What ICB’s Really Want
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- Published: Friday, 08 March 2024 09:49
- Written by Peter Ingle
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Forty Two English Integrated Care Boards (ICB’s) are now able to influence how NHS dental funding is allocated in their area. Despite the constraints of what is still described as a “National contract,” there appears to be some flexibility.
Those still tied to NHS work may want to see if they are giving their ICB what it really wants, and those outside the NHS may wish to see what they are missing out on.
Different ICB’s may have variations in their priorities and objectives, but a recent document from NHS Suffolk and North East Essex ICB (SNEE) could provide clues to contractors further afield, regarding their paymasters preferences. The area covered by this ICB contains some notorious dental deserts. Within SNEE there is a budget of over £54 million for dental care in the year 2023/24. Primary care receives a little over £41 million, Secondary care £10 million, and the Community service £3 million.
The Suffolk and North East Essex Draft Dental Plan proposes a high level strategy for oral health in the area. It is apparent from the header pager onwards, that rectifying inequalities in oral health is at the forefront of its ambitions.
A section explains Poor Oral Health as a key driver of inequality in the area, and that it can affect overall health. SNEE has identified inequality in more deprived populations, giving the example of a propensity for high decay in Asian children. Overall, SNEE Adult Oral Health is at England averages but there is evidence of inequality in NE Essex. 2018 figures show 27% of English adults having evidence of active decay, the equivalent figures for Essex being 40%, and for Suffolk 25%.
It is likely that most of the target audience for the document are non-dental, and it helpfully contains a section headlined ‘NHS dental care is not universally free at the point of use’ for the benefit of the decision makers that will be reading it.
In a section headed ‘The challenge and opportunity’ there are a series of graphs that provide a visual explanation for the access crisis. While activity levels and courses of treatment have finally recovered closer to pre pandemic levels, the percentage of the population seen remains stuck at around 20% less than in 2019. The point is underlined by a table showing that within SNEE only 74% of contracted UDAs are being delivered. Footnotes show that there are 2000 calls to 111 each month for dental reasons, as well as many presentations to A&E and GP practices.
A list of reasons for deteriorating access is given, where the contract looms large, and there is reference to the 2023 Health Select Committee report. The failure to include prevention, locking long term underspending into contracts, and a lack of innovation by the commissioning system are also mentioned. Dentists wishing to remain in the NHS would be unwise to ignore the implications of the observation regarding the contract that: “It rewards treatment of regular attenders, not the significant contingent of vulnerable patients who often present with complex needs.”
The report then identifies opportunities. These include:
National guidance allowing new contract flexibilities for up to 20% of contract value to be paid in agreed ways, and not just UDAs
New flexibilities recognising the role wider professional groups can play e.g. dental nurses, hygienists and dental therapists
Underperformance values can be withdrawn by the commissioner, following due process, from April 2024
When it comes to opportunities for innovation the report identifies; delegation to ICBs enabling innovation and joint work by partners, and options to use underspent contract money to resource new approaches.
The draft plan begins with details of the team that will be recruited to deliver it. This includes having 2 regional Dental Chief Officers, 4 senior shared fellows, and increasing the ICB team from 4 to 6.
Aspects of the plan already being delivered include, for prevention:
Prevention programmes live in 50 schools in Suffolk, plus a further 45 in NE Essex in 3 years. Chosen locations to be based upon deprivation, tooth decay rates and obesity prevalence.
Training for early years staff.
Reduced and sugar free medication.
Oral health messages integrated into health promotion across Integrated Care Partnership membership.
For workforce development, the goals include: establishing two Centres for Dental Development working in partnership with the education sector and dental practices, to operate as “mini teaching hospitals.” One of the centres referred to is the Suffolk University centre set up by former CDO Sara Hurley. An increase in whole time equivalent dental providers also features on the list, but there is no specific information about how this will be achieved.
SNEE intend to commission coverage across the area for priority groups. These are identified as: the homeless, transient populations including GRT and refugees, those with learning disabilities, looked after children, care leavers, urgent and emergency patients, those needing stabilisation for other treatment such as cancer, care home residents, high risk individuals, those with dementia, and sex workers.
When it comes to GDP’s the plan includes:
Withdrawing funds from underperforming contracts
Focusing on areas that have low access, with weighting to deprived areas.
Two interesting notes are that the aim is to use a “more balanced approach to payment” than UDA’S, and that there needs to be regular dialogue with dental providers. “Response is uncertain” has been added to the second note.
There are also plans for Paediatrics, Emergency and OOH, Orthodontics, Specialised secondary care and Community services.
Many specific items are marked as “live” or coming on-stream during 2024, suggesting that the plan is not so much a discussion document, as a statement of intent.
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