NHS dental services for children and young people in West Norfolk

NHS dental services for children and young people in West Norfolk became one of Healthwatch Norfolk’s three priority projects for 2017-18, following local anecdotal intelligence and other external sources of data which highlighted concerns around experiences of and access to local NHS dental services.

When scoping this project, RAF Marham and the Norfolk Armed Forces Covenant Board contacted us about similar issues that the military families were facing around difficulties with accessing local NHS dental services, especially given the rural nature of the area.

Healthwatch Norfolk carried out a survey to understand the experiences of, and access to, NHS dental services in West Norfolk by surveying parents/guardians about their children’s dental care. Healthwatch Norfolk also conducted a “mystery shopping” exercise to enable us to understand the availability of services in the West Norfolk area and the accuracy of information presented online, compared to the information presented over the phone.

Altogether, 314 responses to the survey from parents/guardians were received and analysed, which equated to 606 children and young people. 66% take their children to the dentist every six months (209) and a further 14% take them every year. Interestingly, 15% said their children had never visited the dentist for the following reasons: availability of NHS services, age of children, quality of services and cancellations of appointments.

Over a quarter (26%) of our respondents have to travel over 10 miles to get to their children’s dental practice and unsurprisingly, the majority of the respondents have to drive to get there.

Sixty-nine percent (69%) of parents/guardians felt that it was easy or very easy to book an appointment for their children. Interestingly, although this rating was predominantly positive, appointments featured heavily in the open questions as a barrier to dental care for their children.

The majority of respondents (84%) rated their overall experience of their children’s dentist as good or very good, compared to just 6% who rated the service as one or two stars (very poor or poor). Issues in lower rated reviews related to appointments and quality of service.

Appointments remained an issue in some of the higher rated reviews, but areas of good practice featured also. Positives of overall experience included quality of service, involvement of the children and the environment/facilities.

Respondents were asked two questions about the barriers to NHS dental care for children and young people in West Norfolk and these were open questions so they could share anything that was important to them. Issues surrounding accessing NHS dental care for their children related to appointments, availability of NHS services, location/transport and information/advice. These categories often interlinked and particular issues for those on the RAF Marham Base and other remote villages were highlighted given that not everyone can drive and the public transport is limited.

Unsurprisingly, the most common suggestion for overcoming barriers was around commissioning, predominantly more services in the local area as noted by 24 respondents, with a further 47 simply stating that more practices, spaces or dentists were needed in general.

More availability of appointments in general and more out of school or work hours appointments were highlighted specifically as a way of overcoming barriers. Finally, improvements to information and advice was also welcomed.

The “mystery shopping” exercise we conducted echoed parents/guardians experiences of inconsistent information provided online compared to when they contacted the dental practices directly. Only three of the 13 NHS dental practices that we identified in the scoping stages, provided information on the telephone that matched NHS Choices and/or their own website.

Furthermore, clear issues with availability of services in West Norfolk were noted. Only four out of 13 dental practices were accepting children at the time of the exercise. One of these four would only accept children as NHS patients if their parent/guardian was at the practice as a private patient.

Long waits for appointments – another issue identified by parents/guardians in the survey – were apparent also. Of the four dental practices accepting children, the earliest available appointment was in June/July 2018, with the longest wait being until August 2018.

To conclude findings showed a positive overall experience in general, especially praise for staff members. Having said that, there are clear barriers to accessing NHS dental care for children and young people in West Norfolk, stemming from key areas such as, the availability of NHS dental services, in particular services in the local area to where the parents/guardians live, which went hand-in-hand with transport problems for some; the availability of appointments, and more specifically fitting the appointments around school or work hours; cancellations and long waits for appointments and finally, information/advice around taking their children to the dentist and availability of services.

Particular issues noted by the families in RAF Marham in the survey conducted by the Norfolk Armed Forces Covenant Board last year, seemed to be replicated by the families in this survey, but more importantly, there seems to be a wider issue of access in the civilian population of West Norfolk as well as the military families.