Agenda item

This paper detials primary care pharmacy, optometry and dental services delegated to the Integrated Care Board from July 2022.

Discussion:

Members considered a report from the Integrated Care Board (ICB) on the primary care pharmacy, optometry and dental services delegated to the ICB from July 2022.

The following issues were discussed:

·      Dentist waiting lists – some surprise was expressed by Members that there were no figures available for people waiting for an NHS dentist. The point was made that the lack of transparency around waiting lists was unacceptable. Members were advised there was no requirement to register with a dentist and there were no catchment areas or boundaries. The ICB could though look at how to better understand need and how that demand was being met.

ICB representatives advised that they were able to confirm how many practices in Medway were accepting NHS patients, although they could not give figures on waiting lists.

·    New Patient Premium – in response to queries about how this worked, Members were advised that this was a national initiative which offered a premium for patients who had not seen an NHS dentist over the last two years. The system had not gone live in all areas of the country yet.  Members queried whether the aim of this was to proactively seek patients and were advised this was not the case. The premium was paid to a practice so if a patient had been seen by another dentist (NHS or private), then the premium would still apply. It was suggested that a way should be found to track whether a patient had accessed a dentist elsewhere.

Comments were made from Members that this national initiative seemed a very inefficient approach and concern was expressed this would not improve access to dentistry services.

Once the benefits of this initiative had been assessed, a briefing note on this for Members would be provided. In response to how accurate data could be gathered, the ICB advised that information about private patients was not collected by the NHS but NHS dental activity could be tracked.

·    Pharmacy First –a request was made for details to be provided to the Committee of the timespent by pharmacists in Medway on community pharmacy clinical services and also the costs involved. This would then show the contributions made by local pharmacists and the time savings for GPs. Members were informed these services had been commissioned nationally and the Government had provided additional funding. However, pharmacists were often dispensing items at a loss and funds had been reallocated by the Government into service provision.

A Member asked if all registered pharmacies were offering all of the services detailed in the report and also whether the infrastructure was in place so they could communicate with GPs. Members were informed that by 1 April all pharmacies should all be providing a full service.

·    Pharmacy contraceptive service -reference was made to the fact that only half of the52 community pharmacies in Medway had opted in to provide this  service. The geographical gaps in service provision and what was being done to improve matters were queried and an undertaking was given to detail the geographical gaps.

Members were advised that this service had been launched in two tiers. There was an online map so the public could locate the nearest pharmacy providing contraceptive services. The ICB was also working with local sexual health services to make sure the pathway was clear.

The Director of Public Health added that the Council also commissioned sexual health and contraceptive services.

·    Mobile Dental Vans –disappointment was expressed that Medway was not eligible for this service due to nationally set criteria.

·    NHS Dental Contract reform – reference was made to a national £200 million investment fund to support the dental recovery plan andthe extent to which this would benefit Medway was queried. Members were advised this would help but would not fully address the issues Medway faced regarding access to dentistry. The ICB intended to focus on areas of health inequalities to drive activity there. There was a need to understand why dentists handed back their contracts and what could be done locally on recruitment and making dentists feel valued. If efforts were targeted this could lead to a significant increase in dentistry activity in Medway. 

·    ‘Golden Hello’ for Dentists – in terms of whether Medway had benefited yet, the ICB was waiting for more details. There had been a soft launch in January, which would be followed by a bigger national promotion. The ICB was still hopeful some of the Golden Hellos would come to Medway

·    Children –noting that some children were not able to access an NHS dentist, the point was made that this would have an adverse impact as they transitioned to adulthood.

·    Recruitment and retention – in terms of what could be done to help with recruitment and make dentists feel more valued, Members were advised there were plans to offer more support from primary care. Reference was made to long delays in newly qualified dentists being registered to practice, which was leading to some deciding to work in other countries. Further information on this would be provided to Members.

In terms of what was being done to grow dentists in Medway, the Director of Public Health advised there was a lot of work with the Medway School of Pharmacy.

Reference was made to low morale levels amongst dentists, which was causing some to terminate their contracts, Members were informed that morale was very low and making progress was slow and difficult. 

·     Rapid Commissioning of Permanent Units of Dental Activity (UDAS) in areas of highest need – what lessons had been learned from the pilot in Canterbury was queried. Also, whether Medway was missing out on funding due to its regional rating was questioned. Members were advised there had been very positivefeedback on the pilot. Due to the claw back process, any money received would appear in the next year’s budget. Medway was one of the areas with the highest needs. The ICB was looking at its own approach to dental investment and whether more clinical dentistry leadership could be brought in, so there was a stronger voice nationally.

·     Oral health strategy – in response to how this was assessed, Members were informed that public health provided training for parents and adults and further information on this could be provided.

·     Sourcing drugs – a Member referred to pharmacies often being unable to source drugs and also not being able to purchase them at cost. This led to cases of GPs prescribing drugs which the pharmacies did not have. Members were advised this was a widespread problem. The ICB would look to improve communications between GPs and pharmacies regarding shortage of drugs and what alternatives were available.

Decision:

The Committee agreed to note the report and receive an update in August 2024 on the areas highlighted above where Members had requested further information.