Agenda item

The Chief Medical Officer for the Integrated Care Board (ICB) submits a report to give the Commission an overview of NHS Dental Commissioning across Leicester, Leicestershire and Rutland (LLR).

The Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB) submitted a report to update the Commission on NHS dentistry which continued to operate under a national contract, limiting the extent of local decision making despite efforts to focus activity on health needs and inequalities. The following was noted:

·       It was reported that progress had been made although national contractual constraints continued to pose challenges. Some areas of delivery were mandated nationally, including the requirement to provide seven hundred thousand urgent dental appointments nationally. Locally, an allocation of just over ten thousand appointments had been received. However, the ICB commissioned just under fourteen thousand appointments. Performance in this area had not been as strong as expected, and further targeted communications and awareness activity was planned to improve access for people with specific needs.

·       General dental activity across LLR was reported to be relatively positive compared to other areas. Activity was at forty nine percent which was slightly higher than previous levels and on track to meet its year-end target.  Providers had been invited to participate in an over performance scheme to deliver an additional ten percent of activity, equating to around thirty thousand appointments. Work was also taking place with providers who were underperforming to establish whether additional session time could be offered. 

·       Where practices continued to under deliver activity, contract values could be reduced and reinvested into other areas where need was greater. The ICB has commissioned additional funding to the Community Dental Service CIC for patients with learning disabilities, dental phobias or other complex needs who could not be treated in standard dental settings.

·       The Commission also received an update on oral cancer, with Leicester previously recorded as having the highest prevalence and mortality rates nationally. Partnership work with Turning Point was underway to identify at risk patient groups. Individuals engaged with relevant charities would be able to be referred directly into participating dental practices. A similar pilot had run successfully in the West Midlands.  In addition a care homes had been trialled in Charnwood, Hinckley and Bosworth. Training for early detection of oral cancer continued, with identified patients referred for appropriate treatment.

·       The overall programme was described as being aligned to the local targeted needs assessment with the intention of narrowing health inequalities.

In discussions with Members, the following was noted:

·       Reference was made to previous reports highlighting Leicester’s high rates of oral cancer and poor dental health outcomes for children. Concern was expressed that up to two thirds of children did not have access to an NHS dentist.

·       Members asked how the measures outlined would move the system from its current position to improved outcomes and what additional actions could be implemented. Further clarification was sought on contract rebasing, how it would apply to underperforming providers, and how a Unit of Dental Activity operated within the contract structure.

·       It was explained that children were included within the ten percent over performance scheme and that specific criteria were used when allocating additional units of dental activity.

·       Concerns were raised that contract rebasing could destabilise an already sensitive service. The contract was described as complex, with approximately eight hundred thousand units allocated across LLR. If a provider was unable to deliver its allocation, the expectation was that the units would be redistributed so they could still be used. Examples were provided including one unit for a check-up, three for a filling and twelve for a bridge. Further work was taking place on the rebasing process.

·       Questions were raised about whether there was sufficient UDA capacity to meet local population needs and what the estimated level of required provision might be. It was noted that demand exceeded availability and that some children were receiving hospital based treatment for multiple dental extractions.

·       Unlike general practice, NHS dental practices did not hold a registered patient list and were not obliged to operate in the same way as GP practices. Dentistry operated within an independent sector market and recruitment pressures remained significant, although work was underway with universities to support the future workforce pipeline.

·       Further discussion took place on whether additional units could be delivered if the government provided them. Members asked who the responsible minister was, and whether lobbying might lead to increased allocation.

·       Oral cancer prevention was revisited, with members asking whether activity was being funded locally to target risks associated with shisha use in Leicester. It was confirmed that additional capacity could be delivered and that work with providers was ongoing. The responsible minister was identified for future lobbying, and public awareness work relating to oral cancer risks remained part of ongoing programmes.

·       A query was raised about the ability of residents across LLR to obtain an NHS dentist. It was confirmed that recall lists existed within practices, although wider registration data was not held. Members highlighted the difficulty of accessing services and commented on the complexity of the forms patients were required to complete.

·       Questions were also asked about how many people across LLR were registered with NHS dentists compared to private providers. It was confirmed that no comprehensive list existed and that this was a national issue being considered as part of the ten-year plan for dentistry. Work continued with the local dental committee to explore the business model for NHS dentistry and the challenges practices faced.

·       Concerns were raised about the position in Rutland where 82% of adults were not accessing NHS dental care. Members asked what mitigations were available to address this. It was noted that a procurement for ten thousand UDAs was underway, although legal considerations had delayed progress. An update on the outcome was expected soon. Providers across LLR were eligible to participate in these schemes, although if providers in Rutland did not come forward it indicated a lack of interest in offering NHS provision.

·       The discussion concluded with an acknowledgment that the situation was not ideal and that delays in the procurement process carried risks. There was concern that if progress was not achieved soon, the market would continue to shift further towards private provision. The Commission supported revisiting the issue at a future meeting.

AGREED:

That the report be noted