Oral Health Inequalities and Access to Services in Blackpool

Oral Health Strategy 2006 Executive Summary This strategy reports on Blackpool PCT’s current state of oral health and identifies plans to improve the oral health of the population, reduce oral health inequalities, and improve access to dental services. Oral Health inequalities and access to services in Blackpool Levels of dental caries in 5 year old children in Blackpool have remained persistently high, compare poorly with other PCTs in the North West, and fail to meet national targets.  Levels of caries in 12 year old children in Blackpool still fail to meet national targets. Children in the most deprived areas of Blackpool tend to have the most dental caries.  There is an un-met need for orthodontic treatment in Blackpool.  Dental injuries increase with age. Boys more likely to sustain dental injuries than girls. The long term effects of the current high levels of disease in 12 year olds added to disease levels and treatment requirements of the existing aging adult population will result in a continued need for the provision of restorative dentistry (fillings, periodontal treatment and dentures). The Standardised Mortality Rate for Blackpool for cancers of the lip, oral cavity and pharynx is significantly higher than England.Improving Oral Health and access to services A recently published national oral health plan had identified six key areas for action, which it considers important to secure oral health for a population. A range of evidence-based interventions are also available for use to improve oral health. Local commissioning of NHS dentistry is to be introduced. PCTs will be given a budget to be used to provide or secure NHS dental services in their area.2  A new contractual framework for general and personal dental services, which is expected to improve access, is also to be implemented.  The numbers of dental students and dental therapists in training is to be increased. New opportunities to develop directly employed services are also to be introduced.Current actions to improve oral health and access to NHS Dental Services A number of Oral Health Promotion interventions have been implemented in Blackpool in anti-natal and post-natal classes, and for school children, children with special needs, and some children from hard to reach groups. A fluoride toothpaste distribution scheme has been introduced using Health Visitors. Local systems have been set up to facilitate access to NHS dentistry in Blackpool. Progress has been made in increasing capacity through local commissioning using PDS. Priorities for action The following priorities for action have been identified:Public Health Actions to improve Oral Health  Reduce oral ill health  Reduce oral health inequalities  Investigate mortality from cancers of the lip, oral cavity and pharynx  Reduce dental injuries  Reduce mortality from cancers of the lip, oral cavity and pharynx  Engage with the choosing health agenda particularly relating to: o Smoking o Alcohol o Obesity  Enhance collaboration between agenciesService development actions to improve access to NHS dentistryImprove access to routine NHS dental services3 Ensure existing services transfer to the new commissioning arrangements Good communication and timely contract discussions with practicesDevelop PDS and GDS Consolidate links with the Dental Access Service  Encourage dentists to use the NICE guidelines  Support practices with CDP, audit and Clinical Governance  Support practice growth where appropriateDevelop Trust based services Develop services for hard to reach groups  Integrate CDS and Dental Access Service  Provide flexible employment opportunitiesDevelop secondary care  Increase GA services for children and special needs patients  Increase capacity of Orthodontic ServicesResources to deliverA number of areas of workforce and estate developments have been identified which will support the priority actions. These are:Workforce development  Dentists o To optimise recruitment to Blackpool PCT o To facilitate retention o Support existing dentists o Integrate Clinical Governance into practice o To reduce physical isolation Dental Nurses o To facilitate recruitment o To support exiting nurses into registration o Encourage career development and further training Therapists o Encourage therapists in training to work in Blackpool PCT catchment area4 o To support suitable applicants to undertake therapy trainingEstate development  Ensure dentistry is included in the development of new Primary Care Centres to provide modern services  To support NHS practice estate and to improve where possible.  To encourage outreach teaching facilities  To strategically place facilities (larger delivery units) based on ease of access5 ContentsIntroductionOral Health and access to dental services in BlackpoolBlackpool’s populationChildren’s Oral HealthAdult Oral HealthAccess to dental servicesImproving Oral Health and access to dental servicesStrategies to improve oral healthEffective interventionsStrategies to improve access to dental servicesCurrent actions and servicesCurrent Public Health actions to improve oral healthCurrent service developments to improve access to NHS dentistryPriorities for ActionPublic Health actions to improve oral healthService development actions to improve access to NHS dentistryResource required to deliverFinancialWorkforceEstate development6 Introduction Regular surveys of the population have demonstrated improvements in oral health, however there are large inequalities in oral health between and within primary care trusts. These inequalities are linked with deprivation and poor general health Despite considerable, recent, investment in NHS dental services specifically directed towards improving access to NHS dentistry, some people are still unable to access routine dental care. To address these issues “NHS Dentistry: Delivering Change” and “Choosing Better Oral Health: An Oral Health Plan for England” were published by the Department of Health, in July 2004 and November 2005 respectively. This document describes Blackpool Primary Trust’s strategy, which will localise the visions set out by these publications. It outlines a plan to improve the oral health of the Blackpool population and reduce oral health inequalities. This will be achieved through the prevention of oral disease and improved access to dental services delivering high quality management of existing and treated oral conditions,Key to delivery is the investment of devolved resources to support local dental professionals and the implementation of programs which will prevent oral diseases. This strategy is divided in to five sections. The first provides a description of the population and identifies oral health status and trends.  The second identifies the range of possible interventions available to improve oral health and reduce inequalities.  The third identifies current actions in place and a description of treatment provision currently available.  The fourth section identifies the Priorities and Plans, which the PCT will use to guide commissioning over the next 3 years.  Section five identifies the resources which will need to be developed to ensure delivery of the priorities and plans. 7 Oral Health and access to dental services Blackpool’s population Approximately 153,000 people are registered with a General Medical Practitioner in Blackpool and 72,404 or 47% are registered with an NHS dentist. Fig 1 shows the age structure of this population on census day 2001, which suggests that a substantially higher than average proportion of the population are aged between 60 years and 90 years. The census from 2001 also reveals that approximately one quarter of the population of Blackpool are likely to have a limiting long term illness.Fig 1The population of Blackpool is amongst most deprived in the country. Within Blackpool a substantial proportion of the population live in particularly deprived electoral wards. Rates of life expectancy, cancer mortality and cardiovascular disease are also higher than the majority of the rest of the country. These statistics mean that Blackpool Local Authority is part of the Spearhead group of Local Authorities. These will be implementing Government strategies to improve health at a faster rate than other Local Authorities. Blackpool is a major tourist resort receiving 12 to 15 million visitors each year. As a consequence, there is a substantial transient population linked to the availability of seasonal work. This contributes to low earnings and high unemployment within the town. At the time of the census in 2001, slightly over half of people aged 16 to 74 years were employed. Almost 10% in this age group were permanently sick or disabled. Only 3% of this age group were students. 8 A very small proportion of Blackpool’s population belongs to a non-white ethnic group. The largest minority ethnic group is Chinese.  There are proportionately more elderly residents in Blackpool compared with the rest of the country.  One quarter of the population is likely to have a limiting illness.  There are high levels of deprivation in parts of Blackpool.  Rates of life expectancy, cancer mortality and cardiovascular disease in Blackpool are also higher than the majority of the rest of the country. These statistics mean that Blackpool Local Authority is part of the Spearhead group of Local Authorities.9 Children’s oral health Dental CariesIn the Blackpool PCT area the levels of dental caries in five year old children are consistently high, and in 2003/2004 were, on average, 2.4 times the national target set by the Department of Health (shown in Fig 2) to be achieved by 2003. Fig 2 - Department of Health national caries targets 2003 for England  5 year olds should have no more than an average of 1.0 tooth with decay (caries) experience  70% 5 year olds should have no decay (caries) experience  12 year olds should have no more than an average of 1.0 teeth with decay (caries) experienceNational Statistics 2004Also, five year old children in Blackpool have higher levels of dental caries, on average, than children in Fylde, Wyre, and the rest of England (illustrated in Fig 3)Fig 3 Five-year-old children's average dental decay levels (dmft) in 2003/04 in Blackpool, Fylde & Wyre 3.50 3.25 3.00 2.75 t 2.50 f m 2.25 d e 2.00 g a r 1.75 e v 1.50 A 1.25 1.00 0.75 0.50 0.25 0.00 Blackpool Fylde Wyre North West North West England Lancashire National target10 On average one in two five year old children in Blackpool had experience of dental caries in the most recent local survey. This compares poorly with the Department of Heath target for 2003 of 30% and the average statistic for England (illustrated in Fig 4)Fig 4Percentage of five-year-old children with dental decay experience in 2003/04 in Blackpool, Fylde & Wyre 55 50 45 40 e g 35 a t n 30 e c r e 25 P 20 15 10 5 0 Blackpool Fylde Wyre North West North West England Lancashire National targetConsidering older children, who have permanent teeth, the most recent statistics available show that, on average, 12 year old children in Blackpool had higher levels of dental caries than Fylde and Wyre, the rest of the North West of England. This also exceeds the Department of Health national target (Fig 5) 11 Fig 5Twelve-year-old children's average dental decay levels (DMFT) in 2000/01 in Blackpool, Fylde & Wyre 2.20 2.00 1.80T 1.60 FM 1.40 D e g 1.20 a r e 1.00 v A 0.80 0.60 0.40 0.20 0.00 Blackpool Fylde Wyre North West North West England Lancashire National targetExamination of dental caries data at ward level, collected from five year old children in 2003/2004, reveals the presence of inequalities in oral health within Blackpool PCT. For example, on average, five year old children in Bloomfield, which is one of the most deprived wards in Blackpool, have at least four times the level of dental caries than five year old children in neighbouring Waterloo. This is illustrated in Fig 6. Although the effects of Blackpool’s transient population are acknowledged, these findings are consistent with published evidence which associates childhood caries with deprivation. 12 Fig 6 Levels of dental caries in 5 year old children are persistently high and compare poorly with other PCTs in the North West. These levels of disease fail to meet any national target.  Levels of caries in 12 year old children in Blackpool also exceed national targets.  Inequalities in the oral health of 5 year olds exist within Blackpool. These 13 are linked to deprivation Orthodontic conditionsData relating to orthodontic conditions and treatment need in the Blackpool area have been collected through local surveys since the mid 1990s. Table 1 gives estimates of the orthodontic need and demand of the 14 year old population of Blackpool Fylde and Wyre for three years when data were collected. Table 1 -Orthodontic treatment need and demand in Blackpool Total Children Percentage Percentage Estimated Estimated Estimated Estimated 14 yr old examined surveyed surveyed 14 yr old 14 yr old 14 yr old 14yr old Population in survey with with orthodontic orthodontic orthodontic orthodontic Survey orthodontic orthodontic treatment treatment treatment treatment Year treatment treatment need demand un-met un-met need demand need demand (cases) (cases) 94/95 3,157 293 43.3 33.4 1367 1054 571 259 98/99 3,220 422 52.6 45.0 1694 1449 496 252 02/03 3,755 510 50.8 36.9 1908 1386 781 259Orthodontic provision in Blackpool has been considered as part of a wider Cumbria and Lancashire review. This recommends the establishment of a whole time equivalent consultant services supporting Blackpool and other neighbouring PCTs.Dental injuries There is a paucity of data relating to dental injuries in the Blackpool locality. National data, collected during the national Child Dental Health Survey 2003, revealed that, although the prevalence is falling, still, on average of 5% in 8 year olds and 13% 15 year olds surveyed had signs of dental injury. Boys are more likely to sustain dental injuries than girls. Levels of dental caries in 5 year old children in Blackpool have remained persistently high, compare poorly with other PCTs in the North West, and fail to meet national targets.  Levels of caries in 12 year old children in Blackpool still fail to meet national targets. Children in the most deprived areas of Blackpool tend to have the most dental caries.  There is an un-met need for orthodontic treatment in Blackpool.  Dental injuries increase with age. Boys more likely to sustain dental injuries than girls.14 Adult oral health Dental Caries and Periodontal DiseaseAlthough there are no local adult dental caries prevalence data available for Blackpool PCT, national data collected in the UK Adult Dental Health Survey in 1998 suggest that there is likely to have been a decrease in the levels of caries in adults since the 1970s. A marked increase in the proportion of dentate adults compared with previous surveys was also clearly demonstrated. Notwithstanding the general reduction in caries across the country, marked regional differences were noted. For example along with Northern and Yorkshire, dentate adults in the North West had the highest level of dental caries in the country. Only 36% dentate adults in the North West had no teeth that were decayed or unsound. This compares poorly with the South West where 59% adults had no teeth that were decayed or unsound. These findings, along with the current levels of dental caries in the 12 year old population in Blackpool, indicate that there will be a higher than average need for restorative dentistry in Blackpool’s future adults. Similarly, no local data are available relating to the prevalence of adult periodontal disease in Blackpool. The Adult Dental Health Survey carried out in 1998 found 54% of the adult population had some degree of periodontal disease. Four percent had advanced periodontal disease. It is estimated that 60,600 people living in the Blackpool PCT area will have some degree of periodontal disease, and in 4500 this disease will be severe.In conclusion, in the short to medium-term, high levels of restorative dentistry (fillings, periodontal treatment and dentures), will be needed for the population in Blackpool.Oral CancerTable 2 shows Standardised Mortality Ratio’s (SMR) for deaths from cancers of the lip, oral cavity and pharynx between 1995 and 2004 for Blackpool, Fylde and Wyre. Based on these data it is noted that, deaths from cancers of the lip, oral cavity and pharynx for the years 1995 to 2004 were between 48% and 121% higher than the average SMR for deaths from the same groups of cancer in England. This rate compares unfavourably with the rates from both Fylde and Wyre. This will require investigation. 15 Table 2 - Standardised Mortality Ratio (all persons) Deaths from malignant neoplasms of lip, oral cavity and pharynx 1995 - 200495% Confidence Intervals SMR Upper Lower England 100 102 98 Blackpool 185 221 148 Fylde 82 115 50 Wyre 132 167 98 The long term effects of the current high levels of disease in 12 year olds added to disease levels and treatment requirements of the existing aging adult population will result in a continued need for the provision of restorative dentistry (fillings, periodontal treatment and dentures). The Standardised Mortality Rate for Blackpool for cancers of the lip, oral cavity and pharynx is significantly higher than England. 16 Access to NHS Dental ServicesThe majority of access to dental services in Blackpool is through dental practice. There are two legal frameworks under which dental practice may be delivered. These are General Dental Services (GDS) and Personal Dental Services (PDS).  GDS are provided by independent contractor dentists to a national contract, which is largely unchanged since the inception of the NHS in 1948. The focus of GDS is a high volume of patients and treatment provision. There is little reward for preventive interventions. PDS have been established since the passing of the Primary Care Act 1997. These allow the PCT to make local contracts with independent contractor dentists to deliver NHS dental services. There are opportunities with this type of contract to modernise and move dental practice to a more preventive based approach to patients, recognizing the changing needs of the population. The principles of PDS are the platform on which the new GDS contract is being developed. The Government set a target of 25% of practices in PDS by the end of April 2005. Blackpool met the target having 38% practices working to a PDS contract by this date.The percentage of the Blackpool population registered under GDS or PDS contracts in Blackpool is currently 48.4% of the population. These rates reflect the number of people being cared for on a long term basis and do not include those who attend occasionally , usually when they have a problem. Since April 2005 total registrations have been stable. This is shown in Fig 7.17 Fig 7 Blackpool PCT Registration trends80000700006000050000 gds 40000 pds total 3000020000100000 Apr-05 Jul-05 Oct-05The PCT also directly employs dentists in the Community Dental Services (CDS) and is the provider of the Dental Access Centre activity in association with Fylde Coast Medical Services. The CDS operates from three clinics. It provides care for special needs patients and those who require treatment under general anaesthesia. Patients cared for by this service are not registered and are not included in the graph above. The CDS also provides an oral health promotion service which provides a public health approach to preventing oral diseases through a range of targeted oral health promotion activities. These are described in the next section. There are currently 14 practices providing NHS dentistry, one of which is solely orthodontic and one will cease providing NHS dentistry form 1 st April 2006. The PCT provides CDS services from 3 locations and Access services for the Fylde Coast from two sites. Fig 8 illustrates the locations of the GDS, PDS, CDS, and DAC provided in the Blackpool PCT locality. Access to NHS dentistry has been an issue in the local press and in response local systems have been developed to deal with this through a central point of contact, with patients who both in pain and looking to register with an NHS dentist. These are also discussed in the next section. Fig 818 19 Improving oral health and access to dental servicesStrategies to improve oral healthThe Department of Health has recently published an Oral Health Plan, which lists the six key areas that it considers important to gain sustainable improvements in oral health. These are:  the increased use of fluorides  the improvement of diet and reducing sugar intake  the encouragement of preventive dental care  reducing smoking  increasing the early detection of mouth cancer  reducing dental injuries To address these key areas, there are a number of preventive interventions that can be considered for use in Blackpool. Some of these, for example water fluoridation, could be applied to the whole population. Others could be used as interventions applied to target groups within the population or individually. Effective interventionsTable 3 shows possible evidence based interventions which could be used to improve oral health in Blackpool locality. In planning approaches to improving oral health these interventions must be considered in the context of economic and technical feasibility, political acceptability and appropriateness. 20 Table 3 – Possible evidence-based interventions for the improvement of oral health Intervention Population group Condition or individual Water fluoridation Whole population Dental caries Use of fluoride toothpaste (at Whole population or Dental caries appropriate target group concentration) Twice yearly Medium to high risk application of fluoride Dental caries individuals varnish (2.2%) Na F Placement of fissure Medium to high risk resin sealant on Dental caries children ages 6-16 permanent molars Fluoride mouth rinses High risk children Dental caries 0.05% Na F daily aged 6 -16 Fluoride mouth rinses High risk elderly 65+ Dental caries 0.05% Na F daily Weekly rinsing with chlorhexidine High risk elderly 65+ Dental caries gluconate 0.2% for six weeks Fluoride mouth rinses High risk children Dental caries 0.2% Na F weekly aged 6 -16 Referral to smoking Smokers wishing to Oral cancer cessation service quit Periodontal disease Referral to alcohol Oral cancer Heavy drinkers control service Dental trauma A recently published national oral health plan has identified six key areas for action, which it considers important to secure oral health for a population. A range of evidence based interventions are also available for use to improve oral health. 21 Strategies to improve access to NHS Dental ServicesThe Government has recently announced the commencement of the amendments to the NHS Act, which introduce local commissioning of NHS dentistry. PCTs are being given a devolved budget to be used to provide or secure NHS dental services for those requesting them within their area.A new framework for contracting with providers to deliver GDS or PDS services has been developed. This is designed to encourage a less interventionist approach to dental care, to allow dentists greater freedom in delivering preventive care, to deliver improvements in access and to provide them with a stable NHS income, not linked to individual items of treatment. Guidelines relating to the frequency of recall appointments have also been produced by the National Institute of Clinical Excellence are also expected to improve access to dental services by freeing up dentists’ available clinical time. The government has announced an expansion in the number of dental students to be trained from 2005/6 and has asked for expressions of interest in providing this training for a second phase starting in 2006/7. Cheshire and Merseyside SHA has commissioned, on behalf of Cumbria and Lancashire SHA, an expansion in the numbers of dental therapists. This expansion began in 2004 and will support the introduction of skill mix within the dental team.Traditional routes to accessing NHS dentistry have failed to deliver as increasing numbers of dentists have decided not to take on any more NHS patients. Opportunities to develop new central routing help lines have become available through joint working with NHS Direct and out of hours providers.The government announced a review of the salaried Dental Services in 2002 and produced a report entitled “Creating the Future” which gives new opportunities to develop the directly employed PCT provided service to improve access. Local commissioning of NHS dentistry is to be introduced. PCTs will be given a budget to be used to provide or secure NHS dental services in their area. A new contractual framework for general and personal dental services, which is expected to improve access, is also to be implemented.  The numbers of dental students and dental therapists in training is to be increased. New opportunities to develop directly employed services are also to be introduced.22 Current actions and servicesCurrent Public Health actions to improve oral healthBlackpool PCT Oral Health Promotion team currently delivers a number of interventions, which are based on the stages of socialisation. They conduct sessions in anti-natal and post-natal groups, parents/carers and toddler groups, and pre- school groups. ‘Teeth for Life’ is an oral health education programme, which consists of three one hour lessons. This is provided in primary schools in Blackpool. Weekly brushing schemes are carried out in Special Needs Schools where oral disease is detected early through annual school screening. The Oral Health Promotion team also engage with Teenage Pregnancy Groups, centres for excluded children and Family Centres. In addition, Brushing for Life, which is a national initiative involving the distribution of fluoride toothpaste by health visitors, has also been rolled out to SureStart areas in Blackpool. Current service developments to improve access to NHS dentistry Systems have been developed to deal with this through a central point of contact, with patients who both in pain and looking to register with an NHS dentist. The Dental Access Service, which operates from Fylde Coast Medical Services, was commissioned in December 2004 as an umbrella service housing the Emergency Dental Service, Personal Dental Service, local referral services and Local Dental Helpline. The EDS has been operational since December 2000 and the PDS since March 2002. The functions of the Dental Access Service are illustrated in Fig 9. Almost 13000 calls were handled by the Dental Access Team between 1 st January 2005 and 30th June 2005. More than 3000 appointments were offered for immediate clinical care provided by the Emergency Dental Services in this period. Also between 1st January 2005 and 30th June 2005 more than 4000 patients received urgent care through Trust Based PDS. In addition more than 1500 Blackpool patients were referred to local dentists offering NHS work through the new PDS or through local incentive schemes. Currently 1555 patients in Blackpool are waiting to be registered with a local dentist with approximately 15 patients being added daily. 23 Fig 9Blackpool Primary Care Trust Dental Access Flowchart NHS Direct Medical Dental EmergencyDental Emergency A&E or EnquiryDental Access Service Local Dental Help lineEmergency Dental Trust Based Service PDSReferral for Continuing CareGeneral Dental Special Needs Routine Care PracticeCommunity Dental Service24 Currently the Community Dental Services (CDS) provides screening, epidemiology, treatment under general anaesthesia (GA), treatment for special needs patients and oral health promotion. There is a long waiting list for treatment under GA. The CDS therefore need to commission additional capacity. A national review of the CDS has recently been undertaken by the Department of Health. Recently the Department of Health has published a vision of a new Integrated Primary Care Service. This vision comprises ‘A single, integrated, NHS primary care dental service, where patient benefit from greater access, choice and quality and receive the same care irrespective of the employment status of the individual providing the care.’In addition to Primary Dental Services the PCT also commission secondary care services from local Hospitals. Oral and maxillofacial services have historically been delivered through a federated arrangement between Blackpool, Preston and Morecambe Bay. Until recently orthodontic services have been delivered by a consultant. The post has been vacant since 2002. This has been temporarily filled by a succession of locums. There are currently 22 complex multi-disciplinary cases requiring treatment. A number of Oral Health Promotion interventions have been implemented in Blackpool in anti-natal and post-natal classes, and for school children, children with special needs, and some children from hard to reach groups.  A fluoride toothpaste distribution scheme has been introduced using Health Visitors.. Local systems have been set up to facilitate access to NHS dentistry in Blackpool.  Progress has been made in increasing capacity through local commissioning using PDS. 25 Priorities for actionPublic Health Actions to improve oral Health and reduce inequalities26 Priority Actions Responsibility Time milestonesPublic Health/ Oral Reduce oral ill health Raising awareness of oral ill Health Promotion health Reduce oral health inequalities Promotion of water fluoridation Public HealthTargeted fluoridation Public Health programmesContinue fluoride toothpaste Oral Health Promotion programmes Integrate the CDS Oral Health Community Dental Promotion Team with Public Service/ Public Health Health Encourage health professionals Public Health to promote oral health Achieve consistency of oral Public Health health messages Public Health/ Promote prevention in practice Commissioning27 Priorities Actions Responsibility Time milestonesInvestigate mortality from cancers of the lip, oral Public health investigation Public Health cavity and pharynx.Engage multi-agency working Public Health Reduce mortality from cancers of the lip, oral to reduce alcohol intake and cavity and pharynx. contribute to the tobacco control agendaReduce dental injuries Encourage safer play Public Health environments 28 Priorities Actions Responsibility Time milestonesEngage with the choosing health agenda Forge links with and support Oral Health Promotion/ particularly relating to:  Healthy Schools Public Health Programme  Smoking  Five-a-day  Alcohol  Water in schools  Obesity Engage in Government Public Health initiatives to reduce sugar intake. Enhance collaboration between agencies Engage multi-agency working Oral Health Promotion/ to reduce alcohol intake and Public Health/ contribute to the tobacco Commissioning control agenda.29 Service developments to improve access to NHS dentistry Priorities Actions Responsibility Time milestonesImprove access to routine NHS dental servicesEnsure existing services transfer to the Good communication and Commissioning new commissioning arrangements timely contract discussions with practicesDevelop PDS and GDS  Consolidate links with the Commissioning Dental Access Service  Encourage dentists to use the NICE guidelines  Support practices with CDP, audit and Clinical Governance  Support practice growth where appropriate Develop Trust based services Develop services for hard Commissioning/ to reach groups Clinical Services  Integrate CDS and Dental Access Service  Provide flexible employment opportunitiesDevelop secondary care particularly:  Increase GA services Commissioning for children and special needs patients  Increase capacity of30 Orthodontic Services31 ResourcesFinanceThe financial resources required to deliver the priorities identified will come from a number of sources.The PCT will receive a devolved budget for Primary Dental services which will include existing expenditure on general dental services, personal dental services and emergency dental services. There may be a small amount of growth in addition. Opportunities to commission different services from those delivered historically will arise when a practitioner leaves or retires.The PCT already has the funds to provide the Trust Based Community Dental services and may choose to invest in dentistry as a local priority through the LDP programWithin the budget devolved to the PCT there is an element which it is expected the PCT will recoup through patient contributions for NHS dental Care. A new system of patient charge is being introduced which should ensure that the PCT receives the required income.WorkforceA survey of the dental workforce in Blackpool has been completed. There are 50 dental practitioners provide general dental services. They are aged between 22 years and 76 years. There are 7 GDPs over 55 years of age.The Trust also directly employs 5.1 wte dentists within the Trust based Community Dental Service The PCT is keen to ensure that there is a steady supply of dentists prepared to deliver NHS dental services in Blackpool and the following options have been considered  Introducing flexible ways of working either in general practice or within the trust based dental service Using foreign recruitment either in conjunction with corporate bodies or developed within the trust e.g. Indian recruits Making available bursaries available to encourage VDPs Ensuring participation in all schemes aimed at recruitment for ancillary personnel 32 EstateDental services in Blackpool are currently provided from a range of facilities some of which are fit for purpose. Some facilities need to be improved, or services need to be relocated over time to ensure services are delivered in a modern way. 33 Workforce development prioritiesPriorities Actions Responsibility Time milestonesDentists Bursaries Commissioning To optimise recruitment to Blackpool PCT To facilitate retention Sessional work for retired Clinical Services Support existing dentists dentists Integrate Clinical Governance into practice To reduce physical isolation Introduce incentive Commissioning schemes Dental Nurses To facilitate recruitment Nurse cadet scheme Dental Public Health To support exiting nurses into registration Encourage career development Development of further Dental Public Health and further training placementsTherapists Marketing of therapy course Encourage therapists in training to work in Blackpool PCT catchment areaTo support suitable applicants to undertake therapy trainingTake forward Workforce Development OHS Group Directorate sponsored project to demonstrate new ways of workingBlackpool PCT Oral Health Strategy 2006 Estate development priorities Priorities Actions Responsibility Time milestonesEnsure dentistry is included in the development of new Primary Care Chief Exec Centres to provide modern services To support NHS practice estate and to Increase Dental Access Commissioning improve where possible. Services Chief ExecTo encourage outreach teaching facilities Incentives Dental Public Health To strategically place facilities (larger Chief Exec delivery units) based on ease of access.

Oral Health Inequalities and Access to Services in Blackpool

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