Jason Atkinson

Welcome to the transforming Primary Care podcast. My name is Jason Atkinson.

I’m the LDN chair for Humber North Yorkshire. Today we will be discussing the recent announcement from the Secretary of State for Health and Social Care, Wes Streeting, where the government is committed to supply 700,000 urgent dental care appointments across England and we’re going to be focusing on how ICBs in our area are trying to meet that supply of urgent dental care appointments.

The ICBs are working within the current NHS contract to introduce where they can, programmes that support increased access for patients with urgent care needs and vulnerable patient groups.

They do this through utilising clawback, non-recurrent funding – that’s funding returned to the ICB for under delivery on the dental contract – ICBs recognise the challenges the dental contract has on the delivery of all healthcare to the population we serve.

Joining me today is Sally Eapen-Simon, consultant in dental public health, NHS England for the North East and Yorkshire; Mark Green, Chair of the Yorkshire Humber Council of Local Dental Committees; Tom Robson, Dental Clinical Lead within the NHS North East and North Cumbria Integrated Care Board; and Ian Wilson, Dental Training Programme Director for NHS England, North East and Yorkshire; and also Anna Beaven, Speciality Registrar in Dental Public Health for Yorkshire and Humber.

So with this panel, the first question I want to ask you all really, is why do we need to improve patient access to dental care? Sally:

Sally Eapen-Simon

Yeah. I mean, Jason, you know, when we look at the data, it’s really clear. So when we look at the levels of disease in the people that we’re trying to provide services for is high, so we know that around 1/5 of children experience tooth decay and for those that do have tooth decay, it’s pretty bad.

So talking about on average 3 teeth, we know the impact on service provision, the cost to the NHS to hospitalise a child for GA you know you’re talking about over one and a half thousand pounds.

The data for us in Yorkshire, Tom. I know you’ll have data for the North East in terms of dental access, yes, we might be above the England average, but, you know, across our 3 ICBs, we’ve got between like 45% and 55% of the adult population that are seen within two years, the children, that figure is a little bit higher, kind of ranging from the 55 to 63, 64 I think in South Yorkshire.

So it just kind of gives you a flavour for the significant proportion that are not able to access services and there are lots of reasons you know behind that. I think the GP survey also is telling us that people do find it difficult to get appointments.

In terms of the burden of poor oral health, you know, we know that for our health inclusion groups, they suffer the greatest burden, so their inequality’s in oral health, but also inequalities in in access and you know, I’m sure Mark can give a real flavour of what that feels like from a dental practice team perspective – when you’re working so hard to try and meet demand and need.

Jason Atkinson

Thank you, Sally. Tom:

Tom Robson

Yeah. So we do have similar access figures to Yorks and Humber. But in terms of equitable access, we’ve been running incentivised access schemes as part of our COVID recovery plan.

So since 2021 we’ve had incentivised access for urgent care across North Cumbria and the North East and we commissioned Healthwatch to evaluate our schemes.

And one of the key findings of the Healthwatch report was that whilst patients were generally happy, once they accessed care, they still perceived barriers and being able to get through the door of dental practices. And so we were very keen to try and reduce the inequality of access that patients were actually having or perceived themselves having, so we were listening to the Healthwatch findings that they were telling us from our initial incentivised access reports, and so we introduced in our dental access centres online booking, which is where patients themselves can book into appointments and the practices don’t exhibit any level of control.

So the practices obviously are working in partnership and are willing to relinquish that control to allow patients to directly book in on online themselves; and also for those patients with acute dental needs to be able to be booked in directly by NHS 111.

So these are really key differentiators, I think, between ourselves and some of the other incentivised access schemes that we operate in the in the North East and the idea is that by summer, if you’re a patient seeking care across North East and North Cumbria, you’ll be able to click on an ICB landing page and be directed to the online booking portals for these sites so you can directly book in yourself and these online booking urgent dental centres will deliver for us 100,000 urgent appointments a year.

Jason Atkinson

So, Tom, before I, before I bring in Mark, for Mark’s perspective on the need to improve patient access, are you anticipating that that programme will also reduce the impact on NHS 111 services – in fact that patients will no longer need to utilise that service and will start to shift towards the ICB portal?

Tom Robson

Well, we use NHS 111 as you know, for patients who have got an NHS pathways determinant of their urgency of dental needs. So if you’re a patient who is seeking unscheduled care, but haven’t got a high acuity need at the moment, NHS 111 isn’t a portal by which you would access that care.

So the urgent dental centres that we’ve set up, is to accommodate those 111 patients, but to divert from 111 those patients who have unscheduled, but let’s call it subacute dental need, so as to provide not only urgent care, but also unscheduled non-urgent care.

Jason Atkinson

Thank you, Tom. Mark, So why do we need to improve patient access to dental care? And what are your reflections on access that you’re providing for patients coming to you?

Mark Green

Yeah, I think, well, a bit of a history lesson as to where we are now. I mean, it’s what, nearly, 20 years since this contract came in and the talk of UDAs, which is the unit of dental activity, which is a very crude measurement and didn’t really reward practices for high needs patients. And let’s not forget, the contractor never was for 100% of the population. So if we’ve got 45-50%, that’s pretty good because it’s only funded for 56 to 60% anyway.

So we’re in this situation ‘cause of a decline over the last 20 years almost and dentists need to run a practice that has to be profitable and it wasn’t proving to be the case with NHS. So they left it and now we’ve got even more of an acute problem. We’ve got a government now that are saying they’re going to do something or we need to hear more than just words.

The 700,000 – it highlights a problem. It’s asking ICBs to scrabble around and use clawback monies to provide this, which is what we’ve been doing already in this area.

It’s a political shift that needs to happen and it’s a will that needs to make the difference. Flexible commissioning was brought in really just to give a lifeline to practices. It wasn’t intended to be the new contract. It was always intended to help practices get to that 96% of their contracted delivery by other means other than the UDA or the Units of dental activity.

I’m very happy that I work in this part of the world doing NHS dentistry, because that clawback money it’s allowed us to see more people. People have never had access before that we’re going on to – the homeless – so Ian will talk about more in a bit, but those hard-to-reach groups are being targeted with the callback funding working flexibly within this current contract which we’re trying our best to make work as best we can. But I’m interested to hear what Tom Robson was saying about the direct booking in thing, I’d be interested to hear more and see how that works in the future.

Tom Robson

Yeah, sorry, I don’t want to jump in, but just to answer that one question: most dental software – in fact, all dental software providers – have an online booking capability and so it’s been about enabling that online booking capability. At the moment individual QR codes are available for local social marketing, but essentially by summer you’ll be able to log on, find the local practices and then book in. The visibility is only ever five days in advance, so there’s appointments released every day and you will have an equitable opportunity to book in through that capacity. It’s not adequate in terms of covering all of the need, but it’s equitable and that’s one of the key findings that we found from the Healthwatch report that if you can get into an urgent care appointment at a dental practice, patients are generally happy. The problem was Just actually physically getting past reception sometimes. So sorry to jump in there.

Jason Atkinson

Thank you, Tom. I’m going to bring in Ian now, because actually I think you raised a very good point, Tom, about equity of access and one of the programmes, Ian was heavily involved in developing was access for homeless people who may find IT more of a struggle. So, Ian, do you want to talk a little bit about your experience of why access is important, but specifically for the patient cohort that you’re supporting through the work you’ve done with the ICBs over the past 3 years.

Ian Wilson

Yeah. Thank you, Jason. And Tom and Mark, thank you. And for Sally as well, just thank you for what you’ve brought to the conversation so far.

I think my experience certainly over the last three years is that the cohort of homelessness, addicts, sex workers and no fixed abode demographic of patients find it incredibly difficult to not only access current urgent care as it stands now, but even now, what we’re talking about Jason, you remarked about IT, that in itself is incredibly difficult. Where somebody, as an example, one of our one of our clients that we’ve been working with over the last couple of years, will be regularly losing her phone either because of just her chaotic lifestyle, still dependent on drugs to get through the day or various aspects of abuse that she has to find protection from.

So I hear what we’re saying in the conversation, and I’m incredibly glad that this is the incentive, this is an agenda that’s coming from the current government, but all I ask is that in this conversation we do not forget those marginalised communities.

That because of their lifestyle, because of the current way that their life is, they find it incredibly difficult to even turn up to an appointment on time.

As an example, if I may, Jason as chair, a gentleman – we can’t see him on a morning because he has to stay awake during the whole of the night because of fear of being beaten up or having his things stolen so he would stay awake all night and then he will sleep from 6:00am in the morning onwards when the first members of the outreach team going to visit him and he’ll find a doorway or somewhere to sleep till around about 12 o’clock, 1 o’clock and then he feels confident enough to then go with that support worker or outreach worker and come and be part of our clinical outreach from 2 in the afternoon. Which is why, purposely, we hold these sessions in an afternoon and not in the morning.

So that’s my point really, just we need to factor in how if we’re going to create access to, for urgent care, for the population that somewhere in this conversation we understand the needs of marginalised groupings like we’ve been working with over the last 3 years.

Jason Atkinson

Thank you, Ian. I’m going to bring in Anna now, who’s going to explain a little bit more about some of the programmes ICBS are developing to support access.

So, Anna, what sort of things are ICBs doing to support access for various patient groups?

Anna Beaven

Thanks Jason. So, I wanted to describe a little bit about the sessional contracts that were set up to try and improve access. So, Ian’s already touched on the amazing work we’ve done for some of our inclusion health groups, which would include people experiencing homelessness. But we’ve also, we’ve also got some sessional models of care for people who are housebound, including people in care homes, and also people in secure settings as well, so people with severe mental illness and refugees and asylum seekers. And what we found with this sessional model of care is that the practice, the dental practice gets a set fee for providing dental care to a particular cohort.

And this is found to be really effective as well at promoting workforce retention because if for any reason a patient’s having a difficult day, which often can be more, can be more common with certain groups. The practice at the end of this day will not lose their funding because under the normal UDA system, a practice only gets paid for a certain level of activity, a unit of dental activity. And so if someone has got more challenging needs or struggles with accessing the dental surgery, it means that with the sessional model, the practice isn’t negatively impacted on this and they can cater to these groups more easily, which reduces oral health inequalities as well.

In West Yorkshire we’ve had some really good breakthroughs where with the domiciliary pilot, some of the homeless and refugee and asylum seeker contracts. They’ve been secured for longer term, so they’re not just for one year, which means that the time taken to get the service up and running can then be kind of benefited in the long term as well and that provides stability to practices.

That was just one of the great kind of wins that we’ve had recently in Yorkshire.

Jason Atkinson

Thank you, Anna, and expanding on that sessional model, Humber and North Yorkshire, has a programme supporting local authorities in supervised tooth brushing programmes and also access for those children that have got a dental need, but also the parents and siblings of those children as well.

Anna Beaven

Thanks Jason. For the Humber and North Yorkshire Let’s get better oral health campaign, we had 1.3 million views on social media, including Instagram and Tiktok, and we had 5000 clicks through to the Let’s Get Better website and that those are evidence-based oral health messages to try and promote prevention activity at home.

So that was that was a good win for us in Humber and North Yorkshire.

Jason Atkinson

Thanks Anna. There’s also a programme based on similar principles you just described Anna, which is just launched in Humber, North Yorkshire but also West and South Yorkshire, again, trying to facilitate access for vulnerable patient groups, but also importantly, prevention, which is actually something I want to bring Sally in now on the role prevention has and actually working with these patients to try to prevent the disease in the first place. So, Sally, do you want to touch on a little bit about the prevention, what the ICBs are doing to support prevention for our patients?

Sally Eapen-Simon

Yeah. Thank you, Jason. So there has been a significant amount of work and some of this work, Jason and colleagues on this call have been involved with, in really trying to change the nature of very treatment-based services. So we’ve got Mark and colleagues across Yorkshire really embedding evidence-based prevention and the kind of innovative way of commissioning that Anna and yourself have talked about in terms of the sessional payment, which is enabling Ian releasing time to build up those partnership networks to optimise the best use of skill mix and to absolutely embed prevention- because prevention has a really, really important role.

So, you know, we know that the tooth decay, you know, it’s largely preventable.

So getting these really important messages in ,having our oral health champions, a really key member of the dental team have time to have these really important conversations with families, with children, with the most vulnerable people in our communities. To really start that behavioural change model is kind of really important and it was really interesting. Jason, I don’t know whether have you seen the head and neck cancer data, it’s really kind of quite stark, really.

You know, the number of new cases in England is significantly increased. We’re talking about nearly 50% increase in 2013. I think what really touched me was that 53% of those are diagnosed at a very late stage. So again, you know, getting access to services, yes, you know, let’s treat the disease and we know there’s a lot out there.

Let’s absolutely get the prevention messages in and where we can pick up disease and including, you know, cancers, let’s make sure that we’re embedding our care with prevention.

Jason Atkinson

Thank you, Sally. And obviously dental teams also have a role in preventing other diseases and I think Anna wants to explore a pilot that’s launched in Humber and North Yorkshire where we’re looking at cardiovascular case finding screening. Anna:

Anna Beaven

Yes, so in dentistry, we want to link general prevention for oral health with general health and there’s a lot of links between oral health and general health. And one of the pilots that that we’ve been running is a national pilot – some practices in Humber and North Yorkshire ICB have taken part and this involves giving some patients, that meet the appropriate criteria, having with them, blood pressure monitors and this allows to screen them for being for risk of cardiovascular disease and cardiovascular events. And we’ve heard some really positive patient stories so far from this scheme.

So one in particular was describing a patient who was having early symptoms of a stroke, and the CVD pilot in Humber and North Yorkshire, managed to escalate a patient being able to be referred through her GP and then she was able to be admitted to hospital.

So with flexible commissioning, we’re able to use the wider dental workforce, other dental care professionals, including dental nurses, dental therapists, to make sure that we’re also looking after the whole patient and their general health as well.

Jason Atkinson

Thank you, Anna. One of the important things that all of us in this podcast are aware of is the importance of working with stakeholders and before I bring in Tom to talk a little bit about a pilot in the North East, I’d like Ian just to kind of touch on that key part of actually establishing these pathways to support patients and how we work with stakeholders.

Ian Wilson

Yeah. Thank you, Jason. The programme that we’ve been involved in for the last three years without being able to build relationships and signposting pathways with local stakeholders who are involved with homelessness, we wouldn’t be talking about some of the successes that we’ve been able to see. In not only patient care, but also the anecdotal evidence coming from the patients themselves.

As we explore in sessional outreach working with certainly across West Yorkshire at the moment we’re working with at least a dozen stakeholders who actually bring the client or who will chaperone the client and help to bridge that rapport, that sense of trust between the client and the practitioner, and we’ve seen that to be incredibly important to move the programme forward.

And just another final point very briefly, is that we’re now working with GP practices who again have been able to signpost it in South Leeds where I work. A colleague of mine has just over the last 12 months worked with a GP practice, again in South Leeds, signposting clients who are involved or suffering with homelessness.

And they’ve been signposted directly into the practice and become part of the sessional outreach that we’ve been exploring and developing over the last 2-3 years.

So yeah, without building networks and relationships with local stakeholders, these sessional outreaches would be very difficult to maintain. Thanks; Jason:

Jason Atkinson

Thank you, Ian. And obviously, we’ve also touched on other stakeholders that dental teams can work with health and social care teams, social workers, the representatives of the vulnerable patient groups, the migrant groups, but also GP practices, which is also something the ICBs are looking to explore and support with various programmes over this year.

I want to kind of come back to urgent care and want to bring back Tom into the conversation. About an innovative pilot that’s on running in the North East, where they’re looking at sort of developing urgent dental care access centres and Tom, did you also explain a bit more about that concept?

Tom Robson

Sorry about jumping the gun previously, but essentially the idea of the urgent care centre or effectively a commissioned surgery, often within an existing mandatory services contract practice, was to try and get rid of this inequitable access that we have. Where Healthwatch are reporting that no matter how many practices patients phone, because practices are prioritising their own patients. Let’s put the inverted commas up for ‘registered’ before I say the word.

So practices that have an established patient group tend to look after their established patients, and if you’re an irregular patient seeking a health intervention is often particularly difficult to get any practices to accept you.

So the concept of having practices relinquishing control of a diary to allow either 111 to directly book into slots or for patients themselves who have slightly less acute treatment needs to book in themselves seemed equitable.

And so we recognise that it in terms of stakeholders, the practices have to engage with this and for some it’s a significant cultural change. But it’s been very well evaluated from the sites that we set up in summer of 2024. And now we’re rolling out for the 2nd and 3rd tranches of these urgent centres.

So we will actually have 30 surgeries of urgent dental access up and running by July and these provide us with just over 103,000 appointments per year.

And as I say, the beauty of it is that it provides a positive direct booking by NHS111 using the ITK messaging into NHS mail and it allows patients to directly book into the practice sites using the online capability that exists within the dental software.

And we think it’s not a silver bullet and it requires true partnership working.

And we are also keen to understand that we get high quality outcomes from these.

So we monitor what the practice sites are delivering in terms of definitive clinical outcomes per episode of care and the number of antimicrobial prescriptions that are issued.

So it’s a definitive care service, not just a palliative oral antibiotic service delivering positive outcomes for the people of the North East and North Cumbria and it’s working well so far. But you know the proof of this is ,you know, how it works in the medium term.

Jason Atkinson

Thanks, Tom. And I think certainly think that’s one of the exciting and much needed things that we’re doing is focusing on outcomes rather than using unit identical activity to judge an outcome. And actually as we probably all agree in this room that UDAs don’t really focus on quality outcomes, they focus on how many widgets you’ve done that year.

One of the factors obviously supporting this is the workforce. And the implications of access and how the workforce, the current dental workforce, could support that and I want to bring in Mark now for his kind of reflection on the workforce issues that dentistry is facing l at the moment.

Mark Green

Well, just when Tom was saying about practices, relinquishing their books – they want to look after their own patients they’ve had for many, many years.

And what you’re finding is you workforce is stretched getting the new patients in and looking after the existing patients. So you’re pushing them out.

I’ve got lots of patients on 18 month recalls now, or two year recalls, because I can’t see them like they want to be seen every six months. And I’ve been telling them for frankly for years, they don’t need to come in every six months.

But there’s a cohort of patients that still want to come in. We’ve had a problem when we’ve had people booking themselves in online where I work, and it’s people who are told they don’t need to come in for 12-18 months and they’re booking themselves online in 6 months – and so trying to do everything with a limited workforce- so using nurses with extra qualifications is useful but we don’t have enough of those either – so we need to be careful how we keep pushing and pushing and pushing.

Doing too many things too often and we’re left with people just spinning too many plates and it gets too much sometimes.

So we just need to be wary that the workforce is an issue and that’s the thing that we can’t sort out locally here. We need a national steer on that, so hopefully that will come, but we’ll have to wait and see.

Jason Atkinson

I think workforce is a huge issue with NHS dentistry and getting the people to actually, once they’ve been trained, to work in the NHS because one of my other roles is to develop foundation dentists to work in the NHS – a lot of foundation dentists within about five years move away from the NHS. And some of that is probably linked to the system, but some of that’s also linked to the opportunities for career development in the NHS as a dentist and I want to bring in Sally here about the sort of level.2 pilots that we have introduced across Yorkshire and Humberside, and how they could potentially support the workforce, but also support recruitment and retention of dentists in the workforce. So Sally.

Sally Eapen-Simon

Yeah. Thanks, Jason. So you know workforce in each of the 3 ICBs there are dental workforce strategies. So training, education and development is a key priority.

So we know that children can be seen by High Street dental practice teams and their care for some of those patients. They can be managed quite ably by the dental team. For those children with more complex needs, that might need a referral to our specialist consultant-led community dental services in in Yorkshire.

We know that those waiting lists, Jason, are really long and we also know there’s lots of children who are waiting and some joint work that was done with NHS England, workforce Training, education colleagues, you know, Rachel Nichol, one of our local consultants in Wakefield. Great huge innovation developing a Level 2 programme so we have dentists who are trained and have completed the Level 2 programme and working with NHS England Prize delegation and now robustly with the ICBs, we’ve been able to accredit level 2 dentists who have now been commissioned. We’ve got 3 contracts in Yorkshire, 2 in West, and 1 in Humber, North Yorkshire, one on your patch, Jason in Hull.

And the dental teams are doing such a fantastic job in managing the care of patients who would have potentially been on a general anaesthetic list, so would have had teeth out and potentially having less complex treatment because they’re able to get in and save teeth rather than extract teeth.

And you’re right, Jason, I think that, you know, the primary aim I think was about reducing waiting lists and patient experience. And we know that the patient experience from this work has been phenomenal.

So some work that University of Sheffield is telling us that the parents and the children really are seeing the benefits and really love the care that they are receiving, but actually ,it’s turning out to be a workforce retention potential initiative because actually what the dental teams are telling us, they love it, they love the sessional time to provide the care that they’ve been trained to do. They feel empowered and it’s a real adjunct to being a dentist, potentially in Yorkshire.

So and I know you know, you’ve got, you’ve got ideas about how this could be rolled out and developed in terms of fellowships, etc to kind of develop that level 2 workforce.

Jason Atkinson

Thank you, Sally. So I think I think we’ve kind of discussed the kind of broad range of projects that ICBs are supporting and with a noticeable focus on the commitment to provide further access sessions for urgent dental care.

What else do you think is coming down the line as a result of Wes Streeting’s commitment to dental care – kind of crystal ball-gazing now.

Between now and the next 5 years, what areas do you think we can improve upon and what else can the ICBs do to support patient access to dental care. I want to kind of bring in Anna first and then Tom.

Anna Beaven

Thanks Jason. So we know that access to dental care is is really important to reduce the burden of oral disease on our populations. But we also know that the majority of oral disease is also preventable. This recently has come into the into the public foray from Wes Streeting because he’s committed to providing local authorities with additional funding to support some of their existing community supervised toothbrushing schemes.

So a lot of local authorities are working hard to determine the best way to use the money as a complementary targeted approach to improve oral health.

And this could also benefit the existing primary care dental access initiatives.

So we would, we would really like to be able to do some short term evaluation on the monies that that government have provided to help us coordinate prevention in the long term as well, and that will also help reduce people needing to access dental services.

Jason Atkinson

Thank you, Anna. And Tom?

Tom Robson

Yeah. Obviously touching on the community water fluoridation agenda across the North East and North Cumbria as one of the key strategies we have to reduce health inequalities and increase prevention. So I don’t want to sort of diminish prevention because it’s a key pillar, but I just wanted to talk about service delivery really across North East and North Cumbria

Across the North East and Cumbria, we’re looking to enhance our retention within our workforce – to retain mid-career dentists who are most experienced and most proficient within the health service and we’re keen to explore that. And that’s something that we’re developing at the moment.

And the second thing really is just to enhance the overall capacity model – we’re developing this community dental access facility whereby again with online booking, practices will have an outreach/ in-reach contract.

So they’ll outreach into early learning establishments and into care homes using the ROX model for community outreach into care homes. And then when identified, we’ll then facilitate patients into their own practices, again into a sessional arrangement and also act as care navigators for those patients who require more enhanced services into the community dental service or into secondary care.

So that’s something that we’re looking to develop now – in terms of what we’re doing in the future, the Public Accounts Committee have always referenced the need to have a true cost of care and so we’ve already piloted with seven surgeries the true cost of care, and we’re rolling that out as a general offer to re-evaluate the true cost of NHS care across our providers, starting with the providers that are in the most deprived localities. Because we recognise that the UDA model is, even if it was functional in 2006, is not functional now because of a variety of demographic change and cost changes. So it’s an interesting piece of work that we’ve already been working on for over a year and this has resulted in either an activity change within the UDA-contracted activity that is being delivered or an enhancement of the overall contract value and the true cost of care, I think is a key way to determine sustainable care within NHS dental practice in primary care going forward.

We’re having all of our urgent dental access centres report on items of service in the because all of the dental programmes are based on item of service codes. And so we’re reporting all of the item service codes and we collating those and then producing a matrix of activity over episodes of care. And so we’ve got good statistical evidence that it provides good value for money.

Jason Atkinson

Yeah, yeah. And that value for money. Quite rightly we’re focusing on getting people out of pain, But actually what we’re focusing on also stabilising them because actually what you don’t want to happen is them to come back again in three month’s time, six month’s time, with a problem from a different tooth.

Thank you, Tom and Mark, your closing remarks.

Mark Green

Yeah, I mean, the sessional payments have actually helped retain dentists within NHS. They like doing that without the treadmill or they’re looking at the UDA, what they’re getting on the UDA, which doesn’t work for, say, high needs patients; so the sooner we get away from a UDA way of paying practices, the better. Really, that’s what we need from government, for Wes Streeting and he’s acknowledged that. So hopefully they’ll come up with something.

I’d like to hear more about Tom’s plan of retaining later-career dentists on a personal level because we used to have the retention, we used to have those retention fees in the old scheme and that was lost. And you know what’s to stop me saying ‘oh, I’ve had enough of this. I’m going to go private’, which is what’s happening.

We’re getting dentists who are not even trying the NHS, they’re getting their performer number and then doing a year or two and then going to the private sector and it’s not, it’s not all the grass is greener on the other side either, but they would need to retain not just the young, we need to retain the older generations.

I’ve got a few years left in me, yet I think, and I think I provide a very, you know, I provide a very cheap service for the NHS to be honest and I would expect that to be recognised and these sessional payments do help recognise that, so sessional payments get away from the UDA.

Jason Atkinson

Thank you, Mark. And I agree without a workforce, patients don’t have access and that’s the bottom line and prioritising the workforce is hopefully something that the government will consider and I’m certainly interested myself in Tom’s pilot and looking at supporting people during their careers with enhanced payments.

Ian, I’d like to wrap this up with some of the kind of feedback you’ve had from patients and some of the quotes you’ve had from patients who’ve gained access through the various programmes that Yorkshire and Humberside and the NE have introduced. So Ian, you would like to just give me some of your impressions of what patients have told you about gaining access to dentistry?

Ian Wilson

Oh, Jason. I mean, time doesn’t allow me to go through them all, but two very much come to mind. A young lady last week who has been a recovering cocaine addict and because of her lifestyle, we needed to treat her to remove approximately 10 and 11 teeth that were affected by drugs, by methadone, by her lifestyle and place in immediate dentures, and that’s all she wanted when I sat down with her, she said ‘I just want my smile back’ and at the end of the appointment last week, we removed the teeth, replaced the dentures and she burst into tears and we gave her a moment and I just said ‘why? why the tears?’ And she just said ‘not only have you given me my smile back’ – but quote – ‘you have given me my life back.’

And I find it incredible and all of us on this call know the impact of the burden of dental disease on to people’s lives. But when we’re talking about these marginalised groups, the simple procedure of removing teeth in and placing dentures, not only gives a smile back, but it gives somebody their life back.

I found incredibly profound and the fact that we’re talking about moving away from an old system of units of dental activity into sessional care that allows us, as clinicians, to provide the best care for our patients, whether they’re regular, you know, the 18 month recalls that Mark is talking about, the paediatrics that Sally and others have has been talking about, all the marginalised grouping that we’ve been talking about and Jason one last quote – let me give us this last quote from a client who said this – ‘People in recovery will think I still looked like an addict because I’ve got no teeth. I feel I’m a normal person again.’

The service that we’ve been working on this service over the last three years, it’s an amazing service. It’s changed lives. You could see the happiness on his face after his dental treatment and I think, Jason, that says it all. Thank you.

Jason Atkinson

Thank you very much, Ian. Can I thank everybody’s participation in this podcast today? I think we’ve covered an awful lot of ground and covered a lot of the main issues that we see, a challenge in delivering NHS care for patients and some of the innovative programmes and schemes that have been developed by the ICBs and by everybody that’s taking part in this podcast. So thank you for your participation and thanks for taking part in this podcast discussion.