NHS Dental Services Topic Group - Final Report - amendedDocument Transcript
NHS Dental Services
Report of the Topic Group
1.0 Purpose of Report 4
2.0 Recommendations 4
3.0 Background 6
4.0 Access to NHS Dental Services within the County 7
5.0 Children’s dentistry 9
6.0 Quality of dental treatment 11
7.0 Specialist treatment 13
8.0 The impact of the reconfiguration of acute health 14
services in Hertfordshire on actual dental services
9.0 Conclusions 14
Appendix 1 Scoping Document
Appendix 2 Membership of the Topic Group, Witnesses, Documents & dates
Appendix 3 Dentistry and Oral Health in East and North Hertfordshire and
West Hertfordshire PCT’s
In presenting this Topic Group Report on NHS Dental Services I acknowledge
the support and advice we were given by the Primary Care Trust
Commissioning Lead Officer, Jane Robinson, Dr Sue Gregory, Consultant in
Dental Public Health, and Lynda Dent, Head of Public Engagement
Hertfordshire PCT. Between them most of our queries and questions were
answered and the complexities of providing this essential service, so
important for the health of us all, became clearer.
We received helpful evidence from several dental practitioners, which gave us
a greater understanding of their concerns.
Our greatest challenge was to gain the public’s response to dental service
provision, and I do thank those people who took the trouble to contact us with
You will find within this Report our recommendations, and some background
to the scrutiny we carried out. During 2008/09 and for 2009/10, the PCT has
made considerable additional investment in dental practices to ensure
improved access for patients that will strengthen dental services available to
Finally can I thank Victoria Griffiths our Scrutiny Officer, along with Elaine
Gibson for noting all the details of our Topic Group meetings, and drawing up
County Cllr. Doug Drake
Chairman of the NHS Dental Services Topic Group
HERTFORDSHIRE COUNTY COUNCIL
Report of the NHS Dental Services Topic Group
Author: Victoria Griffiths, Scrutiny Officer Tel: 01992 588385
1. Purpose of report
1.1 To report on the work of the NHS Dental Services Topic Group which
was set up to assess the following issues:
• The accessibility of NHS dental services in the county
• Children’s dentistry
• The quality of dental treatment, including customer satisfaction and
• Specialist treatment such as orthodontics, domiciliary and sedation
• The impact of the reconfiguration of acute health services in
Hertfordshire on the provision of acute dental services within
1.2 Appendix 1, the scoping document, provides further details of the
planned work of the topic group.
2.1 The PCT should ensure that effective communication is deployed and
reviewed on a regular basis for the following areas:
a) How to access NHS dental treatment, particularly when there are no
dentists able to offer treatment on the NHS locally (see 4.5-4.9).
b) What treatment is available on the NHS and what the charge will be
c) How to access treatment in an emergency or out of hours (see 6.9).
d) How to make a complaint (see 6.7).
2.2 The PCT should continue to ensure that the public can access
appropriate and clinically necessary dental treatment on the NHS
through the redistribution of dental activity and further investment as
more funding becomes available. (See 4.6-4.9).
2.3 The PCT should work to increase and improve communication with dental
contract holders in order to
a) Promote among dental practitioners the advantages of NHS
contracts for the provision of dental services. This might instil a
more positive feeling and encourage new dentists to choose to
provide NHS dental services (see 4.11).
b) Provide guidelines and advice on the delivery of the contract. (see
c) Ensure greater understanding of the administration of the contract
2.4 The PCT should consider ways to ensure that all children, including
the most disadvantaged children, in the County are receiving quality
dental services”.(See 5.5).
2.5 The PCT should ensure that dentists with NHS contracts are displaying
the NHS posters explaining the banding charges and that leaflets are
available in reception areas. (See 6.2-6.5).
2.6 The PCT should work to ensure effective monitoring of the Out of
Hours service to improve access to emergency treatment outside of
normal working hours. (See 6.10-6.12).
2.7 The PCT should more closely monitor the clinical data received on a
quarterly basis from the Business Service Authority and any other
performance information available to them on the quality of NHS
services provided by dental practices in Hertfordshire. In particular the
PCT needs to be aware of any reduction in complex treatments and
ensure that this is not due to a disincentive among dentists to carry out
this type of treatment. (See 6.10-6.12).
2.8 The PCT should ensure that effective communication is deployed and
reviewed on a regular basis for the following areas:
a) How to access a home visit (domiciliary visit) and what the patient
can expect (see 7.6).
b) The requirements for accessing sedation treatment on the NHS
c) The requirements for accessing orthodontic treatment and where
alternative orthodontic treatment can be accessed if patients are
faced with a lengthy waiting time (see 5.6-5.8 and 7.4).
2.9 The PCT should more thoroughly examine the quality and accessibility
of domiciliary and sedation services in order to determine actions to
improve these services where necessary. (See 7.3). In particular, the
PCT should work to establish clear and consistent guidelines for
dentists delivering domiciliary visits. (See 7.6).
2.10 The PCT should work to improve access to orthodontic treatment by
reducing the length of waiting times between referral and treatment.
(See 5.6-7and 7.4)
3.1 The NHS Dental services topic group considered a variety of evidence
over the course of five meetings in order to assess the issues outlined in
paragraph 1.1 above. Membership of the topic group, details of officer
support and information on witnesses consulted can be found in Appendix
3.2 It is important to note that the scrutiny undertaken relates to NHS dental
services under the new General Dental Services contract introduced
across England in April 2006. This made significant changes to the way
that NHS Dental services were delivered, notably:
• Primary Care Trusts (PCTs) were given powers to commission
services to meet local needs (previously commissioning had been
done centrally by the NHS).
• The charging system for patients was simplified.
• The system by which dentists were remunerated changed from a
fee-per-item of treatment provided to payment in return for an
agreed annual level of service provision.
3.3 The cost to the patient now takes the form of a banded charging system as
follows. The patient pays one of three charges depending on the type of
treatment they receive:
Band 1 (£16.20) covers an examination, diagnosis (e.g. x-rays), advice
on how to prevent future problems, and a scale and polish if needed.
Band 2 (£44.60) covers everything listed in Band 1 above, plus any
further treatment such as fillings, root canal work or if your dentist
needs to take out one or more of your teeth.
Band 3 (£198.00) covers everything listed in Bands 1 and 2 above,
plus crowns, dentures or bridges.
The patient pays the charge for the highest band that applies to their
course of treatment. Only one charge applies to each course of
3.4 Dentists receive the following Units of Dental Activity (UDA’s) for each
Band 1 1 unit
Band 2 3 units
Band 3 12 units
The value of the unit varies between dental contracts from between
£18 to £29. This was determined by the level of activity that took place
during the test period in 2004/05. During this period it was also
determined how many UDA’s a practice would be allocated each year.
The contract holder is paid in monthly instalments based on the agreed
annual contractual value less patient charges received.
3.5 In addition, there is no longer a system of patient registration as a
patient may expect to be seen and receive the same treatment by any
dental practitioner holding a contract with the NHS.
3.6 The following sections provide a summary of the information received
against each of the topic group’s areas of interest.
4. Access to NHS Dental Services within the County
4.1 It was noted by the topic group that a significant strength of the new
arrangements is that it allows PCT’s to influence where new dental
contracts are established. A number of dental practitioners who attended
meetings to give evidence identified that, after 1st April 2009 when the
three year funding guarantee ends, the ability of the PCT to commission
services should allow it greater flexibility to ensure that funding is targeted
to areas of need.
4.2 In addition to this, figures that were presented to the group in a
presentation from Dr Sue Gregory, Consultant in Dental Public Health
and Mrs Jane Robinson, Primary Care Trust Commissioning Lead,
indicate that Hertfordshire’s figures for population per dentist compare
favourably with the region and England. (See slides 11 and 12 in
4.3 Similarly, responses to a patient questionnaire carried out between April
2007 and September 2008, indicated that waiting time for an appointment
had not been a significant issue for the majority of patients. Approximately
87% of patients in both East & North and West Herts said that the time
taken to get an appointment was as soon as was necessary. However, it
was noted that this survey was only of patients receiving treatment and did
not indicate whether there are problems for those who have not been seen
on the NHS during this period.
4.4 The topic group also received information on the complaints passed to the
PCT during the period 1 April 2007-31 March 2008. West Herts PCT had
received only two formal complaints which concerned access, whilst East
and North Herts had received none. Other informal complaints had been
received, although as these were informal, they are not documented.
4.5 Despite evidence that there is suitable NHS dental service provision in the
county so that access should not be a significant issue, there were a
number of indications that access to an NHS dental appointment could
sometimes be difficult.
4.6 The majority of dentists who gave evidence to the topic group suggested
that the nature of the new contract could sometimes restrict patient
access. This is largely due to the fact that the number of UDA’s1 allocated
to a dental contract holder based on their activity during the test period
was not representative of the dentists’ typical activity or had not taken into
account the future growth of the practice. One dentist commented that the
dental contract holders who had been most disadvantaged were those that
were doing more complex work than they had during the test period
because the terms of the new contract oblige them to see a fuller range of
cases that spans the treatment bands mentioned in section 3.3.
4.7 There was general frustration expressed that the lack of flexibility in the
contract meant either turning patients away or over performing on the
contract, for which they would not be remunerated. On occasions, dentists
also offer private treatment due to a lack of units of dental activity to
accommodate everyone who wishes to be seen on the NHS. It was noted
that patients lack an understanding of the system and so are often
frustrated when they cannot access an appointment.
4.8 It was also acknowledged by both dental practitioners and PCT officers
that, due to negative messages in the media, the public perception across
England is that NHS dental services are hard to access. It was felt that this
factor may discourage residents from trying to arrange a routine
appointment, waiting until there was a real emergency before seeking
treatment. The national removal of patient registration may have also
exacerbated this problem as patients may be unsure how to access an
appointment if their local dentist, with whom they were previously
registered, is unable to see them.
4.9 Despite a generally good spread of practices providing NHS treatment
across the county, it was noted that some rural areas in Hertfordshire are
not as well provided for. This was particularly the case in areas of East
Herts where sometimes a limited number of practices are also under strain
from picking up patients living across the borders in Essex. Evidence from
the presentation given (see Appendix 3) showed that in East and North
Herts around 10% of Hertfordshire residents go out to neighbouring
counties to receive treatment, whilst around 20% come in from other
counties to receive treatment in Hertfordshire. The topic group discussed
with PCT officers the possibility of finding more creative ways to improve
access for these rural areas such as through the provision of transport for
those who might find it difficult to travel to urban areas for an appointment,
or through the possible use of mobile practices visiting more isolated
See section 3.4 for an explanation of Units of Dental Activity (UDA).
4.10The topic group also looked at a number of other issues in order to
determine whether access might be a problem now or in the future. This
included looking at whether there are a sufficient number of newly qualified
dentists providing NHS services, and whether there are any cases of
residents going abroad or to A&E with dental health issues which might
indicate difficulties in accessing an appointment.
4.11When asked whether there was a trend among newly qualified dentists to
start private rather than NHS practices, dental practitioners felt that there
was a generally negative perception of the current contract among new
dentists that might discourage them from committing to the NHS.
However, at present there is a good mix of ages of dentists with NHS
contracts within the county and it is felt that the current economic climate
will encourage dentists to seek NHS contracts at least in the short term.
4.12There is no record of whether patients are going abroad for treatment,
although it was suggested that there were dangers associated with this as
treatment abroad can differ and cause problems later on when a patient
needs continuation of treatment by a dentist locally.
4.13Similarly there have been no reports from hospitals to indicate that they
have seen a significant number of people at A&E who should have seen a
dentist, which suggests that this is not an area for concern.
5. Children’s dentistry
5.1 The majority of dental practitioners who gave evidence to the topic
group did not feel that children were particularly disadvantaged by the
new contract. However, there were some concerns raised.
5.2 In particular, it was expressed that the new contract did not promote
preventative work, which whilst effecting all patients, would significantly
impact children who were most likely to be in need of this type of
treatment. Further information about this can be found in section 6.
5.3 The topic group questioned the degree to which schools are involved in
the promotion of children’s dental health. Children no longer have dental
health checks in schools due to evidence that such checks did not have
much effect or benefit. Schools can choose on an individual basis whether
to cover dental health as part of Personal, Social and Health Education.
5.4 The topic group were presented with statistics that indicate that the dental
health of children is generally good (see slides 37 and 38 in Appendix 3).
This was also supported by evidence from a 2006 Health Related
Behaviour survey of over 9600 young people in Hertfordshire aged 9 to 15.
This showed that 87% of pupils reported that they cleaned their teeth at
least twice on the day before the survey (the recommended frequency)
and only 17% reported that they had to have a filling last time they visited
5.5 However, the PCT reported that the challenge remains to reach children
from the most disadvantaged backgrounds who are likely to have the
poorest dental health. It is unlikely that these could be reached through the
school system as they would require parental consent for a dental health
check and often come from families where this consent is hard to acquire.
5.6 Another concern about children’s dentistry was raised in the area of
orthodontics. There are currently long waiting times for treatment at some
orthodontic practices and this may have a negative impact on children
where it is important that orthodontic treatment is in line with children’s
5.7 In some cases children were referred to alternative orthodontic practices
where they could access treatment faster, however evidence suggested
that they then might be required to travel quite lengthy distances to other
parts of the county. This could involve a longer period of time out of school
for each appointment and hence interfere with school attendance.
5.8 There also seemed to be confusion among parents of children accessing
orthodontic treatment. The Index of Orthodontic Treatment Need (IOTN)
used to assess whether children are eligible for orthodontic treatment on
the NHS was said by orthodontists to be subjective, making assessment
difficult. Some parents seemed to be unaware of this, so that they could
not understand why one child in a family could be eligible for NHS
orthodontic treatment while their other child was not. Parents that were
aware of the index system could sometimes put pressure on orthodontists
to tweak the measurement for a child to tip them over into the eligibility
criteria for NHS support.
5.9 With regard to the performance of child-only contracts, where dentists will
see children on the NHS whilst treating their parents privately, it was
reported to the topic group that there are not many of these now in
Hertfordshire and there are no real issues. The majority of dentists see all-
5.10The topic group were reassured that children with specialist needs, such
as anxiety or behavioural problems, or children looked after, are seen
through the PCT dental service, the performance of which is considered in
section 7.7 of this report. This is with a view to integrating them back into
general dental services when and wherever possible.
6. Quality of dental treatment
6.1 A number of areas were considered by the topic group in relation to the
quality of NHS dental treatment in the county. Whilst generally there
seemed to be no evidence that pointed to a significant cause for concern
in this area, in many instances, it was felt that better communication to the
public could hugely improve the service provided.
6.2 There is a requirement under the NHS dental contracts that practitioners
provide patients with a treatment plan showing cost for treatment. In
addition, contract holders are supplied with posters and leaflets for display
and distribution at their practice. However, evidence received by the topic
group suggested that there is much confusion among the public regarding
the charging system, suggesting many do not have or do not understand
their treatment plan and that either the posters and leaflets are not being
displayed by all practices, or that they are not effective in informing the
public of the costs of treatment.
6.3 The chairman of the topic group wrote a letter to the local press asking
residents to get in contact regarding their experience of NHS dental health
care. Around 60 responses were received. Whilst around a third of these
were very positive about the dental treatment they received, two thirds
were not, and many of the comments centred around the difficulty in
understanding charges. Indeed, many seemed to have paid a private
charge in addition to the NHS charge and did not know why.
6.4 Further to this, responses to the patient questionnaire carried out from
April 2007 to September 2008 indicated that there was some confusion as
to what patients had been charged for. Around 100 patients were unsure
or could give no response about their understanding of the treatment they
had received and whether this was covered by the NHS. A small number
believed they had received only private treatment when they had actually
received at least some treatment on the NHS in order to be eligible to
complete the patient questionnaire (see slide 32 in the presentation in
6.5 The topic group felt that it is of the utmost importance that patients are
better informed about their treatment and the cost of treatment, particularly
as many may not be able or willing to challenge the costs if they are
unsure about them. The topic group recommended that different methods
of communication be explored and that these are reviewed on a regular
basis. Some suggestions included the distribution of leaflets in other public
places such as libraries and citizens advice bureaux. It was also
suggested that training could be considered for receptionists and dental
nurses so that they might better support dentists in communicating patient
6.6 Better methods of communication could also be employed around other
aspects of NHS dental services in order to improve the service received by
patients. For example, which materials can be used for fillings under the
NHS, and why the length between check up times can differ between
6.7 With regard to the complaints service, information presented to the topic
group on the complaints received between 1 April 2007 and 31 March
2008 indicated that there were no significant issues. Only 40 complaints
had been passed to the two PCT’s during the whole year, 18 of which
were about care and treatment, 16 regarding charges with others covering
topics such as hygiene, access, manner and attitude. This reiterates the
need for better communication around charges. It was also felt that the
public could be better informed about how to make a complaint if they so
6.8 Customer satisfaction results presented to the topic group indicated that
92% of patients responding to the patient questionnaire between April ’07
and September ’08 were completely or fairly satisfied with the dentistry
treatment they had received.
6.9 The dental practitioners, who attended the topic group to give evidence,
felt that the telephone triage service for out of hours emergencies could be
improved. Some had received complaints from patients that there was a
lack of access in an emergency, and others commented how they had
sometimes seen patients with a cosmetic issue whilst others who were in
pain had complained that they had not been able to get an appointment.
There was a feeling that the lack of patient registration was detrimental to
patient care in an emergency as it was unlikely that a patient would be
able to see their regular dentist and instead might be required to travel
some distance for an appointment. Again, it was felt that better information
about what to do in an emergency would help to improve this service.
6.10Another significant issue which was raised was the fear that the new
contract arrangements might be creating a disincentive for dentists to carry
out some restorative work. A number of dentists pointed out that under the
new banding system, they were remunerated the same for carrying out
some very complex and time-consuming restorative work e.g. a root canal,
as they would be for something more straightforward such as an
6.11Whilst the number of complex treatments carried out in Hertfordshire has
reduced under the new contract this does not differ from the rest of the
region or England as a whole and could be due to better dental health care
amongst the population in general. In addition, the PCT do regularly
receive reports from the Business Service Authority’s (BSA) cycle of
clinical inspections of practices which would highlight any unusual areas of
low activity or unusual continuation of treatment.
6.12Nevertheless, some of the dental practitioners did feel that the PCT could
challenge contract holders more to show how they are performing to the
required level as it is possible to ‘cherry pick’ the cases examined by the
BSA. Better monitoring of performance information would place the PCT in
a stronger position to identify any unusual activity. This would support the
intention of the new powers they hold in the commissioning process to
promote high standards of professional practice.
6.13Dental practitioners also felt that the quality of the service they provided
could be improved through better communication with the PCT and more
guidance about how to handle the contract and access additional funding
to see more patients. They also felt that the system could be improved by
a more transparent and consistent approach in the way the contracts were
7. Specialist treatment
7.1 The topic group considered access to and quality of a number of specialist
services; sedation, domiciliary, orthodontics and the service delivered by
the PCT dental service to those who cannot access treatment under the
general dental services contract due to anxiety, behavioural or learning
difficulties, disability or other special needs.
7.2 Eight of the responses received to the Chairman’s request to the public for
information indicated some difficulty in accessing specialist services. Of
these four concerned orthodontics, two concerned maxillofacial services
delivered at A&E for broken teeth, one on disabled access and one on the
PCT dental services clinics for those with special needs.
7.3 With regard to domiciliary and sedation services there is insufficient
evidence to come to a conclusion about the quality of this service. The
PCT are soon to start a review of these services in order to better
understand current circumstances.
7.4 In the case of orthodontics, the topic group received figures in a
presentation (see slides 25 and 26 in Appendix 3) that indicates that
waiting times for this service can vary greatly between practices. The
problems associated with this have already been discussed in section
5.6-8. There was concern expressed by PCT officers that there were some
children on the waiting list for orthodontic treatment that were too young to
start the course of treatment but were slowing down the referral time for
others as they would need to be reviewed regularly whilst on the waiting
list. The PCT plan to look at a central referral mechanism as an option to
reduce waiting list lengths.
7.5 Again there seemed to be a problem with communication around NHS
entitlement under these services. In the case of sedation, dentists are
required to assess whether or not sedation is clinically necessary for a
patient and is therefore eligible to pay NHS charges for the treatment. A
patient can pay privately if they choose to have the treatment carried out
under sedation when the dentist does not deem sedation clinically
necessary. The topic group heard from one member of the public who had
been wrongly charged for sedation and had been refunded by the dentist.
7.6 Dental practitioners also pointed out that the contract does not create
much incentive to carry out domiciliary visits, as even though this takes
longer to deliver, the payment received is no different. Practitioners
complained that there was a lack of guidance and consistency about
domiciliary visits and doubted that many members of the public were
aware of them or what service they would receive from a home visit.
7.7 In terms of the service delivered by the PCT dental service, survey results
indicated a good level of satisfaction with this service. 87% of patients of
the PCT dental service clinics who completed a patient questionnaire
during October-March 2008 indicated that overall they had found the
service they had received excellent, and a further 10% reported it to be
good. However, it should be noted that only a third of patients completed a
questionnaire and there was one complaint received from a member of the
public whose experience had not reflected these generally good results.
8. The impact of the reconfiguration of acute health services in
Hertfordshire on acute dental services
8.1 The topic group received information in the presentation delivered by Dr
Sue Gregory and Mrs Jane Robinson that the reconfiguration of acute
hospital services in Hertfordshire will have little effect on primary care
dental services. (See slide 56 in Appendix 3).
8.2 Currently, patients attend a number of hospitals for dental surgery and the
majority of dental services are delivered to them as outpatients. Dr Sue
Gregory reported that the quality of care given by these services is felt to
outweigh the inconvenience of travelling to a central location for the
9.1 The NHS dental services topic group have identified a number of areas
where the PCT might make improvements to the provision of NHS
dental services in Hertfordshire. Recommendations are largely around
communication and clarification of the services provided and the costs
involved both for the public and dental contract holders.
9.2 However, the topic group also felt there was some work to be done around
improved access, particularly for those who are most vulnerable, whether
it is those isolated in rural areas of the county, or children from the most
disadvantaged backgrounds. There is also further work to be done around
the redistribution of dental activity and further investment as more funding
becomes available. The waiting time for those in need of orthodontic
treatment also needs to be reduced.
9.3 The PCT could improve the service further by building on their
understanding of the patient’s experience of accessing services and the
quality of care they receive. This could be gained through effective
monitoring and management of performance information regarding the
quality of service provided by dental practices and a thorough review of
aspects of the service such as sedation and domiciliary care.
9.4 The topic group recognise that there are a number of developments and
pieces of work planned over the coming year by the PCT. These should
place the PCT in a strong position to respond to these recommendations.
9.5 In 2009 further PCT funding will be made available for investment in
primary care dentistry. The extra funding will be used to support patient
access, as well as improve public awareness and education through a
communications plan. Improved access will also be supported by the
planned reallocation of UDA’s for contracts that are over and under
9.6 Further to this, a survey of public behaviour in relation to dental services in
the county is to be commissioned in early 2009. These results will help to
provide further information about the best ways additional funding can be
9.7 The PCT will also be monitoring more clinical data which will be
benchmarked against the PCT area, the East of England and England as
9.8 Detailed work is also planned on domiciliary and sedation services and a
commitment has been made to guarantee a maximum waiting time of 18
weeks from referral to treatment for all NHS services, including orthodontic
treatment, by April 2010.
9.9 The PCT should ensure that the recommendations from the topic group
are incorporated in to these future developments.
METHOD: Topic Group Target Start date: May 2008
Doug Drake (Chairman)
Mary Bayes 2
Health Scrutiny Committee
TOPIC: NHS Dentistry
FRAMEWORK FOR SCRUTINY:
Districts: and Questions to be addressed:
Brian White,topic group will prioritise consideration of the first two questions.
NB. The Three Rivers
SOURCES OF dentists in Hertfordshire sufficiently accessible?
1) Are NHS EVIDENCE/ WITNESSES:
• Jane Robinson, waiting lists, and if so, what needs to be done to address them?
a) Are there Primary Care Trust
• BritishAre measures taken to make sure that access is equal for all, in both rural and
b) Dental Association
urban areas? Is there any difference between the different urban centres?
• Practicing NHS dentists
• Patients there evidence that residents are going outside the county for treatment
because they cannot access a dentist in their local area (including making trips
HOW THE ITEM HELPS DELIVER HCC’s The HCC challenges
CHALLENGES 1. Helping people feel safe &
d) Is there a trend in Hertfordshire of more young dentists choosing to move into
N/A as for Health Scrutiny Committee.
the private sector or moving abroad to practice dentistry overseas?
2. Maximising opportunities for
e) Is there evidence of dental practices reducing theirchildren ofyoung people
quota & NHS provision?
3. Supporting the independence of
f) Is there evidence of people going to A&E or to their GP’s regarding dental care?
the growing number of older
2) What are the facilities for children’s dentistry? 4. Tackling the causes and impact
a) Is there suitable access and quality of care? If not, of congestion key issues and
what are the
what steps are being taken to address these? 5. Dealing with worn out roads and
b) Are child only contracts performing adequately? If not, what are the key issues
6. Reducing the impact of new
and what steps are being taken to address these? development on the
3) What is the quality of NHS dental treatment in Hertfordshire?
7. Maximising efficiency savings
a) Do patients understand their treatment and the costs of treatment; is it
HOW THE ITEM DELIVERS THE CfPS (Centre for CfPS Objectives
communicated sufficiently to them and in a timely manner?
Public Scrutiny) OBJECTIVES
b) What is the process for handling complaints and•is it suitable?
Provides ‘critical friend’
• c) How is ‘critical friend’ challenge to the PCT
Providing customer satisfaction measured? What are the outcomes and results?
challenge to executive policy-
d) How easy is it to access emergency or out of hours makers and decision-makers
• Will be calling on members of the public for • Enables the voice and
e) Is there evidence that more complex treatment has reduced and if so does this
evidence and opinions
indicate that the health of the population has improved? What the public
• Is activities out undertaken?
carried are by governors independent of • Is carried out by ‘independent
minded governors’ who lead
Health and the County Council and own the scrutiny role
4) What is accessibility and quality of care like for specialistimprovement in This
• Aims to help drive improvement for NHS Dental • Drives
Health Care in Hertfordshire.
b) Sedation Democratic
Scrutiny Domiciliary services
c) Officer: Vicky Robb Services Officer: Elaine Gibson
Lead Service PCT dental service
d) The Advisor: Jane Robinson,
5) Is the reconfiguration of acute health services in Hertfordshire likely to have
Approved by on the provision of acute dental services within hospitals?
an impact the Topic Group on 5 June 2008.
CONSTRAINTS: The topic group will focus on independent practices delivering NHS
treatment through contract with the PCT. The PCT is unable to provide information on
purely private practices though information will be sought from the British Dental
Members of the Topic Group
Doug Drake (Chairman)
Brian White, Three Rivers District Council
Executive Member for Adult Care and Health: Sally Newton
HCC WEBSITE LINK: http://www.hertsdirect.org/yrccouncil/civic_calendar
Jane Robinson, Commissioning Lead
Sue Gregory, Consultant in Dental Public Health
Gill Lowey, Clinical Director
Lynda Dent, Head of Public Engagement
Jenny Greensheilds, Finance Lead
Christine Neal, Hertfordshire Complaints Service
Victoria Griffiths, Scrutiny Officer
Elaine Gibson, Democratic Services
Rumeet Patel, Dentist
Shajee Ali, Dentist
Sab Bhandal, Dentist
Steven Wagner, Orthodontist
Shamique Ismail, Orthodontist
Stephen Des Clayes, Dentist
Nikki Davey, Dentist and Chairman of Local Dental Committee
Richard Elvin, Dentist and member of Local Dental Committee
Documents provided by the PCT
Dental Services – update for PEC, January 2008
Dental Contracts and Dentistry Services in Hertfordshire, Boards, March 2008
Dental Access Paper, PEC, September 2008 (subsequently split as
appropriate for each Board in September)
NHS Dentistry – Finance, August 2008
Specialist Services/Quality of Care, September 2008
Monitoring Performance of Specialist Services, October 2008
NHS Dental Complaints, 1st April 2007 – 31st March 2008
How to make a Complaint about the NHS
BSA Patient Responses to Questionnaires Summary for West Hertfordshire
PCT, April 2007 – March 2008
BSA Patient Responses to Questionnaires Summary for East & North
Hertfordshire PCT, April 2007 – March 2008
Oral Health Needs Assessment for Hertfordshire PCTs, a Working Document,
Hertfordshire PCT Dental Service, Information Report, April 2007 – April 2008
DOH Information to Patients leaflet
Contributed to Glossary of Terms produced by HCC
Dates of Meetings
5 June 2008
6 August 2008
11 September 2008
17 November 2008
10 December 2008