Somerset's "dental desert" shows little signs of improving six months after the commissioning process for NHS dentistry was changed.

Somerset has struggled for years with a shortage of NHS dentists, with numerous practices refusing to take on new or existing NHS patients and health bosses struggling to recruit and retain staff.

Since April, the task of commissioning NHS dental services in the county has fallen to the NHS Somerset Integrated Care Board (ICB), taking over the commissioning role from NHS England.

But despite officials' best efforts, Somerset councillors claim the situation is not improving for their constituents, leading to large bills at the hands of private sector dentists and other health conditions being missed.

Eva Bryczkowski, who is based in Glastonbury, raised the issue candidly when Somerset Council's adults and health scrutiny committee when it met in Taunton on October 5. 

She said: "Somerset is the worst in the country – a dental desert, with many patients in pain having to foot £1,100 bills by having to go private.

"With the cost of living crisis, many people who have severe dental problems are pulling their own teeth out because they cannot afford to visit a non-NHS private dentist.

"Dental examinations can reveal serious health conditions, such as oral cancer, heart disease, and are necessary for women who are pregnant. Consequently, severe health problems are not being spotted early enough.

"Children are increasingly being admitted as emergency patients. Their teeth are bad because parents or caregivers are unable to afford private dentistry.

"This has led to an even greater strain on our already overloaded NHS.

"For people who are not registered as an NHS patient, how long will it be before they can register as a new NHS patient in Somerset?"

Rather than working directly for the NHS, dentists are private contractors, who enter into agreements with NHS England to provide a certain amount of treatments (known as units of dental activity) per year.

Each dental practice has an agreed amount of units of dental activity which it must perform – and if it doesn't meet them, the NHS allows other practices to bid for the remaining units on a short-term basis to meet demand (known as 'clawback').

Sukeina Kassam, NHS Somerset's deputy director of primary care, said her team would be looking into "contractual compliance", ensuring that practices which had promised to carry out a certain amount of NHS work were continuing to do so.

She said: "The way patients engage with dentistry has evolved. Patients no longer stay with one dentist for life; instead, they typically visit a dentist for the duration of their treatment.

"We understand that finding a dentist can be challenging, and dental surgeries may not always have the capacity to accept new NHS patients.

"In such cases, you might need to join a waiting list, seek out a different dentist currently accepting new NHS patients, or consider private dental care.

"We are actively collaborating with local providers to address the shortage of NHS dental services in the region. Our efforts include implementing initiatives to increase the availability of dental appointments and launching preventive care programs to support patients in maintaining their oral health.

"We are also exploring opportunities to commission additional NHS services from dental practices that have the capacity to provide them.

"We are actively addressing these challenges to improve access to dental care for our community."

The Department for Health and Social Care (DHSC) is expected to shortly publish its long-awaited dentistry recovery plan, laying out how dentist waiting lists will be cut and NHS access improved.

Ms Kassam said many of the issues being experienced in Somerset were widely reflected at a national level, with the government seeking to tweak the existing contracts to make dentistry a more attractive profession.

She said: "These changes, coupled with further adjustments to the national dental contract, are aimed at enhancing patient access to dental care and making NHS dentistry a more attractive option for dental professionals.

"While we await the specifics of these developments, we remain optimistic that they will bring positive improvements to the field of dentistry."

Councillor Gill Slocombe, who chairs the committee, criticised the government's delay in bringing out the recovery plan, citing issues within her own Bridgwater West division.

Ms Slocombe – a member of the Conservative opposition group – said: "We've been waiting and waiting. Dentistry is very, very high on our agenda.

"It's a major issue which keeps coming back and coming back, and we always seem to be waiting. I'm sorry, but it just seems to be frustrating for us."

Councillor Sue Osborne (who represents Ilminster and the surrounding villages) said the delays in paying dentists for NHS work was putting many off.

She said: "If you're with a private practice, you pay by card and they get the money instantly.

"Anecdotally, I've heard that if a dentist does NHS work, you might find yourself waiting four months before the invoice is paid."

Tessa Fielding, NHS England's programme manager for Cornwall, Devon, Dorset and Somerset, rebutted this notion, stating: "Dentists begin the year on April 1 with their contract and they receive 12 equal monthly instalments of that contract from day one.

"We adjust those payments in-year if they have underperformed on their contract, but there is no delay. What comes off the bottom line is what the patient pays over the counter.

"The practices can ask for payment up front, which is banded, because it's an incentive for patients to turn up for their next appointments for a course of treatment."

Matthew Jerreat, chairman of the NHS South West local dental network, admitted that there was not enough funding to provide dental treatment for all Somerset residents on the NHS.

He said: "There is only 50 per cent funding for the population. Even if you were trying to fund 100 per cent of Somerset, we're not going to deliver for all patients – and that's knowing that some people wail choose to go private and some don't like seeing the dentist.

"One of the things that we can do is have a charter, so there's an expectation for patients and the dentists providing treatment.

"Having that message mean that you as councillors and MPs can then go back up the food chain to the government and actually try and get more funding for NHS dentistry, so we can increase that percentage of the population further."

A further discussion of NHS dentistry in Somerset is expected to take place at a joint meeting of the council's adults and health scrutiny and children and families scrutiny committees, due to be held on October 25 at 10am.

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