‘My role is not just representing dentists – it is ensuring the wider oral health message is embedded in healthcare management and leads to improvements in patient care’

BDJ In Practice spoke to Dr N. Tony Ahmed, the Local Dental Network (LDN) Chair for Shropshire and Staffordshire and England’s only dental professional on any Integrated Care Board across the country, to talk about his role, what it means and the impact it could have for other areas of the country.

I am the LDN Chair locally, and I feel that has been a driving force. I was approached by the Chief Medical Officer of the ICB who said we need someone from dentistry on the board, and here I am! My motto locally is ‘working together to improve oral health’. I’m not just looking after dentists as a profession and it is not only about the money, I’m trying to improve oral health. There are big areas of deprivation throughout the locales I represent, and that’s where money needs to go, even if that means my own area gets less, because that’s what’s best for the population. That’s my approach.

We have pushed quite hard to improve dentistry though a number of schemes, looking at areas of high needs in great detail and assessing what is best for our population.

Because of the good work we’ve done, the Staffordshire and Stoke on Trent ICB started to notice and decided dentistry representation is something they wanted to bring in. In the build-up to the General Election 2024 there was a lot of bad press involving dentistry – patients queuing up around the block at all hours of the day and night – so integrating our LDN work and ideas within the ICB was a win for all concerned.

Very much so. As the only dental professional on this board, and the only dental professional on any dental board in England, my role is to ensure dentistry is represented at the highest level of healthcare planning and decision-making available for the population I serve. We have to advocate for oral health, which is increasingly seen as a vital component in general health. We’re moving beyond simply the treatment bit, but prevention as well. My priority is ensuring dental services are considered in strategies aimed at improving overall population health.

On a practical level, contributing to discussions on health inequalities and allocation of local funding is a priority. I’m sure this is happening in other areas, but we must collectively push to try and stop the dental budget being raided to fund services elsewhere. There are parts of the country where this is already happening, even though there is a national directive saying you cannot take the dental budget – it is ringfenced for a reason! I want to make sure the dental budget stays within dentistry and is invested back into the profession which is in dire need of funding. Locally, in Shropshire and Staffordshire, I’m pleased to say we’ve been able to make this happen. That’s not to say the chief finance officer was very pleased about it! But it does show the fight dentistry has on its hands.

My role is not just representing dentists – it is ensuring the wider oral health message is embedded in healthcare management and leads to improvements in patient care. That catchphrase the former Chief Dental Officer for England used – putting the mouth back in the body – is pertinent. Locally, it’s very important to do that.

From my perspective, I’m very grateful that Staffordshire, is a very forward-thinking, visionary and innovative area. I have to thank the CMO Paul Edmonson-Jones for this approach, who is based in Staffordshire, and is pushing the boundaries of what’s previously been done to ensure integration with dentistry happens and happens effectively. The wider role within the ICB has to be that oral health impacts other areas of healthcare. ICB’s allow for a more comprehensive approach to commissioning. We know those connections are there, but it is great to see wider healthcare professions following suit.

Really good question! Dentistry has been overlooked in the past. Historically, it has been commissioned differently and seen as separate from the rest of healthcare and, largely due to funding structures, there’s a perception its transactional in nature and doesn’t need a wider overall plan. This is a shame and shows a fundamental misunderstanding of the system.

By not integrating dentistry in ICBs, there are a number of missed opportunities. Part of my role is to change the narrative and demonstrate the impact improving oral healthcare has on the wider population. Hopefully, moving forward, ICBs who are broad-minded and have a wider focus of how they can improve the healthcare of their local population will follow suit and invite dental representatives onto their board.

There are lots of areas of progress. Bridging the gap between dentistry and other areas of healthcare is probably the one that’s had the most impact. We talk about dental practices working in silos, and that’s reflected in dentistry’s standing within healthcare, too. There hasn’t really been that integration on a national scale, and you get the impression decision-makers still haven’t fully understood the impact poor oral health can have on general health.

There are challenges – workforce and funding especially. No matter how we slice it, there aren’t enough people to do the job, and there isn’t enough money to pay those people to do the job. NHS dentistry is so unattractive, why the need for unnecessary crushing bureaucracy? Private dentistry does not have these barriers. Large swathes are handing back their NHS contracts and going fully private. That’s a difficult conversation we need to have.

I’m trying to fly the flag for NHS dentistry and championing local empowerment, to varying degrees of success. For example, we have always talked about community water fluoridation and the impact that can have, and that has to be one of the big decisions taken nationally. Fortunately, lots of the Midlands is already fluoridated, so hopefully we’re pushing at an open door with that discussion. Coming back to integration, if you look at IT infrastructure, I ask why do we not have access to electronic prescribing and patient summary care records? GPs and pharmacists talk to each other – why aren’t dentists involved? Shared data systems are a big ask, but it can be done with the right attitude towards service improvement. It would make a huge difference for all concerned.

Those are the big ones, especially the discussion surrounding ‘is it a lack of workforce or is it a lack of workforce in the NHS’? There will be challenges in trying to make NHS dentistry attractive again. It isn’t, at the moment; people want to work in dentistry, but the issue is they do not want to work in NHS dentistry. Locally, I talk to new graduates, so many have already been put off from NHS dentistry and do the bare minimum before heading off to private practice. It’s soul-destroying. They are our future, and we are abandoning them.

There are so many other smaller challenges that contribute to this feeling of the NHS being unattractive. For example, why is it so difficult to sort out occupational health, why are we making it so hard to get a Performer number, how many hoops do we have to jump through for the CQC – these are all small problems compared to those previously mentioned, but they’re just as impactful. The red tape and bureaucracy around CQC, GDC Performer lists and occupational health is completely unnecessary and puts people off working in NHS dentistry, and I cannot blame them. We have three regulatory bodies in dentistry – CQC, GDC and commissioners. Why? One is more than enough.

In my view we need to get rid of the regulatory role of the CQC in dentistry. They are not fit for purpose overseeing high street dentistry. They’re not doing what they’re designed to do – are they protecting the public? No, absolutely not. They’re going into practices and making it much more of a challenge to do the job we need to and want to do, which impacts patients. We need to find some way of reducing the regulatory and bureaucratic burden on NHS dentistry.

We should return to local dental practice advisors. We have found that local intelligence provides much better protection for patients – we know locally who needs to be managed with greater oversight. A national body doesn’t get the nuances involved. These challenges are all going to take time, both politically and financially. Better integration and a complete mind shift is needed in order to address them.

Mahatma Gandhi said, “Be the change, you want to see”. Everything that exists collectively is rooted in personal choice. It only takes one person to make a difference that can then lead to fundamental change. Let’s all come together as the dental family and make that change. ◆