North Central London Dental Update and Governance Overview

North Central London Dental Update Camden and Islington LDC AGM 20 November 2024

Overview dental governance in NCL and LA public health input Delegated Services Board Oversees workstreams from across delegated clinical priorities (including dental). Provide decision-making authority as needed NCL Dental Collaboration Group NCL Dental Transformation Steering Group Discuss challenges and plan solutions to dental service issues, as well as provide updates on progress on different programmes of work collaboration across the ICB, LDC, local authorities Oversees delivery of ICB transformation programmes, funded by 600k pot for dental transformation in NCL. Representatives of each workstream present NCL Oral Health Improvement Network NCL Oral Health Promotion Investment Working Group GULP project task and finish group Forum bringing together commissioners of OH improvement across NCL with Dental PH specialists to to discuss areas of common interest and develop collaborative work at borough/system level Oversees delivery of GULP project in Haringey & Enfield highlight current issues and risks (funded by ICB transformation fund). Escalate to DTSG when needed. Oversees planning and delivery of NCL supervised toothbrushing programme (funded by ICB transformation fund).

NCL ICB Engagement with the LDC 3

2024/25 Underspend 4

Plans for 2025/26 Underspend Utilisation Initiative Description Provider UCLP-led research project to support diabetes patients with regular dental support through the creation of an integrated pathway, allowing GPs to refer to a dental hygienist. GPs have been collecting data over the last 6+months so should have a comprehensive data set to work from. GPPA/UCLP 1. GP/Dental Integrated Pathway Would need to do some work to design the project, so there s costs built in for this. The idea is that there would then be a single point of access, possibly based in a GP settings, and would coordinate the referrals into a dental service. The Dental General Anaesthetic Suites (DGAS) was a continuation of Project Tooth Fairy set up during the pandemic. The service was located at The Royal London Hospital, however, the Dentist and all the pre-op assessments were completed by Whittington CDS. Up until now, the costs of these staff were provided in good will but these now need to be factored in to the running of the service. These funds would be to support the Whittington CDS to continue to deliver at Barts under the DGAS service. The Whittington CDS 2. DGAS Staffing costs The demand for CDS continues to increase due to: 1. The cost of living crisis resulting in more people buying sugary fast foods in some of our most deprived areas 2. The limited capacity in primary care 3. The impact of the pandemic on oral health has seen a deterioration in people not accessing Dental Services 4. The need to treat patients out of hospital 5. The referral pathway; CDS act as gatekeepers for all referrals onto secondary care. This waiting list initiative has been successful in 24/25 at absorbing some of the 40% increase in paediatric referrals that has been seen since the pandemic. This funding would be to provide a further x4 Saturday clinics for 12 months. The Whittington CDS 3. CDS Provision weekend clinics (extension) 5

Plans for 2025/26 Underspend Utilisation Initiative Description Provider The 'Giving Up Loving Pop' programme is a five-week programme across Primary Schools (KS2) and is designed to support the main part of the PSHE Curriculum. It comprises of a Oral Health Educational workshop (covering topics such as Sugar detectives, Hydration, Nutrition labels and Single use plastics) as well as a fun physical delivery element. In response to growing tooth decay and obesity rates Healthy Stadia was commissioned to develop an educational programme. This has been successful run and evaluated in several football clubs in England. The pilot has been delivered across 20 classes in 2024 in schools seeing the higher levels of deprivation in Haringey and Enfield. This funding is to expand this provision to a further 30 classes across NCL. Tottenham Hotspur Foundation 4. Expansion of GULP (Giving Up Loving Pop) There is a pan-London Level 2 Complexity Endodontic (root canal) service delivered in the primary care setting by clinicians with enhanced skills. The patient pathway requires consultant led triage under the restorative dental specialty by specified trusts across London. After triage, the patient is either returned to the referring practice if inappropriate, sent on to the appropriate Level 2 provider for treatment, or retained by the trust if the complexity is Level 3. Income for the trust is only generated where they retain Level 3 complexity patients. Rejections and onwards referrals are a cost pressure which is not met within their contractual envelopes. UCLH 5. Endodontics Triage As the triage is unfunded, there are no contractual leavers available to commissioners with which to force trusts to address the backlogs and waiting times, nor is there an option for trusts to pay clinicians to deliver the levels of triage required. The London Region Restorative Dentistry Managed Clinical Network has devised an appropriate remuneration model for triage and using this, costs to address the existing backlog and fund future triage activity have been calculated. A reduction in the triage waiting times will have a direct and positive impact on the delivery of care for patients, e.g. shorter waiting times, more teeth restored (rather than extracted) and increased patient satisfaction. The funding of triage within trusts will improve workforce morale and the ability to plan clinical activity. 6

What does the future of Dentistry look like? 7

APPENDIX 8

NCL ICB Dental Transformation Programme 2024/25 9

Dental Transformation Funding Recap NCL ICB secured 600k for Dental Transformation projects. This funding is recurrent although the projects will change based on priorities and needs. The funding has come from headroom in the Dental Primary Care contracts Priorities for key areas of investment are to reduce inequalities in access to dental services in the community The projects currently funded (2024/25) include: - Giving Up Loving Pop (GULP) - NCL supervised toothbrushing programme teeth for life - Care homes pilot - Weekend clinic pilot for people experiencing homelessness - Waiting list clearance - children and dental anaesthetic suites (DGAS) 10

2024/25 Live Dental Initiatives 2024/25 Initiative Project Overview Evaluation/Outputs GULP is a five-part programme across primary schools in KS2 and supports the main part of PHSE education. The development of the educational programme was commissioned by Healthy Stadia and has been successfully run by several football clubs in England. In NCL, it is being delivered by the Tottenham Hotspur Foundation. GULP (Giving Up Loving Pop) The pilot is in it s last two weeks of delivery and successfully secured all 20 spaces in the pilot. The pre and post surveys have a current response rate of 90-92%. The anecdotal feedback from schools, teachers and children has been overwhelmingly positive. Surveys will be collated in Nov/Dec for full intervention evaluation with report being published by January. Alongside, a Public Health Dental Trainee is conducting interviews with key stakeholders to map out a process evaluation for how the pilot could be improved if expanded in 25/26 as is currently expected. Programme focused on the most deprived schools in two of the ICB s boroughs Haringey and Enfield Run from 1 April 2024 for one year with a target reach of 20 schools (10 in each borough) and up to approx. 400-600 children. NHS-funded programme to complement other child oral health improvement programmes in NCL commissioned by local authorities - such as Brushing for Life , staff training and other fluoride delivery programmes, as well as wider work to ensure children have a healthy weight. Quarterly and annual service monitoring data will be used in addition to other information to evaluate the programme in the first year Supervised Tooth Brushing Programme Teeth for Life Run from 1 August 2024 to 31 July 2025 with a target reach of 80-120 settings across these 25 wards and 3,000 3 and 4 year olds (Barnet 23 settings; Camden 27; Enfield 35; Haringey 32 and Islington 19) Delivered by Whittington Health NHS Trust Oral Health Promotion (OHP) Team To provide virtual oral health training to increase staff awareness about oral health care of residents in care homes and provide advice and signposting to dental services. Training will be delivered over 1.5 hours (CPD-certified) and offered to all staff in the care home by OHP team supported by a dental officer including: Practical tips for special care toothbrushing aids and techniques Denture care OH resource pack including basic guide booklet and tailored leaflets Signposting information and referral pathways between care homes, GDS and CDS The pilot launched in July and lasts for 6 months. First session held on 15 July 15, offered to 11 care homes and attended by 87 staff. Care Homes Pilot Evaluation planned: Effectiveness of the programme will be evaluated by process evaluation. The programme will be assessed using evaluation questionnaires completed by the care home staff. Knowledge retention from training will be covered as part of the training programme delivered by the Whittington OHP team. Pilot for weekend clinic for patients experiencing homelessness - To be run on Saturdays for 12 weeks over the summer months providing treatment for patients experiencing homelessness or rough sleeping. Pilot running July September Evaluation of the pilot to be conducted Oct-Nov to also capture learnings to inform future program design. Evaluation will consider treatments received (time in chair) as well as number of patients seen due to the complexity of this cohort. Weekend clinics for people experiencing homelessness/ rough sleeping During the pandemic, the use of theatres for paediatric dentistry was significantly reduced due to demand for other services and, as a result, Project Tooth Fairy (PTF) was established through the collaboration of both North and South London Paediatric Networks, London Region Paediatric Managed Clinical Network and London Region DOP Team. The Royal London are running this service from 1 April 2024 31 March 2025. Further agreement needed if continuing after this date. Waiting lists: children and dental anaesthetic suites (DGAS) The Whittington CDS are delivering this service at The Royal London for two sessions per week (1 day) for NCL ICB. This service is a waiting list initiative. However, with paediatric referrals up 40% since 2019/2020 there is a need to consider more than the current waiting lists for service impact. 11

Giving Up Loving Pop (GULP) GULP is a five-part programme across primary schools in KS2 and supports the main part of PHSE education. The development of the educational programme was commissioned by Healthy Stadia and has been successfully run by several football clubs in England. In NCL, it is being delivered by the Tottenham Hotspur Foundation. Programme focused on the most deprived schools in two of the ICB s boroughs Haringey and Enfield Run from 1 April 2024 for one year with a target reach of 20 schools (10 in each borough) and up to approx. 400-600 children. Delivered in schools over five weeks and includes oral health-focused educational workshops and physical delivery (exercise element). The programme also partners with Surfers Against Sewage linking the impact of reducing sugary drinks and single use plastics to the benefit to the planet. Healthy Stadia will conduct an evaluation based on the outcomes and impact on the schools/children. A further systems evaluation will be conducted by a Public Health Dental Trainee on what could be improved in the set up for the future. To date the pilot has delivered nearly all 20 schools, due to complete in 2 weeks time, with final totals of children reaching being tallied. The pre and post surveys have a current response rate of 90-92%. The anecdotal feedback from schools, teachers and children has been overwhelmingly positive. The pilot is scheduled to complete delivery by the end of November before taking 6 weeks for evaluation. NCL ICB is hoping to expand this provision into 30 schools during 25/26. 12

Supervised toothbrushing programme Teeth for Life NCL-wide programme focused on each borough s 5 most deprived wards Run from 1 August 2024 to 31 July 2025 with a target reach of 80-120 settings across these 25 wards and 3,000 3 and 4 year olds (Barnet 23 settings; Camden 27; Enfield 35; Haringey 32 and Islington 19) Delivered in nurseries including nurseries attached to schools, pre-schools, day nurseries, children s centres, maintained nurseries and independent nurseries Cover all 5 boroughs in NCL during year - but likely to start in Enfield, Barnet and Haringey where either no/less comprehensive pre-existing supervised toothbrushing programmes in early years Delivered by Whittington Health NHS Trust Oral Health Promotion (OHP) Team - OHP team responsible for coordination of the programme, training of staff, provision of toothbrushing supplies and protocols, quality assurance of programmes, with nursery staff responsible for consenting children and supervision of children brushing on a daily basis within their settings NHS-funded programme to complement other child oral health improvement programmes in NCL commissioned by local authorities - such as Brushing for Life , staff training and other fluoride delivery programmes, as well as wider work to ensure children have a healthy weight In boroughs with existing supervised toothbrushing (STB) programmes the programme complements other programme and offers STB to settings which are not part of existing programmes Other elements of the programme include: Staff training on delivery of a supervised toothbrushing programme and wider oral health and healthy eating messages as well as dental access; information for parents about oral health and healthy eating and work in collaboration with the settings and local authorities to ensure settings have healthy eating, snack and drink policies in place Programme oversight provided by NCL Oral Health Promotion Investment Working Group, Chaired by Dudu with representation from all 5 borough PH teams, ICB dental team and Whittington Monitoring and evaluation - routine monitoring data on the reach of the programme (settings and children) and impacts on staff and parents knowledge and behaviour; and conducting a full evaluation at the end of the year, led by one of the Registrars in Dental Public Health. 13

Supervised toothbrushing- Monitoring and evaluation Quarterly and annual service monitoring data will be used in addition to other information to evaluate the programme in the first year Core service monitoring data Extra for evaluation 1. Activity - Quarterly (and annually) e.g. Reach - Number/ % settings (NCL and by borough) Reach - Number/ % children Training sessions delivered and % staff trained Quality assurance sessions delivered Healthy snack/ water only policies in place Reach by ethnicity and deprivation (based on children participating) (annual only) 1. Process/outcome evaluation at 12 months Reasons for refusal for settings not taking part Number and reason for any settings not passing quality assurance visits and any mitigations put in place Costs of delivering the programme Oral health promotion staff feedback on delivering the programme More in-depth data collection e.g. focus groups with settings and parents around delivery and maintenance 2. Surveys (reported annually) Parent satisfaction questionnaire (done at >6 months) Parent knowledge and behaviour questionnaire (including dental access) (baseline and after >6 months) Staff pre-post training questionnaire (knowledge, confidence etc) 2. Outcome evaluation medium-long term Decay prevalence Teeth extractions Dental access 14

ICB dental transformation: Dental health provision 15

Care homes pilot Programme scope: To provide virtual oral health training to increase staff awareness about oral health care of residents in care homes and provide advice and signposting to dental services. Training will be delivered over 1.5 hours (CPD-certified) and offered to all staff in the care home by OHP team supported by a dental officer including: Practical tips for special care toothbrushing aids and techniques Denture care OH resource pack including basic guide booklet and tailored leaflets Signposting information and referral pathways between care homes, GDS and CDS The session will include both didactic and practical elements with videos to offer staff the opportunity to practice mouthcare and troubleshoot problems. Care staff will complete a knowledge questionnaire prior to the training. This will be repeated after the training to assess retention of knowledge. The prioritisation of the training offer has been based on areas of greatest need - Camden, Islington and Enfield care homes have full coverage for staff training within the existing Whittington OHP contracts with respective local authority public health commissioners, as such the NCL training offer will focus primarily on Barnet (50+) care homes and Haringey (7) care homes. The pilot launched in July and lasts for 6 months. First session held on 15 July 15, offered to 11 care homes and attended by 87 staff. Evaluation planned: Effectiveness of the programme will be evaluated by process evaluation. The programme will be assessed using evaluation questionnaires completed by the care home staff. Knowledge retention from training will be covered as part of the training programme delivered by the Whittington OHP team. 16

Weekend clinics for people experiencing homelessness/ rough sleeping Pilot for weekend clinic for patients experiencing homelessness - To be run on Saturdays for 12 weeks over the summer months providing treatment for patients experiencing homelessness or rough sleeping. Pilot running July October. Location - Clinic located near Seven Sisters. Due to location, pilot focussed in Haringey and Enfield but open to all NCL; good links with nearby shelters/centers. Whittington CDS have built on existing contacts/relationships with key workers and center managers to raise awareness within this community. Knowledge that this cohort was likely to have (and indeed has seen) very high DNA and cancellations rate despite reminders, calling on the day and linking with case workers. Timings of clinic has shifted from starting at 9am to 10am due to non-attendance. Evaluation of the pilot to be conducted Nov-Dec to also capture learnings to inform future program design. Evaluation will consider treatments received (time in chair) as well as number of patients seen due to the complexity of this cohort. 17

Waiting lists: children and dental anaesthetic suites (DGAS) Background: During the pandemic, the use of theatres for paediatric dentistry was significantly reduced due to demand for other services and, as a result, Project Tooth Fairy (PTF) was established through the collaboration of both North and South London Paediatric Networks, London Region Paediatric Managed Clinical Network and London Region DOP Team. The aim of PTF was to reduce the increasing dental waiting lists for paediatric patients. PTF secured two years of funding for the creation of three GA procedure rooms (not full theatres but suitable for the treatment required) at The Royal London and the staffing costs incurred by the extra activity. The funding ceased on 31 March 2023 and the service was referred to as Dental GA Suites (DGAS). Given the delegation of dental services to ICBs, the payment of DGAS now falls to the ICBs. The Royal London are running this service from 1 April 2024 31 March 2025. Further agreement needed if continuing after this date. The Whittington CDS are delivering this service at The Royal London for two sessions per week (1 day) for NCL ICB. This service is a waiting list initiative. However, with paediatric referrals up 40% since 2019/2020 there is a need to consider more than the current waiting lists for service impact. 18