To examine Hereford’s oral health outcomes and the work being undertaken to improve the oral health of the local population.

The committee considered a report on Dental Services in Herefordshire by NHS ICB colleagues.

The principal points of the discussion are summarised below:

1. The Director of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) introduced the report and welcomed the opportunity to update the committee on progress on dental services in Herefordshire. The committee was advised that since 2022, NHS England has delegated the responsibility for the commissioning and purchasing of dental services to the Integrated Care Board (ICB). The ICB took this on in 2023. As part of the process at looking at improvements to dental services in Herefordshire, the ICB have developed a ‘Dental Recovery Plan’ which is aimed to ensure that the populations across both Herefordshire and Worcestershire have access to sustainable NHS dental prevention, care and treatment. It was recognised that the national contract for dentistry is not attractive to the profession and the ICB is tackling two key issues which challenge access to NHS dentistry – the national dental contract; and workforce. 

2. In response to a question about where new NHS dentists are being supervised, the Director of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) noted that a dental training school has been introduced locally which will support training and fast-tracking dentists that will be brought to the area.

3. The Head of Delegated Commissiong (NHS Herefordshire and Worcestershire ICB) added that the training school taps into some of the overseas dentists who are brought to the local area. They are fully qualified from their country of origin but NHS regulations in the UK require a period of mentoring before they can become a fully qualified NHS dentist. It is hoped that this scheme will help attract dentists into the local area. Some of the incentives that are being put in place incentivises them to stay for a minimum of three years and it is hoped that they will want to continue working in the area.

4. In response to a question about the contract hand-backs referenced in the report, the Director of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) commented that they are the hand-backs that were in place just prior to the ICB becoming the responsible commissioner between October 2022 - March 2023. As part of the assessment of dental service need, the ICB has undertaken an oral health needs assessment to identify across the 176 wards within Herefordshire and Worcestershire where the areas of greatest need are. The Dental Services Equity Audit looked at areas of deprivation, the number of children with decayed, missing and filled teeth (DMFT). The ICB have looked at how many units of dental activity (UDA) have been commissioned across Herefordshire and how many are needed to be commissioned to get back to the pre-covid level of 55% of the population having access to NHS dentistry. Two new dental practices being commissioned in Hereford city which was located as an area of high need.

5. The Head of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) highlighted findings from the Dental Services Equity Audit, which examined the 176 wards across Herefordshire and Worcestershire. The audit revealed that Leominster has sufficient capacity within existing contracts. However, the main challenge in the area is the limited number of providers, with only one dental access service provider and one dental provider. Discussions with underperforming practices have offered reassurance regarding workforce improvements needed to meet contractual obligations. It is acknowledged that these practices will require some time to recover and demonstrate their ability to deliver the expected activity. If they fail to do so, the contracts will be withdrawn and re-commissioned to engage additional providers within the local area.

6. The Director of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) noted that providers have been informing them that the national UDA of price is insufficient to attract dentists into their practices and to have associate dentists. Nationally that was uplifted last April to £28 for a minimum UDA rate. In recognition that many practices are struggling, the ICB has taken a decision to increase that minimum UDA rate to £31 to try and support those practices in the delivery of their contracts. In addition, in relation to training practices, nationally there is a programme for dental training practices. The national training grant that is given to that provider to become a training practice has not changed for ten years and is a reason why many practices are struggling. Consequently, for any practice that is a training practice, there are plans to increase the UDA rate to £33.50. Additionally, for any trainee that is in a practice, instead of them leaving after the end of their two-year foundation practice, they will be offered a grant to stay in the NHS.

7. In response to a question about the lack of dental places in Herefordshire, the ICB has recently opened up two new dental services. One commenced last July and a further surgery will open in April, providing a significant amount of UDA which will support in the region of 10,000 patients gain access. In addition, there has been the facilitation of the takeover of the former Bupa dental practice at Pool Farm which will be taking on new NHS dental patients.

8. In response to a question about children's tooth brushing, the Consultant in Public Health explained that the Time to Shine programme received £25,000 in funding from NHS England. Due to the success of the supervised tooth brushing initiative, the local authority public health team contributed an additional £10,300. The Time to Shine programme includes five key elements, one of which is supervised tooth brushing. Notably, 1,600 children are now brushing their teeth at school as part of this initiative emphasising the benefit of prevention.

A short presentation was then delivered by officers on the success of the Time to Shine programme in 2025.

The principal points of the subsequent discussion are summarised below:

9. In response to a question about the number of schools have taken up supervised toothbrushing in Herefordshire, the Consultant in Public Health noted that schools were targeted based on deprivation. In relation to numbers, the percentage of the number of children without access to supervised toothbrushing could be provided in the future.

10. The Consultant in Public Health added that in terms of supervised toothbrushing, the council are trailblazing in its efforts to promote the service in schools.

11. The Cabinet Member Adults, Health and Wellbeing noted the potential for a mobile dental service that could be offered to areas of the county which lack public transport.

12. In response to access issues, the Director of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) noted that NHS England performance manage all ICBs by the number of patients that are new receiving access to NHS dental services and currently as a Herefordshire and Worcestershire ICB the lowest performing in terms of having the least number of patients gaining access to NHS dentistry. In relation to the DMFT issue, Worcestershire has fluoride in parts of Worcestershire and Herefordshire does not which may help to explain the variance in the DMFT rates for children under five years of age.

13. In response to people on an NHS waiting list for an NHS appointment, the Head of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) affirmed the aim to try and provide an NHS appointment for everyone on an NHS waiting list. However, it was noted that this is a multi-year plan and as part of the recovery plan the first objective is to try to return access back to pre-pandemic levels.

14. The Director of Delegated Commissioning (NHS Herefordshire and Worcestershire ICB) added that access to NHS dental services has been in decline for the last ten years. The ICB are fully committed, however, to increasing the current position of access to NHS dentistry across both Herefordshire and Worcestershire to ensure that those patients who want to access NHS services are able to.

Resolved:

That Herefordshire Council:

1. Work with governing bodies of schools to encourage those not participating in the Time to Smile scheme to do so.