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This document provides an overview of a meeting for dental practices participating in a prototype program testing reforms to dental contracts in the UK. The agenda covers updates on the reform program, evaluation of the prototypes, feedback from practices after implementation, and how to access practice data and support. Practices provided feedback that the clinical pathway was working well but that some had concerns about new activity targets. The evaluation plans to assess quality of care, access, value for money and sustainability for wider rollout. Support for practices includes training, visits, and access to monthly reports on their patient lists and activity levels.
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Welcome event presentation
- 1. 1 Dental Contract Reform Programme Prototype Welcome events Summer 2016, London and Leeds
- 2. 2 Housekeeping • There is no fire alarm planned today. If the alarm goes off please evacuate, follow security staff instructions and assemble outside building • Toilets are across core 2 lift lobby • Please turn phones to silent or vibrate
- 3. 3 Agenda • Update from dental contract reform programme • Prototype evaluation • Post go-live feedback • Making it work for you (refreshment break within this session) • Meet your programme support team • Close
- 4. 4 Dental Contract Reform Prototype Welcome Event Summer 2016, London and Leeds
- 5. 5 Thank you • Thank you for your participation in the dental contract reform programme • This is an exciting time for contract reform and your continued support is appreciated and valued • Pathway approach remains at the heart of reform • Aim of today is to: • Provide you with an overview of where we are • To get feedback • Support you to understand and use the data you need to manage your contract • Opportunity to network and share learning
- 6. 6 Changes at the Department • New Minister for dentistry – David Mowat, Parliamentary Under Secretary of State for Community Health and Care. • New Senior Civil Servant Graeme Tunbridge with responsibility for dentistry • BUT cross party support for dental contract reform continues.
- 7. 7 From 2018 – 2019 it may be possible to begin nation- wide roll out Prototype numbers increased, proposed remuneration system finalised for CDS, domiciliary services etc. Learning from prototypes 2016/17 Prototyping new system 2017-2018 Scaling up/stress testing 2018-2019 Potential start of roll-out High level timeline for reform Initial Evaluation Decision on timing of full roll out Full Evaluation
- 8. 8 What are the characteristics of the prototypes? • Total of 82 prototypes – 79 high street – 3 Community Dental Services – 21 new sites (ex UDA) – 58 former pilots • Of the 79 high street practices – 40 Blend A ( 29 former pilot 11 new prototypes) – 39 Blend B (29 former pilot 10 new prototypes)
- 9. 9 How will we measure success of the prototype approach? We will be looking to capture 3 high level measures of success before any new system can be rolled out: 1. Appropriate, high quality care: we will measure outcomes (tooth decay and gum disease) and treatment volumes to check appropriate care has been delivered 2. Access: the prototype approach will need to be able to provide care for at least the same number of patients as the current system 3. Value for money: Care to patients can be delivered within the existing dental budget
- 10. 10 Programme support • Throughout the session today you will hear from the programme about your vital role in prototyping • To support this role, we will be setting out how we will continue to work with you, including regular contact from the programme, visits and future events.
- 11. 11 Communication plans • Over the coming year we will be engaging more widely with the dental and local health communities • This will include a bulletin highlighting the work of the dental contract reform programme • Prototypes will also receive a regular bulletin which you will hear about later
- 12. 12 Evaluation of Prototyping Summer 2016, London and Leeds
- 13. 13 Evaluation – pilot practices Pilot stage of contract reform had two evidence and learning reports • Report 1 found: – the pathway was having the desired effect, i.e. disease risk was being consistently captured, communicated to patients and managed; – Survey responses of patients were positive; and – The arrangements made clinical sense to dentists • Report 2 found: – Reinforcing the early findings report, net shift in risk from red towards amber or green; – Particular improvement in periodontal disease with a reduction in disease prevalence “when measured at a level which would generally be considered moderate but clinically problematic”
- 14. 14 Evaluation – prototype practice • Working group overseeing the work – Chaired by Eric Rooney, deputy CDO – Representatives from BDA and CQC • Key themes – Quality and appropriateness of care; – Improvements in oral health; – Access and accessibility – Value for money – Sustainability for roll out
- 15. 15 Evaluation – prototype practice • Quality and appropriateness of care – Patients getting the treatment they need – Compliance with the pathway / all bits of the pathway adding value – Professional satisfaction with the approach – Patient journey / resources going to patients with the highest need • Oral Health – Were the improvements seen at the pilot stage maintained / improved further
- 16. 16 Evaluation – prototype practice • Access and accessibility – Can practices provide care to the same number of patients – Are patients able to get an appointment (both new patients and existing patients) • Value for money – Can the reformed contract be delivered within the same financial budget
- 17. 17 Evaluation – prototype practice • Sustainability for roll out – Is it scalable? – Does it work for all practice types? – What tweaks are required? – Does the contract structure have the flexibility to evolve over time?
- 18. 18 Evaluation of Prototyping (Table top exercise)
- 19. 19 Evaluation – table top exercise Introduction • The analysis to support the evaluation will take a number of forms: – Quantitative analysis (based on data) – Qualitative analysis (getting people’s views) – One way to conduct the qualitative analysis is to use a structured questionnaire – We would use the structured questionnaire at practice visits or ask practice team to complete online
- 20. 20 Evaluation – table top exercise • What themes should the structured questionnaire cover? – Views on the remuneration mechanism – Views on the pathway – Views on the need for skill mix – Views on flexibility / rigidity to deliver care – What else?
- 21. 21 Post go-live feedback Summer 2016, London and Leeds
- 22. 22 Post go-live feedback • 58 former pilots, 21 new prototypes and 3 CDS make up prototype practices • Since February the programme have completed 68* calls with prototype providers • Purpose of calls was to provide structured post go live support to providers and business managers and obtain feedback on how prototyping was going. • Commenced with the prototype practices new to the reform programme • Moved to former pilot practices who were now prototypes *CDS practices were not included at this time / small number outstanding
- 23. 23 Process • Calls were with practice owners / principals and their business managers • Commissioners were invited • As well as general feedback there were a number of areas covered including pathway, software, remuneration and training • For practices new to the programme only, the call also included the pathway and a clinician joined those calls.
- 24. 24 What you told us We asked you how prototyping had gone? • There was consensus of support across both former pilots and the new prototypes for the clinical pathway and how this enabled clinicians to practice their dentistry, the use of extended practice team approach and focus on behaviour change of patients (and staff) • New prototypes were broadly positive about activity + capitation, teams were still learning and adapting to new way of working • Former pilots had more concerns about reintroduction of activity and, for some, their capitation targets
- 25. 25 Clinical pathway • All prototypes – Use of skill mix to support delivery of pathway remains a positive approach – Some concerns around meeting needs of differing patient populations within the current model – Practices understood need to keep appointment lengths as short as clinically required and new majority of prototypes were working towards this from an early stage
- 26. 26 Clinical Pathway ctd • New prototypes – Majority had fully understood pathway approach and all were positive about the benefit to patients – Still early for these practices who are adapting to the pathway and the clinical approaches to managing individual patient needs • Former pilots – Most practices have not made significant changes to the way they practise dentistry as a prototype practice OHA/Rs continue to vary considerably in length. – Some concerned that compensating for reduced treatment need (where patient’s oral health has improved) by increasing numbers of patients under capitation will not be easy.
- 27. 27 Practice Management • New prototypes – Practices were getting used to how to run their appointment books within prototyping such as zoning and managing length of appointments – Practices were considering how best to implement skill mix to support pathway delivery – There was some concerns about waiting times lengthening but practices felt this would come down again as they become more confident in the pathway approach
- 28. 28 Practice management ctd • All prototypes – Majority of practices confirmed that patients were accepting of the fair processing notice, there were some questions from a small minority of patients but generally were able to deal with these in practice – Practices had taken steps to ensure all their patients had seen the notice with reception and clinical staff highlighting and laminated copies also being available in the waiting areas – Early issues with supply chain of leaflets and prototype paperwork had been resolved
- 29. 29 Performer contract • New prototypes – Mixed response, some were waiting to see how prototyping progressed in practice, others had already made changes, some were not looking to make changes at this time – Where changes were made there were different approaches taken using BDA model, Code, or their own versions • Former pilots – As above, some practices have introduced activity measures into contracts, some capitation and some both. Again have used a variety of models
- 30. 30 Software support systems • New prototypes – No major issues raised regarding change over to prototype software • Former pilots – Greater level of concern from some former pilots, with particular focus on slowness or clunkiness of systems – These issues were generally being resolved in reasonable timeframe • All prototypes – There had been positive feed back about their relationship with and support received from their software companies, but this had depended on the individual practice issues and concerns – Some practices reported good support and training from their software companies
- 31. 31 Transmissions • All prototypes – Under a third of practices reported some issues with transmissions – These included reported issues with slowness of transmissions and high levels of error messages and the impact this had on the practice – For a few practices there were specific transmission issues which were being resolved directly with software companies
- 32. 32 Assurance Framework • All prototypes – Practices were made aware of the framework and were keen to understand what the elements were to be included – There was some concern from new prototypes around a patient experience due to the lengthening of waiting times
- 33. 33 Remuneration model • All prototypes – The majority of practices felt they were comfortable with the remuneration model and had felt well supported with the training, individual calls and web materials – Where specific issues were raised these were picked up outside of the calls – Where practices needed support was in accessing data
- 34. 34 Portal reports • New prototypes – At time of calls reports were only just becoming available on the system for practices to access • Former pilots – High level of concern regarding access to timely information to be able to monitor and manage contracts. – Many would like software systems to support monitoring of capitation and UDA levels directly within software systems – Many had missed communications on how to access portal reports in temporary home (pilot portal) – For those who had been able to access reports they had further questions regarding what the data was showing them and how to interpret it
- 35. 35 Support and Training • All prototypes – Practices were happy to have a practice visit if they were chosen for one – Practices had felt comfortable being able to train their staff using materials made available – 50/50 split response in whether practices had access to or had used the training material available on the website – Practices were interested in idea of topic based webinars but would need more information and was mixed response as to whether these should be held at lunchtime or after surgery – A number of former pilots had missed the more hands on programme presence and more frequent events provided under the pilot programme
- 36. 36 Summary • Programme would like to thank practices again for their time in participating in the post go-live calls • Has the feedback you have heard today resonate with you and your experience? • Is there any other feedback you would like to give the programme in relation to your experience of prototyping
- 37. 37 Making it work for you Summer 2016, London and Leeds
- 38. 38 What we will cover in this session • Introduction to the assurance framework • Where to find your prototype reports • What prototype reports are available • Understanding your current position using the reports available • Update on year-end • Help and support available
- 39. 39 Introduction to the assurance framework • Programme has produced a Dental Assurance Framework (DAF) for prototype practices, with input from Commissioners and the National Steering Group • Currently finalising publication via NHS England’s gateway process • Format of the framework has been based on the DAF for UDA practices, incorporating the four framework indicators: 1. Delivery 2. Patient Safety 3. Patient experience 4. Quality / clinical effectiveness
- 40. 40 Introduction to the assurance framework (2) • Set out the process for assurance: – What is required – By whom – Timescales • Reports to support assurance – What is available / when – How to access – Interpretation • Considerations for practices if you are experiencing problems with patient numbers and UDA delivery
- 41. 41 Introduction to the assurance framework (3) • Focus of version 1 for 2016/17 is the delivery domain • Dental Assurance Framework for Prototypes will be developed during 16/17 to include clinical indicators and incorporate any learning from the prototypes • Publication for Commissioners will be via the regional bulletin and Prototypes will be notified by the Programme
- 42. 42 Where to find your prototype reports • Prototype reports have a temporary home on the pilot portal • https://pilot.nhsbsadental.nhs.uk/portal2/ • Each user will have their own username and password to access this website • The exact location of these reports varies depending on whether you were a former pilot or former UDA practice
- 43. 43 Where to find your prototype reports (2) • For former UDA practices – Once logged in you will be taken directly to your reports • For former pilot practices – Once logged in • March 2016 tab • Vital signs tab • Custom reports
- 44. 44 Where to find your prototype reports (3) • No access for performers to their individual information via pilot portal • Permanent home for prototype reports will be within Compass • Planned date for move to Compass is August 2016
- 45. 45 Prototype reports available • A suite of eight reports are produced for prototype practices each month • Reports are published in the first full week following month-end – July reports will be available to practices by week ending 5 August 2016 • There is a cut off date for data included in the monthly reports: – Appointment data: 22nd of each month – FP17 data: This varies slightly each month and the schedule programme for 2016 is available via NHSBSA: http://www.nhsbsa.nhs.uk/i/DentalServices/Schedule_prog ramme_2016.pdf. For July reports the scheduling date is 19 July 2016
- 46. 46 Prototype reports available (2) 1. Capitation remuneration report 2. Capitation and activity report – performer level 3. Capitated patient list – details 4. Capitated patient list – summary by performer 5. Imminent lapsers – details 6. Imminent lapsers – summary by performer 7. Joiners and leavers – details 8. Joiners and leavers – summary by performer
- 47. 47 Understanding your current position using the reports available
- 48. 48 In your table groups • Review the example report pack available to discuss – Which reports do you use to assess overall position of the practice? – Which other reports do you use regularly, and why? – Do you have any queries / questions about these reports? – Are there any other reports / information you would find useful?
- 49. 49 Understanding your current position • Key reports: • Capitation remuneration report ‒ Summary of the actual patient numbers on the capitated patient list against the expected patient numbers for 2016/17 (CECP) and the prototype UDAs delivered against the expected minimum activity level for 2016/17 (EMA) • Capitation and activity report performer level ‒ Performer-level breakdown of the number of capitated patients and the number of prototype UDAs delivered, as reported on the capitation remuneration report
- 51. 51 What triggers capitation? • A new patient joins the practice patient list when they attend for an oral health assessment (OHA) • They will remain on this list for a period of three years unless they attend for NHS treatment elsewhere, except where the patient attended another practice for urgent, referral and charge exempt treatment. In these cases the patient remains on your practice list
- 52. 52 What triggers capitation? (2) • The capitation period is refreshed each time NHSBSA receives notification of the following trigger events: • Appointment data (DPMS) ‒ Any OHA / R appointment • FP17s ‒ Band 1 course of treatment (non-referral, non-urgent) ‒ Band 1a (interim care) course of treatment ‒ Band 2 course of treatment (non-referral) ‒ Band 3 course of treatment (non-referral)
- 53. 53 What data should we be transmitting? • There are two sources of data used to record and update prototype reports: ‒ Appointment data (DPMS) ‒ FP17s • Both data sources should be submitted on a regular basis: ‒ Appointment data – we recommend this is done daily. This data must be submitted within seven calendar days ‒ FP17s – we recommend these are submitted as soon as the course of treatment is complete and no later than two months after the course of treatment is complete
- 54. 54 Can I transfer a patient list from one performer to another? • The facility for “bulk transfers” will be introduced for prototype practices • This will allow the transfer of a patient list from one performer to another – The full patient list has to transfer – Transfers can only be made between performers of the same type, i.e you cannot move patients from a DFT to performer • An online form will be completed to request a transfer • Guidance note on how to do this will be issued
- 55. 55 What is the transitional allowance? • This applies to former pilots only • It is an allowance to recognise the change in rule set for counting capitated patients between the pilot and prototype phase • The calculation is undertaken individually for each former pilot practice • The allowance (if applicable) is shown section 1 of the capitation remuneration report
- 56. 56 What is the difference between scheduled UDAs and completed UDA? • Scheduled UDAs ‒ Total number of UDAs reported on FP17s received by NHS BSA between the previous cut-off date and the current schedule cut-off ‒ Therefore the June 2016 figure is those UDA received between 18 May and 13 June 2016 ‒ This will exclude those FP17s transmitted outside the two-month rule
- 57. 57 What is the difference between scheduled UDAs and completed UDA? (2) • Completed UDAs: ‒ Total number of UDAs reported on FP17s received by NHS BSA allocated to the month in which the treatment was completed ‒ Therefore the June 2016 figure is those UDA completed between 1 June and 13 June 2016 ‒ This will exclude those FP17s transmitted outside the two-month rule
- 58. 58 Relationship between patient numbers and activity • As part of their individual prototype agreement each practice has: ‒ Expected patient list (CECP) ‒ Expected minimum activity level (EMA) • However, there is the ability within the prototype agreement to exchange activity for patient numbers
- 59. 59 Relationship between patient numbers and activity (2) • Practices can over-deliver on patient numbers to compensate for any under-delivery against activity • If patient numbers are less than or equal to 100% of expected numbers, then any adjustment relating to activity delivery will be capped at a maximum of 100% • If patient numbers are more than 100% of the expected level, then any adjustment relating to activity delivery will be capped at the same percentage as the achieved level for patient numbers
- 61. 61 Year-end 2015/16 • Year-end process for 2015/16 is underway • The dental contract reform programme is working with local offices to calculate individual positions • Calculation will vary depending on when you commenced as a prototype and also what system you were operating under prior to prototype arrangements • NHS England will write to individual practices setting out the calculations and any financial adjustment / carry forward (if applicable)
- 62. Year-end 2016/17 process onwards STEP 1 • Calculate the year-end delivery percentage for the capitation and activity elements separately STEP 2 • Apply rules for adjustments for activity and capitation delivery (exchange mechanism) STEP 3 • Calculate the combined value of the year-end achievement for capitation and activity and (a) apply CAAML where applicable STEP 4 • Apply the carry forward for the previous year STEP 5 • Calculate the final position and carry forward (if applicable) for the next year and (a) apply tolerances where appropriate
- 63. 63 Final year-end positions 100%90% 96% 102% 1 2 3 5 6 1) CAAML is applied up to 90% and repayment up to 100% is due in full. 2) Repayment up to 100% is due in full. 3) The amount up to 100% is carried forward into the following year, shown as a POSITIVE financial value*. 4) 100% performance. 5) The amount in excess of 100% is carried forward into the following year shown as a NEGATIVE financial value* 6) Any amount over 102% is limited to 102% and 2% is carried forward into the following year shown as a NEGATIVE financial value*. *As shown on capitation/remuneration report 1 4
- 65. 65 Cells requiring manual input Performer name Performer information Actual Annual Prototype Value (AAPV) £517,000.00 - Capitation element (AAPV-C) £446,000.00 Activity element (AAPV-A) £71,000.00 Expected patient list (CECP) 7,966 16-17 transional allowance Expected Capitated Population 7,966 less transitional allow ance Expected Minimum Activity (EMA) 2,000 Carry forward from previous year (£) Estimated performer year-end delivery (practice's own figures) Patient numbers 7,966 UDAs 2,000 Step 1 - Year end delivery percentage for capitation and activity Capitation 100.00% Activity 100.00% Step 2 - Apply rules for adjustments for activity and capitation elements Capitation 100.00% Activity 100.00% Step 3 - Combine the year end achievement for capitation and activty Capitation £446,000.00 Activity £71,000.00 Total £517,000.00 % total 100.00% Step 3a - Additional calculation if initial Y/E position is less than 90% (SFE 4.6 - CAAML) Total £517,000.00 % total 100.00% Step 4 - Apply carry forward from previous year Carry forward from previous year £0.00 £517,000.00 Step 5 - Calculate the final position and carry forward (if applicable) for next year Initial year-end value £0.00 Initial year-end percentage 0.00% Step 5a - Apply tolerances to carry forward figures Final year-end value Met contractual requirements £0.00 Final year-end percentage 0.00% For every 100 UDAs below your expected minimum activity level (EMA) 63.41 extra patients are required to achieve the same financial value Prototype practice year-end calculation modelling tool (1) Input section Result section
- 66. 66 Year- end modelling tool (2) Provider name or company name Practice XXXX Prototype reference number 100YYYY 12,000 Start date for prototype 01/12/2015 100 Prototype Blend A 11,900 Actual Annual Prototype Value - Capitation Element (AAPV-C) £775,000 54,000 Actual Annual Prototype Value - Activity Element (AAPV-A) £480,000 no limit Actual Annual Prototype Value (AAPV = AAPV-C + AAPV-A) £1,255,000 TBC 2016-17 Capitation remuneration report - Prototype 100YYYY - September 2016 2016-17 delivery requirements Contractor's Expected Capitated Population 2016-17 transitional allowance (provisional) Required patients at March 2017 (minus transitional allowance) Expected Minimum Activity Activity and Capitation Performance Tolerance Contract Value Carried Forward - Previous Year1 2 3 4 5 6 7 8 1 2 3 5 6 - calculation 7 8 4 Cells requiring manual input Practice name Practice XXXX Practice information (from capitation remuneration report) Actual Annual Prototype Value (AAPV) £1,255,000.00 Capitation element (AAPV-C) £775,000.00 Activity element (AAPV-A) £480,000.00 Expected patient list (CECP) 12,000 16-17 transional allowance 100 Expected Capitated Population 11,900 Expected Minimum Activity (EMA) 54,000 Contract value c/fwd - previous year (£) TBC Estimated year-end delivery (practice's own figures) Patient numbers 12,250 UDAs 54,000 Practice estimates
- 67. 67 Year-end modelling tool (3) Steps to be carried out:- 1) Input the appropriate data into the identified cells using the data in the capitation remuneration report. 2) Input your own practice estimates for activity and capitation. 3) Review the results. 4) Redo (2) above using different figures. 5) Review the results. 6) Redo (2) above using different figures. 7) Review the results 8) …………………………………. It is a modelling tool
- 68. 68 Year- end modelling tool (4) Exchange mechanism applied (Rule 1) Additional information Initial calculation Raw combined results CAAML if applicable Step 1 - Year end delivery percentage for capitation and activity Capitation 98.32% Activity 100.19% Step 2 - Apply rules for adjustments for activity and capitation elements Capitation 98.32% Activity 100.00% Step 3 - Combine the year end achievement for capitation and activty Capitation £761,974.79 Activity £480,000.00 Total £1,241,974.79 % total 98.96% Step 3a - Additional calculation if initial Y/E position is less than 90% (SFE 4.6 - CAAML) Total £1,241,974.79 % total 98.96% Step 4 - Apply carry forward from previous year Carry forward from previous year £0.00 £1,241,974.79 Step 5 - Calculate the final position and carry forward (if applicable) for next year Initial year-end value £13,025.21 Initial year-end percentage 1.04% Step 5a - Apply tolerances to carry forward figures Final year-end value Under-performance £13,025.21 Final year-end percentage 1.04% For every 100 UDAs below your expected minimum activity level (EMA) 13.76 extra patients are required to achieve the same financial value Prior year c/fwd Re underperformane >4% and overperformance >2% Initial final position
- 69. 69 In your table groups • Review the modelling tool examples showing the 6 potential year-end positions in conjunction with the 5 year-end steps – Is the information easy to understand? – Can you follow the 5 steps? – Will this tool be useful to you in trying to establish what the impact of your estimated year-end position might be? – Is there any other information that you need? – Is the ability to input individual performer data useful? – What other comments do you have about it?
- 70. 70 Answering your questions online support • Dental contract reform website • http://www.pcc-cic.org.uk/resources/dental-contract-reform
- 71. 71 Answering your questions online support • Sections available: • Remuneration • Clinical philosophy • Making it work clinically • Making it work in practice • Contract management • Your questions answered
- 72. 72
- 73. 73
- 74. 74 Answering your questions direct support • Inbox dentalcontractreform@pcc.nhs.uk • Helpdesk https://helpdesk.pcc-cic.org.uk
- 76. 76 Meet your support team Summer 2016, London and Leeds
- 77. 77 Keeping in touch • Part of the support going forward will be regular but informal telephone calls with members of programme support team • Calls will be every 4-6 weeks • Supported by a team • But please don’t wait if there is an urgent query
- 79. 79 Summary, next steps and close Summer 2016, London and Leeds
- 80. 80 Our support for you • Webpages • Help desk • Inbox • Newsletters • Buddies • Future Support – Keeping in touch calls – Mid year 1:1 sessions – Engagement events – Practice Visits
- 81. 81 Newsletters • Monthly news round-up Summary of key messages and communication with prototypes • DCR news Publication for wider dental profession and health economies raising awareness of dental contract reform
- 82. 82 Helping each other • 25 prototype practices buddied with 24 ex pilot practices • Aim is to provide practices new to reform with; – Advice from experience – Support for admin staff – A sounding board for ideas
- 83. 83 Future support • Keeping in touch calls • Mid year 1:1 sessions • Engagement events • Practice visits
Editor's Notes
- Usage: Used for any project plan/timeline, if particular focus and detail around milestones is required How-to: All of the elements above would need to be adapted to each individual project To start, set the green timeline with the appropriate number of weeks/months Move, add, delete and re-size the milestone boxes as appropriate, and add further details Colour code the boxes differently if necessary, but add a legend to explain what the colour code means
- We are planning the following communications about the reform programme: Monthly news round-up We are conscious that in addition to all the general mail you receive in your inbox on a daily basis you are also in receipt of a number of communications from the dental contract reform programme and there is generally not enough time to do the “day” job and keep abreast of all the communications that cross your desk. So to ensure you don’t miss important items – it is our intention to send out a news round-up on a monthly basis that will capture the items we’ve sent you in the past month together with some key messages about the prototyping to help keep everyone on track. We will aim to email the news round-up to practices on the last Thursday of every month. Please look out for first of this communication at the end of July. Dental contract reform newsletter In the interests of engaging the interest of the dental profession at large in the development of a new model of contract, it is our intention to relaunch the dental contract reform newsletter, previously published during the pilot phase of testing. This will be a quarterly publication, each with a focus on a particular topic.
- It was noted by 33 pilots and 11 UDA practices explicitly spoke positively about the care pathway approach. DQ – 10 former pilots have mentioned concerns with achieving capitation numbers 21 pilots mentioned concerns with reintroduction of activity
- A few practices mentioned concerns about the pathway approach with patient groups who are very high need, where new patients require a lot of clinical intervention (this was linked to concerns about how much they have to provide for the uda activity), concerns especially for areas with immigration issues
- 82% (42 pilots) said it wasn’t a major shift from piloting, but some had made changes to ensure providing minimum activity levels as well as prevention
- 4 practices (6% of total) had patients who showed some concern regarding the privacy notice
- 45% have changed contract (23 pilot and 4 udas) 30% have not changed (15 and 1) 25% haven’t changed yet, but are considering it (13 and 6) Of those who mentioned changing 18% used or were considering using BDA (9 and 4) 14% their own variations (7 and 5)
- 31% had usability concerns on usability of system (16 and 5) 33% had positive messages about software (17 and 7)
- 27% reported transmission issues (14 and 4)
- 1 practice asked clarification question on model
- 25% pilots reported issues accessing data reports (13) 33% pilots repored issues understanding data reports (17)
- 92% able to train staff (47 and 13) 50/50 split on those who had accessed website materials 57% thought webinars would be useful as a training method (29 and 10) 69% preferred the timings to be at lunchtime (35 and 9) with 27% after surgery (14 and 3)
- As discussed on recent post live calls Pre-publication copy is / will be available on the dental contract reform website (refer to fact that will go through website later) – Pre-publication copy available on website by w/e 29 July 2016
- Process steps Commissioners should ensure they are familiar with the specific prototype reports available and how to access them. Whilst these reports are available on a monthly basis it is recognised that commissioners may not have the capacity to review these in detail at this frequency. However, it is expected that this be done at the very least on a quarterly basis. Commissioners should review the reports of the prototype practices, using local knowledge and input from colleagues and wider stakeholders where appropriate. This may include members of the dental contract reform programme if necessary. Contractors should also review these reports with their performers and be invited to engage with the local office and / or dental contract reform programme if they have any questions. There should be processes in place to escalate any serious concerns, including patient safety. Where concerns are identified the commissioner should ask the practice to submit a written explanation or action plan around the key concerns and provide details of how the issue is to be addressed, and over what timeframe. A template action plan is included in Annex 2 which can be used for this purpose. Any responses should be reviewed by the commissioner with appropriate clinical advice. Clinical advice can be sought through the medical directorate of the local office. Specialist clinical advise relating to prototypes is also available via the dental contract reform programme. Clinical support is also available from NHS BSA clinical advisors where there are high level concerns. Periodic feedback should be made to the dental contract reform programme. This can be done via the central mailbox dentalcontractreform@pcc.nhs.uk Commissioners should start to develop a timetable for engaging with practices that have been flagged up or where action plans have been received but no improvements found. Where follow up is deemed necessary, this may be done in a face to face meeting or telephone meeting, to be determined locally. The commissioner may wish to invite a member of the dental contract reform programme team. Where this is not possible commissioners should ensure a written report of the meeting is submitted to the dental contract reform programme to support the wider learning from the prototypes. Where practices are experiencing problems with either or both activity and patient numbers commissioners should work with practices to explore the reasons for this, adopting the process set out above. Some of the questions / considerations may include: Are appointment transmissions and FP17s being submitted in a timely fashion? Have appointment times for OHA / OHR been reviewed across the practice? Are there problems / issues implementing the pathway? Is skill mix in the practice (where appropriate) being appropriately utilised?? Are appropriate recall intervals being applied across the practice? A review of the average NHS hours undertaken by the practice The contractor may wish to explore some of these questions with their performers to better understand any problems / issues with meeting the delivery indicators for the prototype agreement.
- We will let commissioners and practices know once published. As mentioned pre-publication version on dental contract reform website, by w/e 29 July 2016
- We will be providing some additional guidance on how to find your prototype reports on Compass prior to publication Initially only the most recent reports will be available on Compass, but NHSBSA will migrate previous month’s report across. In the meantime you will retain your pilot portal access to view previous reports. We will continue to publish the reports on the pilot portal until we are confident that everyone is happy with access arrangements through Compass. Therefore for a few months the reports will be available in both places. NHSBSA are working on making performer level reports available.
- Schedule for rest of year: July – 19 July August – 18 August September – 20 September October – 19 October November – 18 November December – 16 December
- Capitation remuneration report This report is available in pdf format, with the file name “2016-17 Capitation remuneration report - Prototype 1xxxx -month 2016” This overview report provides a summary of the actual patient numbers on the capitated patient list against the expected patient numbers for 2016/17 (CECP) and the prototype UDAs delivered against the expected minimum activity level for 2016/17 (EMA). 2. Capitation and activity report – performer level This report is available in PDF and excel format, with the file name “2016-17 Capitation and Activity Report - Performer level -1xxxx -month 2016”. This report gives a performer-level breakdown of the number of capitated patients and the number of prototype UDAs delivered this month, as reported on the capitation remuneration report. 3. Capitated patient list – details This report is available in PDF and excel format, with the file name “2016-17 Capitated patient list - Details - Prototype 1xxxx - month 2016” The report contains the name and other personal details of each patient on the capitated patient list, the name and performer number of the performer who last saw the patient at the most recent capitation trigger event, and the time left until lapse. Patients are listed in order of the time left until lapse. There is also a red, amber or green icon indicating how imminent the patient lapses. The excel format version can be used to sort and filter the information provided. 4. Capitated patient list – summary by performer This report is available in PDF format, with the file name “2016-17 Capitated patient list – summary by performer - 1xxxx - month 2016” This report provides a summary of the total number of patients included in the practice’s capitated patient list at the end of each month, by performer. This report will be updated every month throughout the financial year. Imminent lapsers – details This report is available in PDF format, with the file name “2016-17 Imminent lapsers – Details - Prototype 1xxxx - month 2016” This report is a sub-set of the main capitated patient list and provides the personal details of patients who are due to lapse within six months from the date of the report. 6. Imminent lapsers – summary by performer This report is available in PDF format, with the file name “2016-17 Imminent lapsers – summary by performer - 1xxxx - month 2016” This report summarises the total number of patients due to lapse within 1 month, 1-3months, 3-6 months, by performer. 7. Leavers and joiners – details This report is available in PDF format, with the file name “2016-17 Leavers and joiners – Details - Prototype 1xxxx - month 2016” This report lists details of patients who have left the practice in the latest reporting month. The report provides the transfer date for the patient, which is the date the patient left the capitated patient list - either because they lapsed or because they became a capitated patient at another practice or started seeing a DFT trainee for continuing care. The report also lists the details of the patients that have joined the practice in the latest reporting month. 8. Leavers and joiners – summary This report is available in PDF format; with the file name “2016-17 Leavers and joiners - Summary level – 1xxxx - month 2016” The reports summarises the number of joiners and leavers and the net increase in capitated patients at the practice, for each month of the financial year to date and the total for the financial year. It also shows the number of joiners and leavers for the financial year to date, broken down by performer.
- Work through each section of report
- A patient should first join the capitated patient list of the practice when they attend for a OHA. They will remain on the practice list for a period of three years from the date of this appointment, unless they attend for NHS treatment elsewhere, or their three year capitation clock is re-set (see below). If the patient however attends another practice for an urgent, referral or charge exempt course of treatment they will not leave the practice list. If the patient requires an IC CoT, the first appointment of each IC CoT will re-set the three year capitation period. The clock will be re-set once again when the patient returns for their OHR. This is shown in the example below and graphically on the next slide. Example: Fred attends for an OHA appointment on 15 December 2013. His three year capitation period starts on 15 December 2013. He attends for further appointments for filings and extractions on 21 January 2014, 15 February 2014 and 28 February 2014. His 3 year capitation period continues to be counted from 15 December 2013. Fred needs an IC course of treatment and returns for this later in the year for this and the date of this 19 August 2014. Fred’s three year capitation period is re-set from 19 August 2014. Fred goes on holiday in September 2014 and has toothache. He attends another practice for an urgent course of treatment whilst on holiday. This appointment does not remove Fred from the practice list and he remains as part of the capitated patient list. Fred is due to return for his OHR in September 2015 – at which point his three year capitation period will re-start once again.
- Note: This is a narrower range of events than was the case during the pilots, when all appointments and all FP17 courses of treatment triggered capitation. During prototypes, an FP17 must be submitted within 2 months of the completion date of the course of treatment in line with the arrangements for the standard GDS / PDS contracts. Failure to do so will result in the late FP17 form being rejected and may result in your reported capitated patient numbers being lower that you expect. The following FP17s will not trigger capitation: Any courses of treatment delivered on referral Band 1 (urgent) courses of treatment Charge exempt courses of treatment
- For former pilot practices only: From 2016-17, the rules that trigger capitation have changed. For example, band 1 urgent courses of treatment will not trigger capitation. The reports for this financial year will, therefore, report capitated patient numbers using the prototype rules. As previously communicated, in order to smooth the move from rules for counting capitated patients during the pilot arrangements to the rules for the prototype arrangements, pilot practices will have a capitation transitional allowance. The transitional allowance is designed to allow practices who need it time to adjust to the prototype capitation trigger rules. The calculation of this allowance will determine is tailored to each practice depending on the number of patients under capitation at March 16. The transitional allowance can only be finalised once the 2015-16 year data has been processed. Therefore this is a provisional number until then. Method for calculating transitional allowance For former pilot practices only. The transitional allowance will be calculated in the following way: At the end of March 2016, each pilot practices patient list will be constructed in two ways, using: 1) Old (pilot) rules, where all appointments/FP17 trigger capitation; and 2) Prototype rules, where prototype capitation triggers apply The transitional allowance is calculated as the difference between these two capitated patient lists. For example, if a practice had: • 6800 patients under old rules; and • 6500 patients under prototype rules the net allowance measured at March 2016 would be 300 patients. It is importance to note that the changes in the capitation rules means that there are circumstances where patients used to trigger capitation under old rules but no longer do under prototype rules, e.g. patients receiving band 1 urgent CoT. There are also circumstances where patients were not included in a practice’s capitated patient list under old rules but will now be included, e.g. under old rules patients referred to another practice for treatment were removed from the “home” practice’s list for the duration of that treatment but under prototype rules they remain on the “home” practice’s list. Thus, the difference between old rules and prototype rules can be made up of patients in capitation under old rules only and also patients in capitation who only appear in prototype rules. Continuing the example above, the net allowance of 300 may consist of: • +400 old rules patients (for example, patients that triggered capitation for urgent treatment only) • -100 prototype rules patients (for example, patients that now trigger capitation when they did not under old rules because they had been referred elsewhere for further treatment). Resulting in a 300 patient net allowance at March 2016. Once this calculation is complete the patient list constructed using old rules is checked to see how many patients would lapse and how many would remain at the next measurement points of 31st March 2017 & 31st March 2018. Continuing the example, out of the 400 (old rules) patients at 31st March 2016, if 200 of them would have lapsed then 200 of them will not have lapsed by March 17 and therefore would count towards the transitional allowance. The calculation then deducts the 100 prototype rules only patients from this resulting in a transitional allowance at 31st March 2017 of 100 patients. This would be the provisional number included in the 2016-17 remuneration reports. This process is repeated to calculate how many of the 200 old rules only patients left at March 2017 will still remain at 31st March 2018. For example say a further 50 patients would have lapsed by this date leaving 150 old rules patients. Then 100 prototype rules only patients is deducted meaning the transitional allowance will reduce to 50 patients for 31st March 2018. This calculation will be undertaken individually for each former pilot practice. Once the 2015-16 year end process has been completed, the transitional allowance will be finalised and practices will be able to view the patient list constructed using the old rules and prototype rules to check the figures.
- The final section on the capitation remuneration reports looks at the scheduled v reported UDAs (full UDAs – not prototype UDAs) Step 1 take the scheduled UDAs for latest month. This will be the UDAs that were reported on FP17s between 18 August and 20 September. This figure will match back to the UDAs on your compass schedule Step 2 – allocate the UDAs to the month that they were completed in, in our example of the 1,423 scheduled UDAs – 600 were completed between 1 and 20 September, and the remainder (823) allocated to the month they were completed. Do drawing on flip chart here. For the purposes of prototype we are only interested in the UDAs that are relevant to your blend. At this point. We allocate the prototype UDAs according to blend which is shown in the activity – prototype UDAs delivered.
- Rule 1: If patient numbers are 97% of the expected levels, then the activity delivery counted will be no more than 100% of the activity levels. Rule 2: If patient numbers are 101% of the expected level, then the activity delivery counted can be no more that the patient number percentage level i.e. 101%.
- CAAML – Capitation and activity adjustment minimum level
- CAAML – Capitation and activity adjustment minimum level
- The tool can be used by the provider for the whole contract or per performer where the contract has been broken down to performer level
- New for this phase of testing is online support, designed to provide you with the resources you need to train staff; including scripted powerpoint presentations to help explain the remuneration model and the care pathway. We would suggest you use these presentations initially to appraise the practice team of the system they are now working with and if new members of staff join the team who have not previously worked in a practice testing reform, to familiarise them with the philosophy and care pathway. Information can be found under six headings; the first two are fairly self explanatory containing information about the financial arrangements and the pathway. In the sections entitled making it work clinically and making it work in practice we have uploaded information, some of it from the experience of practices who were previously pilots, which will help you implement the system in your practice. Under the heading contract management you will find information to help you mange the business side of practice including details of the reports that are available and how to access them. Under the last heading we have posted the questions raised about prototyping and the answers given at the various points of content we have had with you over the course of the last nine months. For example the events held last autumn, the recent post live calls and queries you have forwarded to our inbox or have raised with us personally. All the answers provided have been checked with our DH colleagues, clinical advisers, NHS England and the BSA as appropriate. So if you have question we would suggest that in the first instance you go to this section of the online resource to see if it has been raised before. This will promote your independence and confidence in what you are doing and ensure you get a speedy answer. The webpages also contain guidance documents and links to other resources that are directly relevant to the reform programme or pertinent to the delivery of dental services. It is our intention to ensure that the webpages are a living resource continually be updated with information that will help you successfully embed the prototype system of working in your practices and help you to ensure you stay on top of managing the practice’s performance. Our commitment is to post as much as possible on the webpages to help you. This is the link so please ensure that you list it as a favourite and access the site on a regular basis to ensure that you don’t miss out on knowing important information. We would welcome your suggestions of what other information/help you would like to see online.
- In addition to our online support you can contact the team either by contacting us through the dental contract reform inbox or via the helpdesk. The links for both are on the screen. We will endeavour to respond within a maximum of three days and will try to ensure your question is answered as fully and as quickly as possible. But as I mentioned before, please check the Your Questions Answered webpage before you think about emailing the programme as your question may well have been asked before.
- Keeping in touch calls We are aware that many pilot practices appreciated having a member of the programme team assigned to them as their point of contact. Whilst we’re keen to stay in touch with individual practices we don’t think assigning a specific member of the team to each practice is the best use of resources and so today would like to introduce you to the members of the programme team who will be supporting you. These are faces behind the inbox and helpdesk and the people you will meet at practice visits and events. In addition it is the intention that a member of the team will call you every four to six weeks to check in with you and ensure that prototyping is going well and discuss any issues you may want to raise.
- We all recognise the importance of good and consistent communication to ensure that we are able to properly support you. And to pick up issue early so that we can address them. It will also give us an idea of what will be needed in a potential roll out. This is a list of some of the support we are currently providing and plan to provide in the future. You have heard about the website and inbox, I will now take you through some of the others
- Monthly news round-up To ensure you don’t miss important items – we plan to send out a news round-up on a monthly basis that will capture the items we’ve sent you in the past month together with some key messages prototyping. We will aim to email the news round-up to practices on the last Thursday of every month. Please look out for the first communication at the end of July. Dental contract reform newsletter We plan to relaunch the dental contract reform newsletter, previously published during the pilot phase of testing. This will be a quarterly publication, each with a focus on a particular topic. This will be aimed at the wider dental profession.
- We have put in place buddy arrangements between some practices that are new to testing reform and, ex pilot practices who feel they have mastered the care pathway approach, have been able to maintain their access and were willing to share their learning with the new recruits. The benefits of buddying is the opportunity this provides for new practices to learn from the experience of their peers. We will be keeping in touch with buddy practices to see how things are going. If successful we may consider extending this arrangement if other practices feel they would either benefit from peer support of this kind but this would also be dependent on others willing to share their learning and expertise with others.
- Keeping in touch calls We are aware that many pilot practices appreciated having a member or members of the programme team assigned to them as their point of contact so today I would like to introduce you to the members of the programme team who will be supporting you. These are faces behind the inbox and helpdesk and the people you will meet at practice visits and events. Also, a member of the team will call you every four to six weeks to check in with you to ensure that things are going well and discuss any issues you may want to raise. Mid year 1:1 events We will be holding mid year sessions for providers, the programme and commissioners to look at your contract position. This will give you an opportunity to take stock, discuss issues and most importantly allow time to address these issues before the year-end. Engagement events We plan to hold engagement events in January 2017 to provide the opportunity to share progress with practices and to give an update on next steps. The agenda is in progress – more news of this later in the year. Practice visits As you have already heard we will be starting a programme of visits to prototype practices during the year to offer support and gather learning form the programme. We discussed this on your recent post live calls. Not all practices will be visited but we would like to thank you in advance for those that are chosen.
- On behalf of the programme I would like to once again thank you for all of your hard work in supporting the programme. Without you we would not have a programme.