Barry CockcroftChief Dental Officer

(England)

LPN EventEast of England

8 March 2012

Coalition Commitments

In the coalition Agreement the government stated their intention to:

• Introduce a new contract based on registration, capitation and quality• Increase access to primary dental services• Improve the oral health of the population, particularly children

In the Dental Contract Pilots dentists will be rewardedfor the continuity and quality of care they deliver forpatients, rather than the number of treatments.

Through registration patients will have the security ofContinuing care.

NHS & System Reform

• DH smaller• Establishment of Commissioning Board• Dental presence in Health Education England• Dental presence in Public Health England• Public Health outcome indicator

High Quality Care for all: NHSNext Stage Review June 2008

• A vision for the future of health and healthcare• Quality at the heart of everything we do• Focus is on continuous improvement in quality “The NHS has to keep moving forward to make sure patients benefit from new treatments and technologies”

Definition of Quality

• Patient safety

- safe and clean environments- reducing avoidable harm

• Effectiveness of care

- clinical measures- patient – reported outcome measures

• Patient experience

- personal care provided with compassion, dignity and respect

Clinical Effectiveness and Outcomes Group (CEOG)

• Sub-group of KSG• Principle aim to identify quality indicators for primary care dental services that focus on processes and outcomes• To assess current initiatives in primary care with a view to disseminating good practice and implementing quality indicators.

Steele June 2009

• We recommend that dental contracts are developed with much clearer incentives for improving health, improving access and improving quality

Must ensure that these incentives are passed onto performers’ contractswith the providers

Coalition Government

“There are many aspects of Professor Steele’sReview that are in line with the coalition Government’splan to reform the NHS dental contract” – Lord Howe

Oral Health Assessment

The overall purpose of the NHS primary dental careassessment is to capture the oral health status and disease risk of individual patients with a view to improving patient and population health and reducinginequalities

- to motivate patients and encourage self care- to encourage dental teams to provide patient focused evidence based care and advice- to help the NHS commission needs focused and evidence based care from its providers in an appropriate way

The Principles

The principles underpinning the oral health assessment are that it should be…

• A practical, pragmatic approach, integrated into the workflow of the practice• A predictable standardised activity for the practice and patient which drives patient and practice behaviour• Assure the quality of the assessment process• Provide value for money for all stakeholders• Be trusted and valued by all stakeholders

Quality and Pathways

• To develop a clearly defined clinical pathway – including routine, urgent, disease prevention, continuing and advanced care to support the overall patient pathway• To define and develop an Oral Health Assessment which will capture the oral health status and disease risk of individual patients which will determine the care pathway for that patient,;• To define the criteria and guidelines for entry into an advanced care pathway• To refine and finalise the process and outcome measures identified by CEOG, for the clinical pathways – in order to develop a clearly defined set of quality Indicators.

Pilots

Pilots are testing several components:

• The oral health assessment and risk screening• A capitation approach• An outcomes approach

……. To assess whether they provide the basisfor a new dental contract and contribute to improving oral health.

Overview of the Pilots

• Selection process – sampling to ensure variability• 70 practices went “live” in summer 2011•Support via national pilot team:

- clinical training- Beta testing of pilot software

- deal with queries and concerns from pilots/PCTs

• NHS BSa DSD continues to pay pilots and provide management information as normal• PCTs remain the commissioner

Timeline

• Ongoing evaluation of pilots both qualitative and quantitative• IT review ongoing• Pathway review early summer• Pilots extended till 2013• All GDS contracts will transfer to NHS CB 2013 (subject to Parliamentary approval)

Paying for the DQOF

The contract pilots will allow us to test a paymentsystem based on the three domains to gauge thebest scoring system, the weighting that should begiven to quality, and to the components of the DQOF, and the extent to which external factors,e.g. the size of the practice, and number of patientsseen, affects the quality scores.

Oral Health Improvement

• 67% of 12 year old children have had no experience of tooth decay in their permanent dentition (08/09 data)

• 69% of 5 year old children have no experience of tooth decay in their deciduous dentition (07/08 data)

• However:-Average 12 year old child with caries has 2.21 decayed teeth and the average 5 year old with caries experience has 3.45 decayed teeth

• These last 2 figures are totally unacceptable

Delivering Better Oral Health

Questions