Enclosure T

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Enclosure T

  1. 1. NHS Rotherham Board Meeting 16 February 2009 Primary Dental Services in Rotherham Contact Details: Lead Director: John Radford Lead Officer: Semina Makhani Title: Director of Title: SpR in Dental Public Health Public Health Purpose: To inform the Board on the current position of Primary Dental Services in Rotherham. Recommendations: 1. Continued support for fluoridation of Rotherham water supplies. 2. Continued support for increased spending on Dentistry in Rotherham to help improve dental access for patients, and help reduce oral health inequalities that exist in Rotherham. 3. To support increased expenditure on orthodontic treatment in Primary Care for Rotherham children. 4. To support succession planning of dental workforce by the retention of dentists who have completed the Vocational Training Scheme. 5. To support the increase in provision of domiciliary dental care for older adults; this will be monitored on an ongoing basis. Background: Since the introduction of the new dental contract in April 2006, 9 dental practices in Rotherham have closed or left the NHS. In Rotherham at present there are 30 practices offering NHS treatment to all groups of patients, there are 2 practices which only treat children under the NHS, 1 practice that treats children and exempt adults under the NHS and 1 specialist orthodontic practice. There are 4 dental practices that provide only private care. In the last year 2 new NHS dental practices have opened. As part of the drive to reduce oral health inequalities the Salaried Dental Services provide specialised services for people with special needs. In view of the high decay rates in children in Rotherham, the dental workforce is one of the issues that needs to be addressed. An Orthodontic Needs Assessment carried out as part of the commissioning strategy has shown a shortfall in the amount of orthodontic treatments commissioned in Rotherham compared to the number translating from need into demand. A shortfall in the provision of domiciliary dental care for older patients was identified and is being addressed with allocated money. /home/pptfactory/temp/20100810114628/enclosure-t2023.doc
  2. 2. 2 Analysis of Risks: The areas in which dental provision needs to be increased are generally deprived areas. There will be a shortfall in the PCR (patient charge revenue) as a large majority of patients by the nature of these areas will be exempt. Commissioning is based on the need of an area this has to be seen as an acceptable risk. The PCT needs to be aware that as a majority of orthodontic patients are children, there will be little if any PCR (patient charge revenue) generated from the additional orthodontic commissioning. This will need to be financially managed. The 18 week wait from referral to treatment-start in all dental consultant-led services is a particular problem with orthodontics due to the nature of the treatment. It is likely to result in a proportion of orthodontic patients that are currently being treated in Secondary Care, in the future being referred back to Primary Care for their treatment. In view of this, it will be important to monitor the situation closely and to address any issues that arise appropriately. Return on Investment: The increased investment in dentistry in Rotherham will help to improve access to dental care for Rotherham residents. In June 2008, 55.9% of the population of Rotherham accessed dental care (in the previous 24 months), the aim is to increase this to 68% of the population (in the previous 24 months) by 2001/2012. This will help to improve the oral health of Rotherham residents but will not lead to a reduction in the investment required for dentistry in the future. The additional funding will allow all the patients that wish to have orthodontic treatment and meet the criteria to be treated under the NHS. This will reduce the inequalities that arise when patients have to pay privately to have orthodontic treatment due to the current waiting list. Analysis of Key Issues: Choosing Better Oral Health: An oral health plan for England was published in November 2005. The principles of this oral health plan underpin the Oral Health Strategy in Rotherham. As part of good practice the plan recommends that PCTs in areas where there is high caries levels should explore the need and feasibility of water fluoridation as it is an effective and safe public health measure to reduce the rate of tooth decay. The evidence base suggests that it is the most effective community measure for reducing dental caries. The government’s commitment to maintaining and expanding dental services and increasing access has been reinforced in the NHS Operating Framework 2008/09, with an 11% increase in dental funding to PCTs for 2008/09. The objectives of the framework include achieving improved oral health and access gain through quality services, and that commissioning services should be fit for long term as well as immediate needs. In the NHS Operating Framework 2009/2010, access, quality, prevention and reviewing dental commissioning strategies are again mentioned. With the 11% increase last year, 2 new dental practices have been set up in Rotherham. Further funding will need to be allocated to dentistry, in order to improve access to dentistry for the population of Rotherham, as well as to support succession planning for the future. /home/pptfactory/temp/20100810114628/enclosure-t2023.doc
  3. 3. 3 Prior to the new dental contract in April 2006, orthodontics could be carried out on the NHS for all patients. With the new contract, The Index of Treatment Need (IOTN) is used to score the severity of a child’s malocclusion. Only those children with an IOTN index of 3.6 or above are now eligible for orthodontic treatment under the NHS. Even with these criteria there is a calculated shortfall in the provision of orthodontic treatment for children that meet the IOTN criteria and wish to have treatment. Patient, Public and Stakeholder Involvement: The commissioning and provision of orthodontic activity has been discussed at the Oral Health Advisory Group on which there is patient representation. Equality Impact: The additional funding will allow all the patients that wish to have orthodontic treatment and meet the criteria to be treated under the NHS. Additional dental funding is being used to increase dental access in areas of deprivation where the levels of decay are greatest and need the greatest. An increase in the number of domiciliary cases treated has allowed a greater number of immobile patients to be treated which will lead to an improvement in their quality of life. Financial Implications: To commission the extra orthodontic treatments to meet the need of Rotherham patients will require £195,348.54 on a recurrent basis. A bid for this money will be assessed as part of in the Operational Plan process. The preassessment and treatment waiting list for the current Specialist Orthodontist in Primary care are one and two years respectively. It has been decided to put in £139,362.30 with an existing provider, on a non-recurrent basis in order to reduce both waiting lists. Approved by: John Doherty Human Resource Implications: We are still in the process of assessing whether the current workforce capacity is sufficient to meet the current dental needs of the population. There is a shortage of Specialist Orthodontic Practitioners in Rotherham. There is a need to expand provision of orthodontic services in primary care. The availability of capacity/expertise will have to be established as part of the procurement process. Approved by: Peter Smith Procurement: A specification has been developed and is ready to go out with the tender documentation, if the PE decides to commission the additional orthodontic services. /home/pptfactory/temp/20100810114628/enclosure-t2023.doc
  4. 4. 4 Approved by: Doug Hershaw Key Words: Semina Makhani, Commissioning, Dental services, Orthodontics Further Sources of Information: Semina Makhani - Specialist Registrar in Dental Public Health /home/pptfactory/temp/20100810114628/enclosure-t2023.doc

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