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A Groundswell for Change by Claire Stevens, vice president BSPD, consultant in paediatric dentistry at Central Manchester DHS

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Dentaltown UK Magazine - A Groundswell for Change
by Claire Stevens, vice president of BSPD and a consultant in paediatric dentistry at Central Manchester NHS Foundation Trust

I am issuing a challenge to the dental profession.

I am asking all general dental practitioners (GDPs) to see four extra children under the age of 2 over the coming 12 months.

My challenge was initially made at the British Dental Association conference in May. I hadn’t prepared for this aspect of my talk at all, but about an hour before I stood up to speak, a new insight relating to children’s oral health was shared with me by England’s chief dental officer, Sara Hurley. She told me that only 19 percent of children (in England) under the age of 2 years had seen a dentist in the previous 12 months.

It was another depressing statistic which reflects poorly on a first world country with a National Health Service. We already know that if we don’t see children until they are school-aged, it can be too late. This statistic was the spur I needed to get colleagues on board with making a difference. It also gave a context to the campaign that BSPD was preparing—a campaign to drive up the number of children who see a dentist soon after their first teeth come through.

So I announced the Dental Check By One campaign (#DCby1) and also urged everyone in the audience to increase the number of children under 2 they see by a mere four. This would increase the percentage of under-2s seen by a dentist to 30 percent—a significant difference. And a 10 percent increase annually could soon mean we would be dramatically driving down the number of extraction cases in hospitals up and down the country.

I believe that what we all want right now is solutions, and asking everyone to make one small change to their working life spreads the load. We all need to make a difference. As a profession, we need to work in a more cohesive and smarter way, and increasingly, we need to work more as part of a network, such as the local dental networks, rather than on our own.

At the BDA conference, most of my audience of around 1,000 delegates were young dentists, and I got a rewarding response. The following week I was on the programme for the annual conference of Local Dental Committees, where I also spoke about the DCby1 campaign, and was again really well received.

As chair of Manchester’s Managed Clinical Network (MCN) for paediatric dentistry, part of my role is to ensure that all patients from birth to age 16 can get access to a paediatric dentist when they need an appointment.

From my own experience, I know what a difference it makes to work with motivated and engaged GDPs who want to be part of the community. If anything, it’s the GDPs in Manchester who are leading the way. This had made it much easier for me in my role as the chair of the MCN. In Manchester, because of the devolved authority and budgets it is easier to get decisions made, because we are working for one organisation. Consequently, we’ve made a commitment to prioritise early years prevention, so by five years down the line we believe that we will be able to reduce the £6million that we are currently spending extracting multiple teeth under general anaesthesia every year.

I am seeing more interest to push forward with both upstream and downstream measures; there is now a political will to change things. For instance, there is a renewed interest in community water fluoridation from dentists, MPs and the public. Additionally, MPs across the country are now starting to take an interest in oral health.

We are very conscious in England of the excellent initiatives in both Scotland and Wales—Childsmile and Designed to Smile, both of which are already making a difference. If only we could have such a scheme in England! But with oral health promotion delegated as a responsibility to local health authorities, there is no one fund or organisation that can make a difference in isolation.

Part of my role is to ensure that all patients from birth to age 16 can get access to a paediatric dentist when they need an appointment.

However, we have a CDO in England who is determined to make a difference and who has the drive to make it happen. The Starting Well programme, part of a pledge made in 2016 by then Health Minister Alistair Burt MP to improve children’s oral health, has identified the 13 worst areas for dental decay in England, and four of these are in Greater Manchester. We can also expect more information around the Smile for Life umbrella organisation due to be rolled out in England and already announced by Hurley.

The Children’s Oral Health Improvement Programme Board, chaired by Jenny Godson, is a multiagency working group on children’s health that brings together dentists, health visitors, the RCS, the BDA, the BSPDT, the Midwifery Council, Early Years, etc., and we are now beginning to see that collaborative working will be the key to improving children’s oral health.

The whole dental team must be trained to care for children. I am aware that some practices might not want to focus on this aspect of service, but those that do should promote this fact within their area to make sure that parents are sign-posted to where practices are ‘child-friendly’. If this is to work, then, yes, the practice needs to market its services as being family-friendly.

Part of the MCN’s work is access. Currently about 75 percent of all NHS-contract dentists did not fulfill their UDA contract in the past year. Therefore, there is money in the system—bearing in mind that any money clawed back under the system goes back to the NHS and is not ring-fenced for dentistry. A lot of people tell me that they cannot find an NHS dentist and so they simply give up.

They should be referred to NHS Choices, where they can find lists of dentists local to them and then they can simply ring up. I find that there is a lot of hearsay with regard to children accessing paediatric care, but no real evidence. Perhaps we should map it out across the country to see where the problems lie?

The CDO is trying to get a percentage of the UDA clawback for Dental Check by 1. Another way might be for dentists who have not or cannot utilise all their UDAs to work with commissioners and offer the funding to other dentists who have fulfilled their contract and would like to see more children. This could increase the amount of children accessing NHS Dentistry and reduce the number of children having to attend dental hospital to have a tooth removed. I believe that the system needs to be more flexible in this way.

We need to give GDPs the right to provide services that are required by their local population, as long as they are evidence-based and that the practice is working as part of a network. This is what we are doing in Greater Manchester and as part of the Baby Teeth Do Matter Campaign, we managed to get hundreds of young children into the system, so much so that we are now achieving about twice the national average of infants to 2-year-olds accessing care.

The biggest issue for me is how we reduce inequality. We have greatly ignored oral health and so any initiative that can reduce this has to be good news. We need to continue the national thinking and planning. We need local leaders, too, because what we find works in Manchester might well work in Newcastle as well, for example, without having to reinvent the wheel all the time.

We need to take a strong look at our image as a profession. We need to be seen to be a key part of the community. I also believe strongly in the merits of continuity of care. Children should ideally see the same person on each visit, and this is where the key staff in the team might well be the hygienist, therapist, dental nurse or practice manager, especially if the dentist might not always be available.

It should never be forgotten that our patients—or their parents and carers—cannot always get to us during normal office/school hours and so perhaps we should consider one or more late-night openings. This is one of just many new initiatives that could have the potential to create a groundswell for change.

If you are a GDP, can you see an extra four patients under the age 2 in the next year? Or support BSPD’s #DCby1? Join the groundswell for change—your profession and our patients need you. ¦


Author Claire Stevens is vice president of BSPD and a consultant in paediatric dentistry at Central Manchester NHS Foundation Trust.
Dentaltown Magazine
September 2025
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