Agenda item

Keith Percival, Honorary Secretary, Hampshire and Isle of Wight Local Dentists Committee, Dr Janet Maxwell, Director of Public Health and Dr Jeyanthi John, Consultant in Dental Public Health, will answer questions on his report which is to follow.

Dr Janet Maxwell, Director of Public Health and Keith Percival, Honorary Secretary introduced their reports.  In response to questions from the panel they clarified the following points:

·        With regard to the figures in paragraph 2.3 it was clarified that it was 25% of the total of 12 year olds who had untreated decay.

·         A dentist did not visit all schools routinely. Public Health were focussing on targeting pre-school children, making sure they are registered with a dental practitioner and that parents are able to educate their children on how to brush their teeth.  The team are working with schools to provide dietary advice, targeting those in the more deprived areas of the city.

·         The 'Brush Up' fluoride varnish programme targets children in year R.

·         The issue of fewer NHS dentists may have had a knock effect on the low figures of adults who had attended the dentist in the last 12 months. Mr Percival was not convinced that there were fewer dentists providing NHS dental services and added that there were 28 NHS dental contacts in Portsmouth with a value of just over £9 million. Money from underperforming dentists was clawed back. Due to the 2006 regulations however dental practitioners cannot exceed their contracted value by more than 2% and take on more patients even if they have workforce and appointment capacity, which was a flaw with the 2006 contract. The Local Dental Committee does not commission dental services and this is the responsibility of NHS England.

·         The current system is not flexible and Mr Percival advised that under the forthcoming contract reform process he would like to see equitable activity flexing between practices to allow patients to attend a different practice to capitalise on the funding available in the city areas and beyond.

·         Dental health is the responsibility of the top tier authority so in a two tier system it is the county's responsibility.

·        If a patient is suffering from severe dental problem (out of hours) for example if this was affecting the patients breathing or it could life threatening they should telephone the 111 service who would advise the patient to attend A&E. There should be no reason why A&E should not treat the infection and provide medication with possible hospitalisation.  There are also emergency dentists throughout the area and the 111 staff can advise on the nearest practice.

·        Councillors felt that Portsmouth dental academy was an excellent facility and a great resource for the city.  The dental students and staff provide thorough work and are very patient. 

·         Before the fluoride varnish can be applied, teeth need to be clean and ideally healthy.  The issue with the fluoride varnish outreach programme has been obtaining consent from parents, with the average consent rate for all schools at 80% which is lower than for tooth brushing.  This relates to the adverse publicity surrounding water fluoridation; however in areas such as Birmingham the results of fluoridated drinking water had proved to be excellent.

·         The Wessex Area Team has robust National Performers List structures in place and once dentists who have qualified abroad are established in the UK they are treated in the same way as British dentists.  Dentists in the EU are not required to complete vocational training but must participate in a training needs assessment (review) considered by a Dental Practice Advisor and a NHS England performance panel.  Other oversees dentists complete their ORE qualification to register with the GDC and go through Foundation Training by Equivalence which results in a portfolio of evidence composed over a 12 month period which is competency and quality assessed and similarly a number awarded.

·         A survey of 5 year olds was due in 2014 however there had been a delay on this due to obtaining consents from parents. It will now be carried out in 2015.

·         The supervised tooth brushing programme was targeted and is a rolling programme across schools depending on resources.

·         With regard to the dental survey contract with Solent that will expire in 2016, Dr Maxwell advised that although Solent are the current local provider other providers will be considered.

·         Councillors felt that it there were several organisations involved in dental health which was confusing and asked whether there was a diagram.  Dr Maxwell said she would look to create a diagram although pointed out that it is in the process of change. It was the role of the Health and Wellbeing Board to co-ordinate the health strategy across the system. 

Councillor Read had submitted some questions by email as he was unable to attend the meeting.  Mr Percival provided answers to these:

·         Community dental services provide some parallel treatments to the dental academy but have remits to provide paedodontic and special care services.  Approximately 27% of contracts are provided by corporate bodies but other dental practices may be owned by any number of dentists or other individuals e.g. a dental care professional may own a dental practice but may not hold the contract. These figures should be accessed from NHS England's Wessex office.

·         Individual Funding Requests (IFRs) are based on exceptionality and referrers must complete the appropriate IFR form to satisfy the clinical and non-clinical criteria that are specific to the case. The form with supporting evidence is presented to the Wessex Area Team for consideration. If successful the NHS will fund the specialist treatment from a dentist on the GDC's Specialist List for the targeted treatment discipline e.g. implants. Referrals to secondary care go via the appropriate referral form through Central Referral Centres (oral surgery and orthodontics) or more rarely by a letter generated by the practitioner.

·         Complaints to the GDC are increasing because there is a reduction in the process of local resolution of the complaint by the practices as listed in the NHS complaint process which is robust and the details are displayed in dental practices providing NHS dental services. The GDC has been found to be a poor regulator of dentists and many complaints could be dealt with at a local level to the satisfaction of patients and dentists. The GMC rejects around 50% of complaints whereas the GDC rejects less than 10%. There are robust NHS England processes in place to investigate complaints under the contract and under the National Performers List Regulations.

·         The LDN has core members from general dental practice and special care services (Solent NHSFT).

·         The Question Time Event on 16 June 2015 is open to all dentists and their teams at no cost and sponsored through the LDC and local BDA. However, this event is particularly targeted at young dentists (under 40 years) many of whom are not part of the LDC or BDA and are at risk of becoming isolated and vulnerable as their career pathway may be unclear.

ACTIONS

That the Director of Public Health provides a diagram showing is responsible for the various areas of dental commissioning and oral health in Portsmouth. 

RESOLVED that the Hampshire & Isle of Wight Local Dentists Committee report & update on oral health and dental commissioning reports be noted.