The evolution and future of UK dentistry
Sara Hurley, Chief Dental Officer for NHS England, writes for Hospital Times providing a comprehensive analysis of what the future holds for dentistry in the UK.
Since the beginning of the NHS, General Dental Practitioners (GDPs) have delivered the majority of NHS dentistry and contributed hugely to the improvement in the oral health of the nation. The need for dental care endures but the evident changes in dental disease patterns suggest a need for a greater emphasis on different treatment modalities and integration care pathways.
The requirement for a change in tack and a reconfiguration of the workforce was at the heart of the 2009 Steele Review, frequently cited for its recommendation that NHS dentists be paid according to the number of patients seen, as well as their quality of service. It is expected they focus on disease prevention and not just treatment. Professor Steele’s Review also highlighted how much of the routine clinical work traditionally carried out by a dentist might be undertaken by a suitably trained therapist in the future.
What does the Long-Term Plan mean for dentistry?
The intent and ambition behind the 2014 “Call to Action” have evolved over the past four years as its key tenets have re-emerged within the NHS Long Term Plan (LTP). Rather than a siloed “strategy for dentistry,” we now have tangible examples of integration of dental care and oral health, as the concept of “putting the mouth back in the body” is progressed.
Notable within the LTP and the integration of oral health is the focus on “a strong start in life for children and young people”. The LTP highlights the “Starting Well Core” dental access initiative, the focus on early and holistic prevention and reducing inequalities with a redesign of the existing dental service that provides diet, healthy habit development and prevention advice for early years families.
Early evaluation of the Starting Well Core indicates success in advancing access opportunities for 0 to 2-year-olds, and a raising of public and professional awareness of “Dental Check by One”. A small reduction (7.8 per cent in 2017) in the number of 0 to 4-year-olds admitted to hospital for dental extractions during 2018 offers an indication of further tangible improvements that may be achieved with continued investment and roll-out of the Starting Well Core across the whole of NHS England.
Integrating care pathways with oral health
Dentistry is one of the four pillars of Primary Care, along with our general medical practitioners, optometrists and pharmacy colleagues. Work is underway to firmly include the oral health team into the integrated care system (ICS). Within ICS’s the development of the primary care network will enable the oral health message to reach a wider group of healthcare professionals for the complete treatment of patients at a community level. This relationship will be reciprocal; providing oral health perspectives to the ICSs will give them a chance to see the need to include dental teams.
With the LTP actively supporting the integration of oral health into care pathways, it has set a clear direction for national and local level recognition for intent and implementation. The LTP fosters the adoption of a more holistic approach to “good oral health” provision by placing greater emphasis on an intent to “work with partners to bring hearing, sight and dental checks to children and young people with a learning disability in special residential schools”.
Risk-based dental checks and oral health care are now integral elements of a young person’s personalised care pathway and daily routine. Informed care teams provide support within the residential care setting to help improve health outcomes and quality of life. The opportunity “to do things differently” and provide good oral health outside of the traditional dental clinic setting is reiterated in the LTP ambition for “all care homes supported by a consistent team of healthcare professionals …. ensuring individuals are supported to have good oral health, stay well hydrated and stay well nourished”.
This work draws on the successful “Mouth Care Matters” scheme which already operates in 13 trusts across the south east, providing evidence of improved health outcomes through a validated care model. The scheme is underpinned with support and training in oral health care for hospital staff as they care for elderly and frail patients. Translating this to the residential care setting is a natural next step.
To deliver on these endeavours, a range of health and social care professionals will be required to work together and dental teams will need to be actively involved at all levels. In supporting this “different way of working”, we continue to support and develop NHS England’s Local Dental Networks (LDNs) and Managed Clinical Networks (MCNs) that are key to dental leadership and realising the full gamut of benefits for patients. The continued integration of oral health teams into Primary Care Networks, along with improved digital connectivity, will facilitate joint working between oral and general health teams, better signposting of patients at risk and aid prevention over cure where possible.
The future of dental care is about the dental team as opposed to any single dentist, and the delivery of quality care is dependent on a quality team. The General Dental Council (GDC) states: “good dental care is delivered by the dental team [and] all members of the team contribute to the patient’s experience of dental treatment.”
More recent analysis of the workforce suggests an increasing proportion of dental care could be delivered by professions such as dental therapists and dental technicians as opposed to relying upon the highly specialised skills of the qualified dentist. This fact is not lost on the enlightened practice principal and it is worth acknowledging that the multidisciplinary dental team is not a new phenomenon. We already have an increasing number of dental principals deploying the complementary skillsets within their teams using the full scope of practice to the benefit of patients, with increases in access, availability and delivery of prevention.
As the evolution of 21st century dental practice design continues, it is likely to revolve around the prescribing GDP, who will be the mainstay of the provision of NHS dental care. However, the emergence is likely of a general dental practice team responsible for different elements of the prescribed course of treatment.
This will include dental nurses, hygienists, dental therapists, dental technicians and clinical dental technicians all bringing their differing skills and perspectives to improve patient outcomes in NHS dental care. Patients will have the opportunity to be seen by the right clinician at the right time for the right treatment result, increasing access to dental care and with resources and skills deployed efficiently and effectively.
Achieving this will not be without challenges. The most common barrier is awareness of dental teams and their offerings. Opportunities such as this article allow the dental voice to be heard, what the dental team can bring and the essential need for an oral health component in a patient’s overall healthcare. Afterall, our oral health affects the way we all eat, talk and smile.