22 June 2022
Peter Aldous calls for a new strategic plan for NHS dentistry in England

Peter Aldous lays out the requirements for a strategic plan for NHS dentistry including secure long-term funding; a strategic approach to recruitment and retention; a replacement of the dysfunctional NHS dental contract; a prevention policy, promoting personal oral healthcare; and transparency and full accountability through the new integrated care systems.

Peter Aldous (Waveney) (Con)

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for St Ives (Derek Thomas) on securing the debate. Access to NHS dentistry remains an enormous problem right across England, from his constituency, which is the most westerly, to the Waveney constituency that I represent, which is the most easterly. There is not only a so-called perfect storm, but also a perfect symmetry, which hits the most vulnerable hardest.

The Government have brought in measures to address this crisis, which have had some partial success; but what is needed is a long-term strategic plan for NHS dentistry, which I would suggest should meet the following criteria. First, a secure long-term funding stream. Secondly, a strategic approach to recruitment and retention. Thirdly, replacement of the dysfunctional NHS dental contract. Fourthly, a prevention policy, promoting personal oral healthcare. And fifthly and finally, transparency and full accountability, through the new emerging integrated care systems.

The issue on which I wish to focus falls in the last of those categories. It is the procurement of NHS dentistry, which at present is opaque and has, over a long period, led to some outcomes that are not in the best interests of local residents and do not meet the standards of probity that one is entitled to expect in the award of public contracts.

In 2009, the late Dr David Johnson, a much-loved local dentist with a thriving practice in the high street of Lowestoft, was refused a contract to continue to offer a service that he had provided to the local community for many years. That happened in highly unsatisfactory circumstances, which caused much personal upset and ultimately led to units of dental activity being taken away from Lowestoft, where they were much needed, and reallocated elsewhere.

More recently, approximately two years ago, a contract was awarded for the out-of-hours service in Norfolk. The company that won the contract still does not have either regular dentists or premises, and does not work anywhere near the hours stipulated in the contract.

Dr Poulter 

My hon. Friend is absolutely right when he speaks of the challenges that patients face throughout Suffolk in accessing NHS dentistry. Does he agree that there is availability of emergency out-of-hours dentistry, but that some companies are not taking the correct steps to provide it—and that some dentists are not opening up the number of slots that they are contractually obliged to, to provide it?

Peter Aldous 

I thank my hon. Friend and neighbour for that intervention. He is correct, and the example I have just provided illustrates that point.

On the issues with the probity of procurement arrangements, I will move forward to the present. It is welcome that a new, long-term NHS dentistry contract has been awarded for the Lowestoft area, and the locally based Dental Design Studio will deliver the contract to a high standard for the benefit of local people. However, before DDS was awarded the contract, it was initially won by a limited company with no local presence, no dentists and no premises. That company then offered the contract to local practices, seeking bids, initially of £400,000, which it then reduced to £250,000. When it was unable to sell on the contract, it withdrew from the process.

Procurement arrangements that allow such blatant profiteering are quite clearly not fit for purpose. There is also a worry that the process is skewed against partnerships, which have been the traditional means of providing primary healthcare in local communities. Only single legal entities and limited companies are able to tender for NHS dental contracts, with partnerships excluded from doing so. The feedback that I am receiving is that the tender documents are far from straightforward and discourage some local NHS dentists who remain in practice from bidding for contracts.

The transfer of responsibility from NHS England to the new integrated care systems, which will start operating in just over a week’s time, provides an opportunity to carry out root-and-branch reform of the procurement and oversight arrangements for NHS dentistry. We need to ensure that they are fair, transparent and in the best interests of local people. It is vital that we seize this opportunity.


Intervention on Minister’s Reply

Peter Aldous 

There is some ambiguity about where the negotiations stand. Can my hon. Friend clarify whether a letter has gone to the BDA to start the negotiation process, or whether there are finalised heads of terms ahead of an announcement on a new contract?

Maria Caulfield (Minister for Patient Safety and Primary Care)

The negotiations started back in March and there have been a number of meetings with the BDA. The BDA has been sent final recommendations, but we have not yet heard back, so I encourage the BDA to respond.