Colin Langley29 Jan 2014

The Dental Pilot Concept

PRACTICE PROFILE BEFORE PILOT.Single handed.10,500 UDA’s – Total Contract Value £269k.4 members of staff of which 3 DCP’s.

POSITIVES

NO MORE UDA’s!FOCUS ON PREVENTION.MORE TIME WITH PATIENTS (?)PATIENTS BECOME MORE RESPONSIBLE FOR

THEIR OWN ORAL HEALTH.

The Oral Health Assesment

THE ORAL HEALTH ASSESSMENT

AdvantagesEnsures patient receives a very thorough

examination.Robust notes.

DisadvantagesVery time consuming. Data hungry, average assessment = 160 mouse

clicks. Requires fast, networked computer system.

The Effect On The Practice

HOW THE PRACTICE IS DIFFERENTSkill mix – we are now employing a therapist.Employed extra part time receptionist.Cost to Practice - £35,000.Able to do this due to large Contract Value.More computers and screens in surgery.Recall Intervals have increased for many patients.Patients are registered with the practice for 3

years.See less patients in a working day.

Recall Interval ExamplesPatient A64 Year Old female, non smoker, consumes a ‘glass of sherry on

special occasions’Soft tissues Healthy, BPE 111/121. No caries detectable. Heavily

restored dentition.

Patient B28 Year Old Male, non smoker, drinks 4 or 5 pints a week. Soft

tissues healthy, BPE 111/121. No restorations present. No caries detectable.

COMPUTER SAYS “24 MONTHS”

PROBLEMS ENCOUNTERED

Diary clogging – resulting in less time away from practice.

FTA’s cause proportionally bigger problems.Access has fallen.Most patients are happy at increased recall intervals,

some are very reluctant. Patient Charge Revenue has fallen by about 40%.Potential clawback for failing to maintain capitation

numbers.Transition from UDA’s to capitation.INVESTMENT IN I.T AND STAFF.

At the moment can override the recall period as dictated by the OHA.

currently do this in around 80% of patients, to a recall that I feel is clinically more suitable.

In the future, this may not be possible. Will it be possible to do this independently of the NHS with-out breaking any regulations for the benefit of the patient?

POSSIBLE SOLUTIONS TO ENCOUNTERED PROBLEMS

The Oral Health Assessment needs simplification. Reduce that number of mouse clicks!! Only capture essential information.

There needs to be a paper version of Oral Health Assessment in the event of IT failure.

Informing/educating the public that NHS dental care is changing.

Allow practitioners long lead in time.Skill mix – difficult in smaller practices.Ensure capitation payments are realistic to support

quality.Protected time for prevention and treatment.

Capitation fee per patient needs to be large enough to support more time for quality time and prevention.

The National Average Annual Cost of Care per patient (routine care) is £63.77.

This will include the treatment of high need patients and new patients registered to maintain list size.

Contract value10% DQOF

90% Capitation

High Number of Patients

Low Number of Patients

DENTAL QUALITY OUTCOME FRAMEWORKS.10% of Contract Value -1,000 POINTS.Patient safety – Medical History Updated-100

POINTS.Patient Satisfaction -300 POINTS.Patient Outcomes – your ability to convert

patients from red to green. 600 POINTS 6% OF CONTRACT.

BPE IMPROVEMENT/ REDUCTION IN SEXTANT BLEEDING SITES/ CARIES REDUCTION.

ARE THE PARAMETERS REALISTIC?

SOLVING ACCESS AND FALLING PCR ISSUESA staged introduction of the whole process?Will this bring problems? IT, Patient

Charges etc.No more money from DoH = increased

patient charges?

Quality of care for patients.Prevention for patients.Access for patients.Sensible clinical demands on dentists.Sustainable business model for practices.Affordability for the Department of Health.

Is this New Contract set out to Achieve:

UDA’s

PATIENTS

INFO NEEDED.ARE THE PILOTS GOING TO BE TWEAKED ?IS IT GOING AHEAD ?IF SO , WHEN ?TRAINING – CLINICAL /NON CLINICAL?PERIOD OF RING FENCED PRACTICE

INCOMES ?ADVANCED CARE SYSTEM AND FUNDING ?TIERS OF COMPETENCY ?

In the meantime:Consider full computerisation – in surgery and

receptionThe Oral Health Assessment and Care Pathway

are based upon “Delivering Better Oral Health.” Prevention is the way forward. Try to work out how this can work in your practice.

Consider how skill mix will affect your practice. Can you afford skill mix?

Communication skills – explaining pathway, relevance of alcohol and tobacco etc.

Manage patient lists.Reduce FTA’s – texting/ emails.Research software functionality with regard

to patient list management.Manage lead in time. Don’t over produce UDA’s. Uncertain if this

extra activity will help or hinder.

leedsSOHT@hotmail.comInformation event on scope of practice and employability