NHS contractual obligations and communicating with the NHSBSA · known outcomes - completed vs...
Transcript of NHS contractual obligations and communicating with the NHSBSA · known outcomes - completed vs...
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Brian Kelly Senior Orthodontic Adviser
NHSBSA Dental Services
NHS contractual obligations and communicating with the
NHSBSA
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The NHSBSA has a statutory obligation to
monitor dental contracts on behalf of the
NHS in England and Wales
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Contract Monitoring
NHSBSA Dental Services is responsible for
processing and analysing information received
from NHS dental contractors in order to:
• Monitor the performance of the contractor
• Prevent, detect and investigate fraud or other
unlawful activities
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Orthodontic Contract Monitoring
• Data Collection (FP17O / Patient Questionnaires)
• NHS GDS Regulations and FP17O completion
• Vital Signs Reports
• Dental Assurance Framework Reports
• Clinical Monitoring and Reporting
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Orthodontic Contract Monitoring
• Data Collection (FP17O / Patient Questionnaires)
• NHS GDS Regulations and FP17O completion
• Vital Signs Reports
• Dental Assurance Framework Reports
• Clinical Monitoring and Reporting
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Data Collection: FP17O For 2016/17:
• 5.2% of case starts and 11.9% of completions were submitted without the clinical data set completed
For 2015/16:
• 5.6% of case starts and 12.9% of completions were submitted without the clinical data set completed
• Improvement needed most from GDS ‘mixed’ (mandatory / orthodontic) contract holders
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Data Collection:
Patient Questionnaires
• Random sample of case starts receive a
questionnaire within one month of the date of the
reported start. These are equally apportioned
across all NHS England Area Teams
• ~ 2,500 patients sent a questionnaire per month
• ~ 22% response rate
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Orthodontic Contract Monitoring
• Data Collection (FP17O / Patient Questionnaires)
• NHS GDS Regulations and FP17O completion
• Vital Signs Reports
• Dental Assurance Framework Reports
• Clinical Monitoring and Reporting
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NHS GDS Regulations: FP17O Completion
It is a statutory requirement to inform the
NHSBSA within two months of the
commencement or termination of a course of
treatment.
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FP17O Part 4
Orthodontic Data Set
Treatment Proposed/
Treatment Provided
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FP17O Part 5
Orthodontic Assessment
and Treatment Start
Box 1: Assessment & review
Box 2: Assess & refuse treatment
Box 3: Assess & appliance fitted
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NHS GDS Regulations: FP17O Completion
Part 5 Box 1:
Assessment and Review: 1 UOA
• Patient is not ready/suitable to start
treatment, has to be placed on a
treatment waiting list or is referred to
secondary care for treatment
• Full orthodontic assessment expected
including any necessary records,
radiographs or other investigations.
• It is not just an IOTN screening exercise
or a ‘quick review’
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NHS GDS Regulations: FP17O Completion
Part 5 Box 2:
Assess and Refuse treatment: 1 UOA
• NHS-funded orthodontic treatment is
unnecessary (IOTN < 3.6) or inappropriate
• Full orthodontic assessment expected
including any necessary records,
radiographs or other investigations.
• It is not just an IOTN screening exercise
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NHS GDS Regulations: FP17O Completion
Part 5 Box 3: Assess and appliance fitted:
• Patients aged under 10 years = 1+3 UOAs
• Patients aged 10-17 years = 1 + 20 UOAs
• Patients aged 18 years or over = 1+ 22 UOAs
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NHS GDS Regulations: FP17O Completion
Part 5 Box 3: Assess and appliance fitted:
Patients aged under 10 years = 1+3 UOAs
The number of UOAs credited is determined by
the age of the patient on the date the appliance is
fitted.
• Patients aged 9 years 364 days = 4UOAs
• Patients aged 10 years = 21UOAs
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NHS GDS Regulations: FP17O Completion
Part 5 Box 3: Assess and appliance fitted:
Patients aged 18 years or over = 23 UOAs
It is the patient’s age on the date of initial
assessment that determines their eligibility for
free NHS-funded orthodontic treatment. However
it is essential to record the date of initial
assessment on the ‘Assess and appliance fitted’
FP17O form if the patient becomes 18 before the
first appliance is fitted, otherwise a charge may
be levied and 23UOAs would be credited.
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NHS GDS Regulations: FP17O Completion
NHS transfer cases:
Cross Box 3: ‘Assess and appliance fitted’
Record the pre-treatment IOTN (or cross Box 6
‘IOTN not applicable’ where this information is
not available).
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FP17O Part 5
Orthodontic Assessment
and Treatment Start
Box 4: IOTN
Box 5: Aesthetic Component
Box 6: IOTN not applicable
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NHS GDS Regulations: FP17O Completion
Part 5 Box 4: IOTN (Dental Health Component)
Enter value 1 to 5:
• Grades 5 and 4 = Eligible for NHS funding
• Grade 3 = Borderline eligibility
• Grades 2 and 1 = Ineligible
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NHS GDS Regulations: FP17O Completion
Part 5 Box 5: IOTN (Aesthetic Component)
Enter value 1 to 10:
Mandatory for DHC 3 cases:
• Grades 6 to 10 = Eligible for NHS funding
• Grades 1 to 5 = Ineligible for NHS funding
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IOTN distribution in the population (Brook and Shaw 1989)
Dental Health Component (DHC)
Great (Grades 4 and 5) 32.7%
Moderate (Grade 3) 32.1%
None (Grades 1 and 2) 35.1%
Aesthetic Component (AC) …….
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No/Slight need Moderate/
Borderline need
Great need
58.2%
36.3% 5.4%
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Reported IOTN scores for Assess and Refuse cases
2016-2017 (England & Wales)
40.3
29.0
12.8
9.2
6.8
1.8 1.2 IOTN 3 (Ineligible) IOTN 2
IOTN 4 Missing IOTN
IOTN 5 IOTN 1
IOTN 3 (Eligible)
IOTN 3 (Ineligible) 17,192 40.3
IOTN 2 12,385 29.0
IOTN 4 5,448 12.8
Missing IOTN 3,500 9.2
IOTN 5 2,883 6.8
IOTN 1 760 1.8
IOTN (Eligible) 522 1.2
Assess and Refuse FP17s 42,690 100.0
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Reported IOTN scores for Assess and Refuse cases
2011/12 – 2016/17 (England & Wales)
0
5
10
15
20
25
30
35
40
45
50
11/12 12/13 13/14 14/15 15/16 16/17
%
Year
IOTN 3 (Ineligible)
IOTN 2
IOTN 4
Missing IOTN
IOTN 5
IOTN 1
IOTN (Eligible)
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Reported IOTN scores for Case Starts 2016-2017
(England & Wales)
77.2
16.5
4.3
1.8
0.1 0.1
0.1 IOTN 4 IOTN 5
IOTN 3 (Eligible) Missing IOTN
IOTN 3 (Ineligible) IOTN 2
IOTN 1
IOTN 4 158,395 77.2
IOTN 5 33,922 16.5
IOTN 3 (Eligible) 8,796 4.3 Missing IOTN 3,717 1.8
IOTN 3 (Ineligible) 194 0.1 IOTN 2 162 0.1 IOTN 1 120 0.1
Assess and Accept FP17s 205,306 100.0
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Reported IOTN scores for Case Starts 2011/12 to 2016/17
(England & Wales)
0
10
20
30
40
50
60
70
80
90
100
11/12 12/13 13/14 14/15 15/16 16/17
%
Year
IOTN 4
IOTN 5
IOTN 3 (Eligible)
Missing IOTN
IOTN 2
IOTN 3 (Ineligible)
IOTN 1
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NHS GDS Regulations: FP17O Completion
It is a statutory requirement to inform the NHSBSA
within two months of completion / termination of
treatment.
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FP17O Part 6
Orthodontic Completion
Box 1: Treatment abandoned
- patient failed to return
Box 2: Treatment abandoned
- patient requested
Box 3: Treatment discontinued
Box 4: Treatment completed
Box 5: PAR scores calculated
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NHS GDS Regulations: FP17O Completion
Part 6 Box 1:
Treatment abandoned - patient failed to return.
Post-treatment records not normally obtainable
and supervised retention not possible.
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NHS GDS Regulations: FP17O Completion
Part 6 Box 2:
Treatment abandoned - patient requested.
Post-treatment records are expected unless the
patient is moving away and continuing treatment
elsewhere.
Where appropriate it is expected that retainers
will be provided and that there will be a minimum
of 12 months’ supervised retention.
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NHS GDS Regulations: FP17O Completion
Part 6 Box 3:
Treatment discontinued:
Where treatment is terminated by the performer,
before the treatment objectives have been
achieved, because of lack of patient co-operation
or because the risks of continuing treatment
would outweigh the potential benefits
Post-treatment records are expected.
Where appropriate it is expected that retainers
will be provided and that there will be a minimum
of 12 months’ supervised retention.
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NHS GDS Regulations: FP17O Completion
Part 6 Box 4:
Treatment completed:
Where the treatment objectives have been
achieved.
Post-treatment records are required.
It is expected that retainers will be provided and
that there will be a minimum of 12 months’
supervised retention.
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ORTHODONTIC TREATMENT PROTOCOL
Commissioning Specialist Dental Services
DH Gateway Reference 5865
‘A high standard of outcome is expected. The
following principles indicate the features to be aimed
at in treating a case…….’
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Data Analysis: FP17O
2016/17
• Orthodontic case starts: 205,306
• Reported concluded: 183,336 (89.3%)
• Reported completions: 169,092 (82.4%)
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Data Analysis: FP17O
Reported completions trend
60
80
100
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
%
Year
% ReportedCompletions
Trend
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0
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0 3 6 9 12 15 18 21 24 27 30 33 36 39 42
Pro
po
rtio
n o
f C
ou
rses
of
Trea
tmen
t (%
)
Time Elapsed since treatment started (months)
Orthodontic Treatment pattern of activity for known outcomes
Abandoned/Discontinued Completed Open
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0 6 12 18 24 30 36 42
Pro
po
rtio
n o
f p
atie
nts
th
at s
tart
ed
tre
atm
en
t (%
)
Time Elapsed since treatment started (months)
Survival Rate Analysis - Proportion of patients continuing with orthodontic treatment for known outcomes - completed vs abandoned/discontinued - aged 11 - 17
Completed Abandoned/Discontinued Combined
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Orthodontic Completion Challenge 2011
‘Incomplete’ cases after 36 months or more:
• 18% still in treatment
• 40% completed and discharged
• 13% completed and in supervised retention
• 19% abandoned (12% failed to return)
• 2% discontinued
• 4% transferred
• 4% ‘other’
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Orthodontic Completion Challenge 2011
Reported reasons for non-submission of outcomes:
• 49% administrative error
• 5% unclear how to report
• 5% unsure when to report
• 3% unaware of requirement to report
• 2% recently reported / not yet recorded
• 10% ‘other’
• 25% no reason given
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NHS GDS Regulations: FP17O Completion
Part 6 Box 5:
PAR Scores calculated:
20 cases plus 10% of caseload required.
Acceptable to cross this box before the PAR
scores are actually calculated (this is normal as
most FP17O completion forms are submitted on
the day of appliance removal).
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FP17O Part 6
Orthodontic Completion
Box 6: IOTN DHC (1 to 5)
Box 7: IOTN AC (1 to 10)
Box 8: IOTN not applicable
Box 9: Repair to appliance
fitted by another dentist
Box A: Regulation 11
replacement appliance
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NHS GDS Regulations: FP17O Completion
Part 6 Box 6:
Post-treatment IOTN DHC score.
Part 6 Box 7:
Post-treatment IOTN AC score.
Part 6 Box 8:
‘IOTN not applicable’ e.g. where the patient fails
to return or transfers elsewhere in-treatment.
(IOTN was not intended as a measure of
treatment outcome).
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NHS GDS Regulations: FP17O Completion
Part 6 Box 9:
Repair to an appliance fitted by another dentist =
0.8UOA
This only applies to repairs for patients being
treated by another provider/contract holder, not
for a patient of a fellow performer within the same
practice.
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NHS GDS Regulations: FP17O Completion
Part 6 Box A: Regulation 11 replacement appliance
• Appliances lost or damaged beyond repair as a
result of an act or omission by the patient
• Repairs or replacement appliances necessitated
as a result of ‘fair wear and tear’ are free of
charge to the patient during treatment and
during supervised retention (normally a minimum
of 12 months).
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NHS GDS Regulations: FP17O Completion
Part 6 Box A: Regulation 11 replacement appliance
• No UOAs are credited
• The contract holder retains the patient charge
• The patient charge is 30% of the Band 3 charge
per appliance (currently £73.20 per appliance)
• Twin-blocks are considered to be two appliances
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NHS GDS Regulations: FP17O Completion
Part 6 Box A: Regulation 11 replacement appliance
• The patient may claim a refund where there are
mitigating circumstances or financial hardship.
• Refunds are claimed from, and paid by, the
NHSBSA.
• The patient needs to submit a completed
FP17R11 form accompanied by a receipt for the
charge.
• The contract holder retains the full fee even if a
full refund is made to the patient.
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NHS GDS Regulations: FP17O Completion
Part 6 Box A: Regulation 11 replacement appliance
• Appliances lost or damaged beyond repair as a
result of an act or omission by the patient
• Repairs or replacement appliances necessitated
as a result of ‘fair wear and tear’ are free of
charge to the patient during treatment and
during supervised retention (normally a minimum
of 12 months).
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NHS GDS Regulations:
Mixing of NHS and private services
The charging of private fees to supplement the
appropriate NHS fee is not allowed.
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Orthodontic Contract Monitoring
• Data Collection (FP17O / Patient Questionnaires)
• NHS GDS Regulations and FP17O completion
• Vital Signs Reports
• Dental Assurance Framework Reports
• Clinical Monitoring and Reporting
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Ratio of Assessments to Patient Identities (Contract level)
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Ortho Vital Signs June 2017 % of all assessments that were assess and fit
appliances (rolling 12 month period)
57.1
% of all assessments that were assess and refuse
(rolling 12 month period)
11.5
% of all assessments that were assess and review
(rolling 12 month period)
31.4
% of terminated courses where treatment was
abandoned or discontinued (rolling 12 month period)
7.9
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% of completed treatments indicating that PAR score
was taken (year to date)
63.3
Rate of removable appliances per 100 fixed
appliances – proposed treatment (rolling 12 month
period)
5.54
Rate of removable appliances per 100 fixed
appliances – completed treatment (rolling 12 month
period)
4.76
Ortho Vital Signs June 2017
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% of courses of treatment with removable appliances
only – proposed treatment (rolling 12 month period)
1.9
% of courses of treatment with removable appliances
only – completed treatment (rolling 12 month period)
1.5
% of patients satisfied with the treatment they have
received (rolling 12 month period)
96.1
Ortho Vital Signs June 2017
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Ortho Vital Signs Year End (2008/09 to 2016/17)
0
10
20
30
40
50
60
70
80
90
100
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
%
Year
% of patients satisfied with the treatment they havereceived (rolling 12 month period)
% of completed treatments indicating that PAR scorewas taken (year to date)
% of all assessments that were assess and fitappliances (rolling 12 month period)
% of all assessments that were assess and review(rolling 12 month period)
% of all assessments that were assess and refuse(rolling 12 month period)
% of terminated courses where treatment wasabandoned or discontinued (rolling 12 month period)
Rate of removable appliances per 100 fixed appliances- completed treatment (rolling 12 month period)
% of courses of treatment with removable appliancesonly - completed treatment (rolling 12 month period)
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Orthodontic Contract Monitoring
• Data Collection (FP17O / Patient Questionnaires)
• NHS GDS Regulations and FP17O completion
• Vital Signs Reports
• Dental Assurance Framework Reports
• Clinical Monitoring and Reporting
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Background • Purpose : To support a more standardised approach to
contract performance management
• Not intended to supplant other commissioning guidance nor
the role of routine contracting processes
• Multi-agency group involved in scoping of the framework
• A series of indicators chosen covering four categories:
Delivery, Assessment, Treatment and Outcomes
• Designed as “Tier 1” analysis i.e. overarching and general
in nature
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DAF Orthodontic Reports • Reports available quarterly to Area Teams
• Contracts shown as “flags for attention” …further
assessment needed i.e. report is designed as a starting
point
• Size element used to avoid highlighting smaller contracts
simply because of their size
• Planned for providers to be able to see their results via the
Dental Portal / ‘Compass’
• ‘Drill-down’ data available to commissioners, investigating
factors that relate to a contract’s performance
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DAF Ortho Report Indicators
Delivery:
• % of Contracted UOA Delivered (Year to Date)
Assessment:
• % of assessments that are Assess and fit appliance
• % of assessments that are Assess and refuse
• % of assessments that are Assess and review
• % of assessments and review 9 years old or under
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DAF Ortho Report Indicators
Treatment:
• Ratio of reported concluded to assess and fit
• % of concluded reported as using removable appliances
only
Outcomes:
• Ratio of UOAs per reported completed case
• % of contracts meeting their expected reporting of PAR
scores
• % of concluded cases where treatment is reported as
abandoned or discontinued
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Orthodontic DAF England March 2017
Delivery 2015 % 2016 % 2017 %
UOA Delivered
Overall % of Contracted UOA Delivered (Year to Date) 93.6 94.5 95.5
Flagged Total % of Contracted UOA Delivered (Year to
Date) 24.1 35.8 16.5
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Orthodontic DAF England March 2017
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Orthodontic DAF England March 2017
Assessment 2015 % 2016 % 2017 %
Age at
assessment
Overall % of reported assessments and review
where patient is 9 years old or under 13.2 12.4 12.0
Flagged Total % of reported assessments and
review where patient is 9 years old or under 2.9 2.1 2.5
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Orthodontic DAF England March 2017 Treatment 2015 2016 2017
Cases reported
complete as a
function assess and
fit appliance
Overall ratio of reported concluded (completed,
abandoned or discontinued) courses of treatment to
reported assess and fit appliance.
0.9 0.9 0.9
Flagged Total ratio of reported concluded (completed,
abandoned or discontinued) courses of treatment to
reported assess and fit appliance.
24.2 16.6 25.7
0.9 0.9 0.9
24.2
16.6
25.7
0
5
10
15
20
25
30
2015 2016 2017
%
Years
Overall Ratio of reported concluded (completed, abandoned ordiscontinued) courses of treatment to reported assess and fit appliance.
Flagged Total ratio of reported concluded (completed, abandoned ordiscontinued) courses of treatment to reported assess and fit appliance.
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Orthodontic DAF England March 2017 Treatment 2015 % 2016 % 2017 %
Type of
appliance
used
Overall % of concluded* (completed, abandoned or
discontinued) courses of treatment reported as using
removable appliances only. * currently only using completed
1.7 1.6 1.5
Flagged Total % of concluded* (completed, abandoned or
discontinued) courses of treatment reported as using
removable appliances only. * currently only using completed
2.5 2.1 2.6
1.7 1.6
1.5
2.5
2.1
2.6
0.0
0.5
1.0
1.5
2.0
2.5
3.0
2015 2016 2017
%
Years
Overall % of concluded* (completed, abandoned or discontinued) coursesof treatment reported as using removable appliances only. * currently onlyusing completed
Flagged Total % of concluded* (completed, abandoned or discontinued)courses of treatment reported as using removable appliances only.
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Orthodontic DAF England March 2017 Outcomes 2015 % 2016 % 2017 %
UOAs reported per
completed case
Overall ratio of the number of UOAs reported per
reported completed case (not including abandoned
or discontinued cases)
26.3 27.0 26.0
Flagged Total ratio of the number of UOAs reported
per reported completed case (not including
abandoned or discontinued cases)
11.5 9.1 12.0
26.3 27.0
26.0
11.5
9.1
12.0
0
5
10
15
20
25
30
2015 2016 2017
%
Years
Overall Ratio of the number of UOAs reported per reported completedcase (not including abandoned or discontinued cases)
Flagged Total ratio of the number of UOAs reported per reportedcompleted case (not including abandoned or discontinued cases)
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Orthodontic DAF England March 2017
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Orthodontic Contract Monitoring
• Data Collection (FP17O / Patient Questionnaires)
• NHS GDS Regulations and FP17O completion
• Vital Signs Reports
• Dental Assurance Framework Reports
• Clinical Monitoring and Reporting
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Clinical Monitoring and Reporting
• Five completed cases per Performer
chosen by the NHSBSA
• 450 Performers per annum
• 3-year rolling programme
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Clinical Monitoring and Reporting
• Full records requested including pre- and
post-treatment study models, radiographs
and intra-oral photographs and the
FP17DCO form
• Since 1st January 2014 providers have been
requested to submit 3D digital study models
rather than plaster duplicates
• Details are included in the request letter and
available on the NHSBSA website
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Clinical Monitoring and Reporting
• Full records requested including pre- and
post-treatment study models, radiographs
and intra-oral photographs and the
FP17DCO form
• Since 1st January 2014 providers have been
requested to submit 3D digital study models
rather than plaster duplicates
• Details are included in the request letter and
available on the NHSBSA website
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Clinical Monitoring and Reporting
• Performers are requested to complete
an Orthodontic Case Assessment pro-
forma (rather than forwarding actual
written patient records)
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Clinical Monitoring and Reporting
Summary Report
Three categories:
• Clinical Records (FP17 DCO, OCA
form, Radiographs, Photographs, Study
Models)
• Treatment Need (IOTN) / Accuracy of
IOTN Scoring
• Standard of Treatment
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Clinical Monitoring and Reporting
Summary Report
Traffic Light System
Red: Unsatisfactory
Amber: Acceptable but reservations expressed
Green: Good – satisfying all criteria
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Clinical Monitoring and Reporting:
Summary Report for ATs/LHBs
Red: Issues requiring further investigation
Amber: Issues for discussion at next
scheduled contract review
Green: No cause for concern
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Clinical Monitoring and Reporting
• Written summary sent to the Provider
(Contract holder)
• Observations requested within 14 days
• Report plus observations forwarded to
PCO (AT/LHB)
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Clinical Monitoring and Reporting
• Should concerns arise closer scrutiny could
be arranged using a larger sample or
(rarely) a practice visit
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Provider Report: Covering Letter
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Commissioning Body Report: Covering Letter
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Proposed frequency of orthodontic clinical monitoring
for each Performer
Category Description
Expected
interval
(months)
Red risk: Red grade awarded for Diagnosis and Treatment Planning or Standard of
Treatment. 12
Amber risk: Amber grade awarded for Diagnosis and Treatment Planning or Standard of
Treatment category or a red grade awarded for one of the other four
categories. 24
Green risk: All green grades or green grades awarded for Diagnosis/Treatment
Planning/Standard of Treatment with no red grades for the other four
categories. 36
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Clinical Monitoring and Reporting:
Standards expected?
Three categories:
• Clinical Records (FP17 DCO, OCA
form, Radiographs, Photographs, Study
Models)
• Treatment Need (IOTN) / Accuracy of
IOTN Scoring
• Standard of Treatment
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Good quality pre-treatment records
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Radiographs: Current Best Practice
• Where pre-orthodontic radiographs are required or prescribed, current
best practice is considered to be the use of digital dental panoramic
radiographs supplemented, where necessary, with a lateral
cephalometric radiograph and/or appropriate intra-oral views (Ref.
FGDP(UK) Selection Criteria for Radiographs 2013 and BOS
Orthodontic Radiographs Guidelines, Third Edition 2008 and Fourth
Edition 2015).
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Absence of Radiographs: Standard Phrases
• The current radiographic guidelines are open to interpretation.
However the unanimous view of the NHSDS Orthodontic Advisers is
that appropriate pre-treatment radiographs should be obtained where
significant tooth movement is proposed particularly where extractions
are prescribed (Ref. British Orthodontic Society Orthodontic
Radiographs Guidelines, Third Edition 2008 and Fourth Edition 2015).
• It is considered best practice for the clinician responsible for treatment
to have access to any relevant radiographs (or copies) prior to, during
and after treatment. It is also a requirement of the NHS regulations for
all relevant records (or copies) to be made available on request.
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Unnecessary Radiographs: Standard Phrases
• The act of obtaining { x radiograph} for this patient / these patients
would appear to be contrary to the IR(ME)R 2000 regulations and the
current radiography guidelines which state that such radiographs are
only justified in order to provide information not otherwise available
but necessary to deliver safe and effective treatment.(Ref. FGDP(UK)
Selection Criteria for Radiographs 2013 and BOS Orthodontic
Radiographs Guidelines, Third Edition 2008 and Fourth Edition 2015).
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Clinical Monitoring and Reporting:
Standards expected?
Three categories:
• Clinical Records (FP17 DCO, OCA
form, Radiographs, Photographs, Study
Models)
• Treatment Need (IOTN) / Accuracy of
IOTN Scoring
• Standard of Treatment
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3D Digital Study Models
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Clinical Monitoring and Reporting
Standards expected?
Three categories:
• Clinical Records (FP17 DCO, OCA
form, Radiographs, Photographs, Study
Models)
• Treatment Need (IOTN) / Accuracy of
IOTN Scoring
• Standard of Treatment
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IOTN distribution in the population (Brook and Shaw 1989)
Dental Health Component (DHC)
Great (Grades 4 and 5) 32.7%
Moderate (Grade 3) 32.1%
None (Grades 1 and 2) 35.1%
Aesthetic Component (AC) …….
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Ineligible Eligible
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No/Slight need Moderate/
Borderline need
Great need
58.2%
36.3% 5.4%
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Patient AD: Borderline need based on IOTN DHC and AC
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Patient RL: Borderline need based on IOTN DHC and AC
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Clinical Monitoring and Reporting:
Standards expected?
Three categories:
• Clinical Records (FP17 DCO, OCA
form, Radiographs, Photographs, Study
Models)
• Treatment Need (IOTN) / Accuracy of
IOTN Scoring
• Standard of Treatment
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ORTHODONTIC TREATMENT PROTOCOL
Commissioning Specialist Dental Services
DH Gateway Reference 5865
‘A high standard of outcome is expected. The
following principles indicate the features to be aimed
at in treating a case…….’
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ORTHODONTIC TREATMENT PROTOCOL
Commissioning Specialist Dental Services
DH Gateway Reference 5865
Treatment will normally be completed with fixed
orthodontic appliances in both arches.
Treatment of a single arch should only be undertaken
where this would be sufficient to achieve the requisite
quality of outcome.
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Orthodontic Completions 2016/2017 (England & Wales)
0
5
10
15
20
25
Single FixedAppliance Only
FunctionalAppliance Only
RemovableAppliance Only
Functional &RemovableAppliance
Dual FixedAppliance & Other
Appliance (NotRetainer)
Single FixedAppliances
No ReportedAppliances
%
Mixed Orthodontic
55.3
66.4
Dual-Arch Fixed Appliances Only
68.7
78.9
All Dual-Arch Fixed Appliances
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Trend for appliances used 2008-09 to 2016-17 (E&W)
0
10
20
30
40
50
60
70
80
90
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Dual-arch Fixed Appliance (total)
Dual-arch Fixed Appliance Only
No Reported Appliance
Dual-arch Fixed Appliance + Other
Single Fixed Appliance + Other
Single Fixed Appliance Only
Removable Appliance Only
Functional Appliance Only
Functional and RemovableAppliance
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Standard of Treatment: Standard Phrases
• The standards applied are those outlined in the Orthodontic Treatment
Protocol, as agreed between the Department of Health and the British
Orthodontic Society at the inception of the 2006 NHS orthodontic
contract. This protocol can be found on page 15 of the Department of
Health document ‘Commissioning Specialist Dental Services’ (Gateway
Reference 5865).
• The performer is reminded that where the treatment objectives have
not been achieved a course of treatment should be reported as
‘Treatment discontinued’ or ‘Treatment abandoned – patient requested’
with Part 6 of the FP17O completed accordingly.
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Clinical Monitoring and Reporting:
Standards being achieved ?
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Brian Kelly Senior Orthodontic Adviser
NHSBSA Dental Services
NHS contractual obligations and communicating with the
NHSBSA