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Paper 4 - 26 March 1999 Meeting

ASSOCIATION OF HAMPSHIRE AND ISLE OF WIGHT LOCAL AUTHORITIES

26 March 1999

SHORTAGE OF NHS DENTISTS

Report by the Policy Manager

RECOMMENDATIONS

(1) That representations be made to the LGA seeking its support in urging the Government to take further steps to deal with the shortage of NHS dentists; and

(2) That all relevant local bodies, including the Health Authorities, Community Health Councils, British Dental Association, be notified of the local authorities' serious concern at the shortage of NHS dentists in many parts of Hampshire.

SUMMARY

A shortage of NHS dentists in a substantial part of Hampshire is creating serious problems in addressing the already inadequate oral health of the population. In some of the more rural parts of the area the non-availability of NHS dental services has reached crisis proportions. This problem is particularly severe for the disadvantaged. Addressing this issue is becoming a key part of member authorities' input to the Health Improvement Programmes, and of their anti-poverty and social inclusion strategies.

BACKGROUND

1. Rushmoor Borough Council raised this issue with HIOW following an approach by the West Surrey and North East Hampshire Community Health Council which has received -

"many complaints and enquiries from local people unable to find an NHS dentist in the area. In some towns there is no NHS provision and in others dentists are not taking on new NHS patients."

EVIDENCE OF A SHORTAGE

2. The evidence for the shortage in North East Hampshire has particularly been highlighted by Hart where the situation is at crisis point. At the start of February 1999 there were no NHS dental lists open in either Fleet/Church Crookham or Hartley Wintney. Hook and Yateley NHS dentists only accept children on to their lists. All member authorities in Hampshire report a serious problem in some parts of their areas. Southampton City Council has also notified HIOW that it would support general representations to the LGA and the Government on this subject. The situation appears to be better on the Isle of Wight.

3. East Hampshire District Council report "an acute shortage of NHS dental provision within the whole District ... the position is further exacerbated by the rural setting of the District, where people have to travel considerable distances to obtain NHS dental care".

4. North and Mid Hampshire Health Authority has acknowledged the severity of the problem and are at present exploring ways of providing incentives for existing dentists to consider NHS care and also to attract new dentists to the authority. The Southampton and South West Hampshire Health Authority, Eastleigh and New Forest District Council find themselves in a similar position in parts of their area. Having analysed the availability throughout New Forest, it is clear that some places (eg Ringwood and Totton) have no NHS dentistry available to new patients. The picture is very patchy - for example in Dibden Purlieu currently all four dental practices are open for new NHS patients. The Eastleigh and New Forest work also shows how fluid the situation is as dentists can open and close their books daily. (Dentists as private contractors can decide for themselves whether or not to operate an NHS list).

5. The Southampton and South West Hampshire Health Authority Oral Health Strategy states that NHS general dental service availability is now mainly restricted to Southampton City, with patients in other parts of the district often having to travel considerable distances. Dr John Beer, Director of Social Services at Southampton acknowledges that the problem "seems now to be more marked in the ... rural areas rather than the City."

6. Eastleigh parishes just outside Southampton have also experienced serious problems: 31% of residents in Bursledon, Hamble and Netley reported difficulty finding NHS dentistry recently.

7. Fareham Borough Council has contacted the Portsmouth and South East Hampshire Health Authority helpline and found that they can offer no dentists in the Borough who will accept new NHS patients. However services are available in Southsea, for those who are prepared to travel. Portsmouth City Council reports that provision elsewhere in the City is patchy and variable. The City Council reports an increase in emergency dental treatment and worrying concern for long term oral health.

CAUSES OF THE PROBLEM

8. Fareham Borough Council comment that "many dental practices are going private due to a reduction in NHS payments, necessitating a throughput of patients which is higher than they are comfortable with to undertake a thorough job." This comment is borne out by the Southampton and South West Hampshire Health Authority Oral Health Strategy which states:

"there has been a steady decline in NHS dental availability, particularly in the south of England. Apart from problems caused by the national shortfall in dental manpower, general dental practitioners have reduced their NHS commitment for a variety of reasons, including the desire to leave the NHS "treadmill" and achieve a less pressured and less stressful working environment. An increasing proportion of NHS dentists have sought early retirement, but in many cases have been unable to find another dentist to purchase their practice."

RESULTS FOR ORAL HEALTH CARE IN THE AREA

9. "Fareham Borough Council's major concern is that the whole system is increasing inequalities in health. Instead of a preventative approach to oral health, people are waiting until they have major problems and then falling back on the community dental service or emergency hospital clinics. Even if you are an NHS patient there is this problem that if you don't go for 15 months you are struck off without a warning."

10. At the District Anti-poverty Forum in East Hampshire on 20 January 1999, lack of NHS dental care emerged as one of the key issues. Action to address this has been established as one of the priority areas of action, for which the East Hampshire Health Strategy Advisor will be taking lead responsibility.

11. Hampshire County Council is concerned that the most vulnerable in society are now less able to gain access to vital affordable dental care.

ACTION WHICH SHOULD BE TAKEN

12. The Government has already taken some action and put new resources into NHS dental care, having recognised the problem at the outset. However, there is evidence that Government measures have been "too little and too late". Hart District Council has highlighted the inadequacies of the "Investing in Dentistry" Initiative (started by the Government in 1997). This is reported to be "difficult to access, administratively cumbersome and ineffective". Delays in processing applications and the apparent lack of consistency of decisions taken make it extremely difficult for dentists to make use of the financial assistance offered. No guarantee of funding can be given until approval of the application so that considerable risk is taken by the dentist in securing property in an area of high property value. There is particular cause for concern because the scheme is under-subscribed in an area such as Hart which has such a high level of need for assistance. It is reported that the Government plans to revamp the Investing in Dentistry Initiative or replace it from April this year, but no details have been published at the time of writing.

13. Further action is needed at Government level. In the meantime local health authorities are already addressing this issue, but it would help if they had some clear messages from the local authorities as to the severity of the situation. In some cases the local authorities themselves have succeeded in encouraging new NHS dental practices to come in, and encouraging existing practices to offer NHS services. For example Eastleigh Borough Council's Health Policy Manager has worked with Local Area Committees to encourage dentists to set up in areas poorly served. In Bursledon, Eastleigh has offered premises to a NHS dental practice as part of this process on encouragement. Gosport has recently been successful in getting more NHS dentists as a result of the "Investing in Dentists" scheme. Rushmoor has also had some success.

14. Finally, it is clear that the situation needs to be addressed in close partnership with the dental profession at national level, and that is why representation through the LGA would probably be more effective than any other action for HIOW at this stage.

NICK GOULDER
Policy Manager

Last update: 25/09/2000
Author: Nick Goulder, Policy Manager

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