Target access and prevention where health gaps are greatest

The problem and who is affected

Portsmouth people die earlier and spend fewer years in good health than the England average. Inside the city, life expectancy is about nine years lower for men and eight for women in the most deprived areas than in the least. Fewer adults use an NHS dentist than nationally. Use figures cannot show how many people tried and failed to get care, so the size of unmet need is unknown.

Who is affected: Residents of the most deprived neighbourhoods, especially Charles Dickens, Paulsgrove, Nelson, Fratton and St Thomas; adults without a regular NHS dentist; people with long-term conditions who need primary care. Some low-use areas have many students, whose needs differ.

What this would change

Aim: Improve access to prevention, primary care and dentistry for residents in the neighbourhoods with the greatest evidenced need, and measure whether gaps in use and health outcomes narrow over time.

What success would mean: More residents in the selected neighbourhoods using preventive checks, a GP practice and an NHS dentist, with use measured against a published baseline, and no fall in access elsewhere. Longer term, the life-expectancy gap and preventable deaths would narrow. No numeric target is proposed; any target would need agreement with the ICB and council.

Publish a joint access map that sets ward and neighbourhood figures for dental use, preventable deaths, life expectancy and deprivation side by side. Use it, with resident and practice input, to choose two or three neighbourhoods. In those areas, test practical routes agreed with commissioners: outreach health checks, help to register with a GP practice and an NHS dentist, targeted use of existing dental access schemes, and community-pharmacy prevention. Bransbury Park could host some sessions once open. Record uptake by area and publish results with small-number suppression.

Proposed lead: Portsmouth City Council public health team, jointly with NHS Hampshire and Isle of Wight (proposed; neither has agreed). Partners: NHS Hampshire and Isle of Wight (integrated care board: commissions GP and NHS dental services), Portsmouth Hospitals University NHS Trust, Hampshire and Isle of Wight Healthcare NHS Foundation Trust (community services), GP practices and primary care networks, Local dental practices and the University of Portsmouth Dental Academy, Community pharmacies, Voluntary and community organisations, Portsmouth Health and Wellbeing Board.

Powers: The council has a statutory duty to take steps it considers appropriate to improve residents’ health, including information, prevention services and facilities (National Health Service Act 2006, section 2B; source nhs-act-2b). It does not commission GP or NHS dental contracts; those sit with the integrated care board (source icb-dental-ahs shows the ICB running dental access schemes; source hiow-icb-2026 confirms the board after April 2026). Any change to GP or dental capacity therefore needs ICB agreement and funding. Data sharing for neighbourhood analysis must follow data-protection law and NHS information-governance rules.

Options

• Current approach: Continue current separate arrangements. The council funds public health services, the ICB runs dental and GP commissioning schemes, and the Bransbury Park surgery replaces an existing practice. No shared neighbourhood access map or joint uptake reporting.
• Proposed response: Joint access map plus targeted neighbourhood test. Publish a shared access map, choose two or three neighbourhoods by agreed criteria, and test outreach, registration help and existing dental schemes there, with uptake reported by area.
• Alternative: Citywide universal offer. Spread the same prevention and access effort evenly across the city. Simpler and less stigmatising, but less likely to narrow the gap.
• Alternative: Dental-first focus. Concentrate effort on NHS dental access for adults and children in low-use wards, using ICB urgent and additional-hours capacity and, later, the new dental school.

The choice depends on costs, workforce and what the ICB can fund, none of which is known. A neighbourhood test may show little change within a few years because outcomes such as life expectancy move slowly. Low dental use in student areas may not reflect need, so the selection criteria could change which areas are chosen.

Delivery plan

A first practical step: Publish a draft neighbourhood access table from the public Fingertips, NHSBSA and IoD files already checked here, and invite the ICB and council to correct or add to it. This needs no new data sharing or funding decision.

Costs and funding

One-off costs

Not costed. Mapping and method work would use existing public data and analyst time.

Recurring costs

Not costed. Outreach staff, clinical sessions and data reporting would be recurring revenue costs.

Capital or revenue

Mostly revenue. No capital need identified beyond existing premises such as Bransbury Park.

Funding status

No funding identified. The council public health grant and ICB primary care budgets are existing allocations with competing demands; no allocation to this proposal was found.

Affordability

Unknown. Council budget pressures and ICB running-cost reductions are relevant constraints.

Costing still needed

Cost a specification for the test offer: staff grades and hours, clinical sessions, venue use, data work and evaluation, priced at current year rates with one-off and recurring costs separated.

Benefits, risks and trade-offs

Possible benefits: Better information on where access is weakest; earlier detection of conditions; more residents registered with a GP and an NHS dentist in the selected areas. Health outcome benefits are uncertain and would take years to show.

Risks:

• Moving staff or sessions to selected areas could lengthen waits elsewhere (displacement).
• Dental and GP workforce shortages may prevent extra capacity being filled.
• Use figures may be mistaken for need, especially in student-heavy wards.
• Small-area reporting could identify individuals if suppression is weak.
• Short test periods may show no change in outcomes and lead to premature closure.
• NHS reorganisation could change who holds budgets and data during delivery.

Who could gain or lose: Residents of the most deprived neighbourhoods should gain most. Residents of areas not selected could lose out if capacity is moved rather than added. Targeting by area does not reach every disadvantaged person; people in less deprived areas with high need would still rely on the universal offer.

Capacity: GP and dental workforce is the main constraint. The new dental school will add trained dentists only from about 2030 onwards (training places from 2027). Council analysts and ICB data teams would need time for the mapping and evaluation.

How to judge progress

Reassess when: When a funding decision is made by the ICB or council; when the first access map is published; when NHSBSA publishes 2026/27 dental statistics; or if NHS commissioning responsibilities change again.

Where things stand

What is known:

• Life-expectancy gaps, preventable deaths and healthy life expectancy figures are published and verified for 2022-24.
• Adult NHS dental use is about 30% in Portsmouth against about 40% in England.
• 15 of 125 neighbourhoods are in England’s most deprived 10%.
• A GP surgery is being built at Bransbury Park to replace an existing practice.
• The University of Portsmouth has 25 dental training places from 2027.

What is not known:

• How many residents tried and failed to get GP or dental care.
• Portsmouth-only GP access and experience figures for 2025 or 2026.
• Whether the ICB has capacity or funding for a targeted test.
• The Portsmouth share of the ICB’s extra urgent dental appointments and how many were delivered.
• The cost of any test offer.

Decisions needed:

• Whether the council and ICB will jointly own a neighbourhood access map.
• Which indicators and geography to use for selecting neighbourhoods.
• Whether to fund a time-limited test, and from which budget.
• Who reports uptake and how often.

Existing work:

• Portsmouth Health and Wellbeing Strategy 2022-2030: Adopted strategy (as of 2026-11-02).
• Bransbury Park leisure and healthcare hub (replacement GP surgery): Under construction; contractor schedules completion winter 2027 (as of 2026-10-05).
• ICB dental additional hours scheme: Operating; participating practices include two in Portsmouth (page undated) (as of 2026-11-02).
• Extra urgent dental appointments (national allocation to the ICB): 2025/26 purchase target of 30,032 for the whole ICB; delivery not verified (as of 2025-02-21).
• University of Portsmouth dental school places: 25 places allocated; training from 2027 (as of 2026-06-03).

UK Facts context: Healthy life expectancy: how many years in good health? (National context. Local action here is separate and not a national assessment.) · Preventable illness: early deaths by deprivation (National evidence on preventable deaths.) · Primary care: can people get a GP appointment? (National GP access evidence; GP contracts are commissioned by ICBs, not the council.)

Next review: When NHSBSA publishes 2026/27 dental statistics (expected late summer 2027), or when OHID updates the 2023-25 life-expectancy gap in Fingertips, whichever comes first.. Evidence last checked 2026-11-02.

Sources

Where earlier ideas went

• health-access-plan (earlier 12-point plan): expanded. health-access-plan (whole action) Not carried forward: The original owner wording is replaced by a proposed lead and partners; community services are now named under Hampshire and Isle of Wight Healthcare NHS Foundation Trust.