Derek recognises the need for more NHS dentist provision

I recognise the need for comprehensive access to NHS dentists and myself and other Cornish MPs are working with Cornwall Council, Cornwall NHS and NHS England to try and improve access to NHS dentists. The following is what the current situation is in Cornwall and the rest of England; 

Briefing on access to NHS dentistry

NHS dentists in Cornwall

There are 66 NHS general dental practices that provide NHS care in Cornwall, as shown in the map. Many also offer private dentistry.

Other NHS contracts are held by:

  • Smile Together, which provides community dental services for people who find it difficult to use a high-street dentist; for example, those with learning disability and complex needs. Smile Together also provides an emergency treatment service for anyone who does not have a dentist.
  • Home Visits Cornwall, which provides domiciliary treatment for, among others, people in care homes. NHS England does not have access to waiting-list data for this service.
  • Five orthodontic practices. New contracts have been awarded for orthodontics across the South West from 1 April 2019, to better align provision with demand.

Dentist provision

Access to NHS dentistry in Cornwall

Historically, access to NHS dental services has been difficult both nationally and locally, with parts of the South and South West of England having the greatest challenges.

Devon and Cornwall are unusual in having a dedicated helpline, so people can find an NHS dentist and/or access urgent NHS dental treatment if they do not have a dentist. This system also helps NHS England understand and respond to variations in demand in different parts of Devon and Cornwall.

Practices are encouraged to point prospective new patients towards the helpline, so they can be added to a central waiting list rather than being taken on directly. As a result, people are sometimes under the impression that no practices in Devon and Cornwall are taking on new NHS patients.

This is not correct. Instead, patients are allocated in batches as capacity becomes available, so those who have waited longest get priority. People who are prepared to travel further are likely to be found a place sooner than those who are not.

The number of people being added to the waiting list in Devon and Cornwall has been climbing steadily.

The total waiting list for Devon and Cornwall as at December 2018 was 48,382 – an increase of nearly 15,000 in one year (see table below). The total number of people placed with an NHS dentist in Devon and Cornwall in previous 12 months was 26,958.

Devon and Cornwall dental waiting list – 12-month summary:

dentist table

This is the localised picture, as of 1 January 2019:

Dentist

These are the areas covered by the Cornwall localities (former district council areas):

Dentist

It is important to bear in mind that:

  • Many people will be under the care of a private dentist even while registering with the helpline to find an NHS provider
  • Other people will have found an NHS dentist but not informed the helpline

As well as the dental helpline, there is a separate number that people in Cornwall may call if they need emergency dental treatment but do not have a dentist. This allows them to be booked into a clinic at short notice – usually within 24 hours – by the provider, West Country Dental Care (Smile Together).

See below for helpline details.

How Cornwall compares to the rest of the country:

The NHS dental helpline in Devon and Cornwall is not replicated elsewhere in the country, so it is impossible to compare the number of people registered as being in need of a place.

What can be compared is access rates, which are measured by looking at the proportion of both adults and children who have seen an NHS dentist in the past two years.

The data for October 2018 shows that, while falling, access to NHS dentistry in Devon and Cornwall is still higher than the England average:

dentist

Reasons for increase in waiting list:

  • Dentists in Devon and Cornwall are increasingly unable to meet their NHS contracts. Funding from underperforming contracts is clawed
  • back by NHS England
  • This suggests commissioned capacity is sufficient; funding is not the primary issue
  • The key difficulty reported by practices, leading to underperformance on NHS contracts, is the recruitment and retention of dentists

NHS England in South West South is seeking to achieve improvements in access to dental services by:

  • Working with dental providers to ensure existing contracts are delivering to their maximum potential. We review the under- and overperformance of our dental contracts on a regular basis and, as part of reconciling activity to contract payment, explore with those contractors with the most variance what they are doing to address under-performance. We are able to procure new contracts in an area where there is insufficient dental access, but need to be able to ensure the workforce can be secured by a new contractor.
  • Commissioning additional NHS work from dental practices that have capacity. NHS England in South West South agreed on 5 February to allocate a further £500,000 to practices in Devon and Cornwall that are able to increase their contracted activity this financial year. The offer will be open to all practices that are on course to meet their contracted level of work in 2018/19.
  • Encouraging practices to work with the Dental Helpline to ensure that as NHS places become available, they are offered to those patients on the helpline waiting list. The team are able to help individual patients secure the best waiting list for them according to their location and ability to travel; continuously review where and when places are becoming available; and ensure patients are allocated to a practice as quickly as possible when places become available.
  • Developing plans to commission dental services to meet those areas of demand within available resources. We have a Local Dental Network and a number of Managed Clinical Networks for dentistry through which we work with dentists, public health and the dental school to develop referral pathways, and identify initiatives to increase dental capacity in the community.
  • Engaging with the national NHS England dental workforce team to look at more-innovative ways to attract dental staff to the area and other parts of our geography where it is hard to recruit. We intend to have some firm plans later in the year.
  • Working with practices as part of the dental contract reform programme to test an alternative contract model. We have a small number of practices piloting a new prototype contract model as part of the national work looking at contract reform, as it is considered that the current contract disincentivises dentists undertaking NHS dental work. The outcome of this work will feed into a national contract review process.
  • Looking at ways of prioritising the waiting list based on need rather than time waiting; that is, extending the offer to patients to travel out of area, which is not a question that was posed to patients before.
  • Working with the new 111 provider in Cornwall to establish a ‘soft’ call transfer direct from 111 to Westcountry Dental during their commissioned hours, which means that patients are signposted correctly in Cornwall (reducing the risk of ending up at A &E)

How the dental helpline works:

There are two numbers that people can call for help getting access to NHS dentistry - one for finding a placement for regular care and one for

emergency treatment if someone does not have a dentist.

1 The main helpline:

The dental helpline, run by Access Health Care, helps people in Devon and Cornwall find an NHS dentist. Local dentists are encouraged to direct callers to the helpline rather than taking people on immediately, even if they do have vacancies. This:

  • Enables us to add patients to a waiting list, so they can be allocated to places as they become available. This is usually done in batches,
  • with priority given to those who have waited longest. Those willing to travel further will increase their chances of being placed sooner.
  • Enables us to monitor trends and identify patterns in demand across different areas, so these can be addressed if necessary.
  • Saves patients from ringing round multiple dentists, in the hope of finding a place
  • Sometimes leads people to think erroneously that there are no NHS places anywhere in Cornwall (or Devon); in fact, many people are allocated each month

We are not aware of similar helplines working elsewhere in the country

To contact the general helpline:

2 The emergency helpline:

This service, run by West Country Dental Care, provides emergency dental treatment in Cornwall. Subject to availability, people can usually expect to be treated within 24 hours.

Office hours:

The helpline operates Monday to Thursday 8.30am to 5pm, and Friday 8.30am to 4.30pm.

West Country Dental is contracted to provide emergency dental treatment to patients who do not have their own dentist or who are visiting the county.

If a patient has their own dentist then they should contact them in the first instance.

Callers will be triaged and should be offered an appointment within 24 hours.

Out of hours:

The out-of-hours helpline provides access to emergency dental treatment under strict criteria, covering the following conditions only:

  • dental trauma
  • dental haemorrhage
  • increased dental swelling/airway-threatening swelling

The helpline operates:

  • Monday to Friday from 5.30pm to 7.30pm, with treatment provided from a surgery at Truro
  • At weekends and on bank holidays from 8.30am to 4.30pm, from surgeries across Cornwall

To contact the emergency dental helpline in Cornwall: