Introduction
Citizens Advice is a unique problem solving charity, which supports 494 Citizens Advice Bureaux (CABx) delivering advice and information from 3,200 outlets across England and Wales. The service helps people resolve their consumer, legal, money, health and other problems by providing free information and advice and by influencing policymakers.
Citizens Advice welcomes the Government’s reforms to NHS dentistry which include a) the introduction of a new dental contract from April 2006, which is intended to encourage more dentists to deliver NHS dentistry and b) new responsibilities and resources for Primary Care Trusts (PCT) to ensure that local dentistry services are sufficient to meet local needs. Patients have waited far too long for a resolution to the problem of access to NHS dentistry and it is essential that these reforms deliver for patients from April 2006.
Main Points
- From April 2006 patients will expect that their local PCT will ensure that there is a NHS dental service that meets their needs. For many patients this must mean a local service in their community, as they are not able to manage the cost or inconvenience of travelling long distances to access dental services.
- In planning new dental services therefore, PCTs must ensure that the priority is to provide equality of access across their area, so meeting the needs of patients, rather than for example clustering service provision where it is easiest to deliver.
CAB evidence shows that a key problem is that many patients are unable to travel the lengthy journeys necessary to access NHS dental services. In the summer of 2005 we placed a questionnaire on our website www.adviceguide.org.uk on this issue, which produced 1700 responses. Key findings were that:
- two thirds of respondents did not know about the role of NHS Direct in helping people find a dentist
- only 13% of those who used NHS Direct were able to find a suitable dentist as a result
- of those who could not find a suitable dentist, 63% said the only available dentist was too distant or too expensive to travel to; 68% went without treatment.
- Currently there is no help available for people on low incomes with the costs of travel to dentists, although such a scheme does exist to help with costs of travel to hospital. Citizens Advice has argued for extending the help with travel costs scheme to include travel to dental treatment since this is no longer a locally available service in many parts of the country. However to date the Government has resisted such an extension. Unless the reforms can speedily rectify the access problem, then the case for extending help with transport costs remains strong.
We welcome the recruitment drive, which has resulted in a significant number of new practicing NHS dentists. However at the same time CABx continue to report other dentists withdrawing from NHS work altogether and the prospect of a new contract does not appear to have stopped this practice:
An East Midlands CAB reported that the relief provided in March 2005 when a new NHS dentist opened up in the area was short-lived. In July 2005 another local practitioner abandoned providing NHS treatment.
Many dentists withdrawing from NHS provision appear to give their patients no option but to join Denplan and pay a significant monthly charge:
A CAB in the Midlands reported a client in her late 70s who had been with her dentist for 43 years. She had just received a letter informing her that her dentist will no longer being doing NHS treatment and offering her private care via Denplan at £16 per month.
In addition, despite the new recruitment, in many parts of the country access remains very poor, with patients often unable to manage the long journeys necessary to reach any NHS provider as the following recent cases show.
A CAB in Devon reported an elderly client on a low income and in receipt of pension credit, who has diabetes which has caused rapid tooth decay so that she requires several extractions. Six months ago her dentist stopped providing NHS treatment and she has been unable to find another in her local area. Transport costs and mobility difficulties mean she is unable to travel far so she has felt forced to seek private treatment which she is now struggling to financially to pay.
A CAB in the North East reported a family whose dentist stopped providing NHS treatment. They were put on a waiting list by the PCT and six months later were offered places with a new NHS dentist. However this would involve a lengthy journey. The client was annoyed that not only did he have no choice of dental provision but also that his elderly parents now faced such a lengthy journey.
Inevitably the consequences are that patients’ health suffers and costs are displaced onto other parts of the NHS:
A CAB in Hampshire reported an elderly client on a low income and in receipt of pension credit who had visited her doctor three times because of dental pain and a sore tongue. Her doctor’s opinion is that the problem is dental but she cannot find a local NHS dentist. The client is worried and in pain. She has poor health following two by-pass operations. She cannot afford private treatment and has no transport.
We continue to receive a large volume of similar evidence from CABx across the country. This leads us to believe the following measures are crucial if this important reform is to be successful:
- Every PCT should ensure there is active patient involvement in their strategy for developing local dental services to ensure new services meet patient needs
- Every PCT should have agreed and publicised time and distance standards for patient travel to access NHS dentistry. These will obviously vary depending on local circumstances and the availability of public transport services.
- As an interim measure where access standards are not met, there must be provision of help with travel, either financial or in kind; to ensure people on low incomes or with mobility or caring responsibilities do not face barriers to access.
Parliamentary contact: James Hulme James.hulme@citizensadvice.org.uk
Social Policy contact: Liz Phelps Liz.phelps@citizensadvice.org.uk
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