NHS Dentists: South-West England

Derek Thomas Excerpts

Wednesday 24th May 2023 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I thank my hon. Friend the Member for West Dorset (Chris Loder) for introducing this debate. Nearly a year ago, I introduced a debate in this place on the same subject. The then Minister said it was a priority to increase the number of dentists in specific parts of the country, and she mentioned our loved area, the south-west. At the same time and soon after, contract changes were announced. I would not say that they were completely hopeless, as has just been suggested, but people in the south-west are still struggling to get a dentist, as we have heard. I still get emails from constituents who are not getting the treatment they need or spending their time and money travelling to London, Manchester or even abroad to access dentistry.

Since my debate, I have witnessed dental practices giving up NHS contracts or vastly reducing NHS treatment, forcing people to fund themselves fully, while others who cannot afford that go without treatment; I raised that issue with the Health Secretary in the main Chamber only recently. This week, a lady told me that she had filled her own tooth, using a kit she bought online and the torch on her mobile phone. She was frustrated, and so was the dental practice. It has a contract with the NHS to provide thousands of units of dental activity—UDAs—but that funding allocation is clawed back by the NHS if it cannot deliver those units. It cannot deliver those units because the value is too low to attract the staff it needs.

This year, that practice alone will pay back £132,000 in clawback—enough funding to treat roughly 1,600 patients in west Cornwall. I have asked NHS regional commissioners where those funds go and whether they can be made available for additional dentists; I have not received a reply. In fact, although I previously appreciated a very healthy and helpful dialogue with NHS England commissioners, their engagement and response rate with me and my office this year has been woeful.

Nationally, the underspend in the NHS dental budget could reach half a billion pounds. If I could get just one commitment from the Minister today, it would be to ensure that that money is spent on the dental care we need. For example, it could be used to raise the UDA value to £30. That would be a small step, within existing budgets, that could help dental practices in my constituency afford to treat more patients.

In the longer term, we know that the NHS dental contract needs reform. It does not work for dentists, and it certainly does not work for our constituents—the patients. We look forward to integrated care boards, but we also look forward to their taking ownership of dentistry and driving the delivery of dental care for their regions. In Cornwall, we have an integrated care board just for Cornwall and the Isles of Scilly. It is really helpful now to know exactly where to go to talk about dentistry. As we heard earlier from my hon. Friend the Member for West Dorset, we must work together to really have local accountability and delivery solutions to address people’s oral health.

We need better workforce data on dentistry as part of the forthcoming NHS workforce plan. We heard yesterday that the British Dental Association reported that the numbers of NHS dentists had fallen. The Minister’s Department says that not all NHS dentists have submitted their data for the year. Whatever the truth is, that shows that we do not have credible data; without data, we do not have a plan. The workforce plan needs to ensure not just the number of dentists, dental nurses and other dental professionals, but where they are located. We have a brilliant dental suite in Truro, but graduates rarely stay in Cornwall once they have been trained. We are seeing a slight improvement, with dental practices offering foundation placements for those graduates in Cornwall—something that traditionally we have not done—including in St Ives, but the potential is far greater.

Finally, I recognise that the Minister is as keen as I am to empower the entire dental team to work to their full potential for NHS patients. However, some barriers remain to fully implementing direct access in NHS-funded dental care. In dental care, a system exists that enables the administration of medicines by dental care professionals when they provide care to patients paying privately. That does not apply for NHS dental patients.

On Friday, I visited a new dental practice. Did you hear that—a new dental practice? It is not all dreadful and miserable. The owner is providing five new treatment rooms. He has two dentists and a hygienist, and he will take on more UDAs and dentists—he will have the dentists if he has the UDAs—but he explained the impact of the disparity that I just raised:

“We have therapists in most locations in the Southwest ready to increase NHS access, especially for young children as most of the work for this cohort of patients is within their scope of practice, and it is disappointing we cannot use them fully. Dentists are very reluctant to sign off prescriptions because of time issues and not understanding the process. Our therapists are only doing Hygiene, and some of them are leaving because of the lack of work.”

My understanding is that a statutory instrument in this place is required. That simple piece of legislation would provide the opportunity for NHS dental practices to use the full skillset and competencies of their dental staff to increase the delivery of desperately needed dental care. I know that the Minister is aware of that and keen to drive that forwards. Will he indicate whether that SI will be forthcoming in the near future?