Special care dentistry in the South West


This is an update on an earlier briefing in September 2019 about work by NHS England and NHS Improvement to strengthen special care dental services in the South West region.

The region covers:
• Gloucestershire
• Bristol, North Somerset and South Gloucestershire
• Swindon
• Wiltshire
• Bath and North East Somerset
• Somerset
• Dorset
• Devon
• Cornwall and Isles of Scilly

As part of its commissioning responsibilities, NHS England and NHS Improvement directly commissions special care adult and paediatric dental services.
Special care dentistry is concerned with improving the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability; or, more often, a combination of these factors.

Services are typically used by:
• People suffering from anxiety and/or extreme phobia of dental treatment
• People with learning difficulties and/or autism
• People with physical disabilities

NHS England and NHS Improvement – South West
• People suffering from dementia
• Patients needing bariatric equipment
• People undergoing chemotherapy
• Some homeless people

People are referred via a number of routes, including:
• High street dentists
• GPs
• School nurses
• Social workers
• Care workers
• Voluntary organisations

Special care dental services provide urgent care, check-ups and treatment. Some
are also linked to other services such as oral surgery. Some, but not all, provide
general anaesthetic for patients who cannot be treated by local anaesthetic.

Services across the South West are currently provided by:
1. UH Bristol PCDS (Bristol, Bath and North East Somerset)
2. Smile Together CIC (Cornwall)
3. Northern Devon Healthcare NHS Trust (Exeter, North Devon, East Devon,
Mid Devon, West Devon North)
4. Livewell Southwest (Plymouth)
5. Torbay & South Devon NHS Foundation Trust Community Dental (Torbay,
West Devon (South), South Hams, Teignbridge)
6. Somerset Partnership NHS Foundation Trust (Somerset)
7. Great Western Hospital CDS (Swindon and Wiltshire)
8. Gloucester Health and Care GCS CDS (Gloucestershire)
9. Somerset NHS Foundation Trust (Dorset)

Some of these contracts had been due to end in March 2021. Approval has now
been secured at national level for these to be extended until March 2023.

The three-year plan:

The next three years, running up to that date, will be used to:
1. Carry out a comprehensive regional needs-assessment for oral health
2. Develop a comprehensive dental commissioning strategy covering primary
care, community dental and secondary care (hospital) dental services
NHS England and NHS Improvement – South West
3. Work with all seven Sustainability and Transformation Partnerships/Integrated
Care Systems in the South West to consider appropriate models of care that
integrate with the wider health strategies for the people they each serve
4. Identify services to be redesigned so the best-possible treatment can be
offered consistently across the South West

This work will be informed substantially by feedback from engagement with patients
and carers, which began in September 2019 (see below).

 The next three years will also be used to:
• Work with providers to ensure that patients receive consistently high quality services
• Develop a standard reporting system to help track referrals, activity and outcomes consistently across all providers.
• Strengthen work with local authorities to continually improve the oral health of the population in the South West

Patient and carer engagement:
Engagement work, starting last September, involved reaching out to users of special care dental service to gain insights into their experiences. A survey was conducted across the South West through local Healthwatch teams,
generating 349 responses. Focus groups with service users were also run in Cornwall, Somerset and Gloucestershire, with five further ‘Speak Up’ groups facilitated by Healthwatch Devon for people with learning disabilities.

The key themes that emerged from the research were:
1 Accessibility – many people reported difficulty accessing the service, often because of length
of travel
2 Waiting times – there were geographical variations in waiting times, with some areas better
than others. While two in five people were seen within a month, nearly one in five waited over six months.
3 Parking – of the 71% of people who went by car, more than four out of five reported no difficulty finding a parking space.
4 Flexibility of appointments – just 6% of people said their appointment time was inconvenient, though some
NHS England and NHS Improvement – South West felt improvements could be made by adapting more to travel times and public transport.
5 Quality of service – four in five people were happy with the friendliness of staff, while some pointed to a lack of knowledge about their own condition – especially for people with learning disabilities.
6 Awareness of the service – knowledge about the service’s existence among the target population varied
considerably around the South West, though some people had been using it without realising this was a special service.
7 Communication – most people were happy with the level of communication before, during and after their appointment. Focus groups indicated more could be done, especially by providing written information in accessible formats to augment what people were told verbally.
8 Clinic location – focus groups suggested that home visits were generally not a better option than visiting the specialist surgery, though a significant proportion of people in the survey would like them. There was also strong support for continuing to use the specialist service (75%), rather than a high-street dentist (10%).

Further work will be carried out to test these themes, including with groups that might have been under-represented in the survey and focus groups. As stated above, outputs will be used to shape developments over the coming three
years. Patient representatives will also be involved directly in steering this work.

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