A survey of dental services in England providing targeted care for people experiencing social exclusion: mapping and dimensions of access

Abstract

Introduction Poor oral health and barriers to accessing dental services are common among people experiencing social exclusion. This population experience a disproportionate and inequitable burden of oral disease. A small number of dental services have published models of care that target this population, but no national surveys have been conducted. Aims This study aims to identify what types of services are providing dental and oral healthcare for people experiencing social exclusion in England and the models of delivery adopted by these services. Methods A snowballing sampling strategy was used to identify services that provide targeted for adults experiencing social exclusion. The study used a survey to collect data about the location, service models and barriers and enablers of these services. Results In total, 74 responses from different services met the inclusion criteria for the study. Seventy one were included in the mapping exercise and 53 provided free-text comments that contributed to an understanding of barriers and enablers of services. Discussion Most services operated to meet the needs of the mainstream population and described inflexibilities in their service design models as barriers to providing care for socially excluded groups. Conclusion Limitations of current models of service delivery create frustrations for providers and people experiencing social exclusion. Creative commissioning and organisational flexibility are key to facilitating adaptable services.

Developing oral health services for people experiencing severe and multiple disadvantage: a case study from Southwest England

“…This is particularly acute in Southwest England. Moreover, service commissioning and delivery models are designed for the general population, lacking the flexibility to accommodate complex lives and needs ( 47 ). Previous incentives from NHS comissioners have not always had successful uptake, possibly for not accommodating challenges in reaching Units of Dental Activity targets, which are a common feature of dental contracts in England.…”

“…Through spending a lot of time supporting people with health and social care needs, homelessness support workers hone their skills in handling difficult conversations, recognising important conversational cues, and building relationships with clients who distrust other professionals (47,48). However, since people experiencing SMD rely heavily on emergency care, workers may tend to focus less on initiating general and prevention-oriented health conversations (49).…”