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South West dental stabilisation programme

During the pandemic demand for urgent care increased significantly. NHS England South West commissioned additional urgent care during this time through a variety of models to try and best meet demand. Unfortunately, for those receiving treatment through an urgent care pathway, they are often unable to then find a dentist to complete a more permanent solution, which can lead to them accessing urgent care on numerous occasions. This reduces the number of appointments available to other patients and is unsatisfactory – for patients repeatedly accessing urgent care and for the staff treating them.

In addition, many people also suffer from dental pain or other issues which do not meet the threshold for urgent dental care and do not have access to a regular NHS dentist.

Over spring and summer 2022, NHS England commissioners, clinicians and career development fellows developed a stabilisation pathway, which would ensure patients were able to access care that would stabilise their oral health and would reduce the likelihood of people going in and out of the urgent care system, or of receiving no treatment at all – providing a more permanent solution, improving patient care and improving satisfaction for clinicians.

It is believed that stabilisation will, in time, reduce demand on the urgent care system, ensuring those needing urgent care are able to access the service when they need it most.

Benefits of stabilisation
Stabilisation supports the current demand for urgent care, improves oral health and ensures improved access to dental services for those patients who currently don’t meet the urgent care criteria.

It is hoped, over time, that provision of stabilisation will be of benefit because it will/may:

  • reduce the number of people repeatedly accessing urgent care
  • release more urgent care capacity to other patients
  • reduce the number of people waiting in pain for their dental problem to meet the criteria for urgent care
  • improve the oral health of the population in the South West
  • improve the oral health of individuals, which could lead to them being found a permanent dental home with a high street practice.

Service provision
The proposed model was originally two pronged – utilising both the community providers, and high street practices, providing more choice/accessibility for patients.

Community providers – salaried model
The proposal was to fund an additional salaried post in each integrated care board (ICB) area to provide stabilisation services within the community provider. Unfortunately, no community providers have been able to progress with the stabilisation programme as they have been unable to recruit to these salaried posts.

High street model
Interested contractors were asked provide stabilisation on a sessional basis within high street practices. There are two sub-elements to this offer:

  1. stabilisation for those without a regular dentist who require dental treatment (i.e. general access stabilisation)

Since the commencement of the pilot programme 37 practices across the South West have participated and over 450 patients are seen each week.

Positive feedback has been received from the clinicians involved in the stabilisation pilot so far – the sessional rate and model allows for more time with patients; the work is varied; and there is satisfaction in providing treatment with stabilises the dental and oral health of the patient.

  1. stabilisation focussed on our health inequalities groups, with additional support from a practice-based champion and local voluntary, community and social enterprise (VCSE) partner organisation

This element of the programme has commenced but has had less pickup than standard stabilisation for the general population due to the need to involve the voluntary sector and the additional time this takes, but a homelessness initiative and an asylum seekers programme has started.

Patient pathway
Access to stabilisation is through NHS 111, dedicated local dental helplines where in place, or direct via the practice, for the general population, but through a more tailored and supportive outreach route for the health inequalities groups.

Urgent care need
Patients meeting the criteria for urgent care are booked an appointment and, following clinical assessment, may be selected for stabilisation. For example, the clinician may notice a further problem, which although not qualifying for urgent care now, may require the patient to attempt to access urgent care in the near future. Following clinical assessment, the patient may be offered stabilisation to provide a more permanent solution to other dental issues they may have. They, of course, have the right to refuse further treatment.

Non-urgent care need

Patients accessing care via NHS 111 (or dedicated local dental helpline) and who do not meet the urgent care criteria may be selected for stabilisation for the following reasons:

  • mild or moderate pain that is not associated with an urgent care condition and responds to pain relief measures
  • loose, broken or displaced crowns, bridges or veneers
  • broken, lost or ill-fitting dentures
  • broken or loose fillings

Health inequalities groups
This uses a high street practice model, working in collaboration with a local VCSE partner organisation. The practice delivers one session of stabilisation a week. A practice-based champion (dental care professional) delivers 2.5 hours of outreach once a week – they are responsible for raising the profile of the service and developing the integrated pathway with a partner VCSE organisation in the locality. The VCSE organisation identifies patients requiring dental treatment, liaises with the practice-based champion, makes the dental appointment and can provide chaperoning.

The pilot is continuing into 2023/2024. If you would like more information on the programme please contact Jo Lawton on jo.lawton2@nhs.net.

Last Updated on 28 July 2023