Agenda item

To receive an update on dental services in Wokingham Borough.

The Committee received an update on dental services in Wokingham Borough.

During the discussion of this item, the following points were made:

·       Hugh O’Keeffe commented that patients attending over a two year period had fallen dramatically over the pandemic.  Improvements were being seen but had attendance levels had started to plateau since early 2023.

·       Members were provided with information regarding commissioned activity in January and June 2023.  In April the Beanoak surgery had handed back its NHS contract of around 10,000 units of activity.  It was one of approximately 15 practices that had handed back its contract since 2021.  Temporary activity had been put in place to cover this, and practices in Woodley and Bracknell were providing cover currently.  A plan for recommissioning this activity on a permanent basis, from April 2024, was being developed.

·       With regards to delivery of activity, practices had to deliver a certain percentage of activity that had been commissioned in order to retain a level of funding.  Performance had dropped significantly during the pandemic, and then improved in 2021-22.  Forecasted activity had been exceeded by the end of the year.  During 2022/23 the overall activity delivered in BOB was 80.34% of that commissioned.  Berkshire West and Wokingham had performed slightly better.

·       Those who had not attended a dentist for some time often had more complex dental needs and required lengthier treatments.

·       Many access challenges remained, particularly for those who had not visited a dental surgery for some time.  Often these were from vulnerable groups.  Much of the recovery of access had related to practices recalling patients who had previously attended.

·       It was noted that a third of the queries with the NHS England contact centre regarding dental practices, between January and December 2022, had come from the Earley area. 

·       The Committee was updated on action being taken to improve access.

·       Changes had been made to the national contracts.  These were designed to improve dentist remuneration in terms of more complex treatments, expand capacity by allowing practices to deliver more contracted activity, and to provide more information for patients.  Further changes to the contract were anticipated over the next few months.

·       Some practices had provided additional access sessions.  Take up in BOB had been quite low. 

·       Members were reminded of Flexible Commissioning.  The pilot would run June 2023 to March 2024.  Under this up to 10% of contracts could be flexed and activity targets converted to additional access sessions.  It was hoped that this would help to support more vulnerable groups.  30 practices had signed up in BOB (2 in Wokingham) and it was planned for 3,000 sessions to be delivered (148 in Wokingham).  Between June and August 2023 18 sessions had been held in Wokingham and 62 patients seen.

·       There had been investment in the referral services to try to recover the pre pandemic position and progress was being made.

·       A Member commented that several practices had left the NHS and questioned if these practices were asked their reasons for leaving and what might make them wish to stay with the NHS contract.  Hugh O’Keeffe stated that when a practice left the NHS an ‘exit interview’ was undertaken.  Rural and coastal areas were experiencing greater challenges around workforce retention and recruitment, leading to increased loss of practices in these areas.  Locally, the flexible commissioning scheme was being designed in conjunction with dental professionals.  Nilesh Patel added that it was becoming harder to work in the confines of the system.  Nationally inflation was increasing, however, the government had announced that they would increase the uplift dental practice expense by only 3%.  Whilst he believed that flexible commissioning was beneficial it was still difficult. 

·       Members asked how vulnerable groups were being made aware of additional access sessions.  Hugh O’Keeffe stated that information had been provided to Healthwatches to make available but there had not been a big advertising campaign.  Whilst it was important that vulnerable service users’ needs were met, it was also important that practices were not overwhelmed.  He hoped that more practices would sign up to the flexible commissioning pilot. 

·       In response to a question Nilesh Patel indicated that there were Local Dental Committees in Buckinghamshire, Oxfordshire, and Berkshire West.  With regards to the pilot, he felt that other practices may come on board if they saw it working well in other areas.

·       Members asked if more could be done to stop practices handing back their NHS contracts.  Hugh O’Keeffe indicated that locally work was being undertaken within the confines of the contract.  He reminded Members of the investment in referral services to help wait lists recover.  There was also a recommissioning programme of primary care.

·       The Committee questioned when pre covid levels of attendance were likely to be achieved.  Hugh O’Keeffe stated that this would be more difficult in areas where workforce was a greater challenge.  There also continued to be issues with patients who had had gaps in their treatment because of the pandemic, leading to more complex and greater treatment needs.

·       Members referred to the new minimum indicative UDA value of £23.  Hugh O’Keeffe commented that a review had been long overdue.  Nilesh Patel added that whilst the minimum had been raised, £23 was still not very attractive to dentists.  He wanted to see access levels improve above pre pandemic levels so that those who did not fit into the categories of vulnerable groups or regular attendees could also be seen.

·       Nilesh Patel suggested that it would be helpful if the patient representatives sought information about the budgets, how money was spent on dentistry, how much was allocated to dentistry, what was not spent, and how that money which was not spent on dentistry, could be spent.

·       The Chair questioned whether dental services had a relief fund for those who might struggle to afford their treatment.  Hugh O’Keeffe indicated that some patients were exempt from charges.  Alice Kunjappy-Clifton commented that pregnant women were exempt for 1 year, but some had not been able to make use of this eligibility as they had been unable to access treatment whilst eligible. Hugh O’Keeffe commented that flexible commissioning was helping to address this.

·       The Committee requested a further update in the future, including information around the flexible commissioning pilot.

·       A Member questioned what percentage of patients were private patients.  Hugh O’Keeffe stated that approximately 50% were NHS, 30% private and 20% did not attend.  A higher proportion of private service users was more common in more affluent areas.

·       The Committee briefly discussed budgets.  Members were informed that not all the budget was spent, and that money could be recovered should a practice not achieve its targets.  The recovery in BOB this year was around £14,000,000.

·       Members asked how Wokingham could improve with regards to children under 5 experiencing dental decay.  Hugh O’Keeffe commented that Slough was one of the worst areas for oral health in the country and the Starting Well programme which focused on getting under 2’s to see a dentist was being rolled out in this area prior to the pandemic.  It was hoped that this would restart and be extended.

·       In response to how children with special needs were treated, Members were informed that so far as possible they would access high street dental services, but community dental services could be used if this was not appropriate.

·       A Member commented that some professions were losing colleagues to abroad where they could earn more and have a lower cost of living.  They queried whether this was an issue in dentistry.  Nilesh Patel responded that this was not a big issue.  However, more dentists were moving from NHS to private services.

RESOLVED: That the update on dental services in Wokingham Borough be noted and Hugh O’Keeffe and Nilesh Patel thanked for their presentations.