NHS Dental Services Topic Group - Final Report - Slides
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NHS Dental Services Topic Group - Final Report - Slides NHS Dental Services Topic Group - Final Report - Slides Presentation Transcript

  • Dentistry and Oral Health in Eastand North Hertfordshire and WestHertfordshire PCTs Jane Robinson Primary Care Commissioning Lead Sue Gregory Consultant in Dental Public Health 17th November 2008
  • Outline• What NHS Dentistry should provide• Dental Charges• Access to NHS dentistry• What the PCT is doing to improve access to NHS dentistry• Oral health of children• Customer satisfaction• Emergency/out of hours provision 17th November 2008
  • Primary Dental Services (2003 Act)• PCT has a duty to provide or secure primary dental services to the extent it considers reasonable through:• GDS contracts;• PDS contracts; or• provides them itself 17th November 2008
  • Commissioning for Oral Health Influence over wherenew practices establish Stronger local relationship with NHS dentists Commissioning to meet oral health needs of population Commissioning to more explicitly addressthaccess 17 November 2008
  • Mandatory Services• All proper and necessary care and treatment which includes: - the care which a dental practitioner usually undertakes for a patient and which the patient is willing to undergo, including advice and planning of treatment - treatment, including urgent treatment - ..the referral of the patient for advanced mandatory services, domiciliary, sedation….. 17th November 2008
  • Care and Treatment• Examination • Supply and repair of• Diagnosis dental appliances• Preventive care and • Radiographs treatment • Supply of listed drugs• Periodontal treatment • Issue of prescriptions• Conservative treatment• Surgical treatment 17th November 2008
  • Patient charges• PCT dental commissioning from April 2006• Changes in patients’ charges – Simpler (3 not 400) – Avoids confusion on private/NHS boundary – Breaks link between dentists’ remuneration and charges• Money devolved on practice base, not by address of patient 17th November 2008
  • Patient Charge Bands-Band 1 £16.20• This charge will include an examination, diagnosis and preventive advice. If necessary, this will include X-rays, scale and polish if needed, and• planning for further treatment.• Urgent and out-of-hours care will also cost £16.20 17th November 2008
  • Band 2 - £44.60• This charge includes all necessary treatment covered by the £16.20 charge PLUS additional treatment such as fillings, root canal treatment or extractions. 17th November 2008
  • Band 3 - £198• This charge includes all necessary treatment covered by the £16.20 and £44.60 charges PLUS more complex procedures such as crowns, dentures or bridges. 17th November 2008
  • Population per dentist E&North Herts compared with the East of England SHA and England Population per dentist 15, 2006/07 and 2007/083,0002,5002,0001,5001,000 500 0 England SHA England SHA England England Hertfordshire Hertfordshire East & North East & North East of East of PCT PCT 2006/07 2007/08 17th November 2008
  • Population per dentist West Herts compared with the East of England SHA and England Population per dentist 15, 2006/07 and 2007/083,0002,5002,0001,5001,000 500 0 England SHA England SHA England England Hertfordshire Hertfordshire East of East of West West PCT PCT 2006/07 2007/08 17th November 2008
  • Dental contracts in Hertfordshire Number Number Number of of of contracts dentists practicesWest Herts 142 367 117East & North 123 300 88HertsTotal 265 667 205 17th November 2008
  • GeographicalAccess togeneral dentalpractices in Eastand NorthHertfordshire,3 miles and 12miles distances17th November 2008
  • Geographical Accessto general dentalpractices in East andNorth Hertfordshire,5 miles and 12 milesdistances 17th November 2008
  • Geographical Access to general dentalpractices in West Hertfordshire, 3 miles and 12 miles distances 17th November 2008
  • September 08 telephone audit indicated that 62%of practices in E & North Hertfordshire PCT arecurrently accepting new NHS patients, however Number of patients treated in the previous 24 months periodMarch 2006 328,002March 2007 332,184June 2007 329,488December 2007 320,112March 2008 316,396June 2008 316,195September 2008 317,253% Change since -3.3% March 2006 17th November 2008
  • September 08 telephone audit indicated that 64% of practices in West Hertfordshire PCT are currently accepting new NHS patients, however Number of patients treated in the previous 24 months periodMarch 2006 314,537March 2007 307,439June 2007 301,249December 2007 286,192March 2008 275,014June 2008 272,074September 2008 271,659% Change since -13.6% March 2006 17th November 2008
  • 1 2 Total number of patients seen as a percentage of the population in the previous 24 months ending at the specified dates 4,5,780%70%60%50%40%30%20%10%0% East & North East of England SHA England Hertfordshire PCT 31 March 2006 31 December 2007 17th November 2008
  • Distribution of courses of treatment October to December 2007 East and North Hertfordshire Proportion of Courses of Treatment, October - December 2007 160%50%40%30%20%10%0% Band 1 Band 2 Band 3 Urgent Other East & North Hertfordshire PCT East of England SHA England 17th November 2008
  • Distribution of courses of treatment October to December 2007 West Hertfordshire Proportion of Courses of Treatm ent, October - Decem ber 2007160%50%40%30%20%10%0% Band 1 Band 2 Band 3 Ur gent Ot her West Hertf ordshire PCT East of England SHA Engl 17th November 2008
  • Proportion of dentists by age band as at 31 March 2007 East and North Hertfordshire100%80% 48% 53% 52%60%40% 52% 47% 48%20% 0% East & North East of England SHA England Hertfordshire PCT 39 and under 40 and over 17th November 2008
  • Proportion of dentists by age band as at 31 March 2007 West Hertfordshire100%80% 53% 53% 52%60%40% 47% 47% 48%20% 0% West Hertfordshire East of England SHA England PCT 39 and under 40 and over 17th November 2008
  • The Proportion of Adults with No Natural Teeth in England, 1968-1998Source: National Adult Dental Health Surveys, 1968to 1998. Kelly M, Steele J, Nuttall N, Bradnock G,Morris J, Nunn J, Pine C, Pitts N, Treasure E and 17th November 2008White D (2000).
  • Orthodontics: waiting times at October 08 Practice Length of time Length of time Referral to location to first to case start treatment time assessment appointmentBishop’s 10-12 months 4-8 weeks 12-14 monthsStortfordRoyston 4 weeks 4-8 weeks 12 weeksWare 6 months 30 months 3 yearsHitchin 6 weeks 4 weeks 10 weeksStevenage 10 weeks 3-12 weeks 22 weeks Source: Practice based Data 17th November 2008
  • Orthodontics: waiting times at October 08Practice location Length of time to Length of time Referral to 1st assessment to case start treatment timeBoreham Wood 2-3 weeks 44-50 weeks 1 yearSt Albans 1 week 2 years 2 yearsTring 3 months 4 months 7 monthsRickmansworth 6 weeks 6 weeks 12 weeksHemel Hempstead 4 months 6 months 10 monthsHemel Hempstead Not accepting 8 weeks 8 weeksHarpenden 1-14 weeks 1-14 weeks 28 weeksHarpenden 11 weeks 8 weeks 19 weeksWatford 12 weeks 6-8 weeks 20 weeksWatford 4-6 weeks 4-6 weeks 12 weeksWatford 0-7 weeks 6-24 weeks 31 weeks 17th November 2008
  • Emergency Dental Services: HertfordshireNHS Direct Triage: July 06 to June 07 Call Volume No of Calls Calls Answered 9071 Symptomatic 5954 Health Information 40 Other 834 Clinical Sorting of symptomatic calls No of Calls 999 - (Emergency) 41 (0.68%) A & E - (Emergency) 131 (2.2%) Contact Dentist - <1 hour 177 (2.9%) Contact Dentist - <4 hours 2255 (37.8%) Contact Dentist - Routine Appointment 2113 (35.4%) Contact Orthodontist 84 (1.4%) Homecare and Pharmacy 1137 (19%) Contact GP 17th November 2008 109 (1.8%) Other 9 (0.15%)
  • Emergency Dental Services: Hertfordshire NHS Direct Triage: September 08 Call Volume No of Calls Calls Answered 631 Symptomatic 478 Health Information 9 Other 51 Clinical Sorting of symptomatic calls No of Calls 999 - (Emergency) 0 (0.0%) A & E - (Emergency) 6 (1.0%) Contact Dentist - <1 hour 14 (2.2%) Contact Dentist - <4 hours 181 (28.7%) Contact Dentist - Routine Appointment 133 (21.1%) Contact Orthodontist 6 (1.0%) Homecare and Pharmacy 129 (20.4%) Contact GP 17th 9 (1.4%) November 2008 Other 0 (0.0%)
  • In hours urgent slots• Welwyn Garden City – daily• Stevenage – daily• Hitchin – daily• South East Herts• St Albans, Harpenden, Redbourn• Borehamwood, Bushey• Watford, Rickmansworth• Tring, Hemel Hempstead, Bovingdon 17th November 2008
  • Responses to Patient Questionnaires on time taken to get a dental appointment, April 2007 to September 2008 E& N Herts West HertsPatient’s opinion of time taken to get appointment number % number %It was as soon as was necessary 1,309 87.21% 1,338 87.57%It should have been a bit sooner 105 7.00% 98 6.41%It should have been much sooner 23 1.53% 27 1.77%No response 64 4.26% 62 4.06%Invalid 0 0.00% 3 0.20%Total, 1,501 100.00% 1,528 100.00%Samples: 2,779 and 2,778 Source: DSD data 17th November 2008
  • Responses to Patient Questionnaires on Patient’s Satisfaction with Dentistry Received, April 2007 to September 2008. E& N Herts West HertsPatient’s satisfaction withdentistry received Number % Number %Completely satisfied 1,106 73.68% 1,138 74.48%Fairly satisfied 275 18.32% 278 18.19%Fairly dissatisfied 35 2.33% 32 2.09%Very dissatisfied 26 1.73% 24 1.57%No response 57 3.80% 53 3.47%Invalid 2 0.13% 3 0.20%Total: 1,501 100.00% 1,528 100.00%Samples: 2,779 and 2,778 Source DSD 17th November 2008 statistics
  • Responses to Patient Questionnaires on Patient’s Understanding of NHS/Private Dentistry Received, April 2007 to September 2008.Patients understanding of E& N Herts West Hertstreatment provided Number % Number %Invalid 7 0.47% 13 0.85%No response 50 3.33% 49 3.21%Just NHS treatment 1,307 87.08% 1,313 85.93%Combination of NHS and Private 70 4.66% 98 6.41%All Private treatment 9 0.60% 6 0.39%Unsure 58 3.86% 49 3.21%Total 1,501 100.00% 1,528 100.00%Samples: 2,779 and 2,778 Source DSD statistics 17th November 2008
  • East & North Hertfordshire PCT residents patient flow report fromApril 2008 to June 2008 (Flow Out) Number of % ofHealth Body patients patients UDA UOAE & N Hertfordshire 77,859 90.20% 170,267.35 7,354.20Enfield 2,288 2.70% 4,992.80 942W Hertfordshire 2,201 2.50% 4,449.10 1,497Non neighbouring 1,628 1.90% 3,919.75 187West Essex 1,389 1.60% 2,869.70 167Cambridgeshire 516 0.60% 991.35 3Luton 400 0.50% 1,003.20 1Bedfordshire 310 0.40% 563.40 69.8Total outflow 8,732 10.20% 18,789.30 2866.8 17th November 2008
  • Patients treated in East & North Hertfordshire PCT patient flowreport from April 2008 to June 2008 (Flow In) Number of % ofHealth Body patients patients UDA UOAE & N Hertfordshire 77,859 80.20% 170,267.35 7,354.20West Essex 4,832 5.00% 10,229.80 521Bedfordshire 3,706 3.80% 7,680.00 890W Hertfordshire 2,850 2.90% 5,830.50 4Unknown 2,653 2.70% 5,834.70 412Cambridgeshire 2,296 2.40% 4,047.00 454Non neighbouring 1,448 1.50% 3,250.05 78Enfield 1,172 1.20% 3,305.60 78Luton 221 0.20% 436.75 202Total outflow 19,178 19.70% 40,614.40 2639 17th November 2008
  • West Hertfordshire PCT residents patient flow report from April2008 to June 2008 (Flow Out) Number ofHealth Body patients % of patients UDA UOAWest Hertfordshire 68,853 86.00% 148,285.30 12,044.00E & N Hertfordshire 2,850 3.60% 5,830.50 4Non neighbouring 1,985 2.50% 4,701.00 51Harrow 1,887 2.40% 3,844.65 71Hillingdon 1,722 2.20% 3,698.85 180Barnet 1,437 1.80% 2,674.00 1,160Buckinghamshire 739 0.90% 1,255.65 86Enfield 492 0.60% 1,117.50 50Bedfordshire 311 0.40% 735.10 64Total outflow 11,423 14.40% 23,857.25 1666Source: DSD Statistics 17th November 2008
  • Patients treated in West Hertfordshire PCT patient flow report from April2008 to June 2008 (Flow In) Number ofHealth Body patients % of patients UDA UOAWest Hertfordshire 68,853 84.80% 148,285.00 12,044.00Buckinghamshire 3,143 3.90% 6.55 1,333E & N Hertfordshire 2,201 2.70% 4,449.10 1,497Non neighbouring 1,944 2.40% 3,635.00 1,266Unknown 1,817 2.20% 4,133.45 235Bedfordshire 1,403 1.70% 2,384.90 1,351Harrow 739 0.90% 1,592.95 38Barnet 616 0.80% 1,368.05 3Hillingdon 363 0.40% 677.75 223Enfield 100 0.10% 262.20 0Total inflow 12,326 15.10% 18,509.95 5,946 17th November 2008Source: DSD Statistics
  • Oral Health in Children 2005/06 Average number of decayed, missing and filled teeth in 5 year old children 2 1.78 1.6 1.47 1.29 1.23 1.13 1.2 0.9 0.8 0.4 0 ENGLAND East of Bedfordshire Luton E & N Herts West Herts EnglandSource: Surveys co-ordinated by the British 17th November 2008Association for the Study of Community Dentistry
  • The proportion of 5-Year Old children with experience of caries, Nationally, Regionally and Locally 2005 to 2006 50 41.1 40 38 34.1 34.8 32.1 30 26.7 20 10 0 ND n ts ts d ire to an er r He LA Lu sh tH gl d G En N es or EN & df W of E Be st Eaource: Surveys co-ordinated by the British Association for the17th November Study of 2008ommunity Dentistry
  • School Dental Inspections• Research in the 1980s started to question the aims and effectiveness of the screening examinations. The results of a large Randomised Control Trial have demonstrated that school dental screening is ineffective at a population level in reducing levels of untreated disease and increasing attendance of those who need treatment. 17th November 2008
  • • On 7 November 2006, the UK National Screening Committee recommended to the UK Chief Dental Officers that there is no evidence to support the continued population screening for dental disease among children aged 6 to 9 years.• The Committee’s recommendation was based in part on the view that the resources currently used for screening could be used more effectively in other ways to tackle oral health inequalities 17th November 2008
  • Improving Children’s Oral HealthRequires partnership working from the following stakeholders:• Dental teams• Public Health specialists• Oral Health Promotion Team• Health visitors• Health improvement specialists• Sure start and children’s’ centres• Healthy schools programmes• Local authorities• Voluntary groups 17th November 2008
  • Oral Health Promotion Activities Aimed at Reducing Oral Health Inequalities in Young ChildrenTOPIC FOCUS GOOD PRACTICE INFANT FEEDING Promote breastfeeding Coma recommendations Oral Health input into local infant feeding strategies and guidelines DIET AND NUTRITION POLICY Promote the development and adoption of nutrition and healthy eating GUIDELINES guidelines SUGAR CONTENT Discourage addition of sugars to weaning foods/drinks and vitamin supplements Encourage reduction in sugar content of soft drinks/breakfast cereals, confectionary, etc. Encourage caterers to reduce sugars in prepared foods Encourage vending machine providers to include sugar-free choices PUBLIC Improve consistency of all dietary messages re: importance of reducing the INFORMATION frequency of consumption of sugary drinks and foods Ensure effective dietary education for those at risk of dental caries and erosion AND SUPPORT Restriction of promotion of food and drinks high in sugar, particularly for children EARLY Encourage parents and carers to start toothbrushing with fluoride TOOTHBRUSHING toothpaste within the first year of a child’s lifeHYGIENEORAL BODY AND Incorporate oral hygiene teaching into Personal and Social Education ORALHYGIENE teaching TRAINING AND Improve the effectiveness of oral hygiene instruction provided by oral SUPPORT and health professional 17th November 2008
  • Hertfordshire Oral Health Strategy and Commissioning Group• Primary & Secondary dental care commissioning is outside of Practice Based Commissioning• Integrated approach to budget and decision making• Engagement of primary and secondary care clinicians in assessing needs, developing care pathways and commissioning decisions• Lay representation th 17 November 2008
  • Dept of Health additional growth funding 08-09 Indicative Indicative Net UDAs – Gross Patient Allocation Indicative Allocation Charge £000s Planning £000s Revenue Assumpti £000s onEast & NorthHertfordshire 1,292 258 1,034 55,355PCTWestHertfordshire 1,998 600 1,398 79,945PCT 17th November 2008
  • Additional Growth from PCTsWest Hertfordshire and East and NorthHertfordshire PCTS have added anadditional recurring allocation to total£2million to further improve access togeneral dental services 17th November 2008
  • West Herts - HertsmerePractices in Potters Bar, Borehamwood and Bushey have received the following additional growth: 2008-09 16,700 Units 5,567 of Dental patients Activity 2009-10 31,400 UDAs 10,467 patients 17th November 2008
  • West Herts – St Albans and HarpendenPractices in London Colney, St Albans and Harpenden have received the following additional growth: 2008-09 18,500 Units of 6,167 patients Dental Activity 2009-10 36,400 UDAs 12,133 patients 17th November 2008
  • West Herts- Watford and 3 RiversPractices in Watford, Rickmansworth, Croxley Green, Chorleywood and Abbots Langley have received the following additional growth 2008- 09 15,275 Units of 5,092 patients Dental Activity 2009-10 36,325 UDAs 12,108 patients 17th November 2008
  • West Herts- DacorumPractices in Tring and Hemel Hempstead have received the following additional growth: 2008- 09 5,600 Units of 1,867 patients Dental Activity 2009-10 14,000 UDAs 4,667patients 17th November 2008
  • East and North Herts – SE HertsPractices in Ware, Hoddesden, WalthamCross, Hertford, Flamstead End, Cuffleyand Cheshunt have received the followingadditional growth:2008- 09 22,550 Units of 7,517 patients Dental Activity2009-10 35,400 UDAs 11,800 patients 17th November 2008
  • East and North Herts – N Herts & StevenagePractices in Baldock, Stevenage, Hitchinand Letchworth have received thefollowing additional growth:2008- 09 21,465 Units of 7,155 patients Dental Activity2009-10 44,980 UDAs 14,993 patients 17th November 2008
  • East and North Herts – Welwyn/HatfieldPractices in Welwyn Garden City, Hatfield,Panshanger and Welham Green havereceived the following additional growth:2008- 09 6,400 Units of 2,133 patients Dental Activity2009-10 17,424 UDAs 5,808 patients 17th November 2008
  • East and North Herts- RBBS Practices in Bishop’s Stortford and Buntingford have received the following additional growth funding:2008- 09 8,800 Units of 2,933 patients Dental Activity2009-10 18.102 UDAs 6,034 patients 17th November 2008
  • Total Hertfordshire Growth allocated to dateWest Hertfordshire PCT2008- 56,075 UDAs 18,693 £1,345,8009 patients 02009- 118,125 39,375 £2,835,0010 UDAs patients 0East and North Hertfordshire PCT2008- 59,215 UDAs 19,738 £1,421,1609 patients 02009- 115,904 38,635 £2,781,7410 UDAs patients 4 17th November 2008
  • Supporting Patient Access• PCT telephone number for information• Up to date information on individual practice’s capacity• NHS Choices website• Increasing public awareness• Communications plan (December 2008) 17th November 2008
  • Reconfiguration of Acute Services• In patient beds for oral and maxillofacial surgery were centralised at Luton & Dunstable Hospital in 2004. This serves Bedfordshire, Luton, east and North Herts and the northern part of West Herts.• Most oral surgery and all orthodontics is undertaken as out patient or day stay at the local district general hospital• Reconfiguration will have little effect 17th November 2008