Back in November 2020 at our first online Annual Meeting, due to the COVID pandemic, we asked Croydon residents to tell us which issues concerned them. For the first time dentistry came up as an issue which was also reflected in our general outreach.
Early on, Healthwatch Croydon took the decision to collaborate with the Local Dental Committee to explore this issue. We have valued the relationship learning much about the complexities of how services are commissioned and the impact this has for both dentist and patient. Indeed, from a series of discussions with them, we could shape the questions to ensure the insight was relevant to them and commissioners, as well as accurately reporting the views and perceptions of Croydon residents.
What we found was fascinating. There was a clear variability in access in Croydon, with most contacting a dentist because they were in pain, not just for a general check-up. Most information found dentists’ websites were not seen as that useful. Most rely on a ‘regular dentist’ even if not attending often. Access was the key issue with most happy with the service they received once they were seen. NHS dentistry which was very much appreciated by all but one respondent. However, even with NHS dentistry, there were concerns about costs, as the whole service is not free at point of use.
Our recommendations were, not unsurprisingly, that access needs to be less variable, but more importantly a local need assessment needs to be undertaken. The last allocation was set in 2006, since then Croydon’s population has grown by 50,000 to 390,000 – a 14% rise, putting significant pressure on demand. In context, there have been three pharmaceutical needs assessments since 2015 but not one for dentistry.
There also needs to be a better understanding of the perception by the public of a ‘regular dentist’ like a regular GP. There is a gap between what patients understand compared with how dentistry is commissioned and delivered. This becomes more apparent in our recommendation for prioritising urgent need with regular dentists over check-ups. As dentists deliver access based on the number of units of dental activity, they must meet targets exactly. Go under they are fined, go over and it costs them.
No wonder the patient is confused when they are told they cannot get an appointment. Long discussions with the local dentists helped us explain this complexity even down to variability in UDAs meaning some dentists get paid less than the amount they collect – making them legalised tax collectors. We would not have understood this without the series of conversations that we have had with the LDC.
That said while we agree on many areas, we still challenge the dentists to reallocate the UDAs by increasing the time between regular checkups on those patients whose teeth are in very good order, in line with NICE guidelines, so that they can see more patients, as what happened in Kirklees some years ago. However, we understand their counterargument that why should someone have less of a service just because commissioning does not deliver enough supply.
We also feel there should be better information to manage expectations including better communication of costs. We also ran an assessment of dentist websites, and suggested ways they can clearly show what type of NHS contact they have so patients can easily see if they can easily be put on a particular dentists’ ‘list’. I say ‘list’ because officially there is no registration even though some dentists still refer to it.
Our work has not just been in silo. As part of a wider South West London network of Healthwatch, we have worked with our colleagues in Kingston, Richmond, Merton, Wandsworth, and Sutton to take a collective approach. This has been happening for some time. It is now timely that the new Integrated Care System (ICS) takes responsibility for dentistry from 1 July 2023.
We have already had some good conversations with Mark Creelman who is leading on this for the South West London ICS. We are hoping to make some headway in the coming months and years but have been advised it may take time.
One issue for me is the way the NHS perceives dentistry. It is classed along with pharmacy and optometry as a separate set of services from primary care, yet these are service patients use regularly – particularly pharmacy. Surely, they should be rolled into the wider primary care offer. It is part of our role to raise issues with the NHS on where they should prioritise. It is hoped our evidence base will help support the change that is undoubtedly needed.
One area for hope is Croydon. In recent Croydon Health and Care Board and Health and Wellbeing Board meetings, our Director of Public Health, Rachel Flowers, has made a point about understanding more about dentistry, focusing on the large numbers of the Croydon population, particularly children, not registered with a dentist, let alone accessing one.
We continue to keep this on our agenda. I just want to say a great thank you to the LDC team in particular Sushil John and Martin Skipper, who patiently explained on many occasions the complexity of dentistry commissioning which informed our work and more recently Ritesh Gajree, who I know is flying the flag for Croydon dentistry. Dentistry is now being heard, we just need to keep reminding those who are responsible for commissioning to understand the genuine need for residents both in Croydon and across South West London.
We have produced two recent reports dental services in Croydon; one about residents’ experiences of NHS dental services (June 2022), and the other is about service users’ experiences of using dental practice websites (June 2022).
You can find more information about us on our website: Healthwatch Croydon.