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ICBs do not have ‘resources or expertise’ to manage NHS dentistry

ICBs do not have ‘resources or expertise’ to manage NHS dentistry
By Jess Hacker
14 July 2023

Many integrated care boards (ICBs) do not have the ‘resources, tools or expertise’ to address inequal access to NHS dentistry nor properly integrated services, MPs have cautioned.

ICBs gained commissioning responsibility for dentistry in April with a view to improving to improve local access.

But the Health and Social Care Select Committee today (14 July) warned that it is ‘concerned’ ICBs will in fact be ‘restrained’ from commissioning more flexibly under the current contract.

The report said: ‘Whilst we recognise that they are still in their early stages, and that dentistry poses one of the greatest commissioning challenges for them, it would be disappointing if the opportunity to improve access to local services were not taken.’

MPs claimed that any contract reform now would ‘almost certainly be too late for those dentists who have already left the NHS’, and urged the Government to focus on incentivising those dentists who still undertake NHS work, including the reintroduction of NHS commitment payments.

Earlier in the inquiry, the Committee criticised the lack of dentist representation on ICBs.

The Committee also proposed NHS England give ICBs a deadline of July 2024 to undertake an oral health needs assessment to ensure they are able to fully integrate their services.

MPs also shared concerns as to whether primary dental care underspend would be ‘directed away from dentistry’ and used to ‘plug gaps in other budgets’.

Data previously obtained by the British Dental Association (BDA) forecast an underspend of around £400m by the end of 2022/23.

NHS England’s director of primary and community care at NHS England, Dr Amanda Doyle told the Committee that ‘no ICB can spend a dental allocation on anything that is not NHS dentistry’.

However, she added: ‘The trouble is, we do not know up front at the start of the year the size of the clawback that will be available, because we do not know the extent of under-delivery by dental providers. We have now introduced measures whereby we are actively reviewing and intervening on providers that are delivering less than 30% of their month-on-month contracted activity, so we can try to free up some of that funding earlier in the year and then commission locally to find alternative ways of providing dental activity.’

The MPs recommended that this ringfence be permanently applied, and urged NHS England to put in place transparent scrutiny to ensure compliance.

Chair of the Committee and MP Steve Brine said: ‘Rarely has an inquiry been more necessary than this one. To hear of someone in such pain and distress that they resorted to using pliers to extract their teeth demonstrates the crisis in NHS dental services. The problem is compounded by people being unaware of what they’re entitled to and a contract that is unfit for purpose when it comes to paying dentists for treating NHS patients. Today we register in the strongest terms possible our concern for the future of NHS dental services and the patients who desperately need access to them.

‘Declining levels of NHS dentistry activity should have been sounding alarm bells, as should a projected budget underspend of £400 million. 

‘What’s particularly frustrating is that recommendations made by our predecessor Committee 15 years ago to reform the dental contract have still not been implemented. Yet contract reform alone is unlikely to bring back dentists who have already left the NHS or are considering leaving in the near future.

‘We endorse the Government’s ambition to ensure that everyone who needs an NHS dentist can access one. Belatedly, now is the time to deliver it.’

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