The acting chief constable of Devon and Cornwall police, Jim Colwell, has been suspended pending an investigation into allegations of breaching professional standards.
The region’s police and crime commissioner, Alison Hernandez, has made a mandatory referral to the Independent Office for Police Conduct (IOPC), which has confirmed it will investigate the allegations.
Hernandez said she would announce interim leadership arrangements in due course.
She said: “Sadly it has been my duty to suspend A/CC Jim Colwell and refer this matter to the IOPC. Suspension is a neutral act to enable an independent and thorough investigation to take place. It has no bearing on any indication that the allegations will be upheld and should not be seen as such. A/CC Colwell has seven days to make representations to me relating to his suspension.
“As required for any suspension of a senior officer, I have this morning informed the Devon and Cornwall police and crime panel of my decision and fully understand that there may be concerns within the force, in our communities and with our partners in relation to this suspension. I share those concerns and resolving leadership issues in the force remains my most pressing priority.”
Colwell was leading the force in place of the chief constable, Will Kerr, who was suspended in July last year.
In September Devonlive reported that South West Water owner Pennon had announced rising cases of sewage spills and a hit of about £16 million from the parasite contamination crisis in Devon earlier this year.
The group said it racked up the costs from the contamination incident in Brixham, after paying compensation to affected households, providing bottled water for two months, and after “extensive” action to clean the network.
Now South West Water has pledged £1.2m to help tourism:
A £1.2m fund to help boost tourism and repair “reputational damage” after a cryptosporidium outbreak in south Devon has been described as “desperately important”.
South West Water (SWW) has pledged the money as part of a Destination Marketing Recovery Fund following the water parasite outbreak in May that saw about 100 confirmed cases of the diarrhoea-type illness in and around Brixham.
Business leaders said the incident caused 3,500 pieces of negative coverage across the world, as well as tens of millions of pounds worth of lost bookings.
Much of the money was due to be spent on television advertising, they added.
“The headlines were appalling,” said Chris Hart, chairman of the English Riviera BID Company.
He said: “We were able to demonstrate to SWW that there were around 3,500 pieces of negative coverage about Brixham and the wider Devon area, not just here but across the world.
“Our research showed that around £34m of bookings were lost at the time of the outbreak, with an estimate £6m in future bookings also lost.”
Much of the money would be spent on a national TV advertising campaign, with one advert already in production, he said.
He added: “The aim now is to use the funding to repair the reputational damage that has been caused, and to present Brixham and the English Riviera in a really positive light, showing off the great area this is.”
Business in the area said they were confident the latest funding would help address the situation.
“It’s going to open up channels of marketing we currently can’t afford, such as television advertising,” said Alex Foley, who runs the Guardhouse Café at Berry Head.
“It will allow us to reach many more potential customers and show how great the area is.”
“This is desperately important,” said Linda Lowe, who owns Brookside Guesthouse in Brixham.
She said: “The only way we can get our reputation back in the public eye is to get the marketing out quickly… a massive advertising campaign showing just how beautiful it is here.”
Of the £1.2m pledged by SWW, about £250,000 is also due to be spent on a legacy project in Brixham, which is being delivered by the local Chamber of Commerce.
South West Water said: “It’s important to us that we do what we can to support local businesses and the community in Brixham.”
It added: “The fund will help promote tourism in Brixham and the surrounding area in partnership with the English Riviera BID.”
This explainer was commissioned by NHS England. It was independently developed, researched and written by the authors and all views are the authors’.
What is NHS dentistry?
NHS dentistry provides treatment that is clinically necessary to keep mouths, teeth and gums healthy and free of pain and includes primary, community, secondary and tertiary dental services. In 2021/2022 the NHS contribution to dentistry was about £2.3 billion.
How is NHS primary care dentistry organised?
Primary dental services are one of the four pillars of the primary care system in England, along with general practice, primary ophthalmic services (eye health) and community pharmacy. These services use a ‘contractor’ model of care, which means that almost all NHS primary care services are delivered by independent providers contracted to the NHS.
There are around 11,000 independent dental provider practices in England, private businesses that provide a mix of both NHS and private dental care. About three-quarters of these hold contracts to provide NHS services. These practices might be dentists working as individuals or in partnerships or small businesses, although there are also a small number of large corporate dental providers. Dental providers who have a contract to provide NHS funded dental services can also offer private treatment to their patients. All dental practices must be registered with the Care Quality Commission.
There is no national registration system in dentistry like there is in general practice. People do not need to be registered with a dentist to receive NHS care and should be able to go to any dental practice that holds an NHS contract for treatment, without any geographical or boundary restrictions. Dental practices can choose whether they provide NHS treatment to new patients depending on whether they have capacity under the terms of their contract (see below).
Once a patient is accepted for an assessment of their treatment needs the practice cannot refuse to complete the course of treatment. Once the treatment is completed, the dental practice does not have ongoing responsibility for their dental care, though some NHS treatments, such as fillings, crowns and inlays, are covered by a 12-month guarantee. Dental practices have patients they regard as ‘regular attenders’ for the purposes of planning recall appointments. Dental practitioners can prescribe any items listed in the dental practitioners’ formulary, and can issue both NHS and private prescriptions.
Community dental services provide dental care for patients (adults and children) with more specialist needs. This might include people who need services such as general anaesthetics or sedation, orthodontics, or adults and children with particular needs such as physical or learning disabilities, medical conditions, people who are housebound and people experiencing homelessness. Community dental services are provided in a range of settings including mobile clinics, people’s own homes or care homes, hospitals and specialist health centres.
Most secondary care dentistry is provided by NHS hospitals, including the 10 NHS specialist dental hospitals in England. It includes services such as complex oral surgery, oral and maxillofacial pathology, dental and maxillofacial radiology. Secondary and tertiary care dental providers have an important role in providing dentistry training and may also provide emergency primary care dentistry.
How is NHS dentistry commissioned and contracted?
From 2013 to March 2023 NHS England was responsible for commissioning primary and secondary dental care in England, a process led by the primary care commissioning team. From April 2023 integrated care boards (ICBs) took over responsibility for commissioning primary, secondary and community dental services. The change from NHS England to ICBs is intended to enable commissioning and provision of dental care that meets the particular needs of local populations and addresses inequalities oral health and in access to care. Local commissioners use national commissioning standards and guidance to assess local needs, set a minimum standard for services and ensure outcomes and quality measures are included in service specifications and contracts. In order to provide NHS dental services, providers need to hold one of the following NHS contracts.
General dental services (GDS) contracts
These contracts are the most commonly used for NHS primary care dental services and do not usually have an end date. The GDS contract covers ‘mandatory dental services’, which are routine and clinically necessary urgent treatments needed to keep the mouth, teeth and gums healthy and free of pain. GDS contracts can also cover more specialist services, known as ‘advanced mandatory services’ and ‘additional services’, which include more complex extractions, home visits or sedation.
Personal dental services (PDS) contracts
PDS contracts cover specialist primary services such as sedation, orthodontics or home visits but can also include mandatory dental services and are usually time limited for a period of about five years. They make up about 15% of NHS dentistry contracts. A PDS Plus contract was introduced in 2008 and has a different payment mechanism including payments for meeting certain performance indicators such as re-attendance rates. The National Audit Office reported that in March 2020 there were only 36 PDS Plus contracts in place in England.
Other dental care services are commissioned in the following ways
Urgent dental care services
While urgent dental care to patients who are undergoing a course of treatment at the practice within a practice’s normal working hours is provided as part of the GDS contract, other urgent dental care, including out-of-hours care, may be commissioned separately from a range of providers. Patients usually access this type of care by contacting NHS 111 for triage and are then referred to a local provider.
Community dental services (CDS)
Community dental services provide dental care for patients (adults and children) with more specialist needs. This might include people who need services such as general anaesthetics or sedation, orthodontics, or adults and children with particular needs such as physical or learning disabilities, medical conditions, people who are housebound and people experiencing homelessness. Community dental services are provided in a range of settings including mobile clinics, individual homes or residential homes, hospitals, and specialist health centres. Community dental services are usually commissioned from NHS trusts but may also be commissioned from other suitably qualified providers under PDS or GDS contracts.
Secondary care dentistry provided in NHS hospitals
Secondary care dentistry is commissioned from NHS hospitals under the standard NHS contract.
How is payment calculated?
Units of dental activity (UDAs)
Under the GDS contract, payments for primary care dentistry are made for units of dental activity (UDAs), up to a maximum negotiated annual contract value agreed in each dental provider’s contract. There are six bands of treatment, which attract different numbers of UDAs.
Under the GDS contract each provider agrees to provide a set number of units of dental activity (UDAs), for an agreed price from 1 April until 31 March the following year, with the total value of the contract paid in monthly instalments. If the provider does not achieve 96% delivery of their contract activity at year end, following an annual reconciliation process, money for the care that has not been delivered may be recovered by the commissioner.
Band
Number of UDAs
Includes
Band 1
1
Examination, diagnosis and advice
Band 2a
3
Everything in band 1, plus additional treatment such as fillings, root canals and extractions
*Band 2b
5
Everything in bands 2 where there are three or more fillings/extractions in one course of treatment and/or non-molar root canal treatment to permanent teeth
*Band 2c
7
Everything in band 2 plus molar endodontic care to permanent teeth.
Band 3
12
Everything in band 2 plus more complex treatment such as crowns, dentures and bridges
Urgent
1.2
Examination, assessment, advice and urgent treatment
*Introduced in October 2022.
The first phase of dental contract reform was completed in July 2022. Changes included the introduction of enhanced UDAs to better reflect the cost of providing more complex treatments currently remunerated under Band 2 and introducing a new national minimum value for each UDA across England. Providers will now be able to be reimbursed for up to 110% of their contract value on a non-recurrent basis, subject to agreement with the commissioner. The reforms also promote longer gaps between checkups for those with good oral health, and have made it easier to use the full range of dental health professionals more effectively to deliver services.
Patient charges
Patient charges for NHS dentistry were introduced in 1951. The money from patient charges is collected by dental practices but is passed to the NHS and in 2021/2022 amounted to £633 million. Some patients are exempt from dental charges including children, pregnant women and new mothers, and those receiving certain low-income benefits. There are no patient charges for secondary and tertiary care dentistry.
Band
Patient charges at April 2023
Includes
Band 1
£25.80
Examination, diagnosis and advice
Band 2
£70.70
Everything in band 1, plus additional treatment such as fillings, simple root canals and extractions and simple changes to dentures
Band 3
£306.80
Everything in band 2 plus more complex treatment such as crowns, mouthguards, dentures and bridges
Urgent
£25.80
Emergency appointments or urgent treatment that cannot be postponed
About 85% of the dental workforce work in independent general dental practices. Others work in NHS community services or hospitals.
The normal route to become a qualified dentist is to complete a degree (either BDS or BChD), which is usually a five-year course. Dentists must then register with the General Dental Council before they can practise. Dental graduates trained in the UK then usually undertake dental foundation training for a year, working under supervision in a practice approved by NHS England. Once this is completed they can apply to join the NHS performers list for England if they wish to provide NHS primary care dental services. They may also choose to do further training, known as dental core training, for between one and three years, mostly in dental teaching hospitals, special care and community dental clinics and acute hospitals. This may be followed by a further three to five years of dental specialty training.
Dentists who have qualified overseas need to pass the overseas registration exam to register with the General Dental Council, and if they wish to provide NHS primary care dentistry they must also apply to join the NHS performers list.
Other registered dental care professionals working for a dental provider may also provide NHS services once they have completed the appropriate training set out by the General Dental Council. Recent reforms allow dental therapists and other dental care professionals in a dental practice to assess patients, diagnose common conditions and provide treatment or refer on to a dentist when more complex treatment might be required, rather than patients needing to see a dentist first.
Challenges
Access to NHS dentistry is a significant challenge. In the British Social Attitudes Survey in 2022, satisfaction with NHS dentistry fell to a low of 27% and dissatisfaction increased to a high of 42%. 24% of respondents said they were ‘very dissatisfied’ with NHS dentistry – a higher proportion than for other health and care services asked about in the survey. Healthwatch England reports that patients frequently raise issues around access to dentistry, and that 7 of 42 integrated care boards reported that they had no dental practices taking new adult NHS patients that they had not previously treated. While people can theoretically be treated by any dentist with an NHS contract, data from 2022 found that people who had been to a particular practice before were much more successful in getting an NHS dental appointment than those who were not previously known to the practice (82% compared with 32%). Younger adults and people from minority ethnic groups were had the lowest levels of success in accessing appointments. A report by BBC News and the British Dental Association in August 2022 found 9 in 10 NHS dental practices across the UK were not accepting new adult patients for NHS treatment.
As well as difficulties in securing an appointment, there are wide disparities in the availability of dental practices providing NHS services. There is also a significant geographical variation in the supply of dentists, with dentists concentrated in cities and around dental hospitals and schools. In addition, the number of dentists willing to provide NHS services is falling.
Particular groups of the population are at risk of poorer dental health and worsening health inequalities. Research has shown that people in more deprived areas and those in vulnerable groups such as, homeless people, looked after children and people from Gypsy, Roma and Traveller communities, face particular difficulties accessing dental care. In addition, over the past 10 years the number of children with dental decay has risen significantly, particularly for those in the highest areas of deprivation.
The Covid-19 pandemic has had a significant impact on primary care dentistry. Routine dentistry was completely suspended for several months in 2020. In January 2022 the government announced the investment of £50 million to provide an additional 35,000 urgent dental care appointments to help to drive services back to pre-pandemic levels.
The dental recovery plan was published in February 2024 under the previous government and aims to increase access to NHS dentistry services. The £200 million plan was intended to deliver more than 1.5 million additional NHS dentistry treatments (or 2.5 million appointments) in 2024-25 and has three components.
The additional courses of treatment in 2024-25 were intended to come from the first of these components, through four headline initiatives:
mobile dental vans to deliver some dental services to targeted communities
a new patient premium, in which participating dental practices receive a credit of units of dental activity (UDAs) equivalent to £15 or £50 (depending on the course of treatment) for eligible new patients
‘golden hello’ recruitment incentives of £20,000 (phased over three years) for 240 dentists to work in areas with recruitment and retention challenges in NHS dentistry
an uplift to the minimum value of a UDA to £28. [The amount that the UDA is worth is not fixed across the country or even local areas so NHS dentists get paid different amounts from place to place but is typically around £28. – Owl]
Scope of the report
This report sets out information on the current delivery of NHS dentistry services and the development and progress of the plan for 2024-25. It does not seek to examine and report on the overall value for money of the programme, but we offer some reflections on what the government might want to consider as it develops its future plans for NHS dentistry. It looks at:
access to NHS dentistry before the plan
development of the 2024 dental recovery plan
the government’s progress against the dental recovery plan’s objectives and plans for evaluation
Conclusions
The dental recovery plan aspires to deliver more than an additional 1.5 million courses of treatment in 2024-25 but is not currently on course to do so. Even if these additional courses of treatment are delivered by the end of 2024-25, the plan would still mean that 2.6 million fewer courses of treatment would have been delivered than in 2018-19.
DHSC and NHSE should look to reflect on what has worked in this plan and build upon that as they look to deliver the meaningful reform of the dental contract that they have alluded to.
A proper evaluation of this plan will be needed, as well as a review of whether they have sufficient reporting processes in place to make sure that they are getting back from ICBs the data they need to monitor progress with any future plan. They will need to assess how they engage with ICBs and dental practices who are responsible for delivering NHS dentistry in local areas.
From the detail
There are several issues, beyond just the impact of the pandemic, that are contributing to a lack of access to NHS dentistry:
• The dental contract is in need of reform
• Insufficient provision of NHS dentistry.
• Overall spending on primary care NHS dentistry has fallen in real terms,
The national NHS Dental Recovery Plan, which launched in February, created a £20,000 ‘golden hello’ incentive to recruit NHS dentists to areas that have historically struggle to recruit them or to retain them in the face of competition from private practice.
Funding for a total of up to 240 dentists across England was made available by the government.
Devon secured 17 of those, an allocation it was awarded in October.
But in nearly two months of the scheme running, just one dentist has taken the incentive in Devon.
The scheme does have certain stipulations, namely that dentists need to remain in post for three years to receive the full £20,000.
The state of dentistry in Devon was the subject of a debate in Westminster Hall this month, with Richard Foord MP (Liberal Democrat, Honiton and Sidmouth), stating the South West was a “special case” and that some of his constituents who needed treatment were only able to find available appointments 80 miles from their homes.
Mr Foord said 51 per cent of adults in the South West had access to a dentist in 2015, the same as the national average, but that these figures had now fallen to 40 per cent for England and 34 per cent for Devon.
The pressure on the sector has been exacerbated by the fact Devon now only has 497 dentists compared to 549 in 2020.
A spokesperson for NHS Devon said it was too early to know how the level of take-up of the ‘golden hello’ scheme compared with other counties.
Asked if the scheme would help it secure the number of dentists it wanted, the spokesperson said the organisation did not usually set specific targets for recruiting NHS dentists.
“We are focused on working with our providers to improve access to dental care and meet local oral health needs,” the spokesperson said.
“Recruitment efforts are shaped by challenges such as national dentist shortages and the difficulty of retaining NHS dentists due to workload and contract issues.
“Instead of fixed recruitment goals, we aim to achieve reduced unmet dental needs by using strategies like contract flexibility or incentives, such as the golden hello, to attract dentists, particularly in underserved areas.”
Explains what the recovery plan seeks to do and what isn’t working – such as the basic contract needs fundamental reform and expenditure on dentistry has fallen in real terms.
NAO concludes the plan is unlikely to deliver an additional 1.5 million treatments by March 2025. Even if this target was achieved, it would still mean 2.6 million fewer treatments compared to before the pandemic.
An explanation of the Byzantine complexity of the the current NHS dentistry system in England, commissioned by the NHS and published by The Kings Fund in October 2023.
In Owl’s opinion, only a hard core bureaucrat could dream up something like this, so we shouldn’t be surprised that it doesn’t work!
East Devon Watch 