dental healthfit - nhs grampian hea… · web viewthe strategy for dental services should be a key...
TRANSCRIPT
Introduction
“HealthFit” is the title of a programme comprising an ongoing service of events designed to create a strategic framework for health services in Grampian, to serve as a basis for detailed service planning work.
This report is a summary of the Dental HealthFit event held in Peterhead on 5 and 6 June 2003 which brought together over 100 people, clinicians, managers and public representatives – all ‘experts’ in their own right. Drawing on their experience and judgement, participants worked together to find the ‘best fit’ for Grampian’s dental services balancing their different interests and taking into account the various forces, drivers and constraints on change which affect them and the system in which they operate.
Dental services in Grampian are currently facing considerable pressures, with access to primary and secondary dental care severely limited for a significant proportion of the local population. There is recognition of the difficulties in recruitment and retention of all grades of staff to Grampian, together with severe accommodation problems facing hospital and community services which prevents further development. The delivery of continuing postgraduate education is also recognised as a negative driver in attracting potential staff to the region. These are some of the important drivers which were explored at the Dental HealthFit event.
HealthFit creates an open, inclusive and transparent atmosphere in which service planning can take place and allows the people actually providing and using the service to develop a shared vision of the future. Some strong messages and original learning emerged about how services might need to be organised in the future and the changes at local, regional and national level required to deliver them. The vision which has emerged represents an achievable and powerful framework for the more detailed planning of dental health services in Grampian. The Dental HealthFit event and this report is a starting point and a foundation on which this more detailed ongoing work can be built.
Thanks are due to the Reference Group, established to plan and design the event (see appendix) and to the event sponsors, The Dental Directory, Wrigleys and NHS Grampian. Finally, thanks to the participants themselves who openly shared their experiences and creatively explored solutions to improve dental health services in Grampian in the face of the current pressures on the system.
Martin DonachieChairmanArea Dental Committee
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DENTAL HEALTHFIT
Purpose and ProcessThe Purpose of HealthFit
It is clear to the new NHS Board in Grampian that if the local health system is going to respond to all the pressures for change, as well as meet the expectations of ministers, staff and the public, then there has to be fundamental, whole-system change across the entirety of the health service in Grampian. Funding for services is under pressure, access to care across Grampian is inequitable and press and public concern about the ‘state’ of the health service is growing. Propping up the status quo is no longer an option.
The NHS Grampian Board is attempting to create a vision for the future – a well understood and widely accepted view of how services should develop across the region – which will guide current decision making and provide the basis for a set of robust and integrated service improvement plans.
What is required is an open, inclusive and transparent way of using the opportunities created by a Unified Board that will create the right climate for change, overcoming any natural resistance among service users, politicians and professionals about reshaping services and establish a clear and shared vision of the future.
This is the objective of the HealthFit programme.
The Process
With the help of a local Reference Group, made up of managers and clinicians from across the patch, OPM (the Office for Public Management) designed an event based on a large-scale open negotiation process that would enable over 100 local people from the health service and its public sector partners, along with opinion formers in local communities, to produce a shared view of what a modern health and social care system would be like in Grampian and what outcomes should be expected.
This event took place in January 2002 and a report setting out the process and outcomes of this work is available separately.
Dental HealthFit
Representatives from the Dental Service proposed to build on the successful experience of this model to respond to the current pressures on dental services in Grampian and to develop a shared view of what modern dental services should be like. A Reference Group was made up of clinicians and managers from across the service who designed and organised an event to:
be clear about the forces and drivers for change operating in the national and local health and social care economy and dental health services in particular;
understand what ministers and policy makers are expecting as a result of Our National Health: A Plan for Action: A Plan for Change, the impending White Paper and what this means for Grampian;
produce a shared view of what modern dental health services would be like in Grampian, in the context of a health and social care system and what outcomes should be expected; and
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create a climate in which this change – the modernisation of dental services in Grampian – can be welcomed, understood and pursued enthusiastically.
As a first stage in this process and in preparation for the event, the current forces, drivers and constraints on dental services which any new initiatives or ways of working would have to accommodate, were identified. An analysis of the local and national forces and drivers was prepared by local clinicians and is available as a companion to this report.
At the event itself, groups of clinicians, managers and members of the public, using IT based geographical information systems were firstly asked to identify the pressures and constraints on their services. These ‘teams’ were then asked to consider the changes and developments which would need to be made to cope with these pressures and deliver the best services to patients and their families in the future.
The teams presented their proposals to the wider group of participants to ensure that they were credible and deliverable and were not incompatible with the development of a whole-system approach.
There was a high degree of consistency and agreement in the various models and proposals suggested. They were also realistic and took account of the economic and political realities as well as the impact of geographical and workforce factors as well as public and professional expectations.
Forces, Drivers And Constraints On Dental Health Services In Grampian: A Summary
Background
It is recognised that young children in Scotland have one of the highest levels of dental decay in Western Europe. Although in the last survey of five-year-old children (1999/2000), Grampian was placed third out of 15 Scottish Health Boards, we still lie in the bottom third of all Health Authorities/Boards in the UK.
The Government’s White Paper “Towards a Healthier Scotland” (1999) identifies dental health as a key health topic on which actions need to be taken. It is pointed out that decay is strongly linked to deprivation. The poorest 10% of children have 50% of decay. The White Paper set a target that 60% of five-year-olds should have no experience of dental decay by the year 2010. At the moment the percentage is 44%.
Grampian has pockets of urban deprivation but the deprivation index is less reliable in sparsely populated rural areas as in parts of Grampian. This rural dimension is also compounded by varying patterns in the ratio of General Dental Practitioners per head of the population for example, which range from 1:2900 in Aberdeen City, 1:4400 in Moray to 1:5000 in Aberdeenshire against a Scottish average of 1:2700.
Pressures on the Clinical Workforce
The dental workforce consists of General Dental Practitioners (GDPs) and Community Dental Officers (CDOs) working in primary care, with hospital-based consultants providing specialist treatment in Orthodontics, Oral and Maxillofacial Surgery and Restorative Dentistry. Dental Nurses, Hygienists and Therapists are playing an increasingly vital role in the delivery of dental health services.
Shortage of clinical staff across all areas of the service is threatening the viability of some services in certain locations. The consultant per population ratios, for all the hospital based specialist services in Grampian, are well below national recommendations.
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Factors relating to geography, quality, training, support, remuneration and unsustainable workload all influence the recruitment and retention of clinical staff.
The Scottish Executive is developing a number of initiatives to improve pay, education and working conditions and the White Paper “Partnership for Care” in particular, includes a commitment to introduce new levels of remuneration of dental professionals in primary care.
Changes in Clinical Practice
Change and development in clinical practice and technology is having an impact on the scope, setting, cost and delivery of services generating increasing demand for specialist skills whilst at the same time facilitating increased accessibility and pressure for decentralisation. Ensuring that premises and equipment remain fit for purpose is a particular challenge for dental services. Limitations on the development of suitable surgeries restrict access to dental services and the capacity for vocational training, outreach and general professional training schemes as well as recruitment.
Focus on Quality and Clinical Effectiveness
Patients and the public expect the NHS to provide safe, high quality care and treatment. The Scottish Executive has set up a new body – NHS Quality Improvement Scotland (QIS) – which combines the functions previously undertaken by the Clinical Standards Board and the Scottish Hospitals Advisory Service. QIS will ensure rigorous and independent monitoring and inspection with robust arrangements to investigate and tackle serious failure. Difficulties in supporting single-handed practices, limited access to training and development opportunities and high workloads all have implications for the quality and clinical governance of dental services.
New Forms of Governance and Accountability
“Our National Health: A Plan for Action, A Plan for Change” (2000) introduced a new model of governance replacing the separate Health Board and Trust structures with a single unified NHS Board focusing on health improvement across a single health system. This commitment to inter-disciplinary, integrated working across a unified health system has been further underlined in the most recent White Paper “Partnership for Care” (2003) which abolishes NHS Trusts from April 2004. Each NHS Board is responsible for developing a single Local Health Plan with local Joint Health Improvement Plans to be produced by local authority/LHCC areas.
Information for Health
“Our National Health” (2000) and “Partnership for Change” (2003) both stress the importance of improving public access to health information as well as providing improved clinical information systems. NHS24, a new telephone helpline for patients, has already been introduced in Grampian and will widen patient access to services. Out-of-hours dental services have also been introduced in Aberdeen with a high level of demand for the service. “Partnership for Health” (2003) outlines the commitment to develop electronic patient record systems including an electronic Integrated Children’s Services Record in partnership with local authorities as part of a Ministerially chaired E Health Programme Board. Insufficient investment and inconsistent application of IM&T is a significant challenge for dental services.
Dental Education and Training
Over the last ten years, Grampian has seen an increasing volume of postgraduate education and training activities available to Dentists and the uptake for postgraduate courses is high. The difficulties in Grampian do not stem from the volume and quality of postgraduate training
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but from the availability of suitable accommodation, workforce issues and the economics of providing high quality patient care in the NHS.
An increasing number of general dental practices have reached their required vocational training standard but it has not been easy to fill the Vocational Training places available.
There is currently no undergraduate dental education in Grampian although a pilot student outreach scheme for final year students from the Dundee Dental School was run in 2002. This is to be followed in September 2003 by an embryonic outreach scheme from Dundee Dental School in which final year students will spend time in Community Dental Service clinics. Proposals have been developed to extend this student outreach by developing links to a Dental Access Centre for final year students from both Glasgow and Dundee.
NHS Education for Scotland (NES) has recently assumed responsibility for the continued professional development of the professions complementary to dentistry which will lead to increased demand for postgraduate training for these staff who are vital to the development of the service.
Public Expectations and Pressure on Resources
Patient, public and political expectations of the NHS continue to rise alongside socio-economic and demographic pressures on the service. Despite the significant increase in resource for the NHS in recent times, the demands on the service are ever increasing and will require prioritisation, innovative service redesign and an increased emphasis on partnership both with other public sector agencies and the private sector. It is critical that the public are involved in making these changes at a strategic and operational level as well as their own personal health care.
Partnership Working – Community Health Partnerships
The focus on health improvement, the wider determinants of health and the integration of services is stimulating partnership working across service sectors and professions. The development of local Community Health Partnerships as set out in the White Paper “Partnership for Care” (2003) will be a major focus and catalyst for this work building on the existing foundations laid by LHCCs and local authorities. There is an opportunity for dental services to play a significant part in LHCCs and the emerging Community Health Partnerships where the strength of primary care is the ability to provide a generic and holistic approach to care. At the same time, the development of Managed Clinical Networks provided by the multi-professional teams organised around the patients pathway of care offers the opportunity to integrate dental healthcare across primary care and specialist services.
Remote and Rural Issues
There are many definitions of remoteness and rurality, but that used most often (Scottish Economic Statistics 2000) defines these locations on the basis of “local authority districts with a population density of less than one person per hectare” – equivalent to less than 100 people per square kilometre. Of the fourteen districts in Scotland that fall into this category, two are in Grampian – Aberdeenshire and Moray. Grampian is also one of the areas noted as rural in the recently published ‘Health in Scotland 2002’ (2003).
A full analysis of the local and national forces and drivers was prepared by local clinicians and is available as a companion to this report.
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Building Public Confidence
During Dental HealthFit, members of the public shared powerful accounts of their experience of dental services in Grampian with the participants. Difficulties in obtaining services timeously and the co-ordination of care within dentistry and with other NHS services were particularly strong messages.
Accordingly, a small number of overarching aims for the Dental Service in Grampian were agreed at an early stage:
Dental Services in Grampian should focus on:
Improving the oral health of the people of Grampian
Ensuring speedy and equitable access to high quality dental services
Building public confidence in dental services and ensuring that the needs of the patient remain central to the delivery of the service
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Key Strategic Themes
During Dental HealthFit, a number of key strategic themes emerged from the Working Groups:
Traditionally separate strands of dental services should be redesigned as part of an integrated, whole system approach to oral healthcare in Grampian.
There should be an emphasis on multi-disciplinary working which maximises the use of clinical skills, facilitates the development of new professional roles and increases system capacity.
Managed Clinical Networks should be developed across Grampian and the North of Scotland to maximise use of scarce skills and resources and to improve patient access.
The public should be able to access the dental services they require, speedily, effectively and with confidence.
A balance must be struck between the need to provide services as close to patients’ homes and communities as possible and the requirement to provide safe and sustainable specialist services.
The needs of vulnerable patient groups must be recognised and addressed as well as people living in rural areas and areas of deprivation.
Dental services should positively involve and engage the public in order to improve oral health, develop greater mutual understanding and to support system change.
Dental services require to build stronger partnerships within the NHS eg with LHCCs and with the emerging Community Health Partnerships (“Partnership for Care”) and other external agencies in order to explore joint venture opportunities and make best use of resources.
A properly integrated, long-term strategy for the planning, development and education of the workforce should be developed.
Dental services should make appropriate use of new technologies in order to support improvements in service quality and patient access eg teledentistry, ECCI, electronic, integrated patient record.
The Strategy for Dental Services should be a key element of NHS Grampian’s overarching strategy as part of a holistic approach to health.
A Programme for Action
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Bearing in mind these strategic themes, participants agreed on a range of actions to be taken in order to achieve the over-arching aims of the Dental Service in Grampian.
Multi-purpose services, education and training centre
In order to address both workforce pressures and service improvement, NHS Grampian should work in partnership with the Scottish Executive, NES, Aberdeen University and other Health Boards to provide a multi-purpose facility providing dental education as well as a range of integrated services. The facility might be developed as a joint venture, tapping into a variety of different funding sources including a contribution from the independent sector.
Such a facility might act as the hub for a network of innovative education and services initiatives with a number of satellite facilities provided locally in General Dental Practices or as part of NHS Grampian’s wider commitment to develop local diagnostic and treatment services.
This model should not be developed in isolation and would support the development of managed clinical networks linking General Dental Practitioners, Community Dental Services and Specialist Hospital-based services both within Grampian and with other Health Boards, particularly Highland. The use of new technologies and teledentistry should be fully explored.
This “hub and satellite” development linked to managed clinical networks would be the most appropriate to address the geographic, rural, workforce and capacity issues and would have benefits in both service and education terms.
The development of a multi-purpose facility could be phased if necessary, initially addressing the needs of the Orthodontic Department, currently based in the Children’s Hospital and requiring to relocate as a result of the development of the new Children’s Hospital. A first phase could also accommodate undergraduate trainees from the University of Dundee on an outreach basis and provide improved facilities for postgraduate education and training.
Specialist Services and the Development of Intermediate Care
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NHS Grampian, in partnership with the Scottish Executive, should extend the degree of specialism in Primary Care and Community Dental Services in order to increase specialist capacity. With additional training and support, a number of primary care practitioners with enhanced skills could work part-time in the hospital service or provide specialist sessions in general practice and the community given access to appropriate grants and enhanced payments. Similarly, salaried specialists could operate in surgeries in local dental practices at lower cost than in Primary Care Trust centres. Regular consultant input and supervision would be required within the framework of the managed clinical network as would ongoing specialist training and continuing professional development.
In order to facilitate local training and enhance the skills of primary care practitioners, the hospital-based specialist infrastructure will require to be strengthened in parallel by increasing consultant numbers bearing in mind current consultant population ratios and national recommendations.
Such initiatives would in part, address the need for increased specialist capacity, and make the service more accessible to patients in a cost-effective way.
Primary Care Dental Services
Given the current recruitment and workforce pressures, a number of surgeries are available in local dental practices. At the same time, it is expensive for NHS Grampian to provide centres for salaried dentists. The potential for creating salaried Dentist posts within established local dental practices should be explored in the short-term, through funding mechanisms which would enable the practice to meet the total salary and running costs.
Similarly, NHS Grampian should quickly explore the potential for purchasing protected time for emergency care of non-registered NHS patients in General Dental Practices.
With creativity, there is the potential to link these initiatives to the wider development of walk-in access centres, diagnostic and treatment services and the establishment of managed clinical networks.
Work should be undertaken to define the elements of a core NHS Dental Service and the standards for each level. Consideration should be given to matching the range of treatments available at each level to the skill level of the different tiers of the dental workforce. For example, basic, core dental care might be provided by Dental Therapists; level 2 procedures by Dentists without enhanced skills and complex procedures by Dentists with a semi-specialism and so on.
General Dental Services and the Community Dental Service (CDS) should forge stronger links with other professional colleagues in primary care. The continued development of Local Health Care Co-operatives (LHCCs) and the impending creation of Community Health Partnerships involving health, local authority and the independent sector and the development of the Strategy for Primary Care offers a real opportunity to raise the profile of dental services, influence overall strategy and explore opportunities for joint ventures. In particular, the potential to modernise and develop local dental practices within larger General Practice and third party developments should be exploited.
Recognising that the Community Dental Service is operating at capacity, NHS Grampian should develop a service strategy for the development of the CDS to improve services to vulnerable and excluded groups throughout Grampian. The CDS should be better integrated into a multi-agency approach across health and social care in order to fulfil its treatment and health improvement roles to these groups.
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There should be improved co-ordination between the Community Dental Service and General Dental Services in order to target services to specific patient groups more effectively and make better use of scarce resources (eg older people, community care groups). Consideration should be given to the use of General Dental Practitioners in collecting basic epidemiological data.
Workforce Planning and Development
Given the current pressure on the service, there is an urgent need for a coherent, explicit and written strategy for the development of the workforce. This must be based on the emerging service strategy, embrace the whole spectrum of dental services and be properly co-ordinated with North of Scotland and national initiatives.
Part of this strategy should include a properly orchestrated recruitment campaign targeting student groups, overseas Dentists and qualified practitioners wishing to return to work. Clearly these initiatives need to be linked to appropriate incentives such as student sponsorship, “golden hellos” and importantly the quality and aspirations of the service in Grampian.
Consideration should also be given to making seniority payments to long-serving, experienced practitioners in order to retain their services whilst workforce issues are addressed now and in future years. The Dental Retainer Scheme should be extended to incorporate Dentists at the end of their practising lives.
The development of new professional roles will be critical to the long-term success of any strategy for dental services. Reference has already been made to the development of specialist services through the creation of enhanced practitioners and changes in consultant practice but the importance of developing the role of Dental Nurses, Hygienists and Therapists must also be stressed. Enhancing the training of Dental Nurses through SVQ3 and post graduate certificates and national initiatives to integrate the training of Hygienists and Therapists will increase the capacity of these key staff to contribute to the treatment of dental disease. Clearly, the creation of education and training facilities in Aberdeen would assist the uptake and development of these initiatives.
Systems should be developed which enable the different strands of the dental profession to share information and knowledge across Grampian and the North of Scotland.
Making Use of New Technology
The use of teledentistry as part of the development of managed clinical networks should be fully explored, in order to support resource-efficient specialist services and improve patient access.
In the modern NHS, compatible IT systems are important components of service planning and delivery. Current dental IT systems are not co-ordinated between the various strands of the service and in some instances there is an over-reliance on paper-based systems. Communication between practices and between primary and secondary care is inhibited. NHS Grampian’s Directorate of Health Informatics should be asked to undertake an audit of current IT systems and to make recommendations regarding their integration with other NHS systems under development eg ECCI (Electronic Clinical Communication Initiative) and electronic patient records.
Better information is required regarding the oral health of the Grampian population and which accurately quantifies the demand for services now and in the future. The use of
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information technology for the gathering of epidemiological data by General Dental Practitioners and Therapists, should be investigated.
Public Health and Preventative Measures
In the context of the Grampian Health Plan, the Oral Health Strategy for Grampian should be updated and linked together with other strategies eg Healthy Eating Strategy.
Local sources of dental health information eg health information centres, local health information helpline, should be promoted and developed to aid patient knowledge about the prevention of dental disease and how to access services.
Prevention is always better than cure and regular oral hygiene is important in maintaining good oral health. Promotion of tooth-brushing twice daily with fluoridated toothpaste throughout life can provide significant benefits. However, this habit needs to be developed at a very young age - where parents have the major role to play in this area, and need the necessary support. Grampian should encourage this activity by continuing to support the free distribution of toothpaste/toothbrushes to the parents of very young children, and also expand the programme of supervised nursery school toothbrushing. This will require the continued long-term support of many agencies and individuals if these measures are to benefit dental and oral health in young people.
Whilst this remains a controversial issue, it was the view of those dental professionals at Dental HealthFit, that fluoridation of the water supply is the single most effective public health measure that can be taken to prevent dental decay in Grampian. The measure was one of a number of initiatives included in the Scottish Executive consultation document ‘Children’s Oral Health in Scotland’ (2002) and which now awaits interpretation.
Health Improvement is central to improving oral health in Grampian. NHS Grampian should draft and develop a dental disease prevention strategy for vulnerable groups:
- Young Children- Older People- People with Dementia- People with Learning Disability- People with Physical Disability- People with Mental Health Problems- People with Sensory Impairments- People with Congenital Oro-facial Problems- People with an Alcohol Problem- People with a Drug Problem- People with Terminal Illness- People with Brain Injury- People with HIV or AIDS- Children with Special Needs
The strategy should be multi-agency and develop the current work already undertaken by the Community Dental Service such as: nursery toothbrushing; involvement in Community Schools; residential homes; hospitals; and in the community.
Dentistry as part of the local NHS should be involved at all levels within LHCCs or Collectives (CHPs).
For the purpose of health improvement and tackling health inequalities, dentistry, especially community dentistry, which has a specific role in public health, should be
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represented at least on the Public Health Forum/Group of the emerging Collectives. This would allow a multi-agency approach; co-ordinating and enhancing cross sector activity and involvement in locality planning. Dentistry should also have better access to influencing Joint Health Improvement Plans with representation on Health and Social Care Forums.
At NHS Board level, Dental Public Health should be enhanced and closer links forged with primary care services.
Geography and Demography
The excellent report produced by the NES Working Group “Education and Training for the Dental Team in Remote and Rural Regions of Scotland: Report of a Working Group” published in January 2003 sets out the position succinctly:
“Over the next 20 years the population of Scotland is predicted to fall by around 1%. This fall will be accompanied by an increase in the proportion of older people in the population and this figure will be higher in RaR regions than the Scottish average. At the same time, however, the proportion of the population that is dentate is increasing as is the number of teeth per adult. In the year 2000, more than one million more people in Scotland had teeth and required regular dental treatment than did in 1972. The Highlands and Islands have some of the poorest oral health in Scotland when assessed by a range of measures.
These demographic trends are having and will continue to have a significant impact on dental services. The trend towards a population that is increasingly dentate but has a heavily restored dentition that requires frequent maintenance and repair is leading to increasing demand for oral health care. In addition the elderly are more often medically compromised and frail, and consequently the complexity of care often increases. The ability of such patients to travel long distances is limited.
There is a growing recognition that commonly used indicators of health and social status fail to capture accurately the position of remote and rural areas, particularly with regard to deprivation and disadvantage.
The varied landscape and magnificent scenery which characterises much of Scotland’s rural areas also adds to the pressure on dental services, as in the summer months the population of remote and rural areas may double with tourists and visitors.”
It is vital that the remote and rural areas of Grampian are recognised as such and that there is acknowledgement of the real, practical difficulties associated with the provision of dental services in these areas. It is important that NHS Grampian continues to work constructively and innovatively with colleagues across the North of Scotland to improve quality and access to services for the benefit of patients. With this in mind, we will ensure that the outcome of Dental HealthFit is shared with the North of Scotland Planning Group.
It is important that parts of Grampian are included in the areas classified as “remote and rural” in order that they benefit from additional funding and support which has previously been extended to other areas of Scotland.
Collaboration between colleagues should be encouraged during the planning, development and building stages of the proposed Inverness Medie-Centre and the proposed multi-purpose facility in Aberdeen.
Delivering and Implementing Change
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It is important to maintain the enthusiasm and commitment generated by Dental HealthFit and to make changes quickly wherever possible. At the same time, we need to be realistic about what can be achieved and when. Dental HealthFit should form the basis of a strategy which will improve dental services over a period of time. Some changes can be made immediately, others will involve complex, detailed planning. Small amounts or flexible use of resources can often lead to substantial improvements. On the other hand, larger scale initiatives will require investigation in a robust and systematic way and to be prioritised on an NHS Grampian basis as part of the ongoing capital and resource planning process. If we are to deliver the agenda set out during Dental HealthFit we will need to be creative, identifying opportunities for partnership and to access resources from different sources.
It is important that the profile of Dental Services in Grampian remains high and that the benefits of the ‘whole system’ approach adopted throughout the Dental HealthFit process is not lost. This will require positive clinical and professional leadership and an effort to ensure that the wider health community and the public remain engaged in the process of change and development.
The enormous benefit of involving the public in the HealthFit programme was again evident at Dental HealthFit. Once again the public capacity to understand the pressures on health services and the complex inter-connections involved and the opportunities, increased substantially through the whole system approach. It is evident that the public will accept and contribute to change when it is set in this wider context with an emphasis on improved access and quality.
It is important that a means of engaging the public and public representatives, including MSPs and MPs in the ongoing development of dental services is established as soon as possible.
An effort must be made to engage relevant colleagues throughout the NHS and in partner agencies who were not at Dental HealthFit, about the proposals to ensure that they are involved in the process.
NHS Grampian must continue to work closely with the Scottish Executive and the Chief Dental Officer and NHS Education for Scotland as partners in order to share experience and expertise, mutually influence policy, strategy and operational planning and to maximise use of available resources. NHS Grampian should share the detailed proposals arising from Dental HealthFit with these partners at an early stage in development.
Next Steps
Representatives from the Dental Service to present the Dental HealthFit Report to the meeting of the Grampian NHS Board on 19 August 2003.
The Dental HealthFit Report to be circulated widely in NHS Grampian and to partners.
The Area Dental Committee and the Oral Health Implementation Group should develop a detailed implementation plan building on the draft framework set out below:
Action Proposed Responsibility
Time
Presentation of Dental HealthFit to NHSG Board David Sullivan and Martin Donachie
19 August 2003
Presentation of Dental HealthFit to North of Scotland Planning Group
David Sullivan Summer/Autumn
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2003Development of multi-purpose facilityEstablish Working Group
Oral Health Implementation Group
Development of Managed Clinical Networks NHS GrampianDevelop model for enhanced practitioners and development of specialist services
General Dental Practitioners Sub-committee/ NHS Grampian/ NES
Develop proposals for salaried dentists in local dental practices
General Dental Practitioners Sub-committee and Martyn Merrett
Develop comprehensive Recruitment Strategy linked to incentives
NHS Grampian/NES/Area Dental Committee and Martyn Merrett
Develop Strategy for Workforce Planning and Development
NHS Grampian/NES/Area Dental Committee and Martyn Merrett
Develop links to Diagnostic and Treatment Services Laura GrayDefine elements of Core Service Martyn Merrett and
General Dental Practitioners Sub-committee
Target Special Needs Groups Community Dental Services
Develop Proposal for Emergency Care in General Dental Practices
General Dental Practitioners Sub-committee/Area Dental Committee and Oral Health Implementation Group
Develop links with LHCCs and Community Health Partnerships
Oral Health Implementation Group
Development of Professional Roles and Enhanced Education and Training
NHS Grampian and NES
Explore use of Teledentistry NHS GrampianCommission Audit of IT Systems NHS Grampian
The above suggested leads for implementing the action points provide initial indication only, and would be subject to further refinement
NHS Grampian, the Area Dental Committee and the Oral Health Implementation Group should establish working groups to develop detailed plans and proposals as appropriate and as soon as is practicable.
Proposals must be properly connected with NHS Grampian capital, revenue, prioritisation and approval processes.
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The Chief Dental Officer and the SEHD should be fully involved at each stage.
A formal review of progress should be undertaken in 12 months time.
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Appendix 1REFERENCE GROUPDENTAL
Martin Donachie, Chair, Area Dental Committee
Brian Dawson, General Dental Practitioners’ Sub Committee (immediate past Chair)
Chris Pilc, Chair, General Dental Practitioners’ Sub Committee
Bob Hamilton, Vice Chair, Area Dental Committee
Russell Stuart, Clinical Director, Community Dental Services, Moray
Russell.stuart@gpct,grampian.scot.nhs.uk
John Peatie, Clinical Director, Community Dental Services, Aberdeen / Aberdeenshire
Wendy McCombes, Director of Post Graduate Dental Practice Education for North and North East of Scotland
Martyn Merrett, Consultant in Dental Public Health
Sumithra Hewage, Consultant Orthodontist
David Sullivan, Director of Corporate Planning
Elaine Mottram, Organisational Development Manager
Helen Strachan, Clinical Services Manager
Gill Laing, Events Manager
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LIST OF PARTICIPANTS
Appendix 2
Aidan McKenna GDP WesthillAlan Macaulay Family Health Service Manager GPCTAlan Neill GDP AberdeenAlec Cumming Chief Executive GUHTAlex Matthewson Dental Practice Adviser GPCTAlex Smith Acting Chief Executive NHSGAlexander McDonald Community ForumAlexander Stewart GDP TurriffAlexander Tasker GDP FraserburghAlistair Bain Community Forum PeterheadAndrew Forgie Specialist Registrar/Lecturer in Restorative
DentistryUniversity of Dundee
Andrew Fowlie General Manager Moray LHCCAnn Ovall Dental Officer, Community NHSGAnne Keenlyside Dental Nurse NHSGBarry Maycock Community Forum AlfordBrian Dawson GDP (Immediate past Chairman of GDP Sub-Cmte) BanchoryBrian Ross Rep Dental DirectoryCarol Garden GDP StonehavenCatherine McGrade Vocational Trainee - VT MacduffCatriona Burrell Senior Dental Nurse NHSGChris Pilc GDP Chair GDP Sub
Committee/ LDCChris Reeks GDP InverurieChristine Coutts Physical Planning Officer NHSGColin Larmour Consultant Orthodontist NHSGColwynn Jones Consultant in Public Health NHS HighlandDavid Ovenstone GDP EllonDavid Shaw Dental Co-ordinator NHSGDavid Sullivan Director of Corporate Planning NHSGElaine Brown Public Health Lead, Moray NHSGElaine Mottram Organisation Development Manager NHSGElaine Shields Senior Dental Nurse, Maxillofacial Unit NHSGElizabeth Carnie Dental Nurse NHSGEric Baijal Director of Public Health NHSGEwan Robertson Acting Chief Executive GPCTGeorge Crooks Associate Medical Director GPCTGerry Donald Head of Physical Planning NHSGGill Laing Event Manager NHSGGillian Needham Postgraduate Dean NHS Education for
ScotlandGraeme Legge Property and Environment Engineer NHSGGraham Cunningham Dental Officer NHSGHazel Still Rep Dental DirectoryHelen Strachan Service Manager NHSGIsobel Mutch GDP MacduffJames Donaldson GDP Bridge of DonJamie Weir Chair ACF / AMC NHSGJanice Boggon Staff Grade - Maxillofacial Unit NHSGJennifer Christie Dental Nurse Maxillofacial Unit NHSGJim Royan Chairman NHSGJohn Miller Communications Manager NHSG
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John Peattie Clinical Dental Director NHSGJohn Reid Vice Chair GP SubJoyce Bisset Dental Nurse NHSGJulie Fletcher General Manager Deeside LHCCKaren Tosh Health Improvement Officer NHSGKatherine Lush Community Dental Nurse / GPT / VT NHS HighlandKatherine Yule Dental Nurse NHSGKen Hamilton Finance Manager NHSGLaura Gray Service Planning Lead, Aberdeen City
CollectiveNHSG
Lee Anderson Dental Nurse NHSGLeigh Sutherland Dental Hygienist, Maxillofacial Unit NHSGLinda Horne Dental Nurse ARIMargaret Brown GDP InverurieMargaret Burns Board Member NHSGMargaret Leggate CPD Tutor NHSGMargaret Murray Dental Nurse NHSGMargaret Sutherland Senior Dental Nurse NHSGMark Burrell Staff Grade in Oral Surgery GUHTMark Donaldson GDP PeterheadMark McEwen Public Health Lead Aberdeenshire Collective NHSGMartin Donachie Consultant in Restorative Dentistry NHSGMartin McCrone Chair Deeside LHCCMartyn Merrett Consultant in Dental Public Health NHSGMoira Munro Sister, Maxillofacial Unit NHSGMorven Swan Vocational Trainee - VT AberdeenMoya Nelson Chief Administrative Dental Officer OrkneyNanette Milne MSPNorman Wood Associate Specialist in Oral Surgery NHSGPauline Clark GDP FraserburghPauline Robson NHS 24 NorthRay Watkins Chief Dental Officer Scottish ExecutiveRichard Lochead MSPRobert Hamilton Community Dental Manager NHSGRoelf Dijkhuizen Medical Director GUHTRosemary Hutcheson Salaried GDP GPCTRussell Stuart Clinical Dental Director NHSGSheena Lonchay Complaints & Information Officer Local Health CouncilStephen Court GDP PeterheadStephen Rafferty GDP AberdeenStewart Scott GDP AboyneSue Kinsey Chairman Local Health CouncilSumithra Hewage Consultant Orthodontist NHSGSusan Jappy Assistant Director of Public Health NHSGSuzanne Morrice Dental Nurse NHSGTerry Mackie Physical Planning Director NHSGTony Wilson GDP OldmeldrumVal Tweedie Public Health Lead, Aberdeen City Collective NHSGWendy McCombes Director of Post Graduate Dental Practice
Education for North and North East of ScotlandDental Post Grad Centre
Wilma Balfour Community Dental Officer NHSGWilma Duncan Dental Auxiliary NHSG
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