Local Dental Committees engage with local stakeholders. The member LDCs within the LDC Confederation have, for many years, been building relationships with their respective local Healthwatches, local Councils, local voluntary service organisations and the various NHS structures.
Through this engagement the LDCs have come to understand how different local stakeholders see NHS dental services and, more importantly, what they want to see from them. There are now several locally led pilots either in operation or about to start in London., Oral health needs assessments have taken place in several boroughs and different Integrated Care Boards are making great strides in encouraging the integration of NHS dentistry into local health, and wider community, plans.
The local attempts at reforming services, despite being ostensibly supported by guidance, have been undermined since Covid. Firstly the introduction of the New Patient Premium prevented local plans from being implemented and delivered only a reduction in access, secondly the emphasis on urgent care and the mandate to deliver 700,000 additional urgent care appointments skews priorities and energy away from improving services to meeting centralised targets. Integrated Care Boards have a responsibility to reduce health inequalities and improve health outcomes. But when it comes to dentistry they have an outdated contract and constant interference which prevents the development of local plans to utilise dentistry effectively in their goals to reduce health inequalities and improve health outcomes.
“What ICBs and the wider system do not need is more disconnected reform, which keeps NHS dentistry separate from the rest of the NHS”
The NHS 10 Year Plan makes some welcome statements about integration, though the examples given relate to the Community Dental Services rather than General Dental Services. The consultation on reforms to the current dental contract do not make any move to support integration or give greater decision making to the local level, instead it consists of more centralised diktats. There is a disconnect in dentistry when it comes to the longer term plans for the NHS and the short term, reactionary, goals for NHS dentistry. This is why the LDC Confederation has called for a clear Vision and Mission for NHS dentistry. We think these should be developed by Integrated Care Boards and inform a national Vision which would in turn inform any full reform to the dental contract.
North West London and South West London Integrated Care Boards have both instigated pilots for increasing access to dental care for children. The focus of both pilots is on integrating dental care with other local access points such as GPs, schools and health/children’s centres, to target children from areas of high deprivation. This is because both of these ICBs are concerned to reduce health inequalities. They consider providing the best start in life to be a key enabler for future health. North Central London is running a pilot on diabetes, to improve access for those with diagnosed diabetes. Again, the emphasis is on a holistic vision of the person with dentistry contributing to the reduction of health inequalities. The recent Harrow Oral Health Needs Assessment made a number of recommendations, many of which focussed on improving integration and targeting local populations to reduce health inequalities.
Further conversations with local authorities have highlighted key priorities for many of them including access for children with special educational needs, frail and vulnerable adults and maternity access. These priorities align with local authorities’ traditional responsibilities which is not surprising, but there is a new emphasis away from oral health promotion and on to access, prevention and treatment within the context of holistic models of care. Several Council Public Health Teams we have spoken to want to see a more joined up approach between maternity services and dental care to ensure that babies have their first dental checkup in line with Delivering Better Oral Health. Others are concerned that health inequalities are exacerbated by the lack of access to routine dental care.
What all this shows, from the pilots, assessments and meetings, is that at the local level there is a very strong appetite for greater integration of NHS dental care with the rest of the NHS and social care system. This is the direction of travel set out in the NHS 10 Year Plan, but not in the consultation on reforms to the current contract. We need a clear alignment of values and clarity of purpose for how dentistry is intended to fit as part of the wider NHS plans. What ICBs and the wider system do not need is more disconnected reform, which keeps NHS dentistry separate from the rest of the NHS, preventing it from playing its proper part in reducing health inequalities. We need more integration and local collaboration, not more nationally set targets and goals which do nothing to meet local expectations and needs.
