Dentist Industry and NHS Backlogs

Maria Caulfield Excerpts

Monday 7th February 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate my hon. Friend the Member for Warrington South (Andy Carter) on securing the debate and on raising such an important issue. I answered another Monday Adjournment debate on dentistry recently, and on Thursday there will be another debate on it in Westminster Hall, so it is obviously a significant issue for many hon. Members across the House. I also thank my hon. Friends the Members for Clacton (Giles Watling) and for Isle of Wight (Bob Seely) for raising issues on behalf of their constituents.

I am not going to stand here and say that there is not an issue around dentistry, because there absolutely is —it has been significantly affected by the pandemic. I will touch first on the short-term problems that the pandemic has created for dentistry and for patients, before going on to the longer-term problems around the contract, which my hon. Friend the Member for Warrington South raised and which have existed for a significant time.

A significant backlog has been created during covid. The majority of dental procedures are aerosol-generating, so covid creates a significant risk both for patients and for dental teams. When the lockdown measures initially came into force, only urgent dental procedures were allowed to go ahead. It was not until 8 June 2020 that non-urgent procedures were allowed, and only 20% of normal activity was allowed to go ahead at the time because of infection control measures. Even at that stage, we could see that a significant amount of work was backing up.

For most of last year, dental teams were allowed only up to 40% of normal activity. It was not until the end of last year that they could go up to 65%, and just around Christmas time that they were able to go up to 85% of normal activity. Even today, they are still not allowed to go back to 100% of normal activity, simply because infection control measures make it important that space, intervals between patients and cleaning between patients continue. Even with dentists working at pace and as hard as they can, a backlog is still accumulating nearly every day because those measures are in place.

[Andy Carter]

I thank the Minister for setting out very clearly how dentists have come back to operate in their surgeries. As she mentions and as I said in my speech, dentists were asked just before Christmas to deliver 85% of the UDAs for the three-month period from January to March. A number of small dentistry practices operating with one or two people are saying that we have increased the amount that they are required to deliver in order to be paid, at a time when covid is at its highest with the most infections ever. If a staff member, dentist or patient is unable to attend, the risk that the dentist will not be able to deliver is very significant, which means that they could be financially penalised. Does the Minister understand that the way the contract has been set up can really work against the current timeframe?

[Maria Caulfield]

I absolutely have a lot of sympathy for dentists. It is due to their and their teams’ hard work that, since December 2020, urgent care is back to pre-pandemic levels. I reassure my hon. Friend that when we were at 20%, 40% and 65%, dentists were getting paid 100% of their contract value; it is only since the Christmas period, when we went to 85%, that they have not been paid the full 100%. Throughout most of the pandemic, even though they were seeing fewer patients than their contract allowed because of infection control measures, they were getting 100% of their contract value.

[Andy Carter]

I understand what the Minister says. The way dentists are paid is not that dissimilar to the way MPs are paid: they get a chunk of money and have to pay their rent and pay their staff, as they have had to do all the way through the period. If they get to the point where they are required to deliver 85%, but where covid and the infection levels mean that they cannot physically deliver it because they are not there, they still have all those outgoings—they still have to meet their contractual requirements to pay the rent and pay their staff. That is the issue that I think many dentists are very concerned about.

[Maria Caulfield]

I take my hon. Friend’s point of view, but during the pandemic there has been significant support that many other sectors did not get. That is not to detract from the problems that dentists are facing, however, and no one is a bigger supporter of dentists than I.

I will just move on to some of the other points that my hon. Friend raised. We are not up to 100% of pre-pandemic activity simply because of covid, and that is taking a toll on access to NHS dentistry. A number of patients have waited and waited during the pandemic and now need urgent care, and we are seeing that reflected in A&E attendance and in surgical elective lists, because patients have got to a stage where they need surgery to rectify some of their problems.

I fully take on board many of the issues that have been raised in the debate this evening, but I reassure colleagues that we are trying to support dentistry as much as possible. NHS England is providing local commissioners with help and support to direct patients to where there is availability. It may have been my hon. Friend who mentioned this, but dentists have been asked recently to update their information on the NHS website that records where NHS dentists are, so that we can direct patients to those surgeries that are taking patients. Dentists have also been asked to operate a cancellation list, so that, should someone pull out, the next person on the list is proactively contacted to be offered that appointment. It is difficult for patients to navigate the system and find out where NHS dentists are.

Members may be aware—I hope they are—that just a few days ago, a one-off additional £50 million was secured for NHS dental services, the first pot of money that they have received in a long time. It is specifically focused on this financial year, so it has to be spent by April. It is targeted at those NHS dental teams to ask them what availability they have in increasing capacity, so that those waiting for treatment can start to access some of it. My hon. Friend’s area in the north-west has been allocated £7.3 million to be spent by April. NHS England is working at pace with local commissioners to deliver that and to try to tackle some of the backlog.

The difference between that funding and the contract is that the rates of pay are significantly different, and we are seeing huge uptake from dentists who are keen to do NHS work when they are rewarded accordingly. That additional £50 million will secure up to 350,000 additional dental appointments and will be targeted at those in most urgent need of dental treatments, whether it is oral pain, disease or infections, to help them get the care they need. Children, who a couple of Members mentioned, are being prioritised, as are other vulnerable groups. We are seeing some take-up of that offer, and I hope that shortly we will be able to update colleagues on where exactly that take-up has happened and the difference it has made in accessing NHS dental provision.

I will move on to some of the longer-term dental issues, which have been eloquently set out this evening.

[Bob Seely]

I do not want to interrupt my hon. Friend as she goes on to these important long-term structural issues. There were a bunch of short-term ideas to get dentists into this country in the next year or two to help with the immediate crisis and the lack of NHS dentists. Can she assure us that she and her Department are looking at some of those options, rather than looking purely at the long term?

--- Later in debate ---

[Maria Caulfield]

If my hon. Friend will allow me, I will touch on some of those measures, too. If we move on from just the covid-related problems that have fallen on dentistry, there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.

That is why we have started work on dental contract reform. I am meeting the BDA again tomorrow, and officials are starting contract negotiations, looking at both short-term change, which may give some immediate relief, and long-term reform of the contract, because that is the nub of the problem as to why dentists are not coming forward to take on NHS work, or are handing back their contracts because they no longer want to do NHS work. At the moment, the contract simply does not value the work that dentists do, and I want to reassure hon. Members that we are working as fast as we can to reform it and to make improvements.

We also need to work with local commissioners, because the feedback that we get is that some parts of the country are much better at commissioning local dentistry services than others. That is something we need to address, and part of how the £50 million is spent across the regions will be about helping us to identify those areas that need more support in commissioning services.

Our joint aim is to make patient access better and to reduce health inequalities for patients, while making the NHS a more attractive place for dentists to work. Making NHS dentistry more attractive to professionals will help with recruitment and retention and will provide us with NHS dentists across England. Hon. Members may be aware that Health Education England published its “Advancing Dental Care” review report in September last year and is working to implement the proposals to reform dental education over the next four years. The aim is to modernise training and education and to widen access to and participation in training to ensure that not just dentists are coming through the system but a whole range of dental professionals can be more effectively used in NHS dentistry. Legislative changes may be needed to upskill dental nurses, dental technicians and dental associates, and we are looking at whether we can tackle that later this year so that it is not just dentists who are able to do a significant amount of work. There are highly skilled, highly educated and highly experienced professionals working in dentistry who we could upskill and use to provide more dental support.

Although we are keen to expand dental training, the results of the establishment of new dental schools in regions or the training of more dentists would not necessarily be seen for four to five years. That is not to say that we will not do those things, but there are some immediate solutions, one of which is to create centres of dental development in localities where there is a shortage of provision and we can bring together education and services. My hon. Friend the Member for Warrington South is right that not just dentists but GPs are more likely to stay where they train, so it is important that we look at where the shortages are and try to bring centres of dental development to those areas.

The Government recognise, as my hon. Friend the Member for Isle of Wight pointed out, that the registration process for some internationally qualified dentists can be bureaucratic and inefficient. The overseas registration exam that currently has to be taken was suspended throughout covid. The first exams took place last week, so some overseas dentists are starting to take their exams. The sessions booked in for the rest of the year will cover roughly 700 overseas dentists. They may not all pass the exam, but at least they are starting to get through the system.

The Department is currently working with the GDC on legislative proposals that will allow greater flexibility to expand on the registration options that are open to international dentistry applicants. My hon. Friend the Member for Isle of Wights is right that some experienced qualified dentists currently cannot practise in this country. I am pleased to say that the consultation on the changes with the GDC launched today. Subject to the results of that consultation, we hope to bring forward changes later this year. That will really open up dentistry to those who trained overseas. That is not to say that they will choose to work in the NHS once they qualify, but we are working on plans to encourage as many of them to do so as possible.

Although I am unable to present a quick fix to the House, I hope I have been able to reassure colleagues not only that are we working through short-term measures in respect of covid to open up dentistry and to get on top of the backlog created by covid, but that the long-term plans in respect of dental contract reform, training measures and the opening up of access for overseas dentists will increase access to NHS dental services and hopefully open up access for patients throughout the country.

Question put and agreed to.