An overview of London dental and other primary care services
At the October 2014 meeting of The Community Voice, of which we are a member, the guest-speakers came from NHS England London Region - Julie Sands, Deputy Head of Primary Care Commissioning, Kelly Nizzer, Deputy Regional Lead for Dentistry, and Alice Benton Head of Dentistry for London. Their main points are summarised below:
Kelly Nizzer spoke first, about dentistry: She used slides to provide an overview of North West London’s 1.9m population. The budget to cover all dental services in the eight boroughs is £94m including prison and domiciliary contracts, services in acute hospitals, and out of hours services.
Out of hours assessments are made over the phone from 6pm - 10pm weekdays and 9am - 10pm at weekends. Telephone 0203 402 1312 , or 111. Patients may be booked into a local practice on the following day, with normal NHS charges, or emergencies are dealt with at Charing Cross, University College London, Guys or Kings hospitals..
Orthodontic services across NWL are available under the NHS if patients meet the criteria required.
Children should be given guidance on dental health at an early age. There are to be more specialist practices for children, and leaflets about dentistry for children in public places.
The audience questioned the rising cost of NHS dental services over the years, but the speaker claimed dentistry costs had not increased significantly over the last few years. She noted that there should be posters in surgeries explaining what each of the three bands of treatment entail and cost. The contracts and costs for dentists are different from those for GPs. Dentists are often sited in main shopping areas for accessibility, so reimbursement in a similar form to GPs is not appropriate..
The audience also expressed concerns about difficulty in finding NHS dentists in some areas, concerns about poor child services, and concerns about dental services not being included within the umbrella of general NHS care. Other concerns noted that some dentists refer patients to hygienists or to outside practices for difficult treatments. The speaker noted that some advanced treatments are beyond the remit of most dentists. Her team monitors how each practice performs..
Julie Sands then spoke about primary services: She heads the Local Area Team dealing with the eight Clinical Commissioning Groups and 401 GP practices in NW London whose contracts provide the core primary care services for minor ailments, the chronically sick, terminally ill patients and services such as cervical screening, minor surgery, immunisation programmes and baby clinics.
From 2014-2015 nationally agreed services will include more minor surgery, vaccinations, immunisations, carers’ support, dementia support, and proactive care for vulnerable people to avoid unnecessary admissions to hospital. GP practices will extend their opening hours and set up Patient Participation Groups to look at their services. NHS England's role is to oversee the required changes and to monitor contract performance. It also has a joint role with the CCGs to improve the quality of care and to engage with stakeholders and patients when new developments are proposed.
To ensure improved choice, patients will be able to join GP practices outside their own residential area and be assured of seeing a GP on the same day if necessary, which should improve services for vulnerable groups such as the homeless and drug users. A named accountable GP will be provided for those over 75 years, although the patient may not see that particular GP on every visit. GPs will be contractually required to offer on-line appointments and ordering of prescriptions service and to allow access to the patient's own medical records. In 2015/2016 there will also be a named accountable GP for all patients including children, and practices will be required to publish the net earnings in 2014/15 of all salaried or contractual doctors within the practice.
Members asked about the difference in the responsibilities of NHS England and local Clinical Commissioning Groups within Primary Care. NHS England is responsible for GP services. The CCGs are responsible for specialist primary care services, such as district nurses.
Members also voiced their concerns, noting that not all patients have internet available, and that some GPs do not have the necessary training to identify and to care for dementia patients. They were told that GPs are encouraged to refer such patients to those GPs with that expertise.
NHS England can be telephoned on 0300 3112233.
The speakers were thanked for their interesting presentation and for answering questions, which was endorsed by applause as they left the hall.