To consider the following Motion in the names of Councillors P A Davies and A Smith;
“This Council notes
that:
1) NHS dentistry operates similarly to GP practices in that most dentists are not employed directly by the NHS but operate as independent contractors. In practice, this means that dentists purchase and equip the surgery, hire staff and pay all the running costs (such as wages, materials and insurance) in order to provide an NHS dental service;
2)
Dentists enter into agreements with NHS England
which commits them to perform a set number of ‘units’
of treatment every year. The contract gives NHS dental practices
targets to hit, and this is known as units of dental activity
(UDA). If dental practices do not hit their targets, they risk
losing a significant part of their NHS funding;
3)
Dentists are paid by the NHS according to the number
of UDAs they provide. UDAs are a measure of the amount of work done
during dental treatment. More complex dental treatments count for
more UDAs than simpler ones. For example, an examination is 1 UDA,
fillings are 3 UDAs and dentures are 12 UDAs, but the UDA bears no
relation to the amount of work or true cost of the treatment. This
means that NHS dentists have to subsidise more complex work. In
addition, dentists have inherited different UDA tariffs, so
different dentists get paid different rates for the same
treatment.
4) There is a shortage of dentists in England. According to NHS figures, the number of dentists providing NHS care in England fell from 23,733 at the end of 2020 to 21,544 at the end of January this year. This means that the NHS now has the smallest number of dentists it has had for over a decade. It is also a local problem, with Kirklees losing 11% of its dentists, meaning that it is the among the 25 most affected areas nationally.
This Council believes
that:
1) Access to NHS dental care and treatment has become enormously limited and this is a huge issue. Many people across Kirklees and England have been forced to go private and are battling to get treatment as practices stop seeing NHS patients. Many people travel miles outside their areas to access NHS treatment and some have even travelled overseas for treatment. Sadly, there has been a rise in do-it-yourself dentistry, which is enormously risky and can be harmful to dental health;
2) Dental care is an essential part of health care and should be available to all, yet oral health inequality is widening across Kirklees and across the country. A shortage of NHS appointments and treatment is particularly affecting those on low incomes the hardest, as well as patients with high levels of need, including those who are vulnerable. A lack of access to NHS dental care has real implications; it is deepening health inequalities and resulting in a rise of health issues, such as tooth decay, gum disease and oral cancer;
3) Dental surgeries have been forced to scale back their services. In part this is due to recruitment and retention issues, as well as NHS dental care services being underfunded and overstretched. There are staffing shortages which has been exacerbated by Brexit and Covid-19. Many dentists are unhappy with the NHS dental contact, according to the British Dental Association, and this may also a significant factor;
4) The current NHS dental contract is unworkable and is not fit-for-purpose. The dental contract, introduced in 2006, has attracted criticism from a range of bodies, including the British Dental Association and patient groups. It effectively renumerates dentists solely on their activity, meaning that dental surgeries are incentivised not to deal with the most serious cases. It wrongly puts the focus on meeting targets rather than delivering good patient care. Over the last year, there have been some changes made to the NHS dental contract, but as the British Dental Association note, these minor changes do not go far enough in helping to tackle the current crisis;
5) In some cases, dentists are losing money to see patients, particularly those with high needs. Many newly qualified dentists are simply unable to cover the costs of providing NHS treatment. Many dentists are feeling pressure to go private in order to cover wages and equipment costs and to survive as a business; many are leaving the profession entirely. Under the current model, it is difficult for dentists to provide a standard level of care to all patients, given the time constraints and need to meet UDA targets;
6) There has been a worrying shift towards the privatisation of NHS dentistry. The current system is failing patients and dental teams and contributing significantly to access problems in Kirklees and across the country. The dental contract needs to be replaced with a more modern system which puts prevention at its heart and better reflects dentistry in the 21st century;
7) While a commitment to reform the current NHS dental contact has been an established goal of successive governments, progress has been slow and has not been substantive. The current government and NHS England must intervene and speed up dental contract reform. Urgent and fundamental reform is required to ensure that people can access the dental care they are entitled to. In addition, the government needs to provide sustained funding to tackle the underlying problems of dental access and affordability. These problems lead to increased risk of diabetes, cardiovascular disease and Alzheimer’s disease;
8) It is shocking that there is a massive surge in children and teenagers needing teeth removed at hospital emergency departments due to decay due to a lack of dental healthcare access. Government data shows that 42,180 operations for tooth extraction took place in NHS hospitals in England in 2021/22 for those aged under 20. Tooth decay is the most common reason for children aged 6-10 to be admitted to hospital. We are failing our children. It is essential that we push the prevention of gingivitis before it progresses to periodontitis due to the high cost to the NHS of treating health related conditions, such as those outlined in the previous paragraph.
This Council, therefore, resolves that:
The Leader of the Council writes to the Parliamentary
Under-Secretary of State for Primary Care and Public health to
demand an urgent independent review of the NHS dental
contract.”
Decision:
Deferred to the following meeting of Council to enable the submission of a revised Motion, incorporating the Labour Group amendment.