‘Salaried Dental Services’BDA 21st May 2012
Colette M Bridgman
Consultant In Dental Public Health
NHS Manchester / GM Cluster
On secondment to NHS CB Authority
During this presentation I will:• Give a bit of context to current reforms in NHS • Link these changes with how I see the opportunities and
challenges unfolding for SDS teams• Explore how to define the needs of vulnerable groups,
describe the rationale for services and how to monitor outcomes rather than processes
• Need to respond to the direction towards Consultant / Specialist led care?
• Finally NHS CB approach – where might that lead us in development of salaried dental services in England.
Current reforms and what it means for dentistry and SDS
Liberating the NHS – Government’s vision for health July 2010
• Most relevance for dentistry? NHS Commissioning Board / Public Health England / LPN
• This new architecture will take on many of the roles and responsibilities currently discharged by the Department of Health, Strategic Health Authorities and Primary Care Trusts
• The NHS Commissioning Board will be responsible for commissioning all NHS dental services
Public Health England
NHS Commissioning
Board
Public Health
Primary Dental Care
Secondary Dental Care
DPH schemes
Local
DirPublic Health Medical
EducationEngland
Workforce development
Authority
Commissioning Responsibilities
for Dentistry
Eric Rooney Slides
Public Health England
Public Health England
Public Health EnglandNHS
Commissioning Board
NHS Commissioning
Board
NHS Commissioning
Board
Dental Professional
Network
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OrthoNetwork
Oral SurgeryNetwork
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Commissioning priorities
Local DemocraticAccountability
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Clinical Commissioning
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Health and Wellbeing Board
Understanding Need and Use of Services at the heart
NE
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Unmet Need Met Need
Appropriate Use Avoidable Use
DEMANDNeed to achieve met need & Appropriate use of services
Need Purpose and function: then form…….‘Specialist Advanced Treatment in Primary Care’
First can we agree the need, rationale and future development of salaried dental services – can I be controversial on title SDS?
• Define vulnerable groups by ‘locality’, describe the need consistently plus
take account of future demographics and trends• Direction? Consultant/specialist led services for vulnerable groups• Should be thinking in terms of Complexity/Need and then Competence and
Quality – team and environment • Consistency of delivery outcomes regardless of Setting
Paediatric - Children firstIssues – Safeguarding andGA Referrals +++ Demand led
GA list in acute centreAnalysis of what is happening and
why and pathway designed to improve care
Involved all sectors Specialist led triageChild friendly GDS good
environment and skills in practice i.e. therapist/IHS
CDS responded rapid access
Impact - Care pathway agreedExposed some primary care
referral decisions and care below expected standards
Reduced reliance on GA and numbers by almost 70%
Most received care with LAFollowed up and offered
continuing care ……… BUT
Can scheme be replicated? Needs to ...
Have Consultant/Specialist input and leadership
Be needs led and commissioners involved
Expose GDPs if isolated – need formal link to specialist/SDS/Secondary Care
Deliver evidence informed practice and reflective learning
Have end to end care pathway redesign – single operating model and collaboration across sectors like we have never had in dentistry – how do we go from where we are now? Current reforms offer opportunities?
The Service Model – NHS CBAdvanced / Specialist Care
• Coherent inter service relationships with integrated dental pathways the point of all connections has to focus on the needs of users
• Currently there is a degree of co-operation but little transparency or sense of coherence to meet needs of patients between settings
• A co-ordinated, patient-centred network of dental services in different settings, embodying alignment of policy making, service commissioning, needs assessment, performance management, funding and consistent delivery of outcome measured quality clinical practice.
End to end redesign integrated pathway to co-ordinate care pathway regardless of setting
Monitoring and evaluation built within a effective single service model with consistent need and outcome measurement
Underpinning PrinciplesAll Primary Care contracts performance
managed – frequent referring performers identified / provider informed – training
Consistent data capture (central capture and referral management in place – one way)
of all referrals to all specialtiesAligned need/diagnostic coding and tariff/costConsistency of Specification: quality standards, equipment environment and qualifications/competenceAltered job plans for specialists
So referral management ……….
To date over 1500 referrals processedSteady increase in quality and content of referrals
Rejections reduced from 18% to less than 5%Diversion from secondary to primary care achieving 30% rate
Referrers can easily check the progress of their referral
NHS CB. Design a commissioning system for secondary care dental specialties and salaried dental services capable of excellence
In doing so by specialty there is a need to have in place:
• Ability to describe & meet need• Have consistent delivery and reporting of evidence based services,
diagnosis and outcomes (coding and tariff aligned)• Have a clinical consensus on case complexity that can be adopted within
agreed care pathways – same quality and reporting regardless of setting• A managed clinical network/shared service and single operating model• Clinicians leading and influencing change …….• Excellence & investment/shift to in primary care
Outcomes that will assist:
• Clinical consensus on consistent approach to data collection • Robust information on need /procedure assists understanding
trends• Use evidence base on effectiveness of procedures & outcomes • Produce a consensus on exactly what is defined as minor,
intermediate or major – competence, qualifications, environment • Need to map current service provision and links, WF and costs• Space - to think through how it could be – incentives and barriers• Describe any innovation in system and validate• Same standards and tariffs in secondary and primary care setting?
From the old world to the new
From compliance
States a minimum performance standard that everyone must achieve
Uses hierarchy, systems and standard procedures for co-ordination and control
Threats of penalties/sanctions/shame creates momentum for delivery
Based on organisational accountability
To commitment
States a collaborative goal that everyone can commit to
Based on shared goals, values and sense of purpose for co-ordination and control
Commitment to common purpose and creative energy for delivery
Based on relational commitment
Source: Helen Bevan 2011
...deliver a better balanced system for Central Manchester shifting from:-
- Hospital care to services delivered in the community
- Clinical care to patient self care
- Measuring quantity to measurement of quality
- What the NHS spends to what it can afford
Success will be:--Improved life expectancy
-Improved quality of life for people with long term conditions
-Effective recovery from ill health & injury
-Excellent patient experience
-Safe and effective services; no avoidable harm
-Hitting our targets
-A balanced budget bridging our 2% financial gap
Public health, prevention and patient partnerships - Empowering patients- Promoting healthy lifestyles - Supporting self care- Preventing ill health- Identifying disease early and reducing its progression
Quality of care- Quality improvement
-Primary care-Education and learning-Medicines optimisation
- Quality assurance-Driving quality and safety in the services we commission
Service reform and integrated care-Long term conditions management-Integrated care pathways for planned and urgent care-Mental health services-Services for children
Making it happen- Leading the health system- Measuring quality & outcomes- Shifting resources to community settings- Incentivising for quality- Contracting and performance
Our 41 member practices within four localities
Our provider partners- CMFT- MMHSCT- NWAS- Adult social care- Children’s services- Primary Care- Voluntary sector
Clinical and managerial leadership- CCG Board-Health and Wellbeing Board-Clinical Integrated Care Board
April 2012 – March 2015
Our group
-41 member GP practices-£265m budget-211,000 population and growing-a young population; 56% under 30-Over 30% from BME groups-High levels of deprivation-High prevalence of long term conditions
Our Mission‘Informed by the views of local people and working closely with other health and social care professionals; Central Manchester Clinical Commissioning Group will design and develop health services which are high quality, safe and affordable and which will support communities to be the healthiest they can be.‘
We will be:--Fair in the way we make decisions-Honest about the decisions we make and why we make them-Open in our approach to decision making, encouraging involvement in our processes and structures-Intolerant of poor quality services and health inequalities-Robust in our support for the NHS and local health services
Patient and public involvement at every level of our organisation
Commissioning colleagues- Partner CCGs- Manchester City Council- NHS Greater Manchester- Commissioning support services
A culture of continuous improvement
Development of an excellent commissioning organisation-Strong leadership-A great team-Good systems and processes
People die too young in Central Manchester. We also know that people die younger, and are more ill, in some parts of our locality than others. Central CCG will work with Manchester City Council to deliver targeted programmes addressing these health inequalities; preventing people becoming ill (or more ill), identifying illness early and supporting our communities to manage their own health and use the right services when they need them.
Supporting self care
Establish locality based delivery of long term condition self management programmes
Deliver enhanced Choose Well campaign
Improved patient information on treatment of minor ailments in children
Telehealth for patients where appropriate
Preventing ill health
Establish brief intervention programmes for smoking, alcohol and weight
Increase immunisation and vaccination rates
Identify disease
Increase delivery, and uptake, of health check programmes
Cancer awareness and early detection campaigns
Improve screening rates – adult, pregnancy, neo-natal
Promote HIV testing
Improving services
Redesign Sexual health services (young people’s services and general outpatient services- developing GM specifications)
Drugs Service re-design and re-tender
Review of alcohol care pathway
Reform of School Nursing service
Public health, prevention and patient partnerships
Outcomes
TBC TBC TBC TBC TBC
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