Ian and Hayden X Graphic.jpgToday we want to tell you about one of our top system priorities – improving dentistry and oral health in West Yorkshire.

Our ICB assumed commissioning responsibility for dental services on 1 April 2023, meaning we must ensure that dental services are in place and accessible for the people of West Yorkshire. We were really keen to take on responsibility for these services. We have heard consistently over several years the level of concern that people have with accessing dental services in our region. These are long-standing issues that reflect decades of underinvestment in dental services and a national contract that does not support a population health approach.

Many of the solutions to these problems are beyond our direct control – such as contract reform, dental funding that fully meets people’s needs, water fluoridation and national dental workforce plan. However, we believe that by working flexibly and creatively there is more we can do to better meet people’s needs. Over the past six months we have been listening and learning – both as an organisation, and from people’s lived experiences. We’ve heard first-hand the importance of dental access from the people of West Yorkshire and know that it remains an issue. We’ve also met brilliant clinicians through our Local Dental Network and Local Dental Committees who have real passion for improving services and great ideas about how we could go about it. 

In May our Board considered these issues, and fully supported our plan for making improvements, which included the following:

Utilising our financial resources

A range of complex factors including the national contract, workforce capacity and morale, and post-pandemic recovery, frequently result in dental contracts not delivering contracted levels of activity. This means that people struggle to access dental care, and that a percentage of the total dental budget is often underspent.

Addressing such issues is challenging. It is not impossible. We forecasted the underspend for this financial year and developed a £6.5m investment plan to deliver an immediate impact, focusing on:

  • Continued funding for access to urgent dental care, ensuring that when people are suffering severe dental pain and have an urgent need they can get seen in a timely manner.
  • Targeted intervention for population health groups. For example, our homeless scheme In Leeds, which has delivered 419 treatment episodes to date, working with VCSE organisations to support people to access the appointments they need, has been extended to our other places. We are also investing in other groups, including refugees/asylum seekers, and children.
  • Working with Community Dental Service (CDS) partners to fund a ‘level 2’ scheme that will treat patients in a primary dental care setting and reduce waits, amongst other initiatives.
  • Prevention, including enhancing existing local authority initiatives and partnering with the University of Leeds, for example on an initiative to support oral health in children with autism.

Expanding flexible commissioning

Flexible commissioning is a different way of contracting for and providing dental services. It substitutes part of the dental contract for more targeted activity. This improves and targets access and helps to retain our staff. We are already doing this but can go further. Our ambition is to substitute up to 25% and bring more practices onto the scheme to maximise the benefits for patients.

Toddler cleaning their teethDeveloping a local dental workforce plan

Having the right dental workforce working in an optimal environment is critical. At present the system is beset with significant challenges. Our WY dental workforce plan will aim to address these challenges and set out how we plan to recruit, retain and train to build a multi-professional dental workforce that supports our intentions. The plan will focus on:

  • Surveying the dental workforce
  • Developing innovative training models, e.g. Level 2 Paediatric Dentistry
  • Centres for Dental Development
  • Recruitment of international dental graduates.

Working with local authorities

The ICB responsibility for commissioning runs parallel to local authority responsibility for oral health promotion and prevention. They are two sides of the same coin. Our shared priorities include water fluoridation, as a significant public health intervention and working with the Department of Health and Social Care across the Yorkshire and Humber region on this. And improving and joining up our data to support a life course approach to prevention and treatment.

This is a snapshot of the challenges we face and the breadth of work we’re managing to improve dental services and the state of oral health in our region. It’s an important starting point and will have a positive impact. But we know there is much to do.

On all our priorities, how we deliver them is important. We’re committed to working with the profession to codesign solutions. We also want to involve local people and are working with Healthwatch to do this through a Dental Patient Reference Group.

Some changes require us to look beyond West Yorkshire, for example at the national dental contract and water fluoridation. We will continue to work with regional and national partners to make the case for these things. Some changes are immediately within our gift as the commissioner. Most changes require us to work in partnership, across our Partnership. Poor oral health and access issues have a profound effect on people’s lives, from poorer school attendance for children to social impacts amongst adults and risk factors shared with oral cancers. There is a significant relationship with various indicators of inequality. Addressing this requires action at all levels, from a variety of agencies, and through empowering people themselves.

At just six months in we have only started this journey and have prioritised immediate impact. I really welcome any thoughts you might have about how we grow our impact. Please do get in touch with us.

Thank you for reading.

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