Presentation to AVON LDC Dental Commissioning Peter - - PowerPoint PPT Presentation

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Presentation to AVON LDC Dental Commissioning

Peter Howard-Williams BDS Clinical Chair South West Local Dental Network – NHS England South West Rachel Coke Assistant Contracts Manager, Dental – NHS England South West

Tuesday 15th March 2016

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The new CDO Sara Hurley

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• The new Chief Dental Officer, Sara Hurley

toured the SW region on a fact finding exercise for three days early this month. She met with all branches of the profession to ask them how we can improve oral health in the SW. My impression was that she will be a strong advocate for denEstry in an NHS where we are

• Gen an aGerthought and is someone who

gets things done!

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www.england.nhs.uk

• The Dental SpecialiEes Commissioning Guides for
• ral surgery, orthodonEcs and special care

denEstry have now been published hJps://www.england.nhs.uk/commissioning/ primary-care-comm/dental/dental-specialiEes/

• It will help to understand the guides if you read

the introductory guide first.

• The guides are not "wriJen in stone" and are

intended as a guide to clinicians and commissioners to help improve paEent outcomes.

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Commissioning guides

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This theme recurs throughout the new guides for the commissioning

• f dental specialEes, with the recogniEon that there are a range of

paEents and an equally complex range of oral health needs. Many of the care pathways outlined in the guides will call upon the skills of specialists or Consultants, who may be operaEng in either primary care or secondary care seQngs. However, the guides recognise that many General Dental PracEEoners develop interests, skills and competence with increasing years in pracEce, and that these experienced GDPs are very capable of confidently and competently handling level 2 complexity case loads. NHS England desires to use the skills of these individuals, and the detail of how to validate and contract these highly skilled individuals is vital on-going work.

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Malcolm Pendlebury Memorial Lecture, delivered by the Chief Dental Officer for England, Sara Hurley, to the Faculty

• f General Dental PracAce (UK) on 26 February 2016.

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• We are hoping to appoint Chairs for MCNs in Oral Surgery,

OrthodonEcs, Special Care and RestoraEve denEstry in the near future.

• MCNs have been defined as ‘linked groups of health professionals and
• rganisa2ons from primary, secondary and ter2ary care working in a

coordinated manner, unconstrained by exis2ng professional and

• rganisa2onal boundaries to ensure equitable provision of high

quality, clinically effec2ve services’.

• An MCN is a way of working where clinicians from all seQngs across a

clinical pathway can focus on paEents and services rather than being constrained by organisaEonal boundaries.

• Importantly the MCNs will ensure that any new commissioning

arrangements will be quality assured with paEent reported outcomes PROMs and paEent reported experiences PREMs feedback from providers.

• LDCs will play an important part in MCNs

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Managed Clinical Networks

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• A joint meeEng with both LDNs in the South West is planned for

May 18th to discuss the strategic direcEon of dental commissioning in the SW and the role of LDNs and MCNs.

• I sincerely hope that by then the formaEon of the MCNs will be

well under way.

• I want to explore how we can have a consistent approach across

the region with paEents having access to the same high quality services across the whole patch and combine it with a "local" flavour which involves clinicians at all kinds.

• There is currently a move towards co commissioning with more
• f the pharmacy and eye health commissioning moving towards

the CCGs and I feel it is important for denEstry to have a robust commissioning strategy and system in place for us to keep control of our own profession.

• WHAT DO YOU THINK ??

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Future of The Local Dental Network

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• NHS England is looking to improve

unscheduled and OOH dental care throughout the SW.

• A consistent dental helpline throughout the

SW which will integrate with 111 and be able to signpost paEents to the most appropriate care and give advice. The first draV service specificaAon follows and I would like your feedback

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Unscheduled Care and Out of Hours

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• The same service should be available to all residents of the

NHS England South ( South West) area and should be available as locally as possible.

• The in hours and out of hours access to urgent and

emergency dental treatment and dental help lines should be an integrated service with preferably one provider for call handling and triage throughout the patch .

• One telephone number covering the whole patch for

paEents to contact, or be transferred to from 111, which can:

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Proposed Service Specification

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• Signpost paEents with a dental problem both in and out of hours.
• IdenEfy a true dental emergency and provide an immediate route to treatment
• IdenEfy an urgent dental problem, give appropriate advice including pain relief and

guarantee an appointment for treatment within 24 hours

• Signpost paEents to other healthcare providers as appropriate where pain relief is

advised e.g local pharmacy

• Book appointments at access centres
• Book appointments in GDP urgent care slots
• IdenEfy a non urgent dental problem, give appropriate advice, and signpost the paEent

to the nearest NHS pracEEoner.

• Give up to date informaEon to those seeking to register with an NHS denEst.
• Maintain waiEng lists
• Supply NHS England with regular data on NHS availability
• Maintain NHS Choices
• Log inappropriate referrals to OOH from dental pracEces and paEents who are unable to

access care from their own denEst.

• Work closely with other urgent care services

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Proposed Service Specification

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• The advice should be available 0830 to 2230. Outside these hours a true dental

emergency would be handled by the OOH medical call handlers.

• Out of hours urgent and Emergency treatment should be available in Emergency

dental clinics at Exeter. Barnstaple, Newton Abbot, Plymouth, Truro, Bodmin, Penzance, Bristol, Taunton, Bridgewater, Yeovil and Glastonbury, on Saturdays, Sundays and Bank Holidays

• Rather than operate a limited service on weekday evenings it is considered that on

weekday evenings a beJer response would be a guaranteed appointment the following day with appropriate advice including pain management .

• In hours access to urgent care should be available in emergency dental clinics and

through commissioned urgent slots within general dental pracEces across the area. These in hours urgent slots should be bookable by the out of hours service where a need to see a denEst is indicated.

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Proposed Service Specification

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• These are available on the following link:
• hJps://www.england.nhs.uk/south/publicaEons/

dcis-prof/dental/dental-bulleEn/

• Currently the link from the publicaEons page is "

InformaEon for professionals in Devon, Cornwall and Isles of Scilly" but contains the BNSSSG

• informaEon. I am looking to have this amended as

soon as possible.

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NHS England bulletins and LDN newsletters

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• This sets out a vision of a beJer NHS, the steps and acEons

we must take to get there. You can see it in more detail on the following link.

• hJps://www.england.nhs.uk/ourwork/futurenhs/nhs-five-

year-forward-view-web-version/

• In denEstry we cannot ignore the prioriEes of the wider

NHS or we will be leG behind.

• The BNSSSG LDN work plan has the following prioriEes of

the 5 year forward plan which can be applied to denEstry

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5 year forward view:

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• Improve access for paEents with demenEa and

learning difficulEes

• Enhance diet advice to tackle obesity and diabetes
• Redesign urgent and emergency care services
• Strengthen primary care services
• Ensuring high quality and affordable specialised care
• Whole system change/financial sustainability
• FoundaEons for Improvement/IT

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5 year forward view:

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• LOCAL DENTAL NETWORK
• Consider how the NHS business plan and 5 year forward view is

applied to denEstry

• Develop a robust system of paEent and public parEcipaEon
• Establish a quarterly newsleJer and distribute to all

stakeholders

• Establish a clear communicaEon policy with the ability to

involve all stakeholders in the area with the LPN

• establish a web presence for publicaEon of LPN minutes,

newsleJers and general informaEon

• Develop beJer links with the CCGs

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BNSSSG LDN work plan

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• DENTAL PUBLIC HEALTH
• Establish a working group to idenEfy local oral

health prioriEes and recommend a strategic approach to oral health improvement to the health and Wellbeing Boards of the BNSSSG

• area. The LPN to have a representaEve on this

group in addiEon to the consultant in Dental Public Health

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BNSSSG LDN work plan

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• PRIMARY CARE
• Support the commissioners in idenEfying those areas

where access to NHS dental care is insufficient and help plan new provision and provide clinical input to the tendering and commissioning process.

• Improve informaEon to primary care denEsts on

referral criteria and idenEfy inappropriate referrers. Provide support and guidance for high referrers

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BNSSSG LDN work plan

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• SPECIAL NEEDS DENTAL SERVICES
• Map the current provision of Special Needs Dental Services throughout the patch and

establish a Special Care Managed Clinical Network for the BNSSSG area to implement the special care commissioning guide and develop a plan to create an integrated service with consistent delivery of special care services

• ORAL SURGERY and ORAL MEDICINE
• Establish a Oral Surgery/Oral medicine Managed Clinical Network for the BNSSSG area to

implement the Oral Surgery/Oral medicine commissioning guide.

• ORTHODONTICS
• Establish a OrthodonEc Managed Clinical Network for the BNSSSG area to implement the
• rthodonEc commissioning guide.
• RESTORATIVE
• Review the provision of specialist restoraEve dental services throughout the patch and look to

have a common policy for accepEng paEents for treatment .

• Promote the " Healthy Gums do MaJer" iniEaEve
• PAEDIATRIC AND ORAL DIAGNOSTICS
• Map the current provision of paediatric Dental Services throughout the patch and await the

commissioning guides for paediatric denEstry and oral diagnosEcs.

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BNSSSG LDN work plan

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• URGENT AND EMERGENCY CARE BOTH IN AND OUT

OF HOURS

• Map the current provision of urgent and emergency

care both in and out of hours throughout the patch and look to provide a consistent service specificaEon across the South West with a single point of contact for paEents.

• EDUCATION and TRAINING
• Promote workforce training for the whole dental team

with parEcular emphasis on paEent safety and anEbioEc stewardship.

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BNSSSG LDN work plan

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• Improve access for paAents with demenAa and learning difficulAes
• As a first step circulate the link to hJps://youtu.be/EnPUq00UA8c ,an excellent short video

produced by HEE about Barbara, a paEent with demenEa. There is a longer version " Barbara the whole story" It will help to raise awareness.

• Enhance diet advice to tackle obesity and diabetes
• The LPN can promote the ScienEfic Advisory CommiJee on NutriEon recommendaEons on

carbohydrates, including sugars and fibre. A short summary for GDPs has been published. Links:

• hJps://www.gov.uk/government/publicaEons/sacn-carbohydrates-and-health-report and
• hJp://www.nhs.uk/change4life/Pages/low-sugar-healthy-snacks.aspx
• Redesign urgent and emergency care services
• The LPN will play an important role in advising on dental services
• Strengthen primary care services
• As part of implemenEng the Dental specialty commissioning guides the LPN will expect to be

able to provide a wider range of services within primary care , whilst marinating quality.

• Ensuring high quality and affordable specialised care
• Whole system change/financial sustainability
• FoundaAons for Improvement/IT

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Consider how the NHS business plan and 5 year forward view is applied to dentistry

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Dental Contracting Team

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• Still monitoring contracts quarterly - 4 or more flags
• n two subsequent quarters
• Explanation sought and assurance provided by

contractors

• Well received by providers and performers alike
• Willingness to work with NHS England to drive quality

improvement

• Marked improvements across the corporates with face

to face quarterly contract monitoring

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Dental Assurance Framework

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• Individual performer issues have been identified

through Tier 2 reports

• Performer issues subsequently escalated to PAG if

necessary for further support

• Starting to target practices that have been flagged for

specific indicators e.g Band 3 to 3, Inlays

• Looking at rewriting Dental Visits Protocol
• Will incorporate a risk register based on triangulation
• f data sources

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Dental Assurance Framework (cont)

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• Regular quarterly meetings take place
• 3 month plan of visits provided in advance
• Information sharing protocol being developed
• Learning from enforcement actions taken
• Working with providers to ensure they are taking

action to address regulation notices

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Care Quality Commission

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• No training given to NHS England staff
• Delays in getting new performers onto contracts due

to ‘glitches’ within the system

• NHS Dental Services waiving 2 month rule since

closedown of POL – BDA letter

• Reports will be provided to ensure this waiver is not

exploited

• Issue with providers accessing Portal

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Compass

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• Likely reports will be delayed due to the relaxation of

2 month rule

• Tolerance still the same as last year – 96% to 102%

for UDA delivery

• Breach notices issued if under 96%
• Consistence underperformance and 2 breach notices

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Year End

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• New Dental Policy Handbook
• Located on NHS England website -

https://www.england.nhs.uk/dental/

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Dental Policies