To receive a presentation from Herts and West Essex Integrated Care Board on dentistry provision in North Herts.
Decision:
Herts and West Essex Integrated Care Board provided a presentation on dentistry provision in North Herts, following which Members asked questions.
Minutes:
Audio Recording – 4 minutes 22 seconds
Michelle Campbell and Steve Claydon of Herts and West Essex Integrated Care Board (ICB) provided a presentation on dentistry provision in North Herts, and advised of the following, that:
· The Integrated Care Board had taken over delegated commissioning of all dental services from NHS England (NHSE) in April 2023.
· Unlike GP practices, dental practices did not operate a registered patient list, therefore patients both within and outside the North Herts and West Essex boundaries could access treatment from the dental practices there.
· There were two types of contracts awarded to practices under the National Dental Contract. The first was General Dental Services contracts which were to provide mandatory dental services. Contracts were commissioned on “units of dental activity” (UDA) which was set against a baseline reference year prior to 2004.
· Within each contract, there were four treatment bands going from Band 1 for regular assessments and examinations all the way to Band 4 for urgent treatments.
· Contracts allowed for 4% under-delivery 2% over-delivery of UDA which was either carried over or deducted from the contractual baseline the following financial year. However, if funding was available, they would pay the practices that over delivered their services.
· The second type of contract was Personal Dental Services contracts which were for locally commissioned services such as orthodontists. These were time limited and were not in perpetuity.
· The ICB had delegated functions to make decisions on contractual changes such as practice relocation, alteration of practice activity bases and values, and incorporation requests.
· 229 General Dental Services and Personal Dental Services contracts were active across Herts and West Essex. These were broken down into 185 General Dental Services, 21 Orthodontic Contracts, 2 Special Care Dental Services, 1 Prison Dental Service (not currently managed by ICB), 1 Domiciliary Dental Service, 1 Dental Out of Hours Service, 16 Intermediate Oral Surgery Services, 2 Sedation Services and Secondary Dental Care.
· Since Covid, providers and commissioners of dentistry had faced increased patient demand, more complex treatment needs, workforce recruitment and retention (although this had seen recent improvement), restricted funding for treatments, increased costs due to inflation, financial instability due to under-delivery, and contracts based on activity rather than outcomes.
· A Primary Care Strategic Dental Delivery Plan had been developed in 2023 to identify priorities which would address the oral health needs of the population.
· These were identified as improving urgent access to dental care, delivering oral support to the public through education, strengthening outreach to care homes, allocating the current workforce more effectively and planning routine care to reduce the need for urgent care.
· The priorities identified from the delivery plan would also align with most of the priorities set by the ICB for 2024/25 and 2025/26.
· In February 2024, NHSE in partnership with the Department of Health and Social Care had published a Dental Recovery Plan, targeting the recovery of NHS dental services.
· The plan aimed to support the prevention of poor oral health by working with public health and local authorities through the Oral Alliance Group.
· It also aimed to increase the delivery of dental services by introducing a New Patient Premium for practices to see patients who had been unable to access care in the past 2 years.
· Additionally, there was a national increase to the minimum UDA from £23 to £28, funding for 240 posts nationally on the proviso that the dentist committed to staying for three years (three posts had been allocated for Herts and West Essex ICB) and the introduction of Dental Vans to support rural, under-served and hard-to-reach communities although Herts and West Essex did not meet the criteria for these.
· Almost 90,000 new patients had accessed dental care since April 2024 under the New Patient Premium.
· Since taking over in 2023, the ICB had introduced an enhanced dental access pilot to offer urgent access appointments seven days a week both in and out of hours.
· The pilot was originally commissioned for six months, however, due to its success, it had been extended until the end of March 2025. By the end of March, they predicted that nine to ten thousand additional appointments would have been delivered to patients that were unable to regularly access an appointment.
· As part of the pilot, four providers in Hertfordshire were offered contracts to administer urgent care in-hours and six providers saw their out-of-hours capacity doubled.
· The pilot had provided lots of data for the model to continue once the ICB had reviewed their business planning process.
· 3.14% of all treatment for children had been urgent and just over double the percentage of adult treatment had been urgent at 6.67%.
· As the oral health of the population improved, there would be a reduction in the higher banded treatment as the need for invasive treatment would decline.
· The data on dentistry in Herts and West Essex that had been presented could be circulated to Members after the meeting upon request.
· A dental access and health review had been undertaken for the ICB in late 2023 through to early 2024 which had given them data on the oral health of the population and located hotspots which were areas where residents had low access, but a high need for dental services.
· From this, the ICB were able to able to the areas where it needed to prioritise their resources and had allocated them respectively.
· There had been collaboration with the public health team within the Local Authority to provide pop up dental clinics, reach out to family centres and schools to provide advice, in addition to training and education on oral health.
· There had also been participation in the National Epidemiology Survey where a cohort of patients were assessed to provide information on dental health. The previous year had assessed year six pupils and the current year had assessed care homes, producing a rich data set for commissioners to work with.
· Since taking over the delegated commission, there had been high levels of investment in Herts dental services to increase their level in line with Essex.
· This investment included the purchase of bariatric chairs for bariatric patients that would have previously been referred to Bedfordshire and the implementation of an anxious patient pathway for patients that would have been referred to the London Acutes but are now rejecting out of area referrals.
· There were 20 dental contracts in North Herts, 18 of those were General Dental Services (GDS) practices and 2 were orthodontic practices and 1 of the GDS practices provided oral surgery. Overall, the boundary was well served for NHS dentistry.
· The recruitment and retention of the dental workforce in Herts and West Essex was above average compared with the rest of East of England.
· Healthwatch had published several reports on NHS dental health and access since 2016. The ICB had commissioned Healthwatch to deliver four programmes a year on topics that they had chosen. One of those topics would be the oral health of children which they had given Healthwatch permission to carry out a survey on this that would commence within the week.
· Over the next two years, the out-of-hours contracts would need to be reviewed and reprocured, collaboration with local authorities to improve the oral health of the population would take place, and a care home pilot to understand what the treatment needs of the elderly would be planned.
· Many contracts were not hitting the minimum 96% delivery rate and the ICB would be working with dental contractors to address this.
· From April 2025, the ICB could rebase a contract if there had been 3 years of underperformance. This underperformance could then be redistributed to practices that were demanding activity.
The following Members asked questions:
· Councillor Ralph Muncer
· Councillor Matt Barnes
· Councillor Claire Winchester
· Councillor Jon Clayden
In response to questions, the Herts and West Essex Integrated Care Board representatives advised that:
· The increasing population in North Herts would present a significant challenge to the ICB, however they would work with the Council to understand the growth and commission dental services where they were most needed.
· The ICB Premises Team worked with planning authorities to draft responses to developers on Section 106 contributions for all primary care services including dental practices. This included dental practices in Royston, but it was explained that GP services and pharmacies in the town were covered by Cambridge and Peterborough Integrated Care System and any response to developers on Section 106 contributions within the town would need a dual response from both organisations.
· Dental providers were required to submit workforce returns data to the Business Services Authority, however this was not shared with the ICB.
· If a practice underdelivered on their contract, they would pay back the ICB for any activity that was not performed.
· Under delivery of activity could be down to staffing problems, but it could also be because some practices were unwilling to perform certain treatments.
· Post-Covid, there had been a significant increase in the delivery across Herts and West Essex which had increased from approximately 72.5% in 2022/23 to 92% in 2023/24, and the forecast for 2024/25 was 96%.
· Only three fully funded dental posts had been allocated to Herts and West Essex as there were lots of criteria to be met in addition to other areas being under served compared to Herts and West Essex.
· Two contracts had been handed back to the ICB since 2023 as the providers had decided to go private, however, their activity had been reallocated to others.
· One practice withdrew from the enhanced dental access pilot once they realised the costs associated with providing urgent care as it required the use of experienced dentists whose pay was much higher than newly qualified ones. There was dialogue between the ICB and the provider to find a solution, however they ultimately decided to pull out of the pilot.
· Once a review of the pilot had taken place, their intent was to increase the number of participating providers as it was in their work programme for 2025/26 and they had the funding available to do this.
· A detailed clinical data set was collected for each treatment provided, and if there was a significant variance in activity compared to the national benchmark, they could discuss this with providers and conduct audits where necessary.
· Routine checkups were no longer standard practice. Instead, every patient was individually assessed for their needs and given appointment accordingly.
· The purpose of the ICB was to get the health service to work closely with local authorities to promote and improve oral health. Bio-directional feedback from North Herts Council would benefit the ICB hugely in instances where big housing developments were being considered and the ICB could obtain funding through applying for Section 106 contributions.
Councillor Daniel Wright-Mason noted that it would be useful to see if the recruitment and retention figures in North Herts were examined in more detail to see if external factors such as affordable housing in the region were impacting this.
Councillor Val Bryant advised that Councillor Tina Bhartwas was the Health Champion for North Herts as well as the North Herts Council representative on the Health Scrutiny Committee at Hertfordshire County Council and could help to be a point of communication between the ICB and local authorities.
The Chair thanked Michelle Campbell and Steve Claydon for their presentation.
N.B. Following the conclusion of this item, there was a break in proceedings and the meeting reconvened at 20:43.