Agenda item

To receive a briefing paper from NHS England on their public consultation on two options to improve access to urgent dental care services.

Jane Green, Assistant Contract Manager, Dental and Optometry, NHS England – Midlands and East (Central Midlands) and Semina Makhani, Consultant in Dental Public Health, Public Health England attended the meeting to present a briefing paper on the consulting the public on two options to improve access to urgent dental care services.

The consultation started on 3 August and would finish on 1 November 2015.   A pre-engagement process had taken place in March and the responses had been used to shape the proposals.

The two options were:-

Option 1         Merge the existing Dental Access Centre and the dental out-of- hours services with revised opening times.  The service would be delivered from the Dental Access Centre in Nelson Street (off London Road) Leicester.

Option 2         To establish two new dental practices providing urgent and routine dental care to patients from 8am to 8pm, seven days a week, 365 days a year including all Bank Holidays.  When local practices are closed, the sites will provide urgent care services.  The creation of the new practices is based on the oral health needs assessment and the review of existing contracting arrangements.

The report also contained details of the Specialist Care Dentistry for Leicestershire and Lincolnshire Pre-Engagement which had been extended in Leicestershire for six weeks from the original closing date of 25 September 2015.

NHS England would be considering both issues in late November with a view to the two procurement programmes commencing in January 2016.  It was intended to award new contracting arrangements in June 2016 to enable new providers to have an extensive mobilisation period to establish the new service arrangements.

Members of the Board made the following comments:-

a)         It was difficult to state a preference between the two options as they were not readily comparable. The parameters of services in Option 2 were far in excess of Option 1 but at unknown locations; whereas Option 1 was located in the City where 80% of users of the urgent care services lived.

b)         If there was capacity within the existing dental services, the need to promote and offer ‘routine’ dental services at the urgent care service was questioned.  It may be better to signpost patients to dentists with capacity and encourage registration with them so that on-going care can be provided.

c)         Healthwatch received a number of calls daily from people wishing to go to an NHS dentist and there was a difficulty recommending a dentist that was known to have spare capacity.  It would appear there was a mismatch of dental services availability and it would be helpful if NHS England supplied a list of dental practices that had spare capacity.

d)         There was evidence that in LE2 and LE5 post code areas there was no capacity as people were waiting 6-8 months to apply to see a local dentist.

e)         As 80% of the users of the urgent dental care services were currently living in the City, it was queried whether there would be a guarantee that their need would be catered for in whichever option was adopted. It was important to have a service where City patients did not have less access to the service that the current need clearly demonstrated exists within the City.

f)          It needs to be recognised that car ownership in parts of Leicester with low levels of NHS registration is less than 50% and this has a major effect upon people’s ability to travel, whereas car ownership in the county is higher.  A city centre location is accessible by public transport, but travel is more difficult across the City and into county areas.   

In response to comments made by Members of the Board it was stated that:-

a)         Not every patient contacting the services requires treatment as advice may be given.

b)         There were parts of the population that don’t engage regularly with dental services until they have an urgent care need.

c)         Part of the rationale for offering ‘routine’ dental care services was to address the pockets around the County where there was a need to improve access to dental services particularly in relation to children.  Currently only 20% of 0-2 years olds had been seen by a dentist and NHS England were working with local dental practices to encourage increased levels of attendance so that preventative advice could be given.

d)         Dental practices have not been required to register patients since 2006, they were however required to see patients until a particular course of treatment had been completed.  Dental practices now maintained ‘lists of patients’ that they saw over a regular period.

e)         A list of dental practices was supplied to Healthwatch on a monthly basis, but it was recognised that there were pockets of demand where people were reluctant to travel to see a dentist.

f)          There could be more than one provider for the service and the provider would have to guarantee the service was available during the contracted hours of operation.

RESOLVED:

1)         That the Board does not feel able to indicate a preference for either Option 1 or Option 2 on the information currently provided.  However, the Board would expect that whichever model of care was eventually chosen that it would provide as a minimum level of service:-

i)          The current urgent dental care capacity provided in the City would be sustained.

ii)         The opening hours of access to the service would be a minimum of 9 am to 7 pm Monday to Friday and 6 am to 6 pm at weekends and Bank Holidays.

iii)        That the service would be delivered from a city centre location which was both central located and easily accessible.

2)         That the Board receive a further report in the future focussing on the strategic provision of dental services and strategies for achieving higher levels of dental registration.