Health Scrutiny: Dental Topic Group

HERTFORDSHIRE COUNTY COUNCIL HEALTH SCRUTINY: DENTAL TOPIC GROUP

Specialist Services / Quality of Care 11th September 2008

Specialist Services

Orthodontics

Orthodontics is the branch of dentistry concerned with the growth and development of the teeth and jaws and their corrective treatment.

A new framework for orthodontic treatment was introduced in April 2006. The framework was designed to ensure that the assessment of orthodontic need is carried out more fairly and consistently to make the best use of available resources.

The new system of needs assessment is based on the Index of Orthodontic Treatment Need (IOTN) which considers both the dental health of the patient (normally a child) and the aesthetic need for treatment. There is flexibility for practitioners to treat other cases falling outside the normal criteria where they judge there are exceptional circumstances based on the dental and oral condition of the patient. The IOTN categories are as follows:

 Dental Health Component Grade 1 – no need for treatment Grade 2 – little need Grade 3 – borderline/moderate Grade 4 – definite need Grade 5 – great need

 Aesthetic component Grades 1-4 – little or no need Grades 5-7 – borderline/moderate need Grades 8-10 – definite need

Acceptance for orthodontic treatment under the NHS is:

 Grades 5 and 4 of the dental health component, or  Dental health component 3 with an aesthetic component of 6 or above

The cut off point for NHS funding was determined on the basis of evidence of ability to benefit from intervention, and was piloted under Personal Dental Services arrangements from 1998 to the new contract in 2006.

022d5ff945547bdcf72a079e9d53ee88.doc 1 There are 5 specialist orthodontic practices in East and North Herts PCT and 9 specialist practices in West Herts PCT. In addition, orthodontic treatment is carried out by suitably trained dentists in a number of practices in both PCT areas as part of the General Dental Services contract.

Access to orthodontic services is generally good. However, the wait for assessment and the wait for treatment varies from practice to practice. The average waits for treatment are:

Average West Herts PCT East & North Herts PCT Wait for assessment 3 weeks 9 weeks Wait for treatment 6 weeks 20 weeks

It should be noted that within each area, there are a three practices that have very long waits for treatment of between one and two and half years.

18 week target

The Strategic Health Authority has set PCTs in the East of England a target that ‘extends the maximum waiting time guarantee of 18 weeks from referral to treatment for all non consultant led NHS services by April 2010’.

As part of the work programme of the Oral Health Strategy and Commissioning Group, the PCT will review the provision of specialist orthodontic treatment and work with its current specialist practices towards achieving the proposed milestone target that 75% of patients accessing non consultant led orthodontic treatment will receive treatment within 18 weeks of referral by October 2009 and achievement of the Pledge by April 2010.

Sedation

Dental sedation is the procedure of relaxing patients with the use of drugs without inducing complete loss of consciousness. Verbal contact is maintained with the patient.

The techniques used are:

 Inhalational sedation  Intravenous sedation  Oral/transmucosal benzodiazepine provided adequate competence in intravenous techniques has been demonstrated

Access to sedation services is generally good.

There is one specialist sedation practice in East & North Herts PCT and 5 specialist practices in West Herts PCT.

022d5ff945547bdcf72a079e9d53ee88.doc 2 Domiciliary

Domiciliary services are general dental services provided at the patient’s usual place of residence, e.g. own home, nursing and/or residential homes.

There is one large practice of 5 dentists providing services in East and North Herts PCT and 5 individual dentists providing the service in West Hertfordshire. In addition, domiciliary visits are undertaken by some dentists in each PCT area as part of their general dental services contract.

Quality of Care

There are several ways in which the PCT assures itself of the quality of care offered to patients by dental practices.

Dental Practice Inspection

Dental Practice Inspections are carried out on a three year rolling programme by the PCT Dental Practice Adviser and a member of the Primary Care Commissioning Team.

The practice inspection looks at practice documentation (including written policies), staff training and education, the practice premises, and clinical / resuscitation facilities. Following the visit, a report is sent to the practice together with any recommendations that the PCT feels should be implemented by the dental practice in order that the practice meets good practice guidelines and appears to be a safe environment for the provision of dental treatment and care.

Practice Visits by Dental Reference Officers from the Business Services Authority

These are a series of visits on a rolling programme that involve clinical appraisal of a practice and would involve interview and clinical examination of patients, review of each performer's clinical records and radiographs, and a discussion (with immediate feedback regarding the appraisal) with each performer and the provider(s). On completion of the visit, a formal written report is be forwarded to the dental lead at the PCT regarding the outcome of the visit. All Dental Reference Officers hold the Faculty of General Dental Practitioners (UK) Certificate of Dental Practice Appraisal. Standards for Better Health

The Department of Health’s ‘Standards for Better Health’ include 24 core standards that all NHS dentists in England should achieve, and 13 developmental standards that they should be working towards achieving. These core and developmental standards cover all aspects of healthcare, including the safety of patients, clinical effectiveness and cost effectiveness.

The Healthcare Commission monitors overall compliance with the standards through their assessment of PCT’s quality of care in the annual health check. They look at

022d5ff945547bdcf72a079e9d53ee88.doc 3 how well the PCT is complying with the core standards and the steps it is taking to meet the developmental standards.

To that end Hertfordshire dentists have completed a self-declaration for 2007-8. Further work is being undertaken to align the standards with existing dental guidelines and the Dental Practice Advisor Inspections, which will provide an opportunity to support practices in their understanding, and implementation, of the standards.

Patient Satisfaction Surveys Patient satisfactions surveys are undertaken on behalf of the PCT by the Dental Services Division of the Business Services Authority. A copy of the 2007/08 survey results was been circulated to the Dental Topic Group at the meeting on the 6 th August 2008. Complaints  Hertfordshire Complaints Service The Corporate Complaints Department can assist in the facilitation of the Local Resolution process of the NHS Complaints Procedure in relation to complaints received against general dental practitioners and the services they provide. Under current NHS regulations, the PCT does not have the power or authority to investigate these complaints, which remain practice-owned, practice-based. However the department can assist in the exchange of correspondence and by implementing a conciliation process, as requested. The service is available to both complainants and practitioners alike across Hertfordshire.

Corporate Complaints also co-ordinates the investigation of any dental complaints about services commissioned by both PCTs.

 Patient Advice and Liaison Service (PALS)

PALS is a confidential service, established to provide support, information and help for patients, their carers and families in Hertfordshire.

PALS can help with enquiries about any aspects of local health services.

The PALS service will:

 advise and support patients, their families and carers  provide information and respond to concerns or queries on NHS services  help sort out problems quickly on behalf of patients  put patients in touch with other local agencies who may be able to help, eg voluntary or social care services.

Jane Robinson Primary Care Commissioning Lead

2nd September 2008

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