Hertfordshire dental services improvement plans discussed

Herts County Council’s Health Scrutiny Committee received a report from a health body outlining its plans for dental treatment across the region.

Hertfordshire and West Essex Integrated Care Board (ICB) took over the commissioning of all NHS dental services in the county last month.

As part of its remit, Herts and West Essex ICB will manage 232 General Dental Services NHS contracts. The majority of these (152) are with high street dentists, while 19 are with orthodontic providers and the rest are with other specialists.

Michelle Campbell, head of primary care contracts at Herts and West Essex ICB, presented the organisation’s plan to the council.

Dental decay in Hertfordshire children (Image: NHS)

Ms Campbell said: “One of the few things to note is that actually, dental practices in high streets don’t operate on a registered patient list, so patients can access services wherever they choose. That maybe nearby where they live, where they work or where their children go to school.

“So actually, patients and residents within Herts and West Essex can actually secure services outside of the ICB and vice versa, we have patients from neighbouring ICBs that may receive treatment within our boundary.

“When we did a bit of analysis around the patient flow for 2022/2023… actually 90 per cent of the treatment provided was for the Herts and West Essex population, so we are treating the majority of patients within our contracts.

“There’s a number of challenges nationally around access to dental services and that’s mirrored across Herts and West Essex.

“Patients are required to pay for treatment where they are not exempt, that’s quite a challenging barrier for patients, especially at the moment with the cost of living crisis.”

Ms Campbell added that recruitment is also an issue across the dental sector, and young dentists may be seeking to move into private treatment.

She said: “In 2023, the ICB developed our primary care strategic delivery plan and within that, we highlighted a number of priorities that we want to delivery in dentistry for the next sort of three years.

“One of these is reviewing our in and out-of-hours urgent dental services. We’re fortunate in Hertfordshire that we do have a dental out-of-hours service, which isn’t mirrored across the east of England, open seven days a week, including Bank holidays.

“We’re working with Public Health colleagues in the local authorities around oral health initiatives and how people can improve their oral health.”

The ICB is responsible for implementing NHS England’s joint plan with the Department of Health and Social Care on the recovery and reform of NHS Dentistry, which was unveiled on February 7.

The plan outlines changes that aim to support prevention of poor oral health and increase access to dental services, with the following actions to be taken:

• New Patient Premium/Tariff will be introduced for patients who have been unable to access care in the past 2 years; additional payments on top of the current treatment Bands 1 (£15), 2 and 3 (£50)
• Increase of the minimum UDA value from £23 to £28 – this will take effect from 1 April 2024 and will be applied nationally
• Offer of a “Golden Hello” – funding for up to 240 posts across England where recruitment is challenging on the proviso that the dentist commits to stay in post for a full 3 years
• Ambition to introduce Dental Vans to support rural and/or under-served areas and to support hard-to-reach communities.
• The report also included a table showing the dental decay in 5-year-olds among Hertfordshire’s Lower Tier local authorities.

The table showed the mean number of teeth per child found to have dental decay on average. The best performing local authority was North Hertfordshire at 0.1, followed jointly by East Hertfordshire and St Albans on 0.2.

Dacorum, Three Rivers and Stevenage also fared well with means scores of 0.3. Hertsmere had 0.4 and Watford was 0.5.

In bottom place was Welwyn Hatfield at 0.9, followed by Broxbourne at 0.8. The East of England average was 0.7 and England average was 0.8.

The committee heard from Dr Steve Claydon, independent clinical dental advisor to the ICB.

Dr Claydon said: “I know a little bit of surprise was expressed about the Welwyn Hatfield area and the amount of dental decay in that area.

“If you look at areas of high population density and deprivation, there is a direct correlation with childhood dental disease. Prevention is everything, we don’t want to be repairing teeth and treating pathology, we want to be preventing disease in the first place.”

Dr Claydon added that the three challenges were “workforce, workforce and workforce”.

Cllr Nigel Bell said access to dental treatment was “one of the biggest issues all of us councillors face from residents”.

Cllr Val Bryant, of North Herts District Council, questioned if patients in pain should call 111 for urgent appointments and Dr Claydon confirmed this was the case.

Ms Campbell added that the ICB had launched a campaign locally to make residents aware.