NHS Dentistry: Bristol and the South-west

Debate between Maria Caulfield and Darren Jones

Monday 24th January 2022 Commons Chamber

[Maria Caulfield]

I will come to that in a moment, but let me first conclude on the impact of covid on dental services. The hon. Member for Bristol North West may be reassured to hear that the proportion of adults and children accessing dentists in Bristol, North Somerset and South Gloucestershire remains higher than the average for access to dentistry in England. It is probably no consolation to his constituents, but access is slightly higher.

[Darren Jones]

Is the average acceptable or below where the Minister would like it to be?

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[Maria Caulfield]

I have been clear that covid means we are not yet operating at 100% of normal activity. We need to get back to pre-covid levels, when the majority of patients were able to access a dental appointment and around 28 million people saw an NHS dentist every 24 months. That is where we need to get back to but we will struggle, because of infection-control measures due to covid, to get there until we are at 100% of activity.

I reassure the hon. Gentleman that NHS England is supporting local commissioners. There was an intervention about helping to get more service provision; provision is commissioned at a local level, not by the national Government. National Governments provide the funding and then local commissioners commission the services. It is important that Members talk to their local commissioners to understand what services are being commissioned. NHS England provides flexible commissioning toolkits to local commissioners to help to focus the available capacity.

[Darren Jones]

Does the Minister recognise that local commissioners can only commission dental services if the NHS dentists exist and are willing to provide NHS dental services? The core of my debate this evening is not about the impact of the covid pandemic, which we all recognise; it is about the underlying issues of the dental contract and the shortage of dentists. Does she recognise that?

[Maria Caulfield]

I will come on to the contract, which was developed in 2006 under the last Labour Government, and highlight the impact it is still having on dentistry—

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[Maria Caulfield]

No, I will not give way. The right hon. Gentleman is obviously not interested in my response.

In Bristol, North Somerset and South Gloucestershire, a dental helpline has been set up to help patients to find an NHS dentist for routine care and to arrange urgent treatment. In addition, we have written to dental practices asking them to update their online information on the nhs.uk website. It is really important that this is available so that patients can find out which dentists are taking on NHS patients and which are not. It is crucial that that is kept up to date because it does change on a significant timescale.

Dentists are also being asked to maintain a short-notice cancellation list so that they can proactively contact patients who are on their waiting list if a patient cancellation occurs. All these measures help with the underlying problem of gaining access to NHS dentists. Later this week, there will be an announcement on some extra funding so that local commissioners will be able to commission services, because in some areas there would be more capacity if extra funding were available. Colleagues across the House will see the details of that in the coming days. My hon. Friend the Member for Thornbury and Yate (Luke Hall) intervened on a similar point. I am happy to meet him to discuss the issue around Frampton Cotterell, as I am happy to meet all Members if they want to raise specific local issues around dentist availability in their constituencies.

To get to the crux of the long-term issues, we hope to get to 100% capacity at some point post the pandemic. However, as mentioned by many colleagues, there is an issue with the dental contract, which has perverse disincentives within the UDA—units of dental activity—system, which dentists struggle with because they are paid similar rates when they are taking out one tooth or doing one filling as compared with doing extensive dental work. This is a disincentive to dentists to take on NHS patients, or sometimes to hand back NHS contracts.

Work has already commenced on dental contract reform. The Department and NHS England are working with key stakeholders, including the British Dental Association, to look at alternative ways of commissioning services, because only when we address the fundamental of the contract that dentists are working on will we get to the crux of the matter of the poor uptake of dental contracts and the reluctance of dentists to take on NHS work. Our aim in contract reform is to improve patient access, reduce health inequalities and make the NHS a more attractive place to work for dentists, making them feel more valued and helping to recruit and, more vitally, retain the experienced dentists who do so much to protect and promote oral health in this country. I am sure that the hon. Member for Bristol North West will welcome that. We are making some building blocks in terms of work that is already happening.

A number of Members touched on the issue of recruitment and retention of dentists. Only in September last year, Health Education England published its “Advancing Dental Care” review report on a four-year programme of work to recruit, retain and train not just dentists but dental teams. We have identified more effective ways of utilising the skills mix in the dental workforce. We are widening access and participation to training, we are allowing more flexible entry routes, including for overseas dentists, and we are developing training places for dental professionals, not just dentists; we want to upskill dental technicians and dental associates by providing them with more skills so they can provide a greater range of services. We are also looking at providing training in areas where we have dental deserts—where we do not have dental provision that local commissioners can commission. Importantly, we know from GP trainees that those who train in an area are more likely to stay in the area. We want to facilitate that. Health Education England is doing a huge amount of work to make that happen.

[Darren Jones]

I thank the Minister for her answers. One specific question I asked was about the recognition of EU qualifications and the 22% of dentists in the UK who originate from the EU. Can she answer that specific question please?

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[Maria Caulfield]

Absolutely. We want to encourage everyone who wants to come and work in the United Kingdom to be able to do so, and we are working with the General Dental Council to make sure that happens. Currently a period of continued automatic recognition is in place for dentists with EEA and Swiss qualifications wishing to work in the UK and we want that to continue. Those with qualifications which were previously automatically recognised will continue to be recognised in the UK. I have heard from dentists from abroad who want their qualifications to be recognised here and we will work hard as part of the contract reform to make sure that that process is easier than at present.

On preventive work, my hon. Friend the Member for Mole Valley was absolutely right to point out that, as well as dealing with dental issues, oral health is crucial, and the Health and Care Bill is introducing proposals that will transfer the power to bring forward the new water fluoridation schemes, which will transform the oral health of many in the most deprived parts of our country, and could reduce the level of decay among five-year-olds by up to 28%. Simple measures such as that will make a big difference.

Although tonight I am unable to present colleagues with a quick-fix solution, I want to assure them that we are dealing with the issues covid has brought to us and we will be announcing further funding in this financial year to help to deal with some of that backlog, but there are issues with the current dental contract that unless addressed will continue some of the problems Members have raised this evening.

[Darren Jones]

I thank the Minister for giving way one last time. Might I gently suggest that the advice the Minister has this evening given my constituents in Southmead and across Bristol and the south-west who cannot get access to an NHS dentist is to call 111—they have tried that; it has not worked—to try to find a local NHS dentist, which they have tried too, and has not worked, and to wait for reform of the NHS dental contract, which has been in place since 2006 and this Government have been in office since 2010? They have been waiting for many years for that and I am not sure they are going to see it any time soon. I have constituents who are in pain waiting for dental care, and children who are not being seen. What are the immediate interventions the Minister can make? She has not offered any this evening.

[Maria Caulfield]

I would strongly disagree with the hon. Gentleman. He wants to work in a constructive way to deal with the issues facing his constituents, and he has already said that he wanted to meet the Minister, but he has never made an approach to meet me ever—

[Darren Jones]

Will the Minister give way?

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[Maria Caulfield]

I will not give way any further; I think the hon. Gentleman has made his points fairly clear. I have said to him that we are issuing a range of help. I have said there will be announcements later this week about funding in this financial year to help patients to be able to access dentists. I have also said that we are—

[Darren Jones]

On a point of order, Madam Deputy Speaker.