NHS Dental Services Topic Group - Final Report - Slides

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  • Part of the work on the SHA dental pledge involves the development of a communications strategy to make availability and understanding of NHS dentistry clear to the public. The framework for this will be completed by the end of December 2008
  • Both Hertfordshire PCTs have significantly more dentists relative to their population than both the East of England average and the national average. Thus the population per dentist is lower. These figures are for dentists with an NHS contract. There are others with no NHS contract. E&N Herts has seen a reduction in population per dentist since 2006, because more dentists have been recruited.
  • The dots in lighter green areas were described as rural practices.
  • These figures relate to practices offering the full range of general dental services, not specialist practices.
  • The drop in number of patients seen is not because of lack of access, but may relate to perceptions and behaviours of both dentists and patients
  • We have a higher proportion of younger dentists in East and North Hertfordshire than either the East of England or England as a whole
  • It is estimated that only 6% of adults have no natural teeth currently. A national Adult Dental Health Survey is planned for next year.
  • 90% of East and North Hertfordshire residents who had dental treatment had it within E&N Hertfordshire, 10% went elsewhere.
  • 80% of the patients treated in E & N Hertfordshire were local residents, 20% were from elsewhere.
  • 86% West Hertfordshire residents had their dental treatment in West Hertfordshire, 14% elsewhere
  • 85% of patients treated in West Hertfordshire were local residents, 15% of patients came from elsewhere
  • Bedfordshire does better because of water fluoridation. The good figures form Bedfordshire and the areas of Essex which have natural fluoridation at the optimal level skew the Eof E results down. EofE comprises Norfolk, Suffolk, Cambridgeshire, Essex, Hertfordshire, Bedfordshire and Luton. Both Herts PCTs are significantly better than England.
  • School dental inspections have to be undertaken by a qualified dentist Positive consent has to be obtained by parent or guardian prior to the inspection

Transcript

  • 1. Dentistry and Oral Health in East and North Hertfordshire and West Hertfordshire PCTs Jane Robinson Primary Care Commissioning Lead Sue Gregory Consultant in Dental Public Health
  • 2. 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
  • 3. 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
  • 4. Commissioning for Oral Health Influence over where new practices establish     Stronger local relationship with NHS dentists Commissioning to meet oral health needs of population Commissioning to more explicitly address access
  • 5. 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…..
  • 6. Care and Treatment
    • Examination
    • Diagnosis
    • Preventive care and treatment
    • Periodontal treatment
    • Conservative treatment
    • Surgical treatment
    • Supply and repair of dental appliances
    • Radiographs
    • Supply of listed drugs
    • Issue of prescriptions
  • 7. 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
  • 8.
    • 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
    Patient Charge Bands-Band 1 £16.20
  • 9. 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.
  • 10. 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.
  • 11. Population per dentist E&North Herts compared with the East of England SHA and England
  • 12. Population per dentist West Herts compared with the East of England SHA and England
  • 13. Dental contracts in Hertfordshire 205 667 265 Total 88 300 123 East & North Herts 117 367 142 West Herts Number of practices Number of dentists Number of contracts
  • 14. Geographical Access to general dental practices in East and North Hertfordshire , 3 miles and 12 miles distances
  • 15. Geographical Access to general dental practices in East and North Hertfordshire , 5 miles and 12 miles distances
  • 16. Geographical Access to general dental practices in West Hertfordshire , 3 miles and 12 miles distances
  • 17. September 08 telephone audit indicated that 62% of practices in E & North Hertfordshire PCT are currently accepting new NHS patients, however 317,253 September 2008 -3.3% % Change since March 2006 316,195 June 2008 316,396 March 2008 320,112 December 2007 329,488 June 2007 332,184 March 2007 328,002 March 2006 Number of patients treated in the previous 24 months period
  • 18. September 08 telephone audit indicated that 64% of practices in West Hertfordshire PCT are currently accepting new NHS patients, however 271,659 September 2008 -13.6% % Change since March 2006 272,074 June 2008 275,014 March 2008 286,192 December 2007 301,249 June 2007 307,439 March 2007 314,537 March 2006 Number of patients treated in the previous 24 months period
  • 19.  
  • 20. Distribution of courses of treatment October to December 2007 East and North Hertfordshire
  • 21. Distribution of courses of treatment October to December 2007 West Hertfordshire
  • 22.  
  • 23.  
  • 24. The Proportion of Adults with No Natural Teeth in England, 1968-1998 Source: National Adult Dental Health Surveys, 1968 to 1998. Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, Pine C, Pitts N, Treasure E and White D (2000).
  • 25. Orthodontics: waiting times at October 08 Source: Practice based Data 22 weeks 3-12 weeks 10 weeks Stevenage 10 weeks 4 weeks 6 weeks Hitchin 3 years 30 months 6 months Ware 12 weeks 4-8 weeks 4 weeks Royston 12-14 months 4-8 weeks 10-12 months Bishop’s Stortford Referral to treatment time Length of time to case start Length of time to first assessment appointment Practice location
  • 26. Orthodontics: waiting times at October 08 31 weeks 6-24 weeks 0-7 weeks Watford 12 weeks 4-6 weeks 4-6 weeks Watford 20 weeks 6-8 weeks 12 weeks Watford 2 years 2 years 1 week St Albans 7 months 4 months 3 months Tring 12 weeks 6 weeks 6 weeks Rickmansworth 19 weeks 8 weeks 11 weeks Harpenden 28 weeks 1-14 weeks 1-14 weeks Harpenden 8 weeks 8 weeks Not accepting Hemel Hempstead 10 months 6 months 4 months Hemel Hempstead 1 year 44-50 weeks 2-3 weeks Boreham Wood Referral to treatment time Length of time to case start Length of time to 1 st assessment Practice location
  • 27. Emergency Dental Services: Hertfordshire NHS Direct Triage: July 06 to June 07 9 (0.15%) Other 109 (1.8%) Contact GP 1137 (19%) Homecare and Pharmacy 84 (1.4%) Contact Orthodontist 2113 (35.4%) Contact Dentist - Routine Appointment 2255 (37.8%) Contact Dentist - <4 hours 177 (2.9%) Contact Dentist - <1 hour 131 (2.2%) A & E - (Emergency) 41 (0.68%) 999 - (Emergency) No of Calls Clinical Sorting of symptomatic calls 834 Other 40 Health Information 5954 Symptomatic 9071 Calls Answered No of Calls Call Volume
  • 28. Emergency Dental Services: Hertfordshire NHS Direct Triage: September 08 0 (0.0%) Other 9 (1.4%) Contact GP 129 (20.4%) Homecare and Pharmacy 6 (1.0%) Contact Orthodontist 133 (21.1%) Contact Dentist - Routine Appointment 181 (28.7%) Contact Dentist - <4 hours 14 (2.2%) Contact Dentist - <1 hour 6 (1.0%) A & E - (Emergency) 0 (0.0%) 999 - (Emergency) No of Calls Clinical Sorting of symptomatic calls 51 Other 9 Health Information 478 Symptomatic 631 Calls Answered No of Calls Call Volume
  • 29. 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
  • 30. Responses to Patient Questionnaires on time taken to get a dental appointment, April 2007 to September 2008 Source: DSD data 100.00% 1,528 100.00% 1,501 Total, Samples: 2,779 and 2,778 0.20% 3 0.00% 0 Invalid 4.06% 62 4.26% 64 No response 1.77% 27 1.53% 23 It should have been much sooner 6.41% 98 7.00% 105 It should have been a bit sooner 87.57% 1,338 87.21% 1,309 It was as soon as was necessary % number % number West Herts E& N Herts Patient’s opinion of time taken to get appointment
  • 31. Responses to Patient Questionnaires on Patient’s Satisfaction with Dentistry Received, April 2007 to September 2008. Source DSD statistics 100.00% 1,528 100.00% 1,501 Total: Samples: 2,779 and 2,778 0.20% 3 0.13% 2 Invalid 3.47% 53 3.80% 57 No response 1.57% 24 1.73% 26 Very dissatisfied 2.09% 32 2.33% 35 Fairly dissatisfied 18.19% 278 18.32% 275 Fairly satisfied 74.48% 1,138 73.68% 1,106 Completely satisfied % Number % Number West Herts E& N Herts Patient’s satisfaction with dentistry received
  • 32. Responses to Patient Questionnaires on Patient’s Understanding of NHS/Private Dentistry Received, April 2007 to September 2008. Source DSD statistics 100.00% 3.21% 0.39% 6.41% 85.93% 3.21% 0.85% % 1,528 49 6 98 1,313 49 13 Number West Herts E& N Herts 100.00% 1,501 Total Samples: 2,779 and 2,778 3.86% 58 Unsure 0.60% 9 All Private treatment 4.66% 70 Combination of NHS and Private 87.08% 1,307 Just NHS treatment 3.33% 50 No response 0.47% 7 Invalid % Number Patient's understanding of treatment provided
  • 33. 2866.8 18,789.30 10.20% 8,732 Total outflow 69.8 563.40 0.40% 310 Bedfordshire 1 1,003.20 0.50% 400 Luton 3 991.35 0.60% 516 Cambridgeshire 167 2,869.70 1.60% 1,389 West Essex 187 3,919.75 1.90% 1,628 Non neighbouring 1,497 4,449.10 2.50% 2,201 W Hertfordshire 942 4,992.80 2.70% 2,288 Enfield 7,354.20 170,267.35 90.20% 77,859 E & N Hertfordshire UOA UDA % of patients Number of patients Health Body East & North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out)
  • 34. 2639 40,614.40 19.70% 19,178 Total outflow 202 436.75 0.20% 221 Luton 78 3,305.60 1.20% 1,172 Enfield 78 3,250.05 1.50% 1,448 Non neighbouring 454 4,047.00 2.40% 2,296 Cambridgeshire 412 5,834.70 2.70% 2,653 Unknown 4 5,830.50 2.90% 2,850 W Hertfordshire 890 7,680.00 3.80% 3,706 Bedfordshire 521 10,229.80 5.00% 4,832 West Essex 7,354.20 170,267.35 80.20% 77,859 E & N Hertfordshire UOA UDA % of patients Number of patients Health Body Patients treated in East & North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In)
  • 35. Source: DSD Statistics 1666 23,857.25 14.40% 11,423 Total outflow 64 735.10 0.40% 311 Bedfordshire 50 1,117.50 0.60% 492 Enfield 86 1,255.65 0.90% 739 Buckinghamshire 1,160 2,674.00 1.80% 1,437 Barnet 180 3,698.85 2.20% 1,722 Hillingdon 71 3,844.65 2.40% 1,887 Harrow 51 4,701.00 2.50% 1,985 Non neighbouring 4 5,830.50 3.60% 2,850 E & N Hertfordshire 12,044.00 148,285.30 86.00% 68,853 West Hertfordshire UOA UDA % of patients Number of patients Health Body West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out)
  • 36. Source: DSD Statistics 5,946 18,509.95 15.10% 12,326 Total inflow 0 262.20 0.10% 100 Enfield 223 677.75 0.40% 363 Hillingdon 3 1,368.05 0.80% 616 Barnet 38 1,592.95 0.90% 739 Harrow 1,351 2,384.90 1.70% 1,403 Bedfordshire 235 4,133.45 2.20% 1,817 Unknown 1,266 3,635.00 2.40% 1,944 Non neighbouring 1,497 4,449.10 2.70% 2,201 E & N Hertfordshire 1,333 6.55 3.90% 3,143 Buckinghamshire 12,044.00 148,285.00 84.80% 68,853 West Hertfordshire UOA UDA % of patients Number of patients Health Body Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In)
  • 37. Oral Health in Children 2005/06 Average number of decayed, missing and filled teeth in 5 year old children Source: Surveys co-ordinated by the British Association for the Study of Community Dentistry
  • 38. The proportion of 5-Year Old children with experience of caries, Nationally, Regionally and Locally 2005 to 2006 Source: Surveys co-ordinated by the British Association for the Study of Community Dentistry
  • 39. 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.
  • 40.
    • 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
  • 41. Improving Children’s Oral Health
    • Requires 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
  • 42. Oral Health Promotion Activities Aimed at Reducing Oral Health Inequalities in Young Children
    • Improve the effectiveness of oral hygiene instruction provided by oral and health professional
    TRAINING AND SUPPORT
    • Incorporate oral hygiene teaching into Personal and Social Education teaching
    BODY AND ORALHYGIENE
    • Encourage parents and carers to start toothbrushing with fluoride toothpaste within the first year of a child’s life
    EARLY TOOTHBRUSHING ORAL HYGIENE
    • Improve consistency of all dietary messages re: importance of reducing the frequency of consumption of sugary drinks and foods
    • Ensure effective dietary education for those at risk of dental caries and erosion
    • Restriction of promotion of food and drinks high in sugar, particularly for children
    PUBLIC INFORMATION AND SUPPORT
    • 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
    SUGAR CONTENT
    • Promote the development and adoption of nutrition and healthy eating guidelines
    POLICY GUIDELINES
    • Promote breastfeeding
    • Coma recommendations
    • Oral Health input into local infant feeding strategies and guidelines
    INFANT FEEDING DIET AND NUTRITION GOOD PRACTICE FOCUS TOPIC
  • 43. 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
  • 44. Dept of Health additional growth funding 08-09 79,945 1,398 600 1,998 West Hertfordshire PCT 55,355 1,034 258 1,292 East & North Hertfordshire PCT UDAs – Indicative Planning Assumption Net Allocation £000s Indicative Patient Charge Revenue £000s Indicative Gross Allocation £000s
  • 45. Additional Growth from PCTs
    • West Hertfordshire and East and North Hertfordshire PCTS have added an additional recurring allocation to total £2million to further improve access to general dental services
  • 46. West Herts - Hertsmere
    • Practices in Potters Bar, Borehamwood and Bushey have received the following additional growth:
    10,467 patients 31,400 UDAs 2009-10 5,567 patients 16,700 Units of Dental Activity 2008-09
  • 47. West Herts – St Albans and Harpenden
    • Practices in London Colney, St Albans and Harpenden have received the following additional growth:
    12,133 patients 36,400 UDAs 2009-10 6,167 patients 18,500 Units of Dental Activity 2008-09
  • 48. West Herts- Watford and 3 Rivers
    • Practices in Watford, Rickmansworth, Croxley Green, Chorleywood and Abbots Langley have received the following additional growth
    12,108 patients 36,325 UDAs 2009-10 5,092 patients 15,275 Units of Dental Activity 2008- 09
  • 49. West Herts- Dacorum
    • Practices in Tring and Hemel Hempstead have received the following additional growth:
    4,667patients 14,000 UDAs 2009-10 1,867 patients 5,600 Units of Dental Activity 2008- 09
  • 50. East and North Herts – SE Herts
    • Practices in Ware, Hoddesden, Waltham Cross, Hertford, Flamstead End, Cuffley and Cheshunt have received the following additional growth:
    11,800 patients 35,400 UDAs 2009-10 7,517 patients 22,550 Units of Dental Activity 2008- 09
  • 51. East and North Herts – N Herts & Stevenage
    • Practices in Baldock, Stevenage, Hitchin and Letchworth have received the following additional growth:
    14,993 patients 44,980 UDAs 2009-10 7,155 patients 21,465 Units of Dental Activity 2008- 09
  • 52. East and North Herts – Welwyn/Hatfield
    • Practices in Welwyn Garden City, Hatfield, Panshanger and Welham Green have received the following additional growth:
    5,808 patients 17,424 UDAs 2009-10 2,133 patients 6,400 Units of Dental Activity 2008- 09
  • 53. East and North Herts- RBBS
    • Practices in Bishop’s Stortford and Buntingford have received the following additional growth funding:
    6,034 patients 18.102 UDAs 2009-10 2,933 patients 8,800 Units of Dental Activity 2008- 09
  • 54. Total Hertfordshire Growth allocated to date £2,781,744 38,635 patients 115,904 UDAs 2009-10 £1,421,160 19,738 patients 59,215 UDAs 2008-09 East and North Hertfordshire PCT West Hertfordshire PCT £2,835,000 39,375 patients 118,125 UDAs 2009-10 £1,345,800 18,693 patients 56,075 UDAs 2008-09
  • 55. 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)
  • 56. 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