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Current Issues in Prison Dentistry


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Current Issues in Prison Dentistry

  1. 1. Current Issues in Prison Dentistry Sue Gregory Deputy Chief Dental Officer
  2. 2. DH Update on Prison Dentistry and DwSI Accreditation “The DwSI and PCTs – how it will work” 5 th February 2010 <ul><li>Sue Gregory OBE </li></ul><ul><li>Deputy Chief Dental Officer (England) </li></ul>NAPDUK Conference 2010 Botanical Gardens, Birmingham
  3. 3. April 1st 2006 Primary Care Trusts (PCTs) responsible for reviewing the oral health needs of their population and commissioning services to meet these needs. Dentist with Special Interest (DwSIs) schemes, give PCTs additional flexibility to commission NHS dental services of a more specialist nature within a primary care setting that are directly in line with the needs of their local communities. Why would PCTs use DwSIs?
  4. 4. Definition “ A dentist working in the primary care setting who provides services which are in addition to their usual and important generalist role. The DwSI provides a service which is complementary to the secondary services but does not replace that provided by a dentist who has undergone the training required for entry to a specialist list. The DwSI is an independent practitioner who works within the limits of their competency in providing a special interest service, and who refers on where necessary.” Department of Health, FGDP (UK) 2004;
  5. 5. Definition (contd) “ The DwSI may deliver a clinical service beyond that normally provided by a primary dental care practitioner or may deliver a particular type of treatment. Individual DwSIs will be able to demonstrate their competencies in their special interest areas. Special interests may be demonstrated by dentists through the completion of formal training programmes and/or experience based evidence.” Department of Health, FGDP (UK) 2004;
  6. 6. <ul><li>Why Now? </li></ul><ul><li>Steele Review- NHS Dental Services in England 22 nd June 2009 </li></ul><ul><li>Commissioners should find ways to support dentists to make best and most cost-effective use of the available dental workforce </li></ul>
  7. 7. Steele June 2009 <ul><li>Contractual schedules are introduced through which the more complex and demanding treatments are provided appropriately by dentists skilled and equipped to provide them to a high quality </li></ul>
  8. 8. Steele June 2009 <ul><li>The Faculty of General Dental Practice (UK) and DH have set out guidelines and competencies for dentists with a special interest, and these can support commissioners and providers in developing advanced and complex services. </li></ul>
  9. 9. Primary dental care can be provided by:  ‘ Independent contractor’ dentists or corporate bodies holding contracts with PCTs  Dentists with special interests  PCT provider arms and other NHS organisations DH January 2009 Who provides primary dental services?
  10. 10. The World Class Commissioning Cycle
  11. 11. How? Four initial sets of guidance: - Endodontics - Periodontics - Orthodontics - Oral Surgery
  12. 12. <ul><li>Subsequent Guidance </li></ul><ul><li>A step by step guide to setting up a DwSI Service </li></ul><ul><li>Prison Dentistry </li></ul><ul><li>Conscious Sedation </li></ul>
  13. 13. DH 2007
  14. 15. Model for commissioning prison and detention centre oral health services
  15. 16. 1. Oral health needs assessment <ul><li>Understand the establishment - Types and numbers - Turnover - Future plans - Demography </li></ul><ul><li>Existing Research & Epidemiology - national eg untreated disease 4X greater - local </li></ul><ul><li>Input from prison service </li></ul><ul><li>Rigorous analytical approaches </li></ul>
  16. 17. 2. Develop Service Specification <ul><li>Define scope of the service - Prevention & oral health improvement - High quality, safe clinical care - Urgent/routine/specialist </li></ul><ul><li>Demand management and referrals </li></ul><ul><li>Links to other services </li></ul><ul><li>Quality and risk management </li></ul><ul><li>Prison health support </li></ul><ul><li>Research </li></ul>
  17. 18. 2. Develop Service Specification <ul><li>Prison health support - Security - Ethical issues and safe practice in prison - The prison dental environment - Prison dentistry in the wider context </li></ul>
  18. 19. 3. Review the current service provision <ul><li>Assess against service specification </li></ul><ul><li>Multidisciplinary working group </li></ul><ul><li>Process map the service, analysing demand and capacity </li></ul>
  19. 20. 4. Strategic Decision <ul><li>Reflect strategic direction of PCT Impact assessment: - part of integrated commissioning strategy and Local Delivery Plan </li></ul><ul><li>Identify and agree approach to: - potential new providers and improving care </li></ul>
  20. 21. 5. Shape supply/Market testing <ul><li>Work with all existing and potential providers to develop new services and competent practitioners </li></ul><ul><li>Accreditation of DwSIs </li></ul><ul><li>Pay, contracting, appointing and practicalities </li></ul><ul><li>Procurement process through “Supply to Health” or local process </li></ul>
  21. 22. Competent practitioners <ul><li>The workforce to deliver such services should have a range of different skill mix and adopt a team approach. It could be primary dentists, DwSI in Prison Dentistry, DCPs and finally specialists-mostly in Special Care Dentistry. They should be well trained, resourced, supported and work within and between the prison and the community </li></ul>
  22. 23. Competent practitioners Oral health Promotion Unit GDP DwSI in Prison Dentistry Specialist service providers e.g. Specialists in Special Care, Restorative, Oral Surgery Oral Health Improvement v v v v Needs assessment v v v Routine dental care v v Secondary care and referrals v v Emergency dental care v v v
  23. 24. DWsI Accreditation <ul><li>Formal process of accreditation by commissioning/employing organisation </li></ul><ul><li>National clinical competency framework for each special interest area as basis </li></ul><ul><li>Local appraisers of practitioner’s portfolio of evidence (consultant/specialist, FGDP rep, PCT rep) </li></ul><ul><li>(Administrative support and premises fit for purpose) </li></ul>
  24. 25. Accreditation (contd) <ul><li>Competent and experienced in delivery of primary dental care - minimum 3yrs experience + ?postgrad qualification </li></ul><ul><li>- portfolio approach - audit and peer review </li></ul><ul><li>Special interest competencies - Recent, relevant diplomas, provide set hours of learning and supervision - Portfolio: </li></ul><ul><li>clinical attachments activity/procedure records relevant courses/training and PDP patient feedback </li></ul>
  25. 26. Prison Specific Competencies <ul><li>Environmental domain - Security - Ethical issues and safe practice in prison - The prison environment </li></ul><ul><li>Clinical domain History and Diagnosis - Early diagnosis of oral cancer - Management of localised oral infections - Management of trauma/self harm - Range of special needs skills - Knowledge of medication - Knowledge of prison medical records </li></ul>
  26. 27. Practicalities <ul><li>Independent contractor GDS PDS - cost and volume - cost per case - identified sessions - support with premises and equipment </li></ul><ul><li>Directly employed </li></ul>
  27. 28. <ul><li>The contract for a DwSI will need to specify: </li></ul><ul><li>The core activities and the competencies required </li></ul><ul><li>The types of patients and clinical problems suitable for the service including age range, minimum caseload, medical status and reasons for referral </li></ul><ul><li>The facilities and staffing that must be present to deliver that service </li></ul><ul><li>The clinical governance, accountability and monitoring arrangements, including links with other practitioners working in primary care, at PCT level and specialists in Acute Trusts </li></ul>
  28. 29. <ul><li>6. Manage demand and ensure appropriate access to care </li></ul><ul><li>Address best value </li></ul><ul><li>Monitor resource utilisation </li></ul><ul><li>Check that appropriate access available </li></ul><ul><li>Development of a managed local clinical network </li></ul>
  29. 30. Networks <ul><li>Dental Clinical Network </li></ul><ul><li>A group of practitioners providing treatment in the relevant special interest area, including consultants, specialist practitioners, 1ary care dentists with a special interest and rep of referring practitioners (+academic). Make up will vary depending on pattern of local workforce. </li></ul><ul><li>Prison professional networks Prison dentists needs to understand and work with the extended inter-professional prison teams, including other agencies and support groups outside the prison </li></ul>
  30. 31. Networks <ul><li>PCT needs to work closely with networks on needs assessment, development of the service and monitoring standards of delivery and outcomes of care. </li></ul>
  31. 32. <ul><li>7. Clinical decision making </li></ul><ul><li>Individual needs assessments </li></ul><ul><li>Patient information and choice - a real challenge </li></ul><ul><li>Maintaining records </li></ul><ul><li>Competencies in prison dentistry </li></ul>
  32. 33. <ul><li>8. Managing performance (quality, performance, outcomes) </li></ul><ul><li>Define lines of accountability </li></ul><ul><li>Risk assessment </li></ul><ul><li>Review the service and assess the impact </li></ul><ul><li>Measure performance and outcomes </li></ul><ul><li>Plans for the future </li></ul><ul><li>Re-accreditation of DwSIs </li></ul>
  33. 34. Performance and outcomes <ul><li>Activity - ? need for case-mix data to reflect complexity </li></ul><ul><li>Outcomes - Exit questionnaires - Oral assessment on departure - Assessment of oral habits - Views of the dental team - Prison environment </li></ul>
  34. 35. Reaccreditation Continuing Professional Development <ul><li>Consultant/Specialist practitioner mentor </li></ul><ul><li>50 hours of verifiable CPD in the special interest area in 5 year cycle, in addition to general & verifiable laid down by GDC </li></ul><ul><li>Clinical sessions with consultant/specialist practitioner </li></ul><ul><li>Appraisal, PDP </li></ul><ul><li>Clinical Network Support- Audit </li></ul>
  35. 36. <ul><li>9. Patient and public feedback </li></ul><ul><li>Agree mechanism for collating feedback eg exit questionnaires </li></ul><ul><li>Ensure patient voice heard </li></ul>
  36. 37. <ul><li>Going Forward </li></ul><ul><li>Medical Education England - Dental Programme Board </li></ul><ul><li>Supply side model workstream </li></ul><ul><li>Demand for dental treatment workstream </li></ul><ul><li>Skill mix workstream </li></ul><ul><li>Specialty review workstream </li></ul><ul><li>Review of oral surgery workstream </li></ul><ul><li>Foundation Training workstream </li></ul><ul><li>“ Modular credentialling” </li></ul>