Agenda item

To consider a report from Leeds City Council’s Head of Governance and Scrutiny Support providing background information and introducing an update from NHS England regarding access to dentistry across West Yorkshire.

Further to minute 10 of the meeting held 30^th July 2019, the Joint Committee received a report from NHS England regarding access to both primary care dental services and unscheduled dental care across West Yorkshire. The Joint Committee was also in receipt of supplementary information in the form of a letter dated 29^th March 2019 from the Head of Co-commissioning (Yorkshire and Humber) NHS England relating to Urgent Dental Care provision.

Following the July 2019 meeting, the Chair of the Joint Committee corresponded with NHS England (NHSE), with additional questions and concerns regarding proposed changes to Urgent Dental Care services in some areas of West Yorkshire. The report referenced the correspondence and responses received at Appendices 1 and 2.

The following were in attendance and contributed to discussions:

-  Emma Wilson, Head of Co-commissioning (Yorkshire and Humber) NHS England

-  Ian Holmes, Director, West Yorkshire and Harrogate Health and Care Partnership

In introducing the report, the Head of Co-commissioning (Yorkshire and Humber) NHS England highlighted the following key points:

·  The new call handling service for the urgent dental treatment pathway had commenced on 1^st April 2019. NHS 111 provides initial call handling before transferring urgent dental care requests to the Dental Clinical Assessment and Booking Service (CABS) for assessment and signposting to relevant treatment.

·  Additional capacity had been funded to ensure a number of dental practices could provide additional appointments, including evening and weekends, for urgent dental care requests.

·  A second phase of implementation would target particular areas to build capacity in areas of the greatest need.

In considering this issue, several comments were made by members of the Joint Committee expressing disappointment with the way the urgent dental treatment pathway had been implemented. The Joint Committee commented that procurement and commissioning of the realigned service had taken place without reference to or meaningful consultation with the Local Authority’s directly affected by the service change, or the WY JHOSC itself. Additionally, in discussing the report and appendices, Members expressed disappointment over the inclusion of data from 2017 and that no up to date statistics had been provided to support implementation of the new pathway.

The Joint Committee considered the information provided and discussed the following matters:

The three phases to implementation of the new urgent dental treatment pathway, including the 2017 pilot scheme.

The Joint Committee sought information on how data collected during the pilot scheme had addressed the barriers to accessing urgent dental care and informed the development of the new pathway.

Service provision under the new urgent dental treatment pathway

The Joint Committee sought assurance over the continued provision of urgent dental care services across the WY&H footprint, but particularly for those areas already identified with difficulties – Bradford, north Kirklees and Calderdale.

Additionally one Member reported that Wakefield District residents seeking urgent dental care would now be required to travel to Leeds or Huddersfield for treatment; yet knew of no consultation being undertaken. Information was sought on the number of dental practices in the Wakefield and South East Leeds area, the number of urgent care dental practices in Wakefield specifically; and the number of additional hours provided under the new contract.

In response, it was confirmed that the new urgent dental treatment pathway would increase services through provision at fixed urgent care sites in Wakefield, Bradford, Leeds and Huddersfield. Urgent dental care would also be provided by utilising available appointments in primary dental care practices. Additionally:

-  The new NHS 111/CABS service would signpost increased availability of appointments at identified sites in Leeds/Wakefield

-  At least 50% of callers to the NHS 111/CABs service will be dealt with by a dental professional. 

-  The new pathway envisaged patients would not travel for more than one hour to access urgent dental care.

-  Kirklees patients would access urgent dental care at one of the fixed sites or at one of the primary care dentists who receive funding to respond to local need and offer urgent care, once that element of the service had been established.

In response to a comment regarding preventative work being included within the pathway, the Joint Committee was advised that although preventative measures were not part of this work they would be part of the long term plan.

Barriers to dental care

It was acknowledged that there were several factors which acted as barriers to accessing either primary or urgent dental care. These included:

-  The historical belief that it was difficult to access local primary dental care so potential patients accessed urgent care instead.

-  That dental practices could still say they were closed to new NHS patients. It was noted that dental practices funded under the new urgent dental treatment pathway were required to promote their availability.

The provisions of the new contracts

In response to a query on the monitoring of the new pathway contracts and any penalties to be levied against dental practices which did not make additional appointments available, the Joint Committee heard that call handling data would be reviewed in order to inform the progress of implementation. The Joint Committee received assurance that providers would be held to account for dentistry provided.

Consultation, engagement and communications

There was some concern over the emphasis placed on dental practices to advertise their availability, as the pilot scheme had evidenced that some prospective patients bypassed primary care altogether. The Joint Committee sought details of how NHS England planned to advertise and promote the availability of appointments and whether any work was planned with local Healthwatch groups to advise local residents on access to dentistry in their area.

The Joint Committee heard that NHS Choices (on-line) would be the most frequently used tool to access appointments.

The Joint Committee also received confirmation that a Communications Plan had been developed to advise patients of the new arrangements. The Joint Committee expressed disappointment that this was only now being reported, after implementation of the new pathway, and requested further details of the Communications Plan.

Role of WY&H HCP

The Director, West Yorkshire and Harrogate Health and Care Partnership (WYH HCP) reported that WYH HCP was currently reflecting on the recently published NHS Long Term Plan and the requirements to produce a refreshed 5 Year Plan.  The Director agreed to report back to Members of the Joint Committee on the implications for the dental agenda in due course.

The Joint Committee also considered any influence the WYH HCP may have on Government/NHS England to refine the pathway contracts in order to better meet the needs of local residents and build in flexibility to support preventative work being included.

The Joint Committee noted a suggestion that preventative dental treatment should be a matter for further scrutiny by the Joint Committee.

In conclusion the Chair reiterated the Joint Committee’s frustration and clarified that although NHS England advised the Joint Committee in March and July 2018 of the intention to recommission the service; details were not provided of the procurement process, the outcomes and subsequent proposals. The Chair re-emphasised that proposed changes to services needed to be discussed prior to implementation, with the Joint Committee being provided with an opportunity to consider and comment on proposed service changes or developments – in line with NHS England’s statutory duty.

RESOLVED –

a)  To note the contents of the report and the discussions

b)  To note the implementation of the new urgent dental care pathway on 1^st April 2019

c)  That the further information requested be provided to all members of the Joint Committee; including:

  i).  Communications Plan

  ii).  Data on urgent dental care provision across the West Yorkshire and Harrogate footprint, including what and where urgent dental care services are available.

  iii).  Changes to the provision of urgent dental care compared to previous arrangements.

d)  Having considered the information provided, the Joint Committee identified preventative dental work as an issue for scrutiny in the future.

e)  To note the offer made by the Director, West Yorkshire and Harrogate Health and Care Partnership, to bring a report to a future meeting reflecting on the dental agenda as part of the response to the NHS Long Term Plan.