Integration of dental primary care compromised

Dentists: failed contract remains elephant in the room as integration of primary care kicks off: The British Dental Association has warned the moves announced today to bring forward integration of primary care will be undermined from the start by government’s failure to move forward on reform of NHS dentistry.

A stocktake report, by Dr Claire Fuller on behalf of NHS England and NHS Improvement, published today, has indicated huge benefits for public health, through integration of dentistry with the wider health service. It cites the Connecting Care for Children (CC4C) partnership between hospital and community health providers, GP federations, PCNs, local authorities, charities, patients and citizens in London. That has succeeded in bringing together child health professionals and dental experts to improve children’s oral health for the GP practice population. More than 35 CC4C systems have now been established across the UK.

The new Integrated Care Boards (ICBs) will take on delegated responsibility for pharmaceutical services, general ophthalmic services, and dental services by next April.

Dr Fuller has stressed the need for proper workforce planning and ‘headspace’ for practitioners. This week the BDA warned the House of Commons Health and Social Care Committee of the accelerating exodus of dentists from the NHS. Since the start of the pandemic around 3000 dentists in England are understood to have moved away from NHS work entirely. However, survey evidence suggests nearly half (45%) report they have reduced their NHS commitment since the onset of the pandemic, by an average of over a quarter. 75% say they are now likely to reduce – or further reduce – their NHS commitment in the next 12 months.

The contract – which pays dentists the same for 1 filling as 10, and commissions care for barely half the population – is the key driver. The BDA believes that while the new systems have the potential to improve integration, the current discredited, underfunded contractual model will limit needed progress. After a decade of cuts the BDA estimate NHS dentistry would require an additional £880m per year simply to restore resources to 2010 levels

The BDA has welcomed the fact that the report stresses the need for primary care voice and leadership – across all 4 branches of primary care, not just General Medical Practice – to be at the heart of both local and national NHS priorities and to be embedded across all systems. It has said Dr Fuller’s recommendations that new boards should build strong relationships with Local Dental Committees and create structures through which all pillars of primary care will be able to advise them effectively should be underpinned by appropriate guidance, as strong primary care voice in the new systems was too important to be left to local discretion.

BDA Chair Eddie Crouch said:

“The plans set out for integration across primary care are sound on paper, but the elephant in the room remains. New powers being passed to Integrated Care Boards will collide with the chaos built in to a failed, underfunded NHS contract.

“Progress on joining up the front line of the NHS could bring huge benefits to our patients. But Ministers need to ensure that real change is delivered before the last NHS dentist has left the building.”