically needed, and preventative care such as the application of fluoride varnish or fissure sealant if appropriate.

·         Band 2 course of treatment – 73.50 This covered everything listed in Band 1 above, plus any further treatment such as fillings, root canal work, or removal of teeth but not more complex items covered by Band 3.

·         Band 3 course of treatment – £319.10 This covered everything listed in Bands 1 and 2 above, plus crowns, dentures, bridges, and other laboratory work.

Free NHS Dental Care was available to people in the following categories:

·         Under 18, or under 19 and in full-time education

·         Pregnant or had a baby in the last 12 months

·         Being treated in an NHS Hospital and treatment was carried out by the hospital dentists (dentures or bridges need to be paid for)

·         Receiving low-income benefits, or under 20 and a dependant of someone receiving low-income benefits.

Overall, the trend for NHS free dental care in Essex was going downwards when compared between 2017/18 to 2021/22.

Oral Health

Members heard that the SNEE Joint Forward Plan (JFP) described the key oral health issues in SNEE. Poor oral health was challenging both in terms of symptoms but also had knock-on effects on a person’s overall health and life quality and the overflow demand for wider health services (GP, 111, and A&E).

The Committee thanked the guests for attending the meeting and RESOLVED to note the contents of the report