North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

Proposal to develop an Oral and Dental Health Clinical Network across the North of Scotland for all dental services

Background and present situation The North of Scotland Maxillofacial, Oral & Dental Health Project Board have primarily been concerned with developing the specialist oral and dental care services across the NoS with initial developments maturing around:

§ Maxillo­facial and surgical dental services network; § Restorative dental care network; and § Orthodontics network.

In parallel to the work of the NoS group, specialist dental services have developed within Aberdeen Dental School in a wider range of specialties including Oral Medicine, Oral Radiology and Paediatric Dentistry. The priority for these latter services has been Dental Education however each specialism has started to impact on service delivery and quality of service across the North of Scotland and needs to be integrated into the network.

The majority of work to date has concentrated around five of the six northern Health Boards. Tayside has not linked its dental services to the North in any substantial way as it does not have the same issues of workforce and recruitment in dentistry. NHS Tayside as a Board has one of the highest number of both dental specialists and primary care staff per head of population in Scotland and has close links to Fife for service development.

Primary Care services in the North of Scotland – meeting held September 2012

A meeting was convened in September to review Primary Dental Care service design and delivery. This meeting was primarily concerned with the future use of the salaried dental services in the North of Scotland. The Health Boards represented were NHS Highland, NHS Grampian, NHS Western Isles and NHS Orkney, with apologies from NHS Shetland.

The Boards were represented by a range of staff including Dental Public Health, Clinical Directors and Business Managers of the Public Dental Services (salaried and community staff) from across the North of Scotland. Discussion ranged across many service issues including recent controls by the Scottish Government on the future development of the salaried dental service.

Conclusions from the meeting were:

§ There is a distinct model for delivery of dental care services across the North of Scotland which reflects the more rural and remote aspects of service delivery in the North.

§ In the five Health Boards in the North, the salaried dental services represent a larger component of the total primary care workforce (circa 30%).

§ Control of one section of primary care dental services without consideration of the whole service may lead to Health Boards being unable to plan services appropriately in remote and rural communities.

§ Strategies to develop and support more flexible delivery and design could be achieved by more collaborative working. The five Health Boards in the NoS combining to support such strategies could form a strong alliance to influence national policy.

NORTHOF SCOTLAND PLANNING GROUP

Meeting: NoS Maxillofacial, Oral & Dental Health Project Board

Date: 12 th November 2012

Item: 38/12

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

§ Planning and development of primary care dental services could be facilitated by using the present NoS Maxillofacial, Oral & Dental Health Project Board used for planning specialist dental and oral health care services. Such an expansion/extension would incorporate all dental and oral care services across the five Boards.

§ This collaborative network would facilitate a one system care structure for those accessing any NHS dental services/dental care pathways and ensure a seamless service for patients across the NoS.

§ A network of the North of Scotland Health Boards could deliver over 97.5% of dental care in the North, with limited need to refer patients outwith the North. In this scenario, the majority of services would be delivered through primary care in localities and communities across the North of Scotland. Specific consideration will need to be given to this type of target when considering the most southern area (Argyll and Bute).

§ Improved collaboration could bring efficiency and improved effectiveness to the services through appropriate planning.

§ Planning of services in NoS is considerably different to that in the urban central belt of Scotland, with the relationships between salaried, independent and intermediate care specialists being substantially different in remote and rural localities.

Discussion

Clinical Directors and Consultants in Public Health across the NoS consider that a northern collaboration of the five Health Boards could result in a single planned system for oral and dental health. This type of strategic network would support present structures with Health Boards and Community Health Partnerships and Acute services maintaining a clear role in planning and delivery within an agreed framework for dental and oral care across the North of Scotland.

The emphasis on such planning would be efficient and effective delivery of oral and dental care as close as possible to the community.

The Network would need to establish a structure to allow the broader participation within all five Health Boards and clear participation of all sectors, including independent practitioners (possibly through the Area Dental Committees).

The role of education and training across the NoS would be a key component, with inclusion of NHS Education, Aberdeen University and the University of the Highlands and Islands into the network.

There is reliance, in terms of planning local services in the five Health Boards, on the salaried services. This is highlighted clearly when reviewing the numbers of salaried staff in the North compared with the West of Scotland (see table below 29.4% (5HB) compared with 7.5% West)

ISD March 2012 Headcount

Scotland East Region

West Region

North Region

NOS (5 HB )

General Dental Service Total 3115 831 1484 837 570

Non­salaried dentists 2728 727 1388 646 413 Principals 2486 662 1290 564 361 Assistants 60 9 28 23 20 Vocational Dental

Practitioners 198 57 76 65 38

Salaried dentists 426 112 112 204 168 Salaried as a % of total GDS 13.7 13.5 7.5 24.4 29.5

Recently, the Scottish Government set controls on recruitment of salaried dental staff. These staff contribute about a third of the workforce within the five Health Boards. Planning of dental services is therefore significantly different from other parts of Scotland and the UK.

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

The Group felt strongly that control by Scottish Government of one aspect of planning of Primary Care could jeopardise effective and efficient planning of services, especially in the five Health Boards in the North of Scotland.

Recommendations

1. NoS Health Boards consider this proposal and if agreed, develop a North of Scotland Network. This new network would comprise an estimated 650 dentists, 16 consultants, and over 750 dental care professionals working in 250 locations in hospitals, health centres and dental practices. These teams presently deliver NHS dental and oral care to over 600,000 people across the North.

2. The recommended network would include NHS Grampian NHS Highland, NHS Shetland, NHS Orkney and NHS Western Isles.

3. The NoS Maxillofacial, Oral and Dental Health Project Board will consider (if the proposal is accepted) a more detailed paper for their next meeting with a view to identifying a structure and objectives for the new expanded network and consider how to develop these further through an inaugural meeting of the network for North of Scotland in February 2013. The aim of the meeting would be to develop objectives, themes and structure for the new expanded network.

4. The recommended network would incorporate the following services from each of the five Health Boards:

§ Preventive and anticipatory care services, including Childsmile; § Primary Care Services which includes independent, salaried and community dental services; § Intermediate specialist primary care services care services including Special Care services ; § Hospital Oral and Dental specialist services; and § Aberdeen University, University of the Highlands and Islands and NHS Education Scotland.

Ray Watkins Consultant in Dental Public Health, NHS Grampian / Regional Clinical Lead, NoSPG

*** This paper was developed from an initial meeting with colleagues in the five Boards. It may not represent their views accurately but reflects the issues highlighted and outcomes proposed.