Your NHS dentistry and oral health update
In the latest ‘NHS dentistry and oral health update’, Sara Hurley, chief dental officer for England, and Ali Sparke, director for dentistry, community pharmacy, optometry and the NHS standard contract, revealed that “the NHS will provide patients with hundreds of thousands more dental appointments, thanks to a £50 million funding injection”.
The update continues, “Funding will secure up to 350,000 additional dental appointments allowing people suffering from oral pain, disease, and infection to get the care they need, as services drive back to pre-pandemic levels.
“Children, people with learning disabilities, autism, or severe mental health problems, will be prioritised over the coming months, with the one-off funding available until the end of the financial year.
“Locally, NHS teams will use the funds to secure increased care capacity amongst local dentists already operating to help patients suffering from oral ill-health.
“Dentists involved in the scheme will be paid more than a third on top of their normal sessional fee for delivering this care outside of core hours, such as early morning and weekend work.
“This funding is available within this contractual year only and cannot be accrued into 2022/2023 contract year and we encourage you to take up this offer to tackle the backlog in care. Naturally making full use of this opportunity relies on us working together with practices who are willing and able to take on this work, so whilst local arrangements are made we encourage you to make your local commissioning teams aware if you would like to be considered for this new capacity.
“Today's announcement is another step forward in restoring NHS dentistry to pre-pandemic levels and is a strong demonstration of the NHS' commitment to this important service.”
Further details are included in the update, for example, that “this offer is in addition to the commitment already announced in the Q4 letter to fund GDS / PDS contract holders who are able to deliver up to 110 per cent of their contracted activity.”
Three key areas where spend should be targeted is also included. These are:
1) The purchase of non-recurrent activity outside of contracted hours, i.e. early mornings/evenings and weekends from existing dental contract holders.
This should be commissioned on a sessional basis with a national tariff payment of £654 per 3.5hour session. This figure reflects the requirements for a rapid response on the part of contractors to mobilise additional sessions.
Sessions may be delivered as 3.5 hour blocks or distributed as appropriate to the meet the needs of patients seeking care, for agreement with the contractor. These sessions should provide additional hours of NHS care over and above those described in the contractor’s contract, due to the expectation that contractors should already be maximising use of in hours capacity.
Patients seen in these sessions should be those with an urgent care and subsequent stabilisation need who contact the practice directly or via NHS 111 and be drawn from the clinical priority groups identified in the SOP.
There should be a minimum expected patient volume of 4-6 patients per session and the care offered should include both AGP and non-AGP care. Where supply of additional activity exceeds the funding available to commissioners, priority should be given to those contractors who have the greatest potential to deliver this additional access without adversely impacting upon delivery of the Q4 income threshold.
There should be reasonable confidence that the contractor can deliver this additional activity without adversely impacting upon delivery of the Q4 performance threshold. To be eligible for this additional investment contractors should have met the minimum performance threshold to avoid full financial clawback in H1 and Q3 of 2021/22
2) Purchase of nonrecurrent activity from existing suppliers of NHS contracted Community Dental Services (CDS), ideally at a minimum of two additional sessions per week where the workforce exists to support this in order to start to address the growing backlog in CDS services.
3) Other short-term enhancements to the capacity and efficiency of existing urgent care provision, as agreed with the National Team e.g. use of hospital based dental service providers.
Commissioners will confirm the next steps in your area on how this funding will be allocated and awarded shortly.
Industry responses
Following the release of the update, Sara Hurley said, "More than 600 urgent dental health hubs were rapidly ramped up during the pandemic to deliver urgent care for patients and the NHS is now getting key services like dentistry back to pre-pandemic levels - injecting an extra £50 million into routine services will help provide check-ups and treatment for hundreds and thousands of people."
Minister for primary care, Maria Caulfield, said, “Access to NHS dentistry has been given a much-needed boost with an extra £50 million announced for NHS dental care services which will urgently give more people access to vital dental care when they need it.
“Through the pandemic, we have prioritised urgent dental needs, vulnerable patients and free treatment for children and thanks to the hard work of staff, the delivery of urgent care is back to pre-pandemic levels. We are now working with the dental sector to recover and reform services and this £50 million boost will help with that recovery”.
Responding to the announcement, the British Dental Association (BDA) has said that the funding boost needs to be just the start for the service that is in crisis. They also said new funds allocated to NHS dentistry represent much-needed progress, but warned the time-limited package can only be the start when it comes to rebuilding the service and tackling an unprecedented backlog.With practices already struggling to hit gruelling targets, the BDA has stressed the narrow timeline will limit what is achievable in the short term. Since January 1, contractors must hit 85 per cent of pre-covid activity to avoid financial penalties, amid ongoing disruption caused by the Omicron wave. Given major limits on capacity and the difficulties bringing on new staff at short notice, the BDA is not confident the full allocation can be used by the deadline.Despite calls by the BDA, Healthwatch England, and a growing number of MPs, until now not one penny of the government’s multi-billion pound NHS catch-up programme has been allocated to dentistry.In real terms, government contributions fell by nearly a third between 2010 and 2019. In that period inflation-busting increases saw the proportion of budget drawn from patient charges surge. Given the cumulative impact of inflation and population growth it would take an additional allocation of £880m of government contributions to the service per annum simply to restore resources to 2010 levels.News follows reports from the BBC that the service is “hanging by a thread” having lost the equivalent of 8 per cent of dentist roles in 2021. The BDA is pressing for real reform of the discredited contract system NHS dentists work to, alongside appropriate resources to underpin the recovery and rebuild of services.Shawn Charlwood, chair of the BDA’s General Dental Practice Committee, said, “Any additional funding is needed recognition of the huge backlogs facing NHS dentistry. “After a decade of cuts a cash-starved service risks being offered money that can’t be spent. Hard-pressed practices are working against the clock, and many will struggle to find capacity ahead of April for this investment to make a difference.“Until today not a penny of the government’s multi-billion-pound catch-up programme had reached dentistry. This is progress, but must be just the start if we are to rebuild a service millions depend on.”
Meanwhile, the Association of Dental Groups (ADG) has welcomed the announcement of a additional funding injection into dentistry. ADG Chair Neil Carmichael said, “This additional funding is welcome news to support capacity and ensure that those most in need can get an NHS dental appointment. It is a recognition that support is needed to clear the backlog of care and we hope it will be sustained going forward.”
“ADG members see this as the first step on a road. The government has asked NHS England to lead on dental system reform to better support dentists and deliver better outcomes for patients. Whilst we will do all that we can to help address the immediate backlog of care, only reform of the broken contract model and long-term workforce planning can sustain NHS dentistry for the rest of the decade.”
Abhi Pal, president of the College of General Dentistry, also commented on the announcement; he said, “New funding for dentistry is to be welcomed, and the announcement will provide short-term help to a significant number of people who have struggled to get their oral health needs met during the pandemic, especially children and patients with autism, learning difficulties and severe mental illness.
“However, it is important that longer term underfunding and recruitment problems are also addressed, and the NHS dental contract reformed, as even before the pandemic only half of adults in England were able to access NHS dental care. The College will also be supporting workforce retention through its Career Pathways programme.”
Breakdown of funding by region:
- North West – £7,310,000
- North East and Yorkshire – £8,633,000
- Midlands – £8,904,000
- East of England – £5,731,000
- South West – £4,726,000
- South East – £6,887,000
- London – £7,809,000