HEALTHCARE PROFESSIONALS COMMISSIONING NETWORK

Development meeting 6th September 2011

DENTAL UPDATE

Presenters

REENA PATEL HPCN DENTAL LEAD

RACHEL NOBLE BRITISH DENTAL ASSOCIATION POLICY MANAGER

SEEMA SHARMA DENTIST, BUSINESSWOMAN AND “DISRUPTIVE

INNOVATOR”

Agenda

NHS dental services HPCN Dental update HPCN Outputs Oral Health Frameworks in dental

practice: Implementation Barriers

Dentistry: Where are we now?

Represent 23,000 dentists in primary NHS, private practice, hospitals, armed forces, salaried service, public health and academia

Contracts held locally National level – policy-making committees that represent

each of the ‘crafts’ Piloting a new contract – 68 sites across England Local level – network of Local Dental Committees Challenges – dentists have little time to ‘look up’. Tightly

regulated and perverse incentives of the 2006 contract have left practitioners chasing targets

We’re ready for change, but DH must get it right

Working back from 2013

Services entirely commissioned by the NCB – contracts held nationally

Developing and implementing new contract Articulate policy positions and specialty needs -‘Futures’

documents Working with Local Government Association, PHE, DH

and other stakeholders to smooth the transition for dentists and ensure we’re not missed off the agenda

Health Bill – it works well for dentistry!

HPCN Dental workstream updateCurrent status:

Outputs:Multi-professional collaboration using a robust evidence base

Patients with oral complaints attending GPs Understanding the problem

Need to improve access to, and uptake of, oral and dental care for the Lambeth population

Barriers to the uptake of dental care include Fear Availability Accessibility Cost

Historical studies show that dental attendance at GPs can be significant: out of 1,650,882 patient attendances at 30 medical practices in the study year, 4,891 (0.3%) were for oral/dental problems. 75% of dental attendances were related solely to these problems.

GPs may not be well equipped for managing dental pain

Source: Lambeth Oral Health Needs Assessment, March 2010Mansour and Cox, 2006Anderson et al 1999

An understanding of the extent of the problem

Prescribing guidance for GPs? Enhanced collaboration/communication

between local GPs and GDPs? Provision of information about access to

local services Provision of self care information? Referral pathway between GP GDP

Output 1:What do we need?

Aim: Dissemination of evidence based preventative recommendations for healthcare professionals – a resource based on:

2 key documents: Delivering better oral health: An evidence-

based toolkit for prevention (DH 2009) Prevention and Management of Dental

Caries in Children (SDCEP 2010)

Output 2: Dissemination of consistent evidence based preventative messages

Evidence based messages

Brush for two minutes twice daily Spit don’t rinse Use the correct amount of toothpaste with age-appropriate

level of fluoride Restrict food and drinks containing sugar to no more than

four occasions in any one day Drink only water or milk between meals Snack on sugar-free snacks between meals Do not leave squash, fruit juices, sweetened milk, nor soy

formula milk unattended in feeding bottles through the night. Do not eat or drink after brushing at night Be aware of hidden sugars in food and medicines

Output 2: What is required?

What would be useful? Are there issues around:

Dissemination? Access? Uptake and implementation?

CARIES TOOTH SURFACE LOSS

PERIODONTAL DISEASE SOFT TISSUE LESIONS

1. AB Brushing technique 2. AT Para function 3. ER Reflux/eat disorder

1.Use of Fluoride TP2. Sibling exp3. Xerostomia

Diabetes Site

Summarising dental diseases

Barriers in collaborating with other healthcare providers

Poor communication across organisational boundaries

Over complicated messages Over simplified messages Different messages Boring Non-inspirational or motivational Inconsistent

Oral Health FrameworkMulti-professional collaboration in practice

Appendix 1: BMA GuidanceGPs’ legal and contractual obligations in the provision of treatment to dental patients

Before refusing to treat a patient asking for emergency dental treatment, a GP must ascertain that the condition requires only dental treatment. As always, GPs must put themselves in a proper position to judge the nature of the patient's condition by undertaking reasonable enquiries.

Having established an apparent dental problem, GPs should refer a patient for any further treatment, if necessary, to a dentist or local emergency service. If the patient has no usual dentist, or there is no response from the usual dentist, the patient should contact: PALS or NHS Direct

If GPs choose to treat a patient themselves such treatment would be provided under general medical services and the level of skill and degree of care the GP would be expected to exercise is that of a general medical practitioner. GPs should not, however, attempt to manage a condition requiring dental skills unless they have the appropriate training and expertise. Both the civil courts and the General Medical Council (GMC) require doctors to have appropriate skills for any treatment they offer.