The State of NHS Dentistry in Liverpool
Summary
Access to NHS dental care is increasingly one of the main issues we hear about from the public (we have seen a five fold increase in calls since before the Covid-19 pandemic). Difficulties getting support has led to many people living in pain. In some extreme cases, people take matters into their own hands, resorting to DIY dentistry.
For most of this year there have been no dentists in Liverpool (or elsewhere in Merseyside and Cheshire) taking on new adult NHS patients and very few accepting new child patients.
The only option for people to be seen who are not already signed up with an NHS dentist is to sign up with a dental practice as a private patient, but this is not affordable for most people locally, even before the cost-of-living crisis.
In this report we highlight some of the inequalities presented by the current situation and suggest what could be done to improve it.
Before Covid
Before covid it was sometimes difficult to find an NHS dentist near where people lived in Liverpool. We regularly rang around local practices and could always suggest an NHS practice if people were willing and able to travel.
Impact of Covid
During the first wave of the pandemic (March – June 2020) people couldn’t see dentists and when dentists reopened in summer 2020 they had a lot fewer appointments available because of covid safety measures.
Now
There is a backlog of untreated dental issues, lower numbers of people receiving check-ups or early treatment. This means dental problems get worse and take more time to treat. The problem is getting worse not better and people calling us are more desperate than ever.
For most of this year there have been no dentists in Liverpool (or elsewhere in Merseyside and Cheshire) taking on new adult NHS patients and very few accepting new child patients. Currently (November 2022) there is one dentist taking on new adult patients from a small area of the city on a postcode basis.
The only option for people to be seen who are not already signed up with an NHS dentist is to sign up with a dental practice as a private patient, but this is not affordable for most people locally, even before the cost-of-living crisis.
Some Dental facts and figures
- Even with the rest of the NHS under huge pressure, dentistry is the main problem that people want to talk to us about. Dental problems used to be about 20% of our enquiries but are now over half and the number of people contacting us looking for dental care has increased by five times since before the pandemic.
- Less than a third of Liverpool adults (33.1%) saw an NHS dentist in the past 2 years. This is lower than elsewhere in the country and the rest of Merseyside and Cheshire.
- Less than half of Liverpool children (44.3%) saw an NHS dentist last year. This is lower than every other area in Merseyside and Cheshire other than Halton.
- Patients have a right to register with a GP if they live in their catchment area however busy they may be. This isn’t the case for dentists. Dentists don’t have to accept new patients and can close their books to new NHS patients when they are busy.
- Patients who are on a dentist’s list will be able to get treatment and even check-ups. Those not lucky enough to be on a list will not get a dentist even if they have major pain or decay.
- There is an Emergency Dental Service which sees a huge number of local people in urgent need and great pain for one-off care such as antibiotics or a temporary filling. However, people are then stuck without a dentist to fix their actual dental problem. This does little to reduce need.
- Because of low incomes many local people would be eligible for free NHS dental care if it was available. Even those who do need to pay for NHS dental care face costs many times higher if they go private.
- There are major problems with the NHS dental contract, which doesn’t work well for patients or dentists. National action is needed to fix the dental contract and make sure there is enough NHS dentistry to meet patient needs.
- Dentists get paid for “UDAs” – units of dental activity. A band 1 treatment e.g. a check up, counts as 1 UDA and an extraction counts as 3 UDAs. Dentists are funded for a number of UDAs to use over the year in their NHS work. This doesn’t seem to be meeting the needs of local people
- Currently NHS England commission dentistry. From April 2023 this responsibility moves to Integrated Care Systems, new NHS bodies. It is important that the Cheshire and Merseyside Integrated Care System is ready for this new responsibility.
What the public are telling us
As well as the increasing number of dental problems we hear about, we are also seeing the problems people contact us about becoming more serious. Whereas previously we used to receive some calls from people looking for a dentist for check-ups, now almost all of our dental callers already have a dental problem and have been dealing with pain for some time. People are increasingly desperate about the state of their teeth. Many have already been seen by the Emergency Dental Service which provides one-off care for people with urgent needs and have then been told to find a dentist for their ongoing care.
“I have tried everywhere and desperately need work done on my teeth, I have made a couple of visits to the emergency dentist who has temporarily repaired them but the pain is coming back now. ... I’m struggling to function at the moment.”
The problems affect some people particularly severely:
- People who can’t afford to pay privately no matter how desperate they are.
- People who didn’t have a dentist previously (e.g. people who have moved to Liverpool, asylum seekers or refugees, people who have been homeless, people who avoided dental care previously out of poverty, other life pressures or dental fear).
- Families who have needed to move because of domestic violence and can’t safely access their previous dentist.
- People who might have been prioritised for dental care before, such as: pregnant women, young children, people with major health conditions, are struggling to get routine care and treatment.
Dental pain is not a minor issue. Remember having tooth ache and then imagine living with that for years before you get it treated, while the problem gets worse.
“My partner and I both have painful broken teeth but no dentists in Liverpool are taking on NHS patients and we can’t afford private so we have to live with pain”
“I have tried over 20 practices in the Liverpool area who none are taking on NHS at this time.. the last time I had toothache I resorted to pulling it out myself”
For some people not being able to get dental care puts their physical or mental health at risk too:
“I would like to save what few teeth I have left from worsening/deteriorating ..., I’m at my wits end, it’s affecting my diet which is in turn affecting my blood sugars as I am type one diabetic .... I get £260 universal credit a month”
“now my mental health is being affected as my confidence has been really low”
Incomes in Liverpool are lower than the national average, and now with the cost of living crisis many people have no chance of affording private dentistry which is all they can find:
“I am in pretty desperate need of some dental treatment and on a low wage so can’t afford to pay hundreds of pounds for treatments. It is an ongoing source of anxiety for me as I know I need my teeth looking at but don’t know how I can actually afford to pay”
“I need an NHS dentist for myself and my children. I have tried many practices who have said that I may be treated if I pay privately but I cannot afford this as I am on Universal Credit. My tooth has recently broken and I have been quoted £250 for a filling and £30 for a consultation. Obviously, I cannot afford this. When I asked the practice ‘what do people do who cannot afford to pay?’ I was told ‘go without’. This is unacceptable.”
‘I am a support worker trying to support 24 people to access an NHS dentist in the Merseyside area. The NHS Dental system is broken ..... Not everyone has the internet to access this information, local dentists offer no support if you are not on their books, and nobody is taking on NHS patients. There are so many vulnerable people unable to access NHS dental services - even in an emergency. People are trying to cope with the cost of living crisis and finding money for dental care .... is unrealistic and unacceptable. Some of the people I support have been in the care / prison system. Some cannot read or write. I worry for those who have no support and suffer in silence.”
Some people, out of desperation try to pay for private care by dipping into savings, juggling finances or borrowing money. Private finance for dentistry is now widely advertised but risks putting people into debt they cannot afford to pay. People should have the option of NHS care. We are often in the uncomfortable position of telling people that it might be years before they will get an NHS dentist, but that private care is immediately available to those who can pay.
Action so far
- We are in regular contact with the NHS England regional team who have been liaising with dentists to get help for the most urgent of our dental enquirers, those whose dental issues are impacting on their physical or mental health to a dangerous extent.
- The Emergency Dental service is really important, but it can’t deal with the amount of demand without more appointment in dental practices for ongoing care.
- The NHS dental contract makes increasing the number of NHS appointments difficult and there are problems recruiting and retaining NHS dentists.
- There was a short-term limited amount of extra money for dentistry in February-March 2022 but this didn’t make much of a dent in the amount of people needing treatment.
- There have been some small changes to the contract that NHS dentists work under. Much more needs to be done. Patients need to know that this problem is going to be fixed.
What needs to happen?
We need a national conversation between patients, dental leaders, the NHS and politicians about how the NHS is going to meet the country’s dental health needs. This will need a united effort.
Healthwatch England is calling for the following to address the issues that people have shared with Healthwatch up and down the country:
- A quicker and more far-reaching change to the way NHS dentistry is commissioned and provided – Under the current arrangement, many people cannot access NHS dental care when they need it. The current NHS contract also does not work for dentists.
- Using these changes to tackle the twin crises of access and affordability – No one should be unable to access dentistry because of a lack of local NHS dentists, or because they find it hard to pay fees for treatment. As well as making it easier for everybody to get a dentist’s appointment, the changes should reduce inequalities.
- Creating clearer information about NHS dentistry– It should be easy for people to find clear information about NHS dentistry, including online. This includes information about where and how people can get treatment, and what charges they may need to pay. Information about dentistry ‘registration’ also needs to be clearer and easier to understand. Both patients and dental practices are sometimes confused about ‘registration’. The changes need to deal with this.
- Look at using dental practices to support people’s general health – Dentists could work with other partners in the NHS to link oral health to other key issues. This could including helping people manage their weight, or supporting people to stop smoking.
In addition, Healthwatch Liverpool would like to see locally:
- Honest communication between the NHS and the public about the scale of the dental challenge, how long it is likely to be before patients can get dentists and the action that is being taken.
- An action plan to stabilise and then restore NHS provision locally including fair access to the existing provision during the recovery period to minimise harm and inequality.
- Making sure that people have a fair and equal chance to get an NHS dental appointment rather than just those lucky enough to have had a dentist when the pandemic hit.
- Consideration of whether the length of time between check-ups might need to be temporarily extended to help get more people the chance of an NHS check-up during this recovery period.
- Targeted action to improve access to dental care in Liverpool to at least the Cheshire and Merseyside average to reduce the unequal access within the region (there isn’t enough NHS dental provision anywhere in Cheshire and Merseyside but at present Liverpool is particularly poorly covered).
- Action to encourage recruitment and retention of NHS dentists locally.
Read the full report
Download our findings in full. If you need this document in a different format, please email enquiries@healthwatchliverpool.co.uk or call 0300 77 77 007.
