National Health Service (Performers Lists) (England) (Amendment) Regulations 2023

Motion to Regret

Moved by

That this House regrets the lack of an impact assessment and a full consultation exercise being undertaken in relation to the changes made through the National Health Service (Performers Lists) (England) (Amendment) Regulations 2023 to the National Health Service (Performers Lists) (England) Regulations 2013, given the wide-ranging effect of those regulations on NHS primary care dentistry in England.

My Lords, it is a great pleasure once again to draw your Lordships’ attention to dentistry matters in relation to this statutory instrument. I declare an interest as president of the British Fluoridation Society and related bodies.

These regulations are important in themselves—more important than first meets the eye. They come within the context of wider issues around the problems that patients are having getting access to dentistry under the NHS. In our previous debate, a few weeks ago, I referred to the GP patient survey last year, in which 12.9% of those surveyed said that they had failed to get an NHS dental appointment in the last two years. If you count only those people who attempted to get an NHS appointment the first time, 24% failed to get an appointment in the last two years.

In the last few weeks, I have had urgent representation from the Shildon and Dene Valley branch of the Labour Party about the impact that the closure of BUPA Dental Care in Shildon and Bishop Auckland has had on providing NHS dental services. As the branch says, this is an area where only a minority of people can afford expensive private dental care. The closures will lead to an overall decline in dental health and to increases in related health problems. This is happening up and down the country.

When we debated this in June, the Minister referred to the July 2022 package of dental system improvements, which was aimed partly at improving patient information and at changes to the contract to provide some incentives. However, that is not sufficient to tackle the chronic access problems that patients have.

The announcement in the NHS workforce plan that the Government intend to

“Expand dentistry training places by 40%”

is, of course, very welcome indeed. However, the Minister will need to find some capital funds to help dentist schools expand, and I know the Minister will not be surprised if I mention that the

“tie-in period to encourage dentists to spend a minimum proportion of their time delivering NHS care”

has caused some eyebrows to be raised—although I actually sympathise with that proposition.

However, it is a pity that the Secretary of State asserted that

“two thirds of dentists do not go on to do NHS work”.—[Official Report, Commons, 3/7/23; col. 580.]

I have now seen acknowledgment by officials in the Minister’s department that a mistake was made. Two figures have mistakenly been reversed: around two thirds of dentists perform NHS work. I think an apology is owed to the profession for this.

I come to the regulations. The national performers list is a list of approved GPs, opticians and dentists who satisfy a range of criteria necessary for working in NHS primary care in England. Accessible online, the national performers list allows members of the public to check the status of those performers. The amendments to the National Health Service (Performers Lists) (England) Regulations 2013 include three main changes: first, adjustments to simplify intra-UK cross-border working of medical, dental and ophthalmic practitioners; secondly, amendments to simplify the application process for overseas dentists who have not completed dental foundation training; and, thirdly, postgraduate dental deans will no longer have responsibility to sign off dentists who have gone through a supported period of training called the performers list validation by experience, or PLVE.

Let me say at once that actions to remove bureaucratic barriers and ease workforce pressures by improving the process for overseas qualified dentists to join the NHS workforce are of course welcome, and there is no doubt that the current process is bureaucratic and inflexible. But there are a number of real concerns. First is the lack of consultation. I have talked to the British Dental Association, which was not consulted before the changes were made and had expected a formal consultation to take place before implementation of any changes. The reason given by the noble Lord’s department is the

“strong public interest in introducing this legislation swiftly”

to reduce unnecessary barriers and to ease workforce pressures. I do not dispute that parts of the process need improving, nor do I argue against the view that this should be done as quickly as possible, but I think that the BDA and others in the profession are entitled to be consulted on it.

Then there is the absence of an impact assessment. The Explanatory Memorandum states:

“A full Impact Assessment has not been prepared for this instrument … no, or no significant, impact on”

the private, voluntary or public sector is foreseen. That is arguable. I suggest that the impact on the dental sector could be significant: first, with the loss of a safety net for practitioners and patients; and then with a significant increase in workload for a diminishing group of NHS England dental advisers. The latter point carries the risk that either a backlog of applicants will develop while waiting for assessment or assessments will be watered down to ensure a fast journey through the process, which of course has implications for patient safety.

On patient safety, we know that many working within dental postgraduate education are concerned about the approach adopted and are uncertain about whether the structure now in place is sufficiently robust to offer the public protections required to ensure all dentists will be fit to join the performers list. There is a wider impact, too. There is now an exemption from the need to complete foundation training

“where a dental practitioner is judged, through an assessment by the Board … to have knowledge and experience equivalent to that of a dental practitioner who has satisfactorily completed foundation training”.

This is intended to address the issue of intra-UK cross-border transfers and the process for overseas applicants, but it would be fair to reflect the BDA’s concern as to whether, say, a new graduate from a UK or English dental school would also be able to argue that they could be assessed via this equivalence route rather than going through foundation training.