Health bosses discuss shortage of NHS dentists in Somerset

The number of Somerset adults who regularly see an NHS dentist has dropped dramatically over the last six months – although the access rate remains higher than the England average.

The shortage of NHS dentists across the county has been blamed on numerous factors, from the “flawed” contract system implemented in 2006 to more lucrative opportunities in the private sector.

NHS managers have assured councillors that they are doing “everything we can conceivably think of” to recruit more dentists to the area and to persuade existing practices to see more patients.

How does NHS dentistry work?

Unlike other NHS services, seeing your dentist isn’t free at the point of use – unless you’re on a low income, receiving benefits or meet other criteria.

It was originally free to see your dentist when the NHS was created in 1948 – but following unexpectedly high demand, charges were introduced for dentures in 1951 and for other dental treatments in 1952.

Rather than working directly for the NHS, dentists are private contractors, who enter into agreements with NHS England to provide a certain amount of treatments (known as units of dental activity) per year.

Each dental practice has an agreed amount of units of dental activity which it must perform – and if it doesn’t meet them, the NHS allows other practices to bid for the remaining units on a short-term basis to meet demand (known as ‘clawback’).

How has the coronavirus pandemic affected dentists?

At the end of March 2020, all routine face-to-face dentistry ceased in line with the national lockdown guidelines, with urgent dental care hubs being established across England to deal with emergencies.

As the pandemic has worn on, dentists have slowly been able to see more and more people as restrictions have changed and the vaccination programme has been rolled out.

Between June 8 and December 31, 2020, dental practices were expected to see 20 per cent of their normal patient levels, based on the amount of work carried out in the previous year.

This target has gradually risen and now sits at 85 per cent, with the NHS’s chief dental officer expecting all practices to return to 100 per cent activity levels from April 1, 2022 onwards.

During this entire time, however, dentists were still paid at full contract levels, in order to prevent thousands of dentists from quitting and therefore being unavailable for NHS work as the pandemic has worn on.

Why aren’t there more NHS dentists in Somerset?

NHS England estimates that there is a shortage of at least 23 full-time equivalent dentists across the 66 dental practices providing NHS treatment in Somerset.

There are a number of different factors at play here – many of them relating just as much to Somerset’s unique geography and economy as it does to funding and training.

A report which came before the county council’s adults and health scrutiny committee in Taunton on Wednesday (January 26) identified the following issues:

• Being based in Somerset is viewed as “a lifestyle choice”, with younger professionals often preferring to be based in larger cities due to their “greater transport links and more training opportunities”
• Foundation dentists – who are training for a year after graduating – relocate at the end of their foundation year, with Somerset having less clear routes into hospital-based jobs or further training (possibly due to a lack of university)
• Established dentists leave the NHS because of “high demand from patients”, with new housing growth compounding already low numbers of dentists
• There are “opportunities in private care” which are better paid than NHS work and which allows dentists more flexible work arrangements

According to official NHS figures, the total number of Somerset adults who saw an NHS dentist fell from 214,715 in December 2020 (47.6 per cent of the county’s population) to 196,949 (43.7 per cent) in June 2021 – a drop of 17,766 in just six months.

Despite this drop, it is still higher than the England average of 41.1 per cent of adults (measured over a two-year period).

The number of children seeing a dentist has actually risen in the last six months, from 31,810 (28.6 per cent of children in Somerset) in December 2020 to 37,160 (33.4 per cent) – with this figure also being above the England average.

How bad are patients’ experiences?

Several committee members vented their frustrations at the meeting on Wednesday (January 26), relaying stories about their constituents who had been unable to secure NHS treatment.

Councillor Ann Bown (who represents the Bridgwater West division) said: “Are we trying to push people into private dental care, instead of looking after them in the way that the NHS is supposed to do?

“People can’t go to 111 and get sorted. They’re in pain and they need to see a dentist – a friend of mine has been trying since late Friday [January 21] and they cannot get an appointment. This person has been with this dentist for 20 years.”

Councillor Hazel Prior-Sankey (Taunton South) – who chairs the committee – observed: “It seems if you have a dentist, you can’t access urgent care. And you can’t get through the dentists’ surgery because the lines are always busy.

“Even if you can get through, the urgent list is weeks ahead – people are waiting seven or eight weeks to get an appointment, then the emergency dentist smooths it off or patches you up and sends you back to your own dentist.”

Councillor Andrew Govier (Wellington) added: “People contact me on a weekly basis saying they can’t access their dentist. There seem to be quite a lot of dentists in the Wellington area, but none of them are offering NHS facilities – that seems to be the problem.

“A lot of dentists have withdrawn from the NHS contract. Covid has contributed to that because they’ve not been able to see so many patients on the NHS.

“The cost of private dentistry is vast. I had an elderly couple who both needed work and they were quoted £1,000 each.

“Can we as a council add our shoulder to the wheel in trying to push this up the chain to the government? Unless we get it sorted, this situation is going to get a lot worse.”

Councillor Mark Healey (whose Huntspill division includes numerous villages around Bridgwater and Highbridge) said more needed to be done to incentivise dentists to work on the NHS – making sarcastic comments about his own experience with private dental care.

He said: “My particular dentist has an ocean-going yacht and a second flat – and he charged me £1,700 for some routine surgery.

“There are more people moving from London to come to the south-west, for a cheaper standard of living. That puts a strain on services locally.

“We need to get these private dentists back into the mainstream, and there should be a university in Somerset, practising dentistry, so we can keep people locally.

“This is one area of the NHS which needs pushing – it needs a good filling, frankly.”

What is going to be done?

Louise Farbus, the head of stakeholder engagement for NHS England and NHS Improvement, said she and her colleagues were trying out numerous different approaches to address these issues.

She said: “Our dental team is going everything we can conceivably think of with our dentists – because they are the people we need to convince to do more or see more patients.

“It’s like trying to convince a turkey to vote for Christmas, because our dentists are very overworked.”

The NHS announced on Tuesday (January 25) that £50m would be spent on providing urgent dental appointments to deal with the backlog – of which £5m will be spent across the south west.

READ MORE: Ian Liddell-Grainger welcomes £50million boost for dental services

Tessa Fielding, the NHS’s dental commissioner for the south west, said: “We are now in the process of re-procuring lost contracts, and we’ve already had 16 expressions of interest. People do still want to work on the NHS.”

Ultimately, however, Ms Fielding said many of the problems would persist until issues with the 2006 dental contracts were addressed by central government.

She said: “The current contract that dentists are working under has been in place since 2006 and it’s flawed. We are trying hard to do dental contract reform, but we don’t know when it’s coming.

“Flexible commissioning allows us to take a percentage of a dentist’s contract and ask them to do something with it.”

The committee has asked council leader David Fothergill to write to health secretary Sajid Javid MP, requesting urgent action on this issue.