Warning of dental timebomb facing north Northants

A two-year wait to see a dentist - that's the reality for some NHS dental patients; even those who are lucky enough to be registered with a practice.

Places available for NHS contracted dental care in North Northamptonshire are hard to come by with people scrambling for spaces at surgeries.

In March figures revealed that more than half of adults in Northamptonshire had not been to a dentist in the past two years, with the The British Dental Association warning that access to dental practices has collapsed across England. The stark message is that the impact of the pandemic on the nation's oral health will be felt ‘for years to come’.

Healthwatch Northamptonshire, the independent people’s champion of health and social care in the county, has been working with residents.

Its research and communications manager Jo Spenceley said: “We have seen a concerning increase in the number of people coming to us who are struggling to access NHS dental care and have discussed these concerns with the NHS England regional dentistry commissioning team.

“The team listened to these valid concerns and reassured us that they are doing what they can to encourage dentists to prioritise providing the most essential treatment, including treating the most vulnerable and at risk people as well as the most urgent cases.

“The coronavirus pandemic has reduced the capacity of all dentists and NHS England is working with dentists to restore capacity, but this is still below pre-pandemic levels due to the additional cleaning and infection prevention processes needed.

“Routine NHS dental care is still unavailable for many and even though the NHS England regional team is looking for ways to fill the gaps, the way that NHS dentistry is commissioned can put some dentists off working with the NHS. Reforms to dental contract commissioning are clearly needed.”

Healthwatch Northamptonshire has been contacted by patients from across the north of the county outlining problems with the service.

• One person from Corby said they had started looking for a new dentist just when the country went into lockdown and no-one would take them on. During lockdown the condition of their teeth deteriorated further to the point that the need had become “critical” as their teeth were “breaking all over the place” and their fillings were exposed. Despite having several teeth needing emergency work and having phoned dentists multiple times they said that “nobody was willing to take them on”, that the dentists were unable to help them unless they were in pain and that they suggested getting temporary fillings from the shops. The person was worried about the damage to their teeth getting worse and that they might lose their teeth if they were left untreated, as well as being embarrassed by the appearance of their front teeth. They said they are on a waiting list, but had been told it could be another year before they can be taken on. They can't afford to go private.

• A GP surgery in Corby contacted us for help finding a dentist for a patient. The patient had broken their front teeth and could not find an NHS dentist. While the patient was not in pain, they were struggling to eat and had anxiety and depression due to their appearance.

• A person in Kettering had called NHS 111 and was sent to an emergency dentist but they only gave them a temporary filling (twice). They were told they needed to register with a dentist for the tooth to be treated further. They were still in pain with the tooth being temporarily filled.

Ms Spenceley said: “This is an issue across the whole county, and local Healthwatch across England have seen similar issues. In North Northamptonshire, we have particularly heard from people in Kettering and Corby – 11 and 8 respectively, between January and April 2021.

“Most people have contacted us as they have struggled to find an NHS dentist, including several who were told their dentist in Kettering was no-longer providing NHS treatment. Others have found the condition of their teeth worsening and that they have only been able to have them temporarily fixed – unless they pay for private treatment.”

Figures from NHS Digital show 248,027 people aged 18 and over were seen by a dentist or orthodontist in Northamptonshire in the two years to the end of December 2020 – just 43 per cent of the area's adult population.

In Northamptonshire, 49,487 youngsters were seen in 2020 – down from 94,995 the year before – meaning just 29 per cent of children went to the dentist last year.

And the situation has worsened as one leading Kettering practice told child NHS patients to sign up to a private care payment plan or move surgeries altogether.

Anterior Dental Care in Northampton Road, Kettering, informed parents and carers that their free dental care was coming to an end.

One father of a 15-year-old patient registered at the surgery was given an ultimatum to go private or find an NHS dentist elsewhere. He said: "I find it appalling that after being at the same practice for nearly 30 years and being a private patient under the Denplan scheme, the free treatment for my daughter has been withdrawn leaving us to find another practice elsewhere or sign up to pay dental insurance.

"She does not want to see another dentist. She likes him and trusts him implicitly. She has been visiting the surgery twice a year since before she even had teeth. It's about continuity of care and the principle of free treatment on the NHS to which all children are entitled. Withdrawing from carrying out NHS care seems remarkably short sighted. It's the people with the least who will suffer. Those on low incomes who can't afford to travel, shop around or simply pay for an appointment. It's our children's oral health that will suffer.

"I will pay up but I am saddened that the Government has allowed this to happen to the NHS."

Another patient at the same practice also faced difficulties during the Covid lockdown,

She said: "Having been a loyal and regular patient at Anterior Dental Care for the last 31 years I have been appalled by my treatment over the last 16 months.

"I was due an NHS appointment after the first lockdown started. My first appointment was three days after the first lockdown and understandably this was cancelled, and I was given various new appointments over the next few months, however these were also cancelled. I've not been seen since despite problems with my gums and loose teeth I received a letter last August/September to say if I wanted to continue with my dentist, who I have absolute faith in, then I would need to register as a private patient..

"This had no time frame on it. When I called a couple of weeks later to sort it out I was told that it was too late, that I would have to become a private patient, and that I would have to complain to the practice manager. I was however reassured that I would definitely still have an NHS dentist.

"Since then I have received a letter to say that it 'does not fit with their ethos to have NHS patients any longer' which is beyond belief. However, I am more than welcome to keep on their books if I want to become a private patient. I am so disappointed with this excellent practice. There's no sense of moral obligation. What a sad reflection on society that the NHS has no place or doesn't fit with our society's ethos any more."

A spokesman for the British Dental Association said: "It’s true that children in full time education are entitled to free NHS dental care if they find a dental practice with capacity to see them, and of course one with an NHS contract.

"I am unable to comment on specific practices but I am aware that many NHS dental practices are struggling to meet their targets, and some have found them unworkable to the extent that they have handed their contracts back.

"Practice owners, whether they provide NHS services or not, have to invest their own funds - not taxpayers - in setting up a practice, to pay staff, laboratory costs etc, so their practices need to be viable or they will go bust.

"Practices can only provide NHS services if they are commissioned to do so by NHS England/ their local area team. The contract effectively places a limit on the number of patients they can see, if they see more than they are contracted to do, they will not be paid, if they underperform they can face harsh financial penalties.

"One of the anomalies of the much criticised dental contract in England is that whether a dentist does one filling or 10 on the same patient, during the same course of treatment they will get paid the same, though the latter will obviously take much longer.

"A health select committee enquiry into dentistry as far back as 2008 concluded that the NHS dental contract was unfit for purpose, and patient group Healthwatch has repeatedly raised concerns about people struggling to access NHS dental care."

In January to March 2021, Healthwatch Northamptonshire saw an increase of 50 per cent in both negative feedback and requests for help finding a dentist compared to the three months before (October to December 2020). When compared to the same time period the year before (January to March 2020), there was a massive nine times increase in people contacting Healthwatch Northamptonshire about their difficulty accessing NHS dental care - a jump from three to 27 people.

MP for Kettering Philip Hollobone said: "I am very keen to see expanded NHS dental provision in the Kettering constituency and as a priority will gladly highlight local concerns about this important issue to the Government.

"I urge Anterior Dental Care to write to me as soon as possible with the specific details of the difficulties they are facing in relation to NHS contracts and I will ensure that these concerns land on the desk of the Minister for Dental Health for urgent attention and reply."

Ms Spenceley added: “We will continue to share the concerns of local residents with NHS England.

“Anyone with an urgent need for dental treatment can call NHS 111- or use the online service 111.nhs.uk - or phone any local NHS dentist for advice, regardless of whether they regularly attend that practice.

“The dentist will complete triage over the telephone and provide the relevant support. You can receive NHS dental care at any NHS dental practice and do not need to be registered.”