That this House has considered the provision of NHS dentists in the South West.
It is a pleasure to serve under your chairmanship, Ms Elliott. I am grateful to colleagues from across the House for attending this very important debate. If someone living in Dorset rings their nearest NHS dentist looking for an appointment, there is a 22% chance that they will be told the practice has gone private. If someone living in Dorset rings their nearest NHS dentist, there is also a 42% chance that they will be told the practice is not taking new patients with special or additional needs. There is a 50% chance that they will be added to a waiting list that is over 12 months, so half the constituents calling today could be waiting until May or June 2024 before they are seen. Finally, if someone living in Dorset is calling to book a dental appointment for their child, there is a 77% chance that they will be told the practice is not accepting new child patients.
The reason for these unacceptable statistics is because access to NHS dentistry in the south-west has been on an alarming downward trajectory for some time. Today, rural parts of Dorset, many of which can be found in West Dorset, experience worryingly low access to vital and sometimes life-saving dental treatment on the NHS. This is no doubt a widespread issue across the country, which is plain for all to see in the recent flurry of debates and questions on this subject in the House. Following this debate, there is an Adjournment debate in the House this evening examining dental care in the north-east, which shows how this issue is affecting constituents across the country.
According to recent reports, a quarter of the adult population in England have unmet dental needs, despite there being 24,272 active NHS dentists. That is enough for one for every 539 people, but these statistics can be misleading, because, importantly, even though there has been a 2.3% increase in the number of NHS dentists this year compared with last year, productivity has slowed. As many as half of these 24,000 dentists have cut back on their NHS work, according to the British Dental Association, forcing more people to either choose to go private and shoulder the burden of these additional costs themselves, or to go without and face the risks of poor dental hygiene that that can bring, such as tooth decay and gum disease.
I commend the hon. Gentleman and his team of MPs who come along to support one another on these issues. I am really impressed by how well they do their job. They did it yesterday, and they are doing it today; well done to them.
Across the whole of the United Kingdom of Great Britain and Northern Ireland, there are issues. The hon. Gentleman referred to the figures in his constituency; in my constituency, 100% of people cannot get an NHS dentist. Paying online for a whole year’s subscription to a dentist is not possible for many, including people who are elderly. Does he agree that the Minister should liaise with the devolved Administrations, in Northern Ireland in particular and in Scotland and Wales, on how we can better do this together? Clearly, it does not matter where we are in the United Kingdom of Great Britain and Northern Ireland—dentist appointments cannot be got for those who need them most.
I thank the hon. Gentleman for his short and succinct intervention, as ever. He is absolutely right and confirms that this issue needs to be addressed across the United Kingdom, not just in the south-west. I am delighted that he has attended this debate on dentistry in south-west England.
The south-west region was recently rated fifth out of seven for adult NHS dental coverage, with only 35% of adults covered by access to essential dental services, which is below the national average. Dorset fares slightly better, but adults in my constituency and those immediately neighbouring it also experience below the national average coverage for an NHS dentist.
The inequality is also affecting children, whom I am particularly concerned about. Although they are faring better than adults, with a coverage rate of 46% in both Dorset and the south-west, that is still below the national average for access to NHS dental services. Without those services, almost one third of five-year-olds are suffering from tooth decay, which is the most common reason why children aged between five and nine are admitted to hospital. Tooth decay is mostly preventable, so its effects serve to demonstrate what a lack of access to NHS dentistry is doing to our children.
Why are we faced with this difficulty? Why is dentistry in England, and particularly the south-west, under such pressure? Although the answer is multifaceted, I believe the reason is primarily threefold: first, the National Health Service Act 2006 and the subsequent dental contract; secondly, the lack of institutional services and the knock-on effects; and finally, the NHS backlog following the covid-19 pandemic.
The National Health Service Act 2006 set out the provisions for agreement between NHS England and dental practices in relation to services that would be provided and the renumeration for those services. Before the Act became law, the National Audit Office and the Public Accounts Committee both produced reports to the then Government on reforming NHS dentistry, which raised concerns about the 2006 changes. Those concerns included the urgent need to change the incentive mechanism for dentists to increase their commitments to NHS dentistry, the difficulty for patients in better-off areas in accessing public health services, and the difficulty for those in more deprived areas in accessing any services at all.
Simon Jupp (East Devon) (Con)
My constituents in East Devon regularly contact me about difficulties getting NHS dentist appointments in places such as Sidmouth, Budleigh Salterton and Exmouth. Problems with recruitment and contracts have been compounded by the pandemic, but that excuse will not wash forever. Does my hon. Friend agree that additional reforms of the NHS dental system cannot come soon enough for the south-west?
I thank my hon. Friend for his intervention. I wholly agree with him that reforms are needed urgently, which is the main point I will be sharing with the Minister towards the end of my contribution. It is clear that some of the measures from the 2006 Act do not go far enough. In many cases, they actually deter NHS dentistry provision.
Many of these issues are evident up and down the country today. Discussions with my own integrated care board in West Dorset—which, as of 1 April this year, has taken delegated responsibility for commissioning dental services from NHS England—have confirmed to me that the dental contract signed in 2006 is simply not fit for purpose. It actually restricts the ability of the board to respond to the current situation. That is because the terms and structure of the contract make it incredibly difficult for the integrated care board to attract new dentists to work in Dorset. I am sure that other integrated care boards across the south-west share that problem. The ability to attract new dental talent, especially those who are working on NHS contracts, is further hindered by our specific circumstances in Dorset. We do not have adequate training infrastructure.
Does my hon. Friend agree that this problem is particularly exacerbated for those of us in very rural parts of the south-west? Would the Minister consider putting dentists on a bus and bringing the dental service to us, so that our young people can see a dentist? Realistically, we will not be able to attract the new dentists we need in some of the remote locations that we love to live in.
I thank my hon. Friend for her kind intervention, and I wholly agree. Her constituency of North Devon is not dissimilar to mine; we share many challenges and many wonderful things. I am sure the Minister has heard what she has to say, and I look forward to his contribution.
Without a dental school in Dorset, recruitment continues to be a real problem, as staff often leave the county, and indeed the region, after receiving their training. That leaves Dorset residents short-changed, especially given that our council tax is among the highest in the country.
The third impacting factor is the backlog following the covid-19 pandemic. We are all well versed in that, but I wonder whether we fully appreciate the pressure on dental services since then. It is estimated that as many as 40 million NHS dental appointments have been lost since the start of the pandemic, and that is exacerbated by the fact that 45% of dentists in England have reduced their NHS commitments since the start of the pandemic, which puts more pressure on an already strained system. A reported 75% of dentists say that they are thinking of reducing their NHS commitment this year, so it is important to look at what needs to be done to help the dentists still committed to NHS work and the people up and down the country—particularly in the south-west—who rely on those services. To my mind, there are two primary actions: contract reform and quick investment.
There are clearly a number of issues with the NHS dental contract, as we have said. I recently wrote to all 17 dental practices in my constituency, and I am in regular dialogue with the local integrated care board, and they all tell me that the dental contract needs urgent reform. It seems that the current terms of the contract make it incredibly difficult for local boards to recruit new dentists to meet local demand. I worry that the situation for our integrated care boards is not sustainable and could become worse.
I apologise for interrupting my hon. Friend’s concluding remarks. Does he agree that it is also worth considering whether we can improve the role of dental therapists so they can take on some of the roles, whether the £50 million underspend in the south-west should be delegated across the whole area to deal with that issue, and whether those graduating from the Peninsula Dental School—something we are proud to have in the south-west—should be encouraged to stay in the area, given that the demand there is greatest? Above all, given my hon. Friend’s excellent speech and the points he has made, does he agree that the dental recovery plan, which we have been promised and for which we have been waiting for too long, must be brought forward immediately?
My hon. Friend gives me no chance to do anything other than agree. He is right. I hope the Minister is hearing loud and clear from the south-west that we cannot go on with this situation. There is no need, especially when we have dental underspends, for us not to take advantage of those opportunities as they arise. I also agree with him that we need to find more new and innovative ways of solving the issue and help a broadly willing dental team across the south-west.
To conclude, I urge the Minister to take note of all that I have said and what all my hon. Friends and hon. Members will have to say. I will also leave the Minister with a clear idea of what we need in West Dorset. First, I understand that there are plans for a substantial dental school in Dorset. I am pleased to hear that and am eager to lend my support. Can the Minister share more details? Secondly, NHS 111 needs to understand the situation of our dental practices and stop directing frustrated patients to those practices’ already swamped telephone systems, causing busy staff to receive unnecessary abuse for problems that are not necessarily within their power to fix. Finally, the contract and the amount of compliance within it, as my hon. Friend the Member for Totnes (Anthony Mangnall) pointed out a moment ago, needs an immediate review and immediate reform. Otherwise, we will continue to lose NHS dentists and the situation will worsen dramatically. I look forward to hearing from my hon. Friends and hon. Members in this debate and, indeed, the Minister at the end.
Order. A lot of people want to take part in the debate so, to try to avoid a formal time limit, I ask Members to keep to an informal five-minute limit.
It is a pleasure to see you in the Chair, Ms Elliot. I congratulate the hon. Member for West Dorset (Chris Loder) on securing the debate; the turnout shows why he felt compelled to do so.
Let me quickly outline the key problems that I see in my constituency. People who are not registered with an NHS dentist cannot get treatment now because almost all practices in the area are not accepting new patients. There are patients who are registered with a surgery but cannot get an appointment because there is no longer an NHS dentist working there. In my case, I left my NHS dentist because every time I had an appointment it was cancelled, because the practice was moving dentists around other surgeries in the chain where there was higher demand.
Practices are deregistering NHS patients—that is, removing them from the active patients record—if they have not seen the dentist within a set period of time, to make room for patients on the NHS waiting list. They are legally allowed to do that. Some practices are closing down, including the Bupa surgery in the constituency of my hon. Friend the Member for Bristol West (Thangam Debbonaire), which is used by a lot of my constituents and is about to close.
There is also an issue for pregnant women, who are entitled to free dentistry on the NHS yet cannot see a dentist at all. I have asked a number of parliamentary questions about that. Pregnant women are more likely to suffer particular dental issues and there is an increased risk of certain health complications if the dental problems worsen. An estimated 1 million pregnant dental care patients in England missed out on dental care between March 2020 and March 2022, and they are still finding it very difficult.
On the underlying issue of the shortage of dentists, they say they are not incentivised to work for the NHS. They intend to leave for better pay and working conditions in the private sector, or are considering going overseas. An estimated 2,000 dentists—10% of the workforce—left the NHS last year. As a consequence, patients in pain are being forced to seek private treatment because they cannot see a dentist. They have to wait for tooth problems to become emergencies before they can get urgent treatment at the University of Bristol Dental Hospital, which can offer only a certain number of emergency appointments per day.
It is a pleasure to serve under your chairmanship, Ms Elliot. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this debate on a vital issue for our region.
The issues with getting a new NHS dentist in the south-west are, sadly, all too well known. I have regularly been contacted by constituents who, when their current NHS dentist has retired, or in one case converted to a fully private practice, are unable to find a new practice accepting NHS patients. Last night, when I checked the NHS website for Torquay, there were no practices listed as accepting new NHS patients. Although many were listed as not having recently given an update, their position is easy to work out from the feedback I receive. As has already been set out, the issue is not limited to Torbay.
For me, there are two key areas of focus for tackling this issue: ensuring that more of the existing dental workforce and practices offer NHS services, including by accepting new patients for registration; and expanding the future dental capacity in the south-west through training and recruitment. On the first point, the key will be to ensure that contract arrangements are attractive and provide a viable proposition to those who will provide the services.
I am aware that NHS England is holding further discussions with the British Dental Association and other stakeholders for contract reforms that are planned to take place this year. The Government talk about aiming to reduce barriers to patients trying to access dentists by changing the arrangements for treatments such as root canals, improving patient communication and recruiting overseas dentists—although we should not always assume there is a pot of skilled labour available over an immigration bridge—so it would be good to hear more about the progress being made. Where it is not possible in some areas to secure new contracts with providers, will the Government consider looking at more direct provision? We simply cannot allow deserts of treatment to exist.
Does my hon. Friend agree that it is essential that dentistry, along with other medical disciplines, is included in the upcoming NHS staffing plan, which we all hope will involve a substantial increase in the number of people being trained at all grades of medical discipline, including dentistry?
I look forward to the Minister’s response, and have two specific questions for him, in addition to those already raised. First, what progress is being made with renegotiating the contract, and what results is he expecting to see in the south-west this year from those renegotiations in terms of the increased accessibility of NHS dental services? Secondly, what plans does he have to create additional training spaces in the south-west, given that we know that where people train is where they are likely to stay and practise?
For too many in the south-west, NHS dentistry has become a service that is difficult to access and hard to register for. I hope that in his response the Minister will set out clearly the action we will see to get more dental practices to provide NHS services, and more dentists providing NHS services across the south-west region.
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The reports also raised concerns that there would be a shortage of NHS dentists, a glut of people who would be left without access to NHS dentistry, and no guarantees that the reformed contract would be enough to commit dentists to the NHS rather than private practice.
The contract also seems to include irregular and sometimes near-nonsensical patterns of remuneration, which are undoubtedly playing on the minds of dentists considering their commitment to NHS work. For instance, dental practices are often remunerated for one filling only, regardless of the number of fillings needed for a given patient, which reduces the incentives for dentists to stay working with the NHS. That cannot be right.
Behind-the-scenes work is often missed when the work that a practice has carried out is calculated. For example, if a patient were to require one X-ray examination, two fillings, one extraction and two appointments for root treatment, that would total more than four hours of clinical time and would be counted as five units of dental activity or UDAs, which is the way that the NHS measures practice activity. Not included are the cost of materials, the nurses’ time setting up the procedures or the receptionists’ time booking the appointments and chasing patients should they not attend, all of which are hidden from the current contract. Transparency is key. As part of a wider reform of the NHS dental contract, West Dorset constituents who have got in touch with me would appreciate greater transparency in the requirements for such treatment.
One of my constituents recently had an abscess in their jaw. Like many in that situation, they called the nearest dental practice. As I said earlier, there was a 22% chance that they would be told that the practice had gone private, a 42% chance that they would be told that it was closed to new patients, and a 50% chance that they would be added to a 12-month waiting list, leaving them with an abscess until this time next year. Fortunately, those things did not happen. My constituent got through and made an appointment, although the dentist informed them that they did not regard the situation as an emergency, so my constituent was forced to go elsewhere, which reset the clock on their waiting list.
The dental practices that have contacted me have also shared stories of the abuse that their staff receive on a daily basis due to the lack of capacity, of how 111 continues to tell people to call their dental practices despite them not holding emergency contracts with the NHS, and of how the unfair UDA system acts as a direct negative contributing factor to the current situation faced by NHS dentistry.
Reformation of the service is clearly vital. When we previously debated the Health and Care Act 2022, I said that simply throwing money at the problem will not make it go away. Yet funding is, of course, the other vital area of improvement in this equation. Between 2010-11 and 2021-22, total funding for dental services in England fell by 8% in real terms, from £3.36 billion to £3.1 billion. Further, where practices have underperformed in the past, NHS England have not released the funding, resulting in an underspend of the national dental budget. I therefore urge the Minister to maintain his commitment to reforming the unpopular 2006 dental contract, to make vital and necessary changes to unfair remuneration, and to act before the situation gets any worse and more dentists are lost. That is very important.
Those who cannot afford a tooth extraction with a private dentist and cannot get an emergency NHS appointment are pulling out their own teeth in agony. Constituents have told me that that is a fact. Dentists are seeing more people with higher levels of dental need, because the wait for an NHS appointment means that a minor problem drastically worsens over time so that, in the end, they find they need to have their teeth removed. Some patients say that because they have not been able to get an appointment since lockdown, they have been kicked off the dentist’s records for not attending.
I would like to quote a few constituents. John says he was due a check-up in January 2023. It was cancelled and he was offered a new appointment for April 2023. That, too, was cancelled, and he has been told to phone again in November to make a new appointment. He has a refugee from Ukraine staying with him who managed to go back to Lviv for Christmas. She says she was almost as pleased about getting a dental appointment in Lviv as she was to see her family. John says:
“Dental care in a war zone is functioning better than”
it is in Bristol.
Another constituent, from St George, has not been able to register since she moved to Bristol a year and a half ago. A colleague of hers tripped and knocked out her front tooth. She had not been able to register with an NHS dentist and had to spend her entire £4,000 of savings on a visit to a private dentist.
Katy, another constituent, is halfway through her pregnancy and entitled to free dental care. She spent hours scrolling through lists of dentists, phoning all the ones that might take on NHS patients. She says:
“I cannot find a single dental practice which is accepting NHS patients.”
The final constituent I want to quote is a dental practice manager who says their practice is a little better able to attract and retain dentists because it holds a contract with a UDA—units of dental activity—rate of £30.92, which is well above the area average, which is £25.98. Even then, the practice has been able to fill only half of it NHS dentist vacancies. She says:
“Without long-term workforce planning and meaningful reform of the NHS General Dental Service contract, the system and those who rely on it most will continue to suffer.”
I have taken this issue up with the Government, NHS England and the local integrated care board. Generally, the Government recommend that people visit the NHS “Find a dentist” website. Local NHS services have been working hard to commission more urgent dental care appointments. They are also offering stabilisation sessions for those who do not have an NHS dentist, cannot afford to go private and need an urgent fix to a problem like a broken tooth or a damaged filling. But clearly this is not good enough.
I reiterate the point the hon. Member for West Dorset made. We need to work on retaining as well as recruiting NHS dentists and we need to reform the dental contract which, as he said, is simply not fit for purpose. Given the time, I will leave it to others to raise some of the other questions. I could talk for a very long time about the problems my constituents are suffering from.
On expanding future capacity, the Association of Dental Groups has said that the key to easing the burden of the unmet need for dental services is simply going to be more dentists, which includes creating more training spaces. I am aware that in England the Government fund the training of around 800 dental students per year. In the past, the Government have said that places are capped to ensure that teaching, learning and assessment standards are maintained, as well as to ensure that there are enough high-quality placements for each student.
It is clear that the current level of supply is not going to meet future demand. There does, though, appear to be more capacity for training. In 2020, the cap on the number of dentistry school places in England was lifted, to accommodate the higher number of students meeting their university offers following changes to exam arrangements prompted by the covid-19 pandemic. Similarly, in 2021 the cap was adjusted again. That suggests that capacity is available.
In 2022, the Dental Schools Council called for an increase in the number of dental school places. The DSC presented three proposals agreed by the deans of UK dental schools to safeguard dental training and secure and improve the supply of future dentists by increasing dental school places. Again, that suggests that there is capacity to expand good-quality training here in the UK, ideally in the south-west.