CITY OF YORK COUNCIL
Report to: Overview and Scrutiny Committee
Wednesday 2 April 2025
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Dental Services and Oral Health Update
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Report of the Humber and North Yorkshire Integrated Care Board
by Debra Leadbetter, Primary Care Programme Lead
Executive Summary
Humber and North Yorkshire Integrated Care Board (HNY ICB) has been responsible for the commissioning and contracting of NHS dental services since April 2023. Approximately two years on, this report sets out a current update on dental services across York, providing a focus on services and the local and national direction for the future of NHS dentistry.
1. Introduction
1.1 In April 2023, 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 the City of York.
Dental services commissioned by HNY ICB include:
· Primary Care (generally high street dentistry), accessed by patients directly. Primary care commissioned dental activity is based Units of Dental Activity (UDAs).
· Community Dental Services – 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 – 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 services by referral only.
While Humber and North Yorkshire Integrated Care Board has the remit for commissioning dental services, Local Authorities have statutory responsibilities for 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 local and national position for dental services and oral health improvement.
2. NHS Dental Services – improving local access
2.1 Both nationally and locally, access to NHS dentistry is a challenge with issues identified relating to the national contract itself, workforce gaps, and procurement restrictions, making it difficult to secure new dental provision. 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.
2.2 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.
2.3 Across the City of York, in 2024/25, the ICB has so far:
· 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 a new dental practice in Monks Cross, which opened in December 2024 following earlier contract hand backs from providers in 2022.
· Invested non-recurrent funding in various initiatives aimed at improving access and reducing waiting lists, including increasing urgent access appointments and increasing orthodontic appointments.
o Urgent appointments – 3 practices across the City of York are offering approximately 7,300 patient appointments throughout the year.
o Orthodontic practices – 1 practice in York has increased their capacity to see patients from the waiting list.
· Introduced child only contracts – 4 practices in York are taking part.
· Developed positive relationships with our Local Dental Committees (LDCs) to seek their input into future developments.
· Planned an oral health campaign aimed at children, young people and parents to promote good oral hygiene and to prevent dental decay (launch March '25).
· Explored opportunities to focus on children and adults with neurodiverse conditions or special educational needs and disabilities (under development).
2.4 In addition to the above investments into improving dental access, the ICB has also committed to continuing with its approach to 'flexible commissioning' which enables dental practices to work differently and to prioritise access for the most vulnerable. Through offering community outreach sessions and dedicated clinical appointments, 'flexible commissioning' practices are able to focus on both prevention and treatment. There are currently 5 such practices within the City of York and we are currently transferring practices to participate in a revised version of the Prevention and Access offer, from 1 April 2025, with new sites being invited to join later in 2025/26.
2.5 Finally, the ICB has also invited practices to deliver up to 10% additional activity, beyond their usual contract terms. This incentive encourages practices to work above and beyond contracted levels, with the assurance that the ICB will pay for this increase in activity. 2 practices across York have applied and have been working toward over-delivery since July 2024. In March, all dental practices were invited to join the scheme in a final push to increase activity. Results will be known in 2025/26.
3. ICB Prevention, Access and Treatment (PAT) Programme
3.1 The ICB has implemented several initiatives to improve dental services and oral health across Humber and North Yorkshire. One of the key initiatives is the Prevention, Access, and Treatment (PAT) programme, based on the national ‘Childsmile programme’ in place nationally in Scotland. HNY represents one of the early adopters of this approach in England.
3.2 The PAT programme is delivered in partnership with dental providers, local authorities and schools, targeting children and young people to promote good oral hygiene and prevent dental decay. The programme is aimed at primary school pupils and activities take place within a school setting. Dental providers reach into schools and provide, through a range of practitioners, supervised toothbrushing, fluoride varnish application, and dental assessment. Should assessment demonstrate the need for further work and/or an intervention, the child will be brought into a local practice. In addition, that practice will also offer an appointment for the child’s immediate family.
3.3 Currently, more than 90 schools across HNY have agreed to take part in the PAT programme, supported by a range of dental providers. Initial work commenced in Hull and East Riding of Yorkshire but is now rolling out to other Places across the ICB. In addition to the roll out across primary schools, the ICB is supporting a single pilot in a nursery / pre-school setting in Northern Lincolnshire and, similarly, a single pilot in a secondary school at Withernsea.
3.4 Recognising that Public Health, among other colleagues, have been offering supervised toothbrushing programmes for some time, next steps include developing hybrid models that seek to integrate existing Public Health programmes with the additional elements offered by the PAT scheme. It is anticipated that an initial evaluation will take place in circa six months, recognising the need to get sufficient data in place to make this meaningful.
3.5 The PAT scheme is delivered in addition to the schemes delivered by the local authority and public health colleagues (see additional report from colleagues).
4. Workforce
4.1 To support our plans for improving access to dental services, HNY ICB is also offering workforce initiatives and pilots aimed at recruiting and retaining dentists in the area. Similar to other healthcare professions, dental services face a number of recruitment challenges.
4.2 As part of national government guidance, HNY has approved 27 applications for 'golden hello' recruitment incentive schemes, of which 3 are based in the City of York. These practices were selected based on eligibility criteria as per the national guidance and a local process panel review, considering hard to recruit areas, areas of high deprivation and areas of low dental access for the population. Despite this opportunity, only 4 practices across the whole of HNY have been able to successfully recruit new dentists to the area (as of March 2025) and the scheme continues.
4.3 In addition to the national scheme, the ICB has offered practices the opportunity to pilot a 'Fellowship' scheme whereby newly qualified dentists are supported to work in NHS practices, given mentorship by experienced dentists, to support development of their skills. Only 2 practices across HNY are piloting this scheme, including one in Hull and one in York. If successful, further opportunities to expand the scheme will be considered.
5. National incentives and programmes
5.1 The above local initiatives are delivered by HNY ICB in order to meet the local needs and priorities of those living in the area. In addition, there are also a range of national initiatives focused on improving access to NHS dentistry. Largely introduced by the previous Conservative government, these national schemes which have been implemented across Humber and North Yorkshire include:
· Enhanced rate of pay to see new patients. The new patient premium aims to encourage dental practices to see patients who have not been to a dentist in the past 2 years. However, this programme has been evaluated nationally to determine its impact and Government has announced that it will not continue into 2025/26.
· Increase to the minimum tariff for units of dental activity (UDA) to £28 in the 2024/25 financial year. Already the average UDA tariff in Yorkshire in Humber is £34.31
· Maintaining the ring-fence on dental budgets so that funding for dental services remains in place and focused on improving dental access.
5.2 Since these national changes were introduced, the Labour Government is now in place. They are continuing with the previous plans and have set new priorities to focus on:
· Urgent Access appointments with 700,000 new slots expected nationally
· Further development of prevention schemes, with specific reference to supervised toothbrushing for 3 to 5 year olds.
· Full dental contract reform.
5.3 The rollout of dental van services was set out in the Conservative government plan for dental reform, however under the Labour government this requirement has been removed and remains a local decision. Although access to dental services via a dental van can offer short term access, HNY ICB has concluded that dental vans do not offer value for money and that the time and resources to implement such a service are better focused on longer-term solutions. As such, HNY ICB will not be proceeding with plans to commission a dental van service.
5.4 The ICB dental team is part of a regional NHS England team which meets fortnightly for regular updates, monitoring and guidance on national developments. Data on impact, such as those seen through the new patient premium or in those areas which are using dental vans, are being developed nationally and will be shared through the group for further learning, sharing and implementation as appropriate.
6. Public Health and Local Authority updates
6.1 In addition to commissioning NHS dental services, both the ICB and local authorities play a role in public health initiatives for oral health and wider population health priorities, with health inequalities being of particular importance. Please see the additional paper, from City of York, Director of Public Health for local details.
6.2 As part of the ICB work under this remit, the following schemes are in place or under development:
· Cardiovascular disease pilot: the ICB has received national funding to rollout blood pressure checks in dental practices on a pilot basis. This supports Public Health England's ambition to increase diagnosis of hypertension to 80% of the estimated prevalence by 2029 and NHS England's Long Term Plan to prevent 150,000 heart attacks, strokes and dementia cases by 2028/29. 2 practices in York are taking part, with the first blood pressure readings starting from January/February 2025.
7. Conclusion
7.1 Overall, NHS dental services remains a complex and challenging area however, Humber and North Yorkshire ICB, in partnership with local authority colleagues and dental providers, is working to bring about improvements. A revised focus on improving access to dental treatment through an increase in appointments, combined with a focus on workforce initiatives and preventative programmes via local schools will help to bring about positive changes.
7.2 Data set out in Appendix 1 shows the impact of some of this work, with access for children and adults across Humber and North Yorkshire being better than the England average. York, in particular, is the highest for access to dental services by children, however, there is more work to do to improve access for adults across the City of York.
7.3 Together, working in partnership with local authorities and our dental providers, Humber and North Yorkshire ICB is positive that they can continue to invest in dental services and to improve access to dental treatment for its residents.
Contact Officer: Debra Leadbetter
Primary Care Programme Lead – Dental and Optometry
Humber and North Yorkshire Integrated Care Board
Email: debra.leadbetter1@nhs.net
Background Papers None
Glossary/Abbreviations:
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HNY ICB |
Humber and North Yorkshire Integrated Care Board |
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NHSE |
NHS England |
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PAT |
Prevention Access and Treatment programme |
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UDAs |
Units of dental activity |
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Y&H |
Yorkshire and Humber |
Appendix 1: Data
The above chart shows the changing rates of children accessing dental services, from June 2023 compared to June 2024. Of particular note:
· Across each ICB Place (except Hull) access rates are improving
· Humber and North Yorkshire rates are above the England averages
· Highest levels of access are experienced by children living in York.
The above chart shows the changing rates of adults accessing dental services, from June 2023 compared to June 2024. Of particular note:
· Across each ICB Place (except North Yorkshire) access rates are getting worse
· Humber and North Yorkshire rates are better than the England averages
· Lowest levels of access are experienced by adults living in York.