Added 04 October 2023
Improving access to dental care for people experiencing homelessness
There has been no shortage of recent press coverage about how difficult it can be to sign up with a dental practice providing NHS treatment in England.
There is no doubt that dentists and their dental service teams work hard to care for their patients, and the way dental services are provided under the NHS does aim to make dental services available to everyone. However, a new report (below) by the Homeless Health Consortium* shows that an unintended consequence of most current NHS dental service contracting is that regular treatment pathways feel closed to people experiencing homelessness and they need dedicated support.
The Homeless Health Consortium spoke to people with lived experience of homelessness about their experiences. They said that it was difficult to even find out where to access treatment, and if they could get an appointment some felt dental service staff were not aware of the unique challenges that come along with experiencing homelessness.
Pathways into dental treatment
The Consortium also spoke with dental practitioners and other inclusion health experts and the good news is that there are ways to support people experiencing homelessness to access dental treatment. This includes both immediate term solutions, and examples of good practice in dental service models developed for people experiencing homelessness.
Finding treatment quickly
Anyone in need of immediate care and not signed up with a dental service can call NHS 111 to find the nearest available one offering NHS treatment. The responder will ask for some personal details and then provide details of where any when the nearest available appointment is. Anyone in receipt of benefits is usually entitled to free dental care on the NHS, they just need to fill in the required form, which dental practice staff will commonly help with.
A high street dental service (General Dental Service) will often be able to meet the dental treatment needs of someone experiencing homelessness. However, expert inclusion health dental practitioners recommended that the best outcomes are achieved for people experiencing homelessness when they are helped by a support worker to navigate this process and attend appointments.
That said, it is not unusual for someone experiencing homelessness to have unrelated complex medical conditions or mental health support needs such as severe anxiety or PTSD and to need longer appointment times and clinicians with specialist skills to be involved in their treatment. In such cases the patient can be referred to a Community Dental Service for their treatment.
All these options are covered in greater detail in the report itself. And alongside the report below you will also find a link to the Healthy Mouths Guide, a Groundswell Action Guide which offers further advice for people experiencing homelessness on taking care of their mouthes, finding a dentist and receiving treatment.
Innovation
The current situation can still feel difficult to navigate, but there is hope. Inclusion health and dentistry experts in areas of England including Leeds, Manchester and Plymouth have successfully piloted innovative approaches that not only better support people experiencing homelessness but can also be set up within the current NHS dental service commissioning framework.
These new approaches are based on partnership working between nominated dental practices with flexible commissioning arrangements, and VCSE organisations. Here the dental service to focuses on clinical expertise, during sessions dedicated to the needs of people experiencing homelessness, while link workers from VCSE organisations focus their support on helping the patient to manage and attend their treatment.
Currently, few NHS commissioning areas take advantage of the flexibility in the commissioning system that would allow more partnership working arrangements to be set up. But, now that there is documented evidence of their success the hope is that more commissioning boards will be persuaded to set up similar arrangements.
The Homeless Health Consortium
* Homeless Link, Groundswell and Pathway, work together as the Homeless Health Consortium, which is part of the wider Department of Health and Social Care (DHSC) funded Health and Wellbeing Alliance (HWA). The DHSC-led Alliance programme is designed to facilitate collaboration and co-production between the voluntary and community sector and health system partners – DHSC, NHS England, the UK Health Security Agency (UKHSA) and the Office for Health Improvement and Disparities (OHID) – by bringing the voices and expertise of the sector, and the people and communities they represent, into national policy and delivery.