Against a backdrop of continued growing discontent with current dental provision, both by the profession regarding the contract itself, and from patients about a lack of access, in February 2024 the government published its dental recovery plan “Faster, simpler, fairer: our plan to recover and reform NHS dentistry.” 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.
This plan has followed earlier system reform actions taken by NHS England in 2022.
(https://www.england.nhs.uk/publication/first-stage-of-dental-reform/)
The government’s recovery plan has focused on three key areas:
- Action to prevent poor oral health
- Boosting patient access by increasing access
- Workforce
Within each of these areas, the government has set out key aims and actions that will be undertaken.
Action to prevent poor oral health
It has been shown that preventative care is important throughout life but especially in early childhood. For that purpose, dentistry will be included in the current Start for Life programme as delivered in Local Authority’s Family Hubs, which will include providing guidance on how to promote good oral health to pregnant mums and those with the very youngest of children.
A new Smile for Life programme will be rolled out, giving support and education for children in early year settings (1-3 year-olds). These will both be supported by new guidance, examples of good practice, and educational materials for professionals to use.
Dental teams will start going into state primary schools in areas where dental provision is low, to give preventative advice and to apply fluoride varnish, which is a key preventative measure.
Finally, it will be made simpler to start new water fluoridisation schemes and the government is starting this with a consultation in the North East for an expansion to the current water fluoridisation programme.
Boosting patient access by increasing access
The government recognises that not all patients who wish to see an NHS dentist are able to do so and have looked at several ways to increase access.
The first of these initiatives is looking at ways dentistry can be delivered differently in areas of need and ‘dental vans’ will be provided to deliver care, targeting rural and coastal communities in the first instance.
It has been recognised that attracting dentists in some areas is more difficult and a payment of £20,000 for 240 dentists will be made in identified locations to encourage this. The payment to the dentist will be spread over a three-year period.
The GP patient survey highlighted the difficulty for patients who have not seen a dentist in the last two years to find a dentist who will offer them an appointment. To enable these patients to have access to a dentist for a period of 13 months, Contractors are being offered a new patient premium, recognising this as activity delivered against their current contract.
Each contract has a unique funding arrangement and a new minimum value for any contract has been set at £28 per unit of dental activity (UDA), with practices whose current UDA value is less than this having their contract varied to reach this level and any new contracts being placed will be at least at this minimum value.
It has long been acknowledged that dental care professionals (DCPs) have a valuable role in delivering NHS dental care and under the initial reforms barriers to them working to their full scope of practice were removed. A consultation on further recommendations to support their professional development and roles within practice will be undertaken in 2024 with an aim of implementing any changes in 2025.
Not all contracts consistently meet all their contractual obligations, and where a mutual agreement on how to address this cannot be reached, Commissioners have now been given the powers to undertake a unilateral rebasing of a contract, where certain conditions have been met. These powers will be kept under review as part of the system of reform.
Whilst some practices under deliver, there are practices who can meet their contractual obligations and could do more. Commissioners are now able to recognise this delivery, and with their agreement, a contractor can deliver up to 110% of their contract metrics.
To ensure that commissioners utilise their dental budget, including any finances recovered due to under delivery of contracts, this funding will be ringfenced for the delivery of dental services in 2024/2025.
There will be times when commissioners will be looking to place new contracts. Support will be provided to them regarding any procurement exercise that needs to be undertaken. Commissioners will also be provided regularly with additional data on where dental delivery is being made as well as workforce data. As contract metrics and values are based on historic arrangements, a piece of work examining the relative distribution of need is being undertaken, to help inform future commissioning decisions.
Finally in this area, the government are looking at ways of reducing the bureaucracy within the system for both commissioners and contractors by way of a new stakeholder reference group.
Workforce
The final area that the government has looked at is how to retain the current workforce, attract dentists back to the NHS and make it more attractive for newly qualified dentists to work in the NHS.
As part of this, undergraduate places for both dentists and DCPs will be increased by 40% from current levels. To support this new dental schools are being considered.
For dentists graduating from UK dental schools, the government are considering a tie-in period, where graduates must work within the NHS.
DCPs which include therapists, hygienists and nurses, have a valuable role in the provision of dental care but it is recognised that to fully utilise these skills a shift in the mindset in both the contractors and the public needs to happen. Work has already commenced to ensure that DCPs can work to their full scope of practice. The government are also looking at a ‘return to dental therapy’ programme for hygienists to refresh their therapist skills. A consultation has been undertaken regarding dental therapists being able to administer certain medicines under the NHS without the prescription of a dentist and the consultation results are currently being considered.
The dental workforce includes dentists and DCPs who became qualified outside of the UK and there are a number of criteria that must be met before they are able to practice in the UK, some of which can cause delays before they can practice here. The government are looking at these areas. This includes the process for registering internationally qualified dental professionals and legislation has already been passed to support the General Dental Council (GDC) registration process and the government will continue to work on a further expansion to this. The GDC have been given greater freedom to recognise qualifications gained outside of the UK. For some dentists, part of the process is undertaking an exam to ensure that the requirements to practice in the UK are met, and capacity to take these exams has already been increased with ongoing work being done to further increase this. Where qualifications are not automatically recognised legislation will be introduced to allow for provisional registration, which will provide a new faster route for certain dentists to start working in the NHS. Finally, once a dentist is registered with the GDC and they wish to provide NHS dentistry, they must also be registered on the NHS National Performers List. Improvements continue to streamline the process so that there is minimal delay in the registrations with decisions being made between three and six weeks.
Evaluation
The government will continue to evaluate the provision of NHS dentistry and the reforms outlined in their recovery plan.
PCC supports ICBs to commission dental services and we will be happy to work with ICBs on the implications of the recovery plan and how these can be implemented in their organisations. Please contact enquiries@pcc-cic.org.uk to find out more.
Last Updated on 2 April 2024
