Health and Wellbeing Board

 

20 March 2024

Report of Debra Leadbetter, Programme Lead – Dental & Optometry, Primary Care, Humber and North Yorkshire Integrated Care Board.

 

NHS Dentistry – update March 2024

Summary

1.           Humber and North Yorkshire Integrated Care Board (HNY ICB) has been responsible for the commissioning and contracting of NHS dental services since April 2023.  One year on, this report sets out the current state of dental services within the City of York, providing an update on the national dental recovery plan (launched February 2024) and future HNY ICB plans for dentistry. 

 

Background

 

2.           Humber and North Yorkshire Integrated Care Board (HNY ICB) took on delegated responsibility from NHS England for the commissioning and contracting of all NHS dental services across York since April 2023.

 

Dental services commissioned by HNY ICB include:  

·        Primary Care (generally high street dentistry), accessed by patients directly.  Primary care commissioned dental activity is based on Courses of Treatment (CoT) and Units of Dental Activity (UDAs). 

·        Community Dental Services (CDS) – primary and specialist dental care for patients who cannot be managed by a primary care practice and who have additional health and/or social care needs.  By referral only. 

·        Intermediate Minor Oral Surgery (IMOS) – by referral from a dentist.

·        Orthodontics – by referral from a dentist.  

·        Urgent care - available via primary care practices directly or NHS111.  Urgent Care is for conditions clinically assessed as requiring treatment within 2 and 24 hours.   This does not include emergency care, which is for dispositions which require a clinical assessment within 2 hours and which can only be provided by the A&E pathway.

·        Secondary care – specialist service by referral only.  

 

While Humber and North Yorkshire Integrated Care System has the remit for commissioning dental services, Local Authorities have statutory responsibilities around oral health improvement, including commissioning evidence based oral health improvement programmes to meet the needs of the local population.

 

The purpose of this report is to update members on the current national and local situation.  This report follows on from the report tabled at the Health, Housing & Adult Social Care Scrutiny Committee on 13th December 2023.

 

Main/Key Issues to be Considered

3.           Both nationally and locally, access to NHS dentistry is a challenge with issues identified relating to the national contract itself with payment mechanisms, workforce gaps, and procurement restrictions, making it difficult to secure new dental provision.  In addition, it may not always be clear to patients how NHS dental services work.  It is important to note that dental contracting takes place within the national context and challenges are well-embedded, meaning that HNY ICB has many issues to overcome in its aim to improve dental services.

Improving access remains an absolute priority for the ICB and since assuming delegated responsibility for the commissioning and contracting of dental services in April 2023, HNY ICB has been working hard to improve dental services for those living in the area.  We are building positive relationships with the profession and local dental practices to continue to improve services.  Since July 2023, we have:

·        Increased the number of staff in the dental team so that they can work effectively to support local dental providers to secure and stabilise dental services.

·        Procured three new dental practices, including one in York – as a result of the BUPA contract hand back, which are due to open in summer 2024.

·        Invested non-recurrent funding in various initiatives aimed at improving access and reducing waiting lists, including increasing urgent access appointments and increasing orthodontic appointments.

·        Made good progress in further establishing relationships with our Local Dental Committees (LDCs) to enable us to build relationships with contractors and to seek their input into future developments.

 

National Plans

 

4.           Within this context, HNY ICB welcomed the recent announcement in February 2024 of the NHS Dental Recovery Plan, which provides funding to support access and oral health over the next year.  The recovery plan has been long-awaited and aims to address some of the known issues with the national NHS dental contract. 

The plan has three broad elements:

a)   Smile for Life: a new prevention programme for oral health focused on younger children through:

·         promoting prevention initiatives in Family Hubs to improve the oral health of pregnant mums, and guidance for parents on children's oral health

·         support for early years settings to incorporate oral hygiene routines

·         mobile dental teams being deployed into schools in under-served areas to provide advice and deliver fluoride varnish

·         a consultation on expanding water fluoridation in the North-East

b)  Make access faster and fairer for patients by investing in care delivered to new patients and rolling out new ways of delivering care in rural and coastal areas:

·         A new patient premium paid to practices for appointments with new NHS patients

·         a dental van service

·         an increase to the minimum UDA value to £28 this year (the Yorkshire and Humber UDA average is already £34.31)

·         ‘golden hello’ payments to attract dentists to areas of need

·         reinforcing the ringfence on NHS dentistry budgets for 2024/25

c)   Reducing bureaucracy and making NHS dentistry simpler for patients and all dental professionals:

·         restate commitments from the NHS Long Term Workforce Plan

·         consultation on ‘tie-ins’ to NHS for dentist graduates

·         commitments on improving overseas recruitment of dentists.

 

Further details of the national plan can be found at:  https://www.gov.uk/government/publications/our-plan-to-recover-and-reform-nhs-dentistry/faster-simpler-and-fairer-our-plan-to-recover-and-reform-nhs-dentistry

 

Since the plan was announced, details from NHS England have been arriving to set out the actions required by ICBs.  We are working to meet these actions/expectations and we have been communicating with our dental practices to successfully introduce the plan across HNY.

 

HNY ICB Operational Plans

 

5)          In addition to introducing the national dental reforms, HNY ICB is also working on its 24/25 investment plan for dental services.  In the past, the budget available for non-recurrent investment was not confirmed until November, leaving commissioners and providers only four months in which to rollout new dental schemes, on a non-recurrent basis.  This year, HNY ICB has taken a new approach to managing its financial risk and has agreed to commit to non-recurrent funding, based on past performance, from April 2024.  As such, HNY ICB is developing its investment plan and has already confirmed for York:

·        A continuation of all existing Flexible Commissioning schemes – these promote early intervention and improve access for vulnerable groups through participating practices.

·        A continuation of all additional urgent access sessions.

HNY ICB is also considering its options for the introduction of new schemes, including pilots of innovative approaches to support:

·        Child only contracts – across both NHS and private dentistry.

·        Homeless or Refugee services.

·        Those living in secure mental health facilities.

·        Other schemes aimed at reducing waiting lists (e.g. for orthodontics and routine dental care).

The ICB is also developing its dental plans as part of its core budget, looking at opportunities to procure Intermediate Minor Oral Surgery (IMOS) in York, expand its Referral Management System (RMS), commission additional access sessions and expand its offer for flexible commissioning.  In addition, the ICB aims to work with its communications colleagues to develop key patient messages aimed at promoting good oral hygiene as well as helping patients to understand NHS dental services.  Equally, the ICB aims to further develop its work with business intelligence colleagues to collect, analyse and utilise data in order to assist in making informed decisions about needs and services.

 

        Benefits for City of York

6)          The national plan and HNY ICB operational plans (to date and in future) may have specific benefits for those living within the City of York.  These can be summarised as:    

·          National dental recovery plan – schemes set out within this plan will be available to all dental contractors in York.  It is anticipated that the 'new patient premium' announced as part of this plan will incentivise dental practices to accept new patients.  We are awaiting details on how 'golden hellos' and other schemes aimed at recruiting and supporting new dentists may be targeted.  If York is in scope, this could help practices with their workforce challenges and enable them to deliver more NHS dental care.  

·          Emergency dental care in York – one dental provider in York is currently offering additional access sessions for patients with an urgent dental need.  This scheme has been extended until 31 March 2025.  The ICB is also working with NHS 111 to understand how calls are handled to ensure that patients in York can be signposted to urgent providers closer to home.  This work continues.

·          Children's dental care in York – the ICB is working to establish child only contracts.  In York, we have had good levels of interest from practices, including both NHS and private providers.  We are working to review and evaluate these expressions of interest with a view to the new service being available from April 2024 for 24 months.

·          Dental commissioning plans – in York, the ICB has recently completed a procurement for new dental services, as a result of the contract handback from BUPA.  The new provider is due to open from summer 2024.  In addition, the ICB is working to pilot a new dental service for those living in secure mental health facilities and may look to expand its current Homeless pilot to new areas, such as York.  HNY ICB is also working to review its current Flexible Commissioning offer, making this more accessible to providers – this should enable more sites to join the scheme later in 24/25.  Finally, the ICB is also looking at gaps in services, such as intermediate minor oral surgery (IMOS) and developing plans to commission services in the city.  The ICB is committed to working with dental contractors to retain their contracts and has engaged in a number of supportive conversations to review delivery targets and to support contractors when they are struggling, with the aim of reducing the number of contract hand backs in the city.

·          Linking the ICB developments to the concerns raised by Healthwatch York in its report NHS Dentistry – a service in decay from July 2021, it is hoped that the above actions will help to address some of these issues. 

NHS dentistry faces challenges both nationally and locally but with the February 2024 national dental reforms and the ongoing work of HNY ICB to invest in dental services across the city, we do hope to improve issues associated with access and waiting times.  There is, however, much work to do in terms of correcting years of compounded issues.  Nonetheless, HNY ICB is optimistic that it has the staff and investments in place to begin this work and to bring about improvements for its residents.

 

Contact Details

Author:

Chief Officer Responsible for the report:

Author’s name

Title

Dept Name

Organisation name

Tel No.

 

Debra Leadbetter

Programme Lead – Dental & Optometry

Primary Care

Humber and North Yorkshire ICB

07842418675

 

 

 

 

Report Approved

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Date

08.03.2024

 

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Report Approved

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Date

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Annexes

None