On January 24, 2023, Lord Philip Hunt of Kings Heath opened a debate on regulation amendments for NHS dental services in the House of Lords.
Philip opened the debate by setting out the issues facing dentistry, “Like many aspects of the NHS, our dental services are under great pressure at the moment. Indeed there are reports that some patients are resorting to DIY dentistry or removing their own teeth because they cannot get access to an NHS dentist. In August 2022, the BBC reported that based on a survey of 7,000 NHS practices, nine in 10 were not accepting new adult patients for treatment.
“The BDA believe that NHS is facing, as they call it, an “existential crisis” with the service “hanging by a thread”. The problem pre-dates the pandemic, but it has now reached an unprecedented scale. Over 40 million dental appointments have been lost since the start of the pandemic, the BDA estimates. Those from low-income or vulnerable groups are being disproportionately impacted, with one million new or expectant mothers having lost access to care since the start.
“Dentistry has been subject to cuts unparalleled in the NHS. In real terms, estimates would suggest that net government spending on dentistry was cut by over a quarter between 2010 and 2020. The BDA argue that chronic underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention. We know morale amongst NHS dentists is very low, and we are facing an exodus of them from NHS practice.”
Speaking more generally on the access crisis, Philip recognised the success in the Northeast achieved through “commissioning access sessions renumerated using a sessional fee in practices with an NHS contract”. He hopes this scheme will be “rolled out across the country.” As this could be achieved within the existing regulations, he views the scheme as a potential for “some progress in the short term”.
January 2023 also saw a change in the role of dental care professionals. Philip explained that this allows “dental care professionals the ability to open a new course of NHS dental care treatment when they are trained and competent to do so.” He said that this change should be “applauded”. However, there are “still blockages in making it work effectively.”
Elaborating on the role of DCPs, Philip said, “First, under previous regulations, a DCP would have needed a performer number to open a course of treatment and with that associated pension benefits. I understand that under the recently issued guidance from the NHS, the DCP has to demonstrate competence by entering their GDC registration number, but the dentist whose performer number appears on the form sighing this off actually accrues the pension benefit. I must say that doesn’t seem to me to be fair, and potentially, I think it’s discriminatory.” To clarify this issue, Philip requested written justification.
Philip also mentioned that debates have been going on for “over a decade” on potentially allowing “DCPs to give local anaesthetics without having the direction of a dentist.”
In the package of reforms proposed by the chief dental officer, a potential change to the recall system was discussed in relation to the 2004 NICE guidance. Philip said, “The concept of six monthly recalls is embedded in our society and amongst patients, but is not evidenced based. Recall intervals need to be tailored to risk. In some cases, six months may be appropriate, but not all. The time taken up by unnecessary recalls could be used to grow access.”
Philip recognises that in considering the access crisis, it is impossible to ignore the impact of “the critical shortage of workforce”. The obvious solution is to open new dental schools, which Philip stated he would “like to see”. But there is a caveat to this. Philip explained, “it takes up to 10 years from taking the decision to open a new school to clinicians actually entering the workforce. My lords, we do not have 10 years. So we need, of course, to train more dentists, but in the near term, we have got to make NHS dentistry a more attractive option to improve the retention of existing clinicians while also making it easier for overseas dentists to work in the NHS.
“Now, the obvious way to make NHS dentistry more attractive to dentists in the UK is by increasing the budget for NHS dentistry. Given the real-term cuts that we have seen, a quarter since 2010, this is essential. In the short term, overseas dental professionals are one key to addressing the workforce pressures and ensuring access to NHS dentistry. One way we can achieve this quickly is by streamlining the GDC process for accepting individuals onto the register by the UK striking more mutual recognition agreements for dental qualifications with countries of comparable standards and creating more places for the overseas registration exam.
“The GDC’s current mutual recognition of EEA-qualified dentists is also vital in boosting short-term applicant supply. This must not be removed. Then there is the performers list validation by experience process, which all dentists not qualifying in the UK must go through to practice in the NHS. This needs standardising, simplifying and streamlining.”