Oral Health Needs Assessment Full Report Part 2 Access and Service Provision
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Oral Health Needs Assessment Full Report Part 2 Access and service provision: - Bath and North East Somerset (BANES), Gloucestershire, Swindon, and Wiltshire - Bristol, North Somerset, Somerset and South Gloucestershire - Devon, Cornwall and Isles of Scilly Paul Harwood, Consultant in Dental Public Health Rob Witton, Consultant in Dental Public Health Reena Patel, Speciality Registrar in Dental Public Health Marcus Woof, Strategic Enabler for Dental Public Health Contents Contents 2 Key points: Dental service provision in BGSW 4 Key points: Dental service provision in BNSSSG 8 Key points: Dental service provision in DCIoS 11 Local service provision in DCIoS 14 Access, availability and service provision 20 Access to routine and preventive care 22 Access to routine and preventive care in BGSW 22 Access to routine and preventive care in BNSSSG 35 Access to routine and preventive care in DCIoS 45 Access to urgent dental care 57 Access to urgent dental care in BGSW 57 Access to urgent dental care in BNSSSG 59 Access to urgent dental care in DCIoS 60 Treatment on referral rates 61 Referrals FP17s on Patients in BGSW 61 Referrals FP17s on Patients in BNSSSG 62 Referrals FP17s on Patients in DCIoS 62 Access to anxiety management services 63 Anxiety management services in BGSW 64 Anxiety management services in BNSSSG 66 Anxiety management services in DCIoS 68 Inequalities in access to services 70 Inequalities in access to dental services in BGSW 71 Inequalities in access to dental services in BNSSSG 80 Inequalities in access to dental services in DCIoS 88 Older people: access to NHS dental services 95 Access to dental care for older adults in BGSW 100 Access to dental care for older adults in BNSSSG 104 Access to dental care for older adults in DCIoS 108 Access to dental services for prisoners and people in contact with the criminal justice system 112 Vulnerable children and adults at risk of poor oral health 115 Children attending special schools 116 Adults with learning disabilities 116 Homeless people 116 Drug users 116 Travelling community: Gypsy and Irish Travellers 116 2 Looked after children 117 Oral health admissions data: Inpatients / day cases 118 Water fluoridation in the South West 121 3 Key points: Dental service provision in BGSW Availability: Since 2011/12 the number of dentists per 100,000 population has increased in all Area Teams in the South West, and is above national respective averages The number of dentists per 100,000 population was higher than the national average in BANES, Gloucestershire, and Wiltshire. It was lower than the national average in Swindon. It is interesting to note that Gloucestershire has a higher level of childhood decay in five year olds than the national average, but has a higher number of dentists per 100,000 population than England. Access to dental services is not just about the location of the practices. Most NHS dental practices are located in the towns and cities. Densely populated areas in BGSW appear to be relatively well served by NHS dental services, and there are some services in less populated areas. However, only just under half (47.3%) of the adult population and 68.7% of children visit the dentist in a two year period. For both children and adults patients, a high percentage reside in BGSW and are treated in BGSW. Relatively low percentages of children and adults patients residing outside of BGSW access treatment within BGSW. In addition, low percentages of children and adults patients residing in BGSW access treatment outside of the Area Team boundaries. This indicates how the local population appear to be able to access local services relatively easily, with minimal impact from non-residents receiving treatment in the area. Access to routine and preventive services: Children Across BGSW, there has been little change in the percentage of the child population visiting the dentist between March 2011 and March 2014, currently remaining stable at 68.7%, and marginally above the national average. In this time period, locally access rates have decreased in Forest of Dean, Stroud and Wiltshire. March 2014 access rates were below the national average (68%) in Cheltenham (59.6%); Swindon (65.5%) and Wiltshire (66.5%). In the last two years, access rates for the 0-2 age group (18.9%) and 6-12 age group (83.9%) were just below the respective national averages. Children residing in College; Lansdown; Park (Gloucestershire); and Lyneham; Marlborough West wards (Wiltshire) have to travel the shortest distances in BGSW to access NHS dental services, yet have the lowest access rates across the area. 4 Note that in analysing low access, elements such as patient choice, ease of travel or provision of private dental services need to be considered. The majority of children who attended a dental appointment (72.7%) receive a Band 1, and a further 22.6% received a Band 2 course of treatment Of the 72% attending for a check-up appointment, the percentage of children who receive a preventive intervention (fissure sealant or fluoride varnish application) is low and about half the national average The care index is the proportion of teeth with decay that have been filled. It gives an indication of the restorative care received by children with decay by dentists. The higher the care index the more fillings have been undertaken. Analysis of access alongside care index data on five and twelve year olds, indicates that children in Swindon and Wiltshire may not be accessing, nor receiving the dental treatment they require. Adults Overall the percentage of the adult population visiting an NHS dentist in BGSW within the last 24 months has increased from 42.6% to 47.3%, but are still below the national average (51.4%). Locally, March 2014 access rates were below the national average in Cheltenham and Tewkesbury (37.6%); Cotswold (38.9%) and Gloucester (47.1%) Adults residing in Bathwick (BANES); St Paul's; and Winchcombe (Gloucestershire) have to travel the shortest distances in BGSW to access NHS dental services, yet have the lowest access rates across the area. Note that in analysing low access, elements such as patient choice, ease of travel or provision of private dental services need to be considered. Access to urgent dental care Access to urgent care is a priority for the relief of pain and for accidental damage. One in four, (25%), of the adult population in the South West reported that they only went to the dentist when they had a problem (ADHS 2009). Just over half of the adult population (52.7%) and 31.3% of the child population in BGSW have not visited the dentist in the last two years, and thus may not have a regular dentist when they have a problem. Children: In 2013/2014 4.1% of all courses of dental treatment provided for children were for urgent care (England average 4.6 %). The most common age group was patients aged 6-12 years. Adults In 2013/2014 10.5 % of all courses of dental treatment provided for adults were for urgent care. This is just below the national average of 11.5%. 5 The most common age group was patients aged 25-34 years. Locally, levels for urgent care were higher than the national average in Gloucester (12.9); in Forest of Dean (12%); Swindon 11.8%; and Tewkesbury (11.7%) Access to anxiety management services The provision of adequate anxiety control is an integral part of the practice of dentistry. Child dental anxiety, for example, is widespread and many anxious children, and adults, can be satisfactorily treated using behaviour management techniques. Dental anxiety is a potential barrier to those seeking dental care and its association with oral health is of central importance. Provision across BGSW shows a great deal of variation and this may reflect ease of access to NHS services, rather than patient need. It is not known how many patients may visit private providers to use these services. Children Very few children undergo sedation as part of a course of dental treatment. Only 0.1% of courses of treatment provided for children in BGSW include sedation compared with 0.5 nationally. 9.8% of courses of treatment including sedation are provided for children up to the age of five years. Most (48.4%) are provided for children between the ages of six and twelve years and are mostly for fillings (54.9%) and extractions (61.1%). The percentage of courses of treatment involving preventive interventions occurs at a rate far lower than national averages: fissure sealants 1.5% (national average 6%) and fluoride varnish 1.1% (national average 11%). Adults 0.2% of courses of treatment provided for adults in BGSW include sedation compared with 0.3% nationally. Most (29.2%) are provided for those aged between 25-34 years and are mostly for extractions (90.6%), above the national average of 67.3%. Only 8.7% of treatment involves placing fillings, substantially below the national average of 36.8%. Only 0.7%involved root canal treatment (below the national average of 5.1%). This could be indicative of substantial levels of decay, which mean that restoration is not an option. The percentage of courses of treatment involving preventive interventions occurs at a rate far lower than national averages: fluoride varnish 0.1% (national average 2.5%); and scale and polish 4.1% (national average of 19.3%). Average number of UDA claimed per patient: Children: the highest average rate for contracts was in Forest of Dean, Swindon and Gloucester (2.3) and Stroud (2.2), above national and BGSW averages 6 Adults: the highest average rate for contracts was in Forest of Dean and Tewkesbury (3.7), above national and BGSW averages 7 Key points: Dental service provision in BNSSSG Availability: Since 2011/12 the highest number of dentists per 100,000 population has consistently been in BNSSSG.