Improving dental care access for head and neck cancer patients in primary care: developing the Cancer Action Support Practice pathway in South West England

OPEN GENERAL Improving dental care access for head and neck cancer patients in primary care: developing the Cancer Action Support Practice pathway in South West England Alexander J. Pollard,*1,2,3 Claire Forbes-Haley,4,5 Joanne Purvis,6 Terrance Chikurunhe7 and Matthew Jerreat5 Key points Head and neck cancer patients are a high risk group, especially in the context of radiotherapy treatment involving the jaws. Access to a dental home is extremely important for these patients, to avoid deleterious outcomes while using NHS resources appropriately. Cancer action support practices are an example of a regionally coordinated approach to improve dental access for this vulnerable group. Abstract Aims Describes the development and early implementation of the Cancer Action Support Practice (CASP) pathway in South West England, aiming to improve dental care access for head and neck cancer (HNC) survivors in the primary care setting. Summary of CASP development Stakeholder engagement was central to CASP’s design, involving input from general dental practitioners, local dental committees, commissioners, and secondary care teams. Funding and commissioning options were explored through the regional integrated care boards (ICBs). CASP aligns with national policy, including NHS England’s guidance on oral health for cancer patients. CASP provides a structured pathway enabling HNC patients to access routine and preventive dentistry in primary care to prepare them for and maintain them after oral rehabilitation. Two commissioning models (units of dental activity uplift and sessional rate approach) were proposed, allowing regional flexibility by commissioning ICBs. Consultant-led peer review, data collection, and ongoing professional development are embedded. A pilot CASP has been commissioned in Cornwall, with further strong regional interest. Conclusion CASP demonstrates a regionally coordinated approach to improving dental access for a vulnerable and complex patient group. The model supports integration between primary and secondary care, informed by national guidance and local clinical need, and has potential applicability to other medical conditions with significant dental involvement. Introduction Head and neck cancer (HNC) represents a significant healthcare burden, with approximately 12,200 new diagnoses annually in the UK.1 Despite reductions in traditional risk factors like smoking, over the past decade the incidence of HNC has continued to rise, which is largely being driven by human papillomavirus-related cancers that effect a Torbay and South Devon NHS Foundation Trust, Torbay, UK; 2South West Restorative Managed Clinical Network, NHS England, UK; 3Bristol University Dental School, Clinical Trials Unit, Bristol, UK; 4University Hospitals Plymouth, Plymouth, UK; 5NHS England, England, UK; 6South West Restorative and Paediatric Dentistry Managed Clinical Networks, NHS England, UK; 7South West Collaborative Hub (Hosted by Somerset ICB), NHS England, UK. *Correspondence to: Alexander J. Pollard Email address: 1 Refereed Paper. Submitted 31 July 2025 Revised 18 November 2025 Accepted 16 December 2025 https://doi.org/10.1038/s41415-026-9634-6 younger population.1,2 Treatment typically involves complex combinations of surgery, radiotherapy, and chemotherapy, often resulting in severe functional and/or aesthetic impairments including trismus, xerostomia, and osteoradionecrosis.2,3,4 In the South West region specifically, there are estimated to be nearly 10,000 HNC survivors, with up to 70% having undergone radiotherapy.5 Dental access in this region remains below the national average, exacerbating the already complex dental needs of these patients. Adult NHS dental access in the South West was reported as low as 47.3% between 2019–2020, significantly impacting vulnerable patient groups such as those recovering from HNC.6 In an effort to address some of these challenges, the South West Restorative Managed Clinical Network (MCN) considered adaptation of a model developed by the national paediatric dental MCNs for childfriendly dental practices. Consideration was BRITISH DENTAL JOURNAL | VOLUME 240 NO. 10 | May 22 2026 given to adopting a similar commissioning system to develop a pathway to support cancer patients. The South West Oncology Restorative Network (SWORN) was established in 2023 and became part of the South West MCN for restorative dentistry. SWORN serves to enhance collaboration, share expertise, and improve clinical outcomes through education and regional audits/quality improvement projects/research. SWORN has helped to create a united voice for South West restorative services involving head and neck cancer patients and has become a key stakeholder group in the development of the Cancer Action Support Practice (CASP) pathway. Through focus groups at their annual meeting, SWORN agreed that it was essential to improve access to primary dental care for head and neck cancer patients. This was also supported by national strategies such as the chief dental officer’s guidance on oral healthcare provision for cancer pathways.7 This paper underpins regional initiatives and highlight the critical 695 © The Author(s) 2026. GENERAL role primary care dentistry can play in supporting these patients. Development of cancer action support practices The CASP pathway was developed through a coordinated effort involving members of the South West restorative MCN and the regional chief dental office. This structured pathway provides essential routine dentistry, preventive care, and cancer surveillance for HNC patients post-treatment, effectively providing a parachute between secondary and primary care for patients that don’t have a primary care dental home. The focus of CASP was to allow secondary care restorative units to work seamlessly with primary care dental support for their patients. The support could be accessed once an individual’s complex hospital-based oral rehabilitation was completed, or where required to stabilise basic dental disease before oral rehabilitation. However, CASP does not play a role in prehabilitation of cancer patients, which should always be led by a consultant in restorative dentistry. The CASP pathway supports an open line of communication between CASP practices and secondary care restorative dentistry providers. Extensive stakeholder engagement was crucial. Lessons were learned through meeting with primary care dental teams and LDC chairs who advised on adjustments to the pathway by focusing on the realities of delivering CASP. Regular meetings took place with commissioners from integrated care boards (ICBs) and the collaborative commissioning hub, clarifying funding mechanisms and commissioning complexities. Conversations took place regarding financial risk and sustainability, which informed decisions regarding appropriate funding models. Stakeholders were regularly engaged through MCN meetings, both during virtual MCN meetings and by requesting (...truncated)