NHS Dentists: South-West England

Chris Loder Excerpts

Wednesday 24th May 2023 Westminster Hall

[Chris Loder (West Dorset) (Con)]

I beg to move,

That this House has considered the provision of NHS dentists in the South West.

It is a pleasure to serve under your chairmanship, Ms Elliott. I am grateful to colleagues from across the House for attending this very important debate. If someone living in Dorset rings their nearest NHS dentist looking for an appointment, there is a 22% chance that they will be told the practice has gone private. If someone living in Dorset rings their nearest NHS dentist, there is also a 42% chance that they will be told the practice is not taking new patients with special or additional needs. There is a 50% chance that they will be added to a waiting list that is over 12 months, so half the constituents calling today could be waiting until May or June 2024 before they are seen. Finally, if someone living in Dorset is calling to book a dental appointment for their child, there is a 77% chance that they will be told the practice is not accepting new child patients.

The reason for these unacceptable statistics is because access to NHS dentistry in the south-west has been on an alarming downward trajectory for some time. Today, rural parts of Dorset, many of which can be found in West Dorset, experience worryingly low access to vital and sometimes life-saving dental treatment on the NHS. This is no doubt a widespread issue across the country, which is plain for all to see in the recent flurry of debates and questions on this subject in the House. Following this debate, there is an Adjournment debate in the House this evening examining dental care in the north-east, which shows how this issue is affecting constituents across the country.

According to recent reports, a quarter of the adult population in England have unmet dental needs, despite there being 24,272 active NHS dentists. That is enough for one for every 539 people, but these statistics can be misleading, because, importantly, even though there has been a 2.3% increase in the number of NHS dentists this year compared with last year, productivity has slowed. As many as half of these 24,000 dentists have cut back on their NHS work, according to the British Dental Association, forcing more people to either choose to go private and shoulder the burden of these additional costs themselves, or to go without and face the risks of poor dental hygiene that that can bring, such as tooth decay and gum disease.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman and his team of MPs who come along to support one another on these issues. I am really impressed by how well they do their job. They did it yesterday, and they are doing it today; well done to them.

Across the whole of the United Kingdom of Great Britain and Northern Ireland, there are issues. The hon. Gentleman referred to the figures in his constituency; in my constituency, 100% of people cannot get an NHS dentist. Paying online for a whole year’s subscription to a dentist is not possible for many, including people who are elderly. Does he agree that the Minister should liaise with the devolved Administrations, in Northern Ireland in particular and in Scotland and Wales, on how we can better do this together? Clearly, it does not matter where we are in the United Kingdom of Great Britain and Northern Ireland—dentist appointments cannot be got for those who need them most.

[Chris Loder]

I thank the hon. Gentleman for his short and succinct intervention, as ever. He is absolutely right and confirms that this issue needs to be addressed across the United Kingdom, not just in the south-west. I am delighted that he has attended this debate on dentistry in south-west England.

The south-west region was recently rated fifth out of seven for adult NHS dental coverage, with only 35% of adults covered by access to essential dental services, which is below the national average. Dorset fares slightly better, but adults in my constituency and those immediately neighbouring it also experience below the national average coverage for an NHS dentist.

The inequality is also affecting children, whom I am particularly concerned about. Although they are faring better than adults, with a coverage rate of 46% in both Dorset and the south-west, that is still below the national average for access to NHS dental services. Without those services, almost one third of five-year-olds are suffering from tooth decay, which is the most common reason why children aged between five and nine are admitted to hospital. Tooth decay is mostly preventable, so its effects serve to demonstrate what a lack of access to NHS dentistry is doing to our children.

Why are we faced with this difficulty? Why is dentistry in England, and particularly the south-west, under such pressure? Although the answer is multifaceted, I believe the reason is primarily threefold: first, the National Health Service Act 2006 and the subsequent dental contract; secondly, the lack of institutional services and the knock-on effects; and finally, the NHS backlog following the covid-19 pandemic.

The National Health Service Act 2006 set out the provisions for agreement between NHS England and dental practices in relation to services that would be provided and the renumeration for those services. Before the Act became law, the National Audit Office and the Public Accounts Committee both produced reports to the then Government on reforming NHS dentistry, which raised concerns about the 2006 changes. Those concerns included the urgent need to change the incentive mechanism for dentists to increase their commitments to NHS dentistry, the difficulty for patients in better-off areas in accessing public health services, and the difficulty for those in more deprived areas in accessing any services at all.

The reports also raised concerns that there would be a shortage of NHS dentists, a glut of people who would be left without access to NHS dentistry, and no guarantees that the reformed contract would be enough to commit dentists to the NHS rather than private practice.

[Simon Jupp (East Devon) (Con)]

My constituents in East Devon regularly contact me about difficulties getting NHS dentist appointments in places such as Sidmouth, Budleigh Salterton and Exmouth. Problems with recruitment and contracts have been compounded by the pandemic, but that excuse will not wash forever. Does my hon. Friend agree that additional reforms of the NHS dental system cannot come soon enough for the south-west?

[Chris Loder]

I thank my hon. Friend for his intervention. I wholly agree with him that reforms are needed urgently, which is the main point I will be sharing with the Minister towards the end of my contribution. It is clear that some of the measures from the 2006 Act do not go far enough. In many cases, they actually deter NHS dentistry provision.

Many of these issues are evident up and down the country today. Discussions with my own integrated care board in West Dorset—which, as of 1 April this year, has taken delegated responsibility for commissioning dental services from NHS England—have confirmed to me that the dental contract signed in 2006 is simply not fit for purpose. It actually restricts the ability of the board to respond to the current situation. That is because the terms and structure of the contract make it incredibly difficult for the integrated care board to attract new dentists to work in Dorset. I am sure that other integrated care boards across the south-west share that problem. The ability to attract new dental talent, especially those who are working on NHS contracts, is further hindered by our specific circumstances in Dorset. We do not have adequate training infrastructure.

[Selaine Saxby (North Devon) (Con)]

Does my hon. Friend agree that this problem is particularly exacerbated for those of us in very rural parts of the south-west? Would the Minister consider putting dentists on a bus and bringing the dental service to us, so that our young people can see a dentist? Realistically, we will not be able to attract the new dentists we need in some of the remote locations that we love to live in.

[Chris Loder]

I thank my hon. Friend for her kind intervention, and I wholly agree. Her constituency of North Devon is not dissimilar to mine; we share many challenges and many wonderful things. I am sure the Minister has heard what she has to say, and I look forward to his contribution.

Without a dental school in Dorset, recruitment continues to be a real problem, as staff often leave the county, and indeed the region, after receiving their training. That leaves Dorset residents short-changed, especially given that our council tax is among the highest in the country.

The third impacting factor is the backlog following the covid-19 pandemic. We are all well versed in that, but I wonder whether we fully appreciate the pressure on dental services since then. It is estimated that as many as 40 million NHS dental appointments have been lost since the start of the pandemic, and that is exacerbated by the fact that 45% of dentists in England have reduced their NHS commitments since the start of the pandemic, which puts more pressure on an already strained system. A reported 75% of dentists say that they are thinking of reducing their NHS commitment this year, so it is important to look at what needs to be done to help the dentists still committed to NHS work and the people up and down the country—particularly in the south-west—who rely on those services. To my mind, there are two primary actions: contract reform and quick investment.

There are clearly a number of issues with the NHS dental contract, as we have said. I recently wrote to all 17 dental practices in my constituency, and I am in regular dialogue with the local integrated care board, and they all tell me that the dental contract needs urgent reform. It seems that the current terms of the contract make it incredibly difficult for local boards to recruit new dentists to meet local demand. I worry that the situation for our integrated care boards is not sustainable and could become worse.

The contract also seems to include irregular and sometimes near-nonsensical patterns of remuneration, which are undoubtedly playing on the minds of dentists considering their commitment to NHS work. For instance, dental practices are often remunerated for one filling only, regardless of the number of fillings needed for a given patient, which reduces the incentives for dentists to stay working with the NHS. That cannot be right.

Behind-the-scenes work is often missed when the work that a practice has carried out is calculated. For example, if a patient were to require one X-ray examination, two fillings, one extraction and two appointments for root treatment, that would total more than four hours of clinical time and would be counted as five units of dental activity or UDAs, which is the way that the NHS measures practice activity. Not included are the cost of materials, the nurses’ time setting up the procedures or the receptionists’ time booking the appointments and chasing patients should they not attend, all of which are hidden from the current contract. Transparency is key. As part of a wider reform of the NHS dental contract, West Dorset constituents who have got in touch with me would appreciate greater transparency in the requirements for such treatment.

One of my constituents recently had an abscess in their jaw. Like many in that situation, they called the nearest dental practice. As I said earlier, there was a 22% chance that they would be told that the practice had gone private, a 42% chance that they would be told that it was closed to new patients, and a 50% chance that they would be added to a 12-month waiting list, leaving them with an abscess until this time next year. Fortunately, those things did not happen. My constituent got through and made an appointment, although the dentist informed them that they did not regard the situation as an emergency, so my constituent was forced to go elsewhere, which reset the clock on their waiting list.

The dental practices that have contacted me have also shared stories of the abuse that their staff receive on a daily basis due to the lack of capacity, of how 111 continues to tell people to call their dental practices despite them not holding emergency contracts with the NHS, and of how the unfair UDA system acts as a direct negative contributing factor to the current situation faced by NHS dentistry.

Reformation of the service is clearly vital. When we previously debated the Health and Care Act 2022, I said that simply throwing money at the problem will not make it go away. Yet funding is, of course, the other vital area of improvement in this equation. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8% in real terms, from £3.36 billion to £3.1 billion. Further, where practices have underperformed in the past, NHS England have not released the funding, resulting in an underspend of the national dental budget. I therefore urge the Minister to maintain his commitment to reforming the unpopular 2006 dental contract, to make vital and necessary changes to unfair remuneration, and to act before the situation gets any worse and more dentists are lost. That is very important.

[Anthony Mangnall (Totnes) (Con)]

I apologise for interrupting my hon. Friend’s concluding remarks. Does he agree that it is also worth considering whether we can improve the role of dental therapists so they can take on some of the roles, whether the £50 million underspend in the south-west should be delegated across the whole area to deal with that issue, and whether those graduating from the Peninsula Dental School—something we are proud to have in the south-west—should be encouraged to stay in the area, given that the demand there is greatest? Above all, given my hon. Friend’s excellent speech and the points he has made, does he agree that the dental recovery plan, which we have been promised and for which we have been waiting for too long, must be brought forward immediately?

[Chris Loder]

My hon. Friend gives me no chance to do anything other than agree. He is right. I hope the Minister is hearing loud and clear from the south-west that we cannot go on with this situation. There is no need, especially when we have dental underspends, for us not to take advantage of those opportunities as they arise. I also agree with him that we need to find more new and innovative ways of solving the issue and help a broadly willing dental team across the south-west.

To conclude, I urge the Minister to take note of all that I have said and what all my hon. Friends and hon. Members will have to say. I will also leave the Minister with a clear idea of what we need in West Dorset. First, I understand that there are plans for a substantial dental school in Dorset. I am pleased to hear that and am eager to lend my support. Can the Minister share more details? Secondly, NHS 111 needs to understand the situation of our dental practices and stop directing frustrated patients to those practices’ already swamped telephone systems, causing busy staff to receive unnecessary abuse for problems that are not necessarily within their power to fix. Finally, the contract and the amount of compliance within it, as my hon. Friend the Member for Totnes (Anthony Mangnall) pointed out a moment ago, needs an immediate review and immediate reform. Otherwise, we will continue to lose NHS dentists and the situation will worsen dramatically. I look forward to hearing from my hon. Friends and hon. Members in this debate and, indeed, the Minister at the end.

[Several hon. Members rose—]

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this incredibly important debate. Dentistry is the No. 1 issue that I am working on, and I reassure hon. Members that we are doing so at pace. We know that there are serious challenges across the country; hon. Friends and hon. Members are quite right about the scale of those challenges, which are particularly acute in the south-west.

I met the commissioners for dentistry in the south-west earlier this week. I met the professions separately, and I had further meetings about our dental plan earlier today. This is absolutely top-priority. I have been talking for some time to hon. Friends present and to south-west Members and others to generate the ideas that will go into the plan. They are the first in my mind when I think about those who are contributing important ideas to our dentistry plan, not just in their speeches today but in our conversations.

We have already started the process of reform, but it is only a start. We have created more UDA bands to reflect the fair cost of work and to incentivise NHS work. We introduced the first ever minimum UDA value to help to sustain practices where they are low, and—to address the point raised by my hon. Friend the Member for South Dorset (Richard Drax)—we have allowed dentists, for the first time, to deliver 110% of their UDAs, to encourage more activity from those who want to do more NHS dentistry. We have also started the process of making it easier for dentists to come and work in the UK. Just last month, legislation came into force that enables the General Dental Council to increase capacity for the overseas registration exam. I have also met the council to discuss how we can bust the backlog that built up during covid.

Plans for the centres for dental development are emerging around the country, which is very exciting and will address the issue that colleagues have mentioned about how to encourage dentists to train and then remain in the south-west and in other areas that find it more difficult to attract dentists. We have started to empower hygienists and therapists as well, exactly as my hon. Friend the Member for St Ives (Derek Thomas) proposes. We stand ready to go further. The reforms to split band 2 and the 110% option have been well received by the profession. They are being used: the proportion of the new band 2b that is being used is going up, which is already having some effect on delivery, although of course that effect is not high enough.

In data published by NHS England this week, the proportion of contracted units of dental activity delivered went up from 85% last March to 101% this March, and the number of NHS patients seen has gone up by about a fifth over the last year, so there is progress, but there is much more to do. We will go further in the forthcoming dental plan, which I hope will be out relatively shortly.

The reforms that I have talked about and the forthcoming dental plan draw on the ideas that Members across the House have put forward today. They will build on those initial banding changes, further improve that payment model and start to take us away from the 2006 contract, which everyone agrees is broken. Exactly as my hon. Friend the Member for West Dorset pointed out, that is the core of what we need to do.

We will also ensure further measures to improve access, particularly for new patients, look at how we address historical UDA variations that are not justified, improve transparency—I think my hon. Friend the Member for Torbay (Kevin Foster) made that point—and take further steps to grow the workforce, not least through the workforce plan, which we will publish very shortly. Fundamentally, we will do everything we can to make doing work for the NHS and NHS patients more attractive to dentists. At the same time—to answer the question that the Opposition Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), quite rightly asked—we will do more to encourage prevention as well.

The devolution of dentistry from the NHS regions to the individual integrated care boards at a more local level is an important improvement that we want to build on. It provides an opportunity for much closer integration with other local care services and much more accountability about what is being commissioned and delivered at the local level. People and MPs can go and see the person responsible for delivery in their area much more easily, and our dentistry plan will build on just that.

[Chris Loder]

I very much appreciate what the Minister is saying about the plan for dentistry going forward. The last time I brought up the issue was in July 2022, almost a year ago. We had these problems then, and we have them much worse now. Will the Minister share with us how some of these great initiatives, which I am pleased to hear about, will be expedited so that they can have the maximum effect as soon as possible for those who are most affected in the south-west?

[Neil O’Brien]

I feel the exact same sense of burning urgency that my hon. Friend feels. I hope our plan will be out very shortly.

--- Later in debate ---

[Chris Loder]

I thank my hon. Friend the Minister for his kind response, not just to my contribution but to that of every Member here today. I reiterate that we are in a position of quiet desperation in Dorset. I appreciate a lot of the initiatives the Minister has shared with us today, but I must impress on him, on behalf of all those present, the urgency with which they must be expedited. We look forward to seeing some of the initiatives becoming a reality in due course.

I remind the Minister that my hon. Friend and constituency neighbour the Member for South Dorset (Richard Drax) and I see the dental training college in Dorset as an important component of resolving some of the difficulties. I was hoping to hear a little more about that. Maybe the Minister could share that with us, and write afterwards to tell us a little more. That would be much appreciated.

I am delighted that hon. Members from across the United Kingdom came to my debate about dentistry in the south-west. I was particularly pleased to see the hon. Member for Strangford (Jim Shannon), who I was not expecting—he is not in his place now. As for the hon. Member for Westmorland and Lonsdale (Tim Farron), I was getting a bit worried that he might be on a chicken run to the south-west in the next general election. We will see. I know some—anyway, there we go.

I am very grateful to you, Ms Elliott, for chairing the debate, to all right hon. and hon. Members who have contributed, and to the Minister for his response.

Question put and agreed to.

Resolved,

That this House has considered the provision of NHS dentists in the South West.