Innovative approach to dental care for people experiencing homelessness is praised by patients, but more could be done

A free clinic for people experiencing homelessness in Plymouth has had a transformational effect, but those running it say scope for expanding the model to support other patient groups, and increasing service levels for existing patients is limited.

A recent evaluation of the clinic has concluded that the model is currently constrained by NHS funding, and suggested that services recognising the complex and diverse needs of vulnerable patients require higher prioritisation within dental commissioning.

In January 2018, Peninsula Dental Social Enterprise (PDSE), a not‐for‐profit organisation linked to the University of Plymouth’s Peninsula Dental School, established a community clinic to improve access to dental care for people experiencing homelessness. In the last year, the clinic has expanded its offer to include individuals using drug and alcohol services, as well as vulnerable women at risk of having multiple children removed from their care.

PDSE currently provides this service pro bono to the local community as part of its mission to ensure access to dental care for groups who may feel excluded from mainstream dentistry.

A recent evaluation of the clinic carried out by researchers from the University’s Faculty of Health found it was “a highly successful, acceptable and accessible dental care model for people experiencing homelessness that could be implemented in other locations”. However, the study also said that because many of the people it helps have high needs requiring extensive – and expensive – treatment, it would not be financially viable under a contract based on the current NHS dentistry payment method in England.

The research found the average cost per course of treatment in the clinic is £854.50, almost three times the sum available from the NHS, if the service were state funded only, of £300.

It concluded that for the life-changing approach to be rolled out more widely, new flexible models of care are needed that allow dental professionals to provide routine and continuing treatment for socially vulnerable adults with high needs.

Rob Witton, PDSE Chief Executive and Director of Social Engagement and Community-based Dentistry in Peninsula Dental School said:

“PDSE is absolutely committed to addressing oral health inequalities in local communities and helping those who need it most. I am grateful to all of our partners for making this initiative so successful. Our ambition is to receive NHS funding so we can expand our model across Devon and Cornwall to help more people.

"However, for this to happen, we would welcome NHS England considering a more flexible approach to commissioning dental care, and therefore ensuring everyone can enjoy good oral health – whatever their background or personal circumstance.”  

Since the start of the Community Clinic and up to 18 February 2020, 89 vulnerable individuals have received a range of dental treatments. Outcomes from continuous evaluation of the Community Clinic model often describe dental care as a catalyst for change in many areas of a patient’s life:

“Emotionally he’s transformed, nutritionally he’s put on weight because he’s able to eat, his self‐esteem, his confidence and employment opportunities, his sense of worth is now fully established… his decision was ‘I either continue on this path of destruction’, which was very much influenced by his childhood experiences, or ‘I survive and thrive and I move forward’. And he chose the latter, and part of that was because he was linked to the Dental School.” (Support Worker)

“It gave me so much more confidence, a lot’s come out of that, I mean the day I actually got my dentures I had a job interview and I just felt so much more comfortable and I actually got the job” (Patient)

Lyndsey Withers, community volunteer for the initiative said:

"Unpicking the complexity of homelessness and its impact on an individual is very challenging. We have found that dental care is an excellent entry point to start supporting people affected by homelessness and can lead to multiple positive health and wellbeing outcomes. That crucial first appointment can overcome years of fear and embarrassment and become a life-changing step."

The community clinic has already been recognised with a national industry award from the Oral Health Awards for Best Care of Vulnerable Patients.

Christina Worle, PDSE community clinic dentist added:

“When I first meet a new patient, they have often been suffering with dental pain and infection for many years, and are desperately ashamed of their teeth. This can have a massively detrimental effect on a person’s wellbeing. Without the dental care that this service can offer they would have nowhere else to go for help. Working closely with our community partners helps this service to be as effective as possible.”

Results of the evaluation of the community clinic can be found here.

Peninsula Dental Social Enterprise (PDSE)

PDSE is a Community Interest Company (CIC) committed to improving oral health across the South West. They: run Dental Education Facilities in Plymouth, Truro and Exeter, where students from the University treat NHS patients; improve awareness of oral health in the wider community, focusing on groups such as schoolchildren, the elderly, parents, those with specific conditions, people with special needs substance abusers, the homeless, prisoners and; ensure access to dental care for all, but especially to those groups who may feel excluded from mainstream dentistry.

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