Committee Members’ Questions (unless stated otherwise):

Responses by invited guests (unless stated otherwise):

Is there anything being looked into in regard to education for dentists and to look for in the future? 

For future planning, it is around changing the contracts, the contracts would be that there is a gradual move from NHS practices going more private and reforming the contract, point 1 would be that the NHS contract would be more attractive, that would help support provision, the second point would be that there is clarity over flexible commissioning which would support outreach services which is being worked on in other areas which can be learned upon with the new contracts. There are two schools within SNEE that train undergraduate hygienists and therapists who are also an important part of the dental workforce team. Currently the undergraduate level in Suffolk is aiming to have 72 undergraduates in any given time period.

Is there any more funding from Government coming forward for dentistry?

There is not official funding which becomes part of the issue. There were the 700,000 additional appointments that that Labour Government put in their manifesto, and they have paid attention to dentistry; however, the additional appointments were funded from the current dental budget. In SNEE the entire budget for dentistry is not being spent, mainly because all of the problems that have already been raised. By changing the way the contract works, the aim is that the entire dental budget is spent but there can be clawback money which ICB would not know about until nearer the time (around 3 months) and it makes it difficult to utilise the money.

Would you say that budget administration is a key factor to get the spending of the budgets?

Yes, it is all about working between the commissioners and dental workforce. There will be budget planning, the ICBs from the contract reform that took place two years ago now have the ability to unilaterally claim monies back, particularly the providers that have concurrently year on year not performed to their monies which means that the ICB have the ability to claw back the money and then work with more desirable providers.

With areas of frustrations, where do you think there is progress that is needed, and should Members be worried about 10% under 5-year-olds in Tendring having tooth decay?

In terms of percentage for tooth decay, it is a little bit higher compared to some national levels but there are some reasonings behind these figures. There has been preventative work such as supervised brushing schemes that start at early education. Risk factors do need to be taken into account when looking at the figures.

We know that coastal and rural communities have a higher level of disease just because of the nature of those communities. The national supervised toothbrushing scheme puts money into local authorities to invest monies into these schemes. There are various parts of the contracts that key into the NHS 10-year long term plan which is about putting prevention and community-based practice ahead of secondary care.

In terms of frustrations, from a commissioner’s point of view, ICB share the same frustrations with the providers in the UDA contract. ICB are trying to work with practices to flexibly commission varies schemes that have been mentioned. This has massively improved the relationships with a lot of the practices and open conversations are now happening.

The toothbrushes are supplied to the schools and the teachers are left to administer that scheme, is that correct?

Yes, there are 3 clinical providers which has one particularly centred on this. The idea and what has happened is to organise with Colgate to support with supplying toothpaste and toothbrushes to schools, the teachers will mainly be supervising the children to give a period of time at the beginning of the school day so that the children are able to brush their teeth with a fluoridated toothpaste. There is a lot of evidence behind this scheme which shows a return on investment.

There is good engagement with the young children, and they are having conversations with their parents around brushing their teeth. There is a bit of difficulty with the early years as it is difficult to fit the scheme in with the schedule for education.

Do you find Pat, that the number of tooth decay is going down in the surgeries?

(Pat) – My own practices do not have a NHS contract so I do miss out on these schemes; however, a local school has approached the surgeries, and we have managed to source some toothbrushes and supplied the school with some instructions that the children can take home so the partners have something to refer to.

Are there any plans to increase dentist appointments in the area of Harwich?

There will be a paper that is going to the Board meeting on 15 July about the procurement of new dental services and one of the areas is Tendring East, West and North. The ICB have said that within this the ICB will not be looking practices within that area but if there are practices that want to come along to the meeting then they are more than welcome to do that to start those discussions. 

Is it necessary to teach children to brush their teeth in schools?

When children come to practices, it is clear that children are not brushing for long enough and at home they do not know how long to brush for. There is also an effective technique to brushing the teeth and the right age-appropriate fluoride toothpaste.

The evidence is clear that this scheme can help with the decay in children.

With doing this scheme in schools, it starts the conversation around sugar and sugar reduction and children start to understand the amount of sugar they can consume.

Is it correct that there is no plan to have more dentist appointments in Harwich?

No, the ICB will not be excluding any areas. ICB will be looking at Tendring as a broad area, but we would not exclude providers around the area that came forward and said that they wanted to take part in the procurement and make a bid.

Are there any plans for home schooled children?

We try to hit the broadest population and supervised toothbrushing is specifically targeted to people who need it the most based upon the national directive but there would certainly be opportunities on the flexible commission that would look at the fuller population as well which will identify home schoolers and within ICB there is a programme that reaches out to the wider population and is actively showing that they are engaging with the schemes.

(Mike Carran) are there any plans to expand the number of champions and life long smiles in schools?

These programmes are commissioned by Essex County Council (ECC) and our colleague Julian links in with them who I can feedback to and say Members are asking for extra information.

Some of the programmes across the ICB are being evaluated which will give more evidence to look at different programmes and how they can affect the community and give the drive forward to future funding.

The support from a District Council is always useful to turn up to those meetings and give feedback so the ICB can see where people have identified where there are problems.

(Mike Carran) With flexible commissioning, what are the timescales?

Flexible commissioning reflects a number of different schemes, at the moment the ICB have the Dental Priority Access and Stabilisation Service which is running until the end of this year. Child focus dental practice which is another flexible commission. The ICB is conscious that they will be changing as well as the footprint so we are linking with South Mid Essex who will likely be taking over as Greater Essex which have similar but slightly different flexibility. At the moment there is no timescale but there are new flexibly commissioning opportunities.

(Keith Simmons) What is a high-quality oral health care that you are seeking to achieve and what level of reduction in oral health inequalities are you expecting to be able to achieve?

Once the plan is fully published, we can share that with you. In terms of high-quality oral health, it is making sure that there is an NHS dentistry available to people who need it, to go with that is the dental priority access service and we have procurement in the Tendring area. With reducing health inequalities, we are very aware that people who live in higher areas of deprivation are likely to have higher oral health needs so there are strategic commissioning plans when it comes to procurement.

More targeted commissioning schemes that will look at areas of greater deprivation and various other risk factors that are commonly known and several oral diseases are directly linked to general diseases so we would look to link in with wider health care professionals.

(Keith Simmons) Do you have figures for adults with active tooth decay within Essex? Are there any figures to show that the access to dentistry is improving in SNEE? Is there an update on the reduction on children’s admissions to hospital due to dental decay?

The data is not at hand, but it can be shared at a later date.

The adult oral health survey is generally carried out on a 10-year basis and the latest survey had a slightly different format so we would need to have a look and see if that data is available for the decay rating in adults. Children admissions data is hard to come by but what is known is that the toothbrushing scheme is in place to bring that number down and it would be a longer-term database update in order to achieve the results wanted.

(Keith Simmons) Are we right in reading that the DPASS appointments within the District are from a surgery in Frinton and is that the same for the additional care appointments?

Yes, that is correct, it is a surgery in Frinton, there is more access in Colchester but there is a surgery in Frinton that offers DPASS and urgent care appointments.

(Keith Simmons) Could Members have the figures for the DPASS appointments and additional urgent care appointments relating to the Frinton surgery?

That can be provided to Members.