“Across the country there are challenges with dentistry – and the inequalities that exist make the challenges even greater,” says Mark Creelman, Executive for Merton and Wandsworth boroughs and dentistry lead across south west London.
“We do well on dentistry targets in south west London but we know that’s not the whole picture so we need to start by listening to what residents are telling us.”
“Across the country there are challenges with dentistry – and the inequalities that exist make the challenges even greater,”
NHS South West London took over responsibility for dentistry in 2023 along with pharmacy and optometry. Work to boost access has begun – local dental services are recovering well from the impact of the pandemic and NHS dental hubs are now operating between 8am and 2am, available to anyone with urgent dental problems.
To start to address issues with dentistry long term, NHS South West London came together with dentists, public health experts, Healthwatch and the voluntary sector for a dental day on 9 October 2024.
What are the issues?
According to Katie Rogers from Healthwatch Richmond (below right): “Every week we help people who are unable to find NHS dentists – we’re not aware of any that are currently taking on new NHS patients.”
Residents of Richmond aren’t alone. The six Healthwatch bodies in south west London – the voice of patients on health issues – have examined the NHS dentistry experience across the boroughs, surveying residents, hearing their stories and compiling data.
They found examples of inequalities with people feeling excluded because of cost, where they live and language barriers. There were stories of people avoiding or delaying treatment.
Where people were unable to access dental care early, the impact was felt across the health system as they turned to GPs and A&E.
Prevention is important too
While access to NHS dentists is one issue, improving oral health to prevent disease in the first place is crucial. According to NHS England, tooth decay is the most common reason for hospital admission in children aged 5 to 9-years-old.
Oral health disproportionally affects older adults too, particularly those with dementia or who live in care homes. Lack of dental care can lead to malnutrition, dehydration and worsen other health conditions such as diabetes or pneumonia.
“What I would love to see is an idea of how we can work together across south west London – how we can support with knowledge and resources to help improve outcomes for our populations.”
During the day local public health teams talked about the picture in their areas, with examples of projects to improve oral health. These included ways to make primary schools water only, supervised tooth brushing sessions and training for early years staff and health visitors.
Tolu Oloyede (above) is public health lead for children and young people at Richmond and Wandsworth councils. She talked about the inequalities young people experience in accessing care and her hopes for collaboration: “What I would love to see is an idea of how we can work together across south west London – how we can support with knowledge and resources to help improve outcomes for our populations.”
The national picture
For many of the delegates, issues with care can’t be tackled without addressing the national contract that governs how dentists work in the NHS and which dates from 2006.
Put simply, the contract breaks down NHS dental work into ‘units of dental activity (UDAs)’. The number of UDAs per head of population are commissioned by the NHS locally. These vary across boroughs, even in south west London.
While the national contract is being renewed, there is a frustration among dentists who feel powerless to offer people the care they expect or explain the complex set up that limits activity and sets the cost of treatment.
Kingston dentist Kunal Patel explained: “We know we have a problem in terms of inequalities and patient access on the one side and on the other side we can’t change the national NHS contract. We’re here today to talk as a group about how we can bridge the gap between the two.”
What people said
The day included group discussions around ambitions for dental services with ideas ranging from mandatory access for all under 18s to better integrated dental and general healthcare. While some called for free dental care for all and no waiting times, there were also discussions about incentives for more dentists to take on NHS work and better data sharing across organisations. A big focus on prevention and help for patients to get more engaged in their care was also covered.
“Today is the start of a journey but there are things we can do in south west London to galvanise people, to make change.
While the group won’t solve local dentistry issues overnight, according to Mark Creelman there are distinct areas where progress can be made.
“Today is the start of a journey but there are things we can do in south west London to galvanise people, to make change.
“We will look at what changes we can bring outside the scope of the NHS England contract to improve access, especially when it comes to inequality.
“We can also standardise access across our boroughs. And we can work together to share our intelligence and data for improvements across our organisations.”