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November 14th Lincolnshire LDC Update number 60
It seems no time since the last month’s update! For the LDC it’s been a busy month (more of this later). Thank you for everyone who attended our recent open meeting on Teams.
Jason Wong gave an overview of the role of the Office of the CDO and the interaction with NHSE and the BDA. We also had an opportunity to meet virtually with Adam Morby, who is the newly appointed Regional Chief Dental Officer. Here is a short bio. about Adam and his role.
Adam Morby
Adam, has been a general dental practitioner for 27 years, qualifying from Birmingham University in 1993 and practicing in Staffordshire for the last 21 years. He has spent a number of years as an Educational Supervisor for Foundation Dentists.
He has worked with the South Staffordshire Local Dental Committee as Chair and Secretary for 20 years, along with chairing the West Midlands Association of Local Dental Committees This also involved representing local practitioners in the area at the British Dental Association General Dental Practice Committee since its inception.
Adam’s role includes providing clinical leadership and support within not only NHS England regional team but also to all stakeholders within the region. Adam will also be working in partnership with the National Chief Dental Officer, Sarah Hurley, to implement national work programmes such as Starting Well (Children’s prevention and treatment service), Mouth Care Matters (Oral health in care homes and hospitals) and Making Every Contact Count (general health prevention in dental practices and hospital settings) on a regional basis.
What have we been doing over the last month?
Those at the LDC meeting will have been aware of my report on Dental Services In Lincolnshire. You will be pleased to know that I am not going to reproduce the 16 page report … this month I will deal with Dental Service Performance in Lincolnshire and Children’s oral health.
Dental Service Performance
Of the 62 contracts in Lincolnshire providing general dental services in Q1 and Q2 :
5 contracts (red) delivered less than 36%
32 contracts delivered between 36% - 60%
24 contracts delivered between 60% - 100%
1 contract delivered greater than 100% (i.e. greater than the level of activity commissioned by NHSEI)
For Orthodontic providers the minimum threshold is higher (owing to less complex IPC guidance and less frequent use of AGPs) at 80%. During Q1 and Q2 across Lincolnshire providers delivered 94.4% of contracted orthodontic activity.
Recovery and Restoration of services
Outlining a timeframe for full service recovery remains difficult, owing to the continued requirement for enhanced IPC measures and the impacts upon providers and their staff of the pandemic thus far.
The most appropriate objective measure to illustrate the ‘loss’ of activity is in the shape of 24-month unique patient access figures. These figures show the number of patients accessing NHS dental services over a two-year period. While this measure is not perfect (as some patients may be more likely to visit a dentist in this timeframe and others may not ordinarily visit at all) it does provide a proxy measure for ‘lost appointments’ and demonstrates the scale of the service backlog that exists.
Figure 1 (below) shows the impact of the COVID-19 pandemic on the 24-month unique patient count for both Lincolnshire and the Midlands region:
Broadly speaking, the above chart illustrates that, across Lincolnshire, there were approximately 74,295 patients who would ordinarily visit a dentist but have been unable to do so during the last eighteen months or so. Before dentistry can be fully ‘restored’ to pre-pandemic levels, this backlog will need to be addressed.
To address this backlog NHSE initially offered a Weekend Working Initiative
from January 2021– March 2021 and then again for the period July 2021 – March2022.
Providers expressed an interest to provide sessions, but noted significant barriers
such as burn out caused by increased working hours in difficult circumstances. The net result
was some update in the January – March Period but no uptake in Lincolnshire for the
current session.
Oral Health in Lincolnshire
Child oral health
The national child dental epidemiology programme conducts a survey of the dental
health of 5-year-old state school pupils every two years. The most recent survey
published at the start of 2021 shows that in Lincolnshire average levels of dental decay
are higher than the average for England, however, within Lincolnshire there
areas where there are higher than average levels of experience of dental decay.
At lower-tier local authority level, children living in Boston have the highest levels of experience of dental decay in the region. South Holland, East Lindsey and Lincoln also have child dental decay that places them in the top 10 LTLAs in the region
Experience of dental decay in Under 5 year old …………
There is effectively a clear East/West divide in childhood tooth decay experience in Lincolnshire with children living in the east of the county experiencing poorer oral health and higher levels of tooth decay. This disparity is due to the fact that the West of the county’s water supply is fluoridated under an existing water fluoridation agreement. The east of the county does not receive fluoridated water. Fluoride in the water to the level of one part per million is highly evidenced to be protective against the risk of tooth decay. The difference is tooth decay levels in children as a result of this west/east water fluoridation divide is stark with a 10%-20% absolute increase in the proportion of children experiencing tooth decay between moving from west to east.
Within Boston, the highest levels of experience of dental decay are clustered around Fenside, Skirbeck, Trinity and Witham wards, with tooth decay rates around 50% and above of children affected.
The consequence of this, is the increase in GA Extractions to remove teeth, with percentage numbers in the Eastern European Community particularly high.
The risk of tooth decay in children in the east of the county is compounded by the fact that dental services are in less supply in the more remote, coastal areas influencing the attraction and retention of the dental workforce. Therefore, there is a situation of higher levels of need and lower levels of services. This makes the prevention of dental disease all the more important in these areas.
Prevention of childhood dental disease in Lincolnshire
Lincolnshire has a well-established and very active Oral Health Advisory Group consisting of system-wide partners across health and social care, with the input of specialist dental public health advice through the former Public Health England (recently transitioned into NHS England).
This multiagency partnership group develop strategic plans around oral health improvement for all of Lincolnshire’s children. This is informed by undertaking a joint oral health needs assessment of the population, which is regularly updated as new data becomes available.
The local authority commission a dedicated oral health promotion service who engage with and visit schools across the county to deliver oral health promotion and prevention.
Priorities and actions for the group in tackling child dental decay include:
Increasing access to supervised tooth brushing in nursery and school settings, and increasing access to fluoride across the region (via toothpaste distribution and topical varnish applications), particularly targeted to those areas in the east of the county that do not enjoy the benefits of water fluoridation
Working with health visitors and community workers to better identify children and their families who are at high risk of tooth decay and poor oral health, so that preventative advice, support and signposting to available services can be actioned, thus contributing to a reduction in the number, and associated financial, social and personal burden, of children having to attend hospital for tooth extractions under general anaesthetic.
Working with NHSE dental commissioners to improve access to child dental services, both at primary and community dental care levels across the county, targeted at areas of highest need wherever possible.
NHSE dental commissioning, public health and the local authority co-design and fund a range of evidence-based prevention interventions and initiatives to improve child and adult oral health and mitigate against the recognised risks to oral health
Further funding has been made available to mitigate against the effects of the pandemic on dental services. With the recent government White Paper of healthcare reform plans to take central government control in relation to the future expansion of community water fluoridation schemes in order to help remove some of the existing barriers to this, we would recommend wider political advocacy and support at a local level for expansion of water fluoridation across the whole of Lincolnshire, as this would have a significant positive effect in reducing the inequalities in child dental health across the county.
A downside however is that we are led to believe that Anglian Water will be carrying out essential and major infra structure works in 2023 -2025. This will mean for a period of time, fluoride supplies in the West of the County will be turned off.
Mandatory Covid Vaccination for Health care workers
All individuals undertaking CQC regulated activities in England must be fully vaccinated against COVID-19 by 1 April 2022 to protect patients, as announced by the Department of Health and Social Care (DHSC) this week. This means that unvaccinated individuals will need to have had their first dose by 3 February 2022, in order to have received their second dose by the 1 April 2022 deadline.
Exemptions apply, including those who are medically exempt; under 18 years of age; do not have contact with patients; or are a participant in a clinical trial investigating COVID-19 vaccination. If you are medically exempt, we encourage you to obtain the necessary medical evidence as early as possible.
The BDA is currently reviewing the regulations and currently putting together a package of advice and are drafting a series of template letters to help members manage and communicate this process with staff. We will keep you updated.
Oral Cancer Action Month:
November is Mouth Cancer Action Month and this year the BDA will be holding a free webinar for the whole dental team to learn more about Head and neck cancer: the red flag symptoms to watch out for.
This will take place on Wednesday 24 November at 19:30 and will discuss:
How to recognise symptoms of oral cancer
Recent advances in cancer treatment
The impact of COVID-19 on referrals and treatment.
And Finally …………..there is much work going on behind the scenes regarding the development of the Integrated Care System (ICS) for Lincolnshire and compared to other ICS areas we seem to be progressing well.
Orthodontics is still a major concern and we are constantly getting feedback both from patents and practitioners unable to access services.
A bit of a different update today, but hope you find the information provided interesting.
Best wishes
Kenny Hume Chair Lincolnshire LDC
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