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Research highlights a new approach to tackle inequalities in dental care

New research funded by the NIHR Research Delivery Network and supported by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) has highlighted how applying the ‘Deep End’ concept to dentistry could tackle significant inequalities in dental health in areas of deprivation. The findings have been published in the British Dental Journal.

The ‘Deep End’ refers to a network of general practices who serve socioeconomically disadvantaged communities. The first Deep End network originated in Glasgow, and the movement has since seen success across the UK and internationally. 

In 2020, the NIHR ARC NENC supported the development of a Deep End network for the North East and North Cumbria (NENC) which now includes 52 practices. The network has  delivered a wide range of research-led work to identify and address key areas of challenge for Deep End GPs and patients in the region, including staff recruitment, deprescribing pain medications, reducing cardiovascular disease, and improving mental health in areas of deprivation. The work is supported and funded by the NHS North East and North Cumbria Integrated Care Board (ICB).

Applying the Deep End concept to dentistry

NHS dentistry faces similar challenges to primary care, and oral health and access to dentists are worse for those living in socioeconomically disadvantaged communities. 

The ‘Deep End’ of dentistry is defined as the 10% of dental contracts that treat the highest proportion of patients from deprived areas, using NHS England’s CORE20PLUS inequalities framework. Deep End dental practices are mainly clustered in areas around Newcastle, Middlesbrough, Liverpool, Manchester, Leeds, Sheffield, Birmingham and London.

People from these communities have more pain, are more likely to have to go to hospital with dental problems, and sometimes resort to DIY dentistry. Dental practices who serve these communities struggle to find and keep staff, and patients struggle to access dental care.

The new research suggests that Deep End networks for dentistry, which mirror the GP model, could provide a solution to these challenges. Previous Deep End work aligns well with existing oral health inclusion frameworks, which suggest adapting services to community needs and focusing on research and education. Deep End networks can also advocate for fairer funding of NHS dental practices in areas of deprivation.

The work recommends some practical next steps for setting up a Deep End network for dentistry, which include agreeing objectives for each regional Deep End network based on local needs, securing funding, and collaborating with academic GPs.

Discussions are now underway to explore a Deep End dental group in the North East and North Cumbria.

Dr Sarah Sowden, co-author of the paper and Senior Clinical Lecturer and Consultant in Public Health at Newcastle University, said: “This research provides a much needed focus on the dental workforce supporting those living in socioeconomically disadvantaged communities who experience poorer health across the board.”

Prof Chris Vernazza, interim Head of School of Dental Sciences and Professor of Oral Health Services at Newcastle University said: “We know that dental teams working with socioeconomically disadvantaged communities benefit from mutual support and there is a real need for a powerful movement for identity, advocacy and action, so we recommend establishing Deep End networks for dentistry.”

Morag Burton, Network Director for the NIHR North East and North Cumbria Regional Research Delivery Network, said: “Deep End networks have had a significant impact on raising the profile and addressing some of the health inequalities we see in primary care. This research provides an important step to exploring how the Deep End concept could work in dentistry.”

The Deep End GP Network NENC has become an important area of collaboration for the NIHR in the North East and North Cumbria and beyond. Find out more about the work of the Deep End GP Network for the North East and North Cumbria and discover how the NIHR supports oral and dental health research.

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