Provision of dental services to care homes

NHS Northamptonshire

A pilot to provide NHS dental services to care homes in

Northamptonshire

Anna IrelandSpecialist Registrar, Dental Public Health

NHS Northamptonshire, NHS Milton Keynes


Northamptonshire Demographics

• People aged 65 and over are 14.1% of population

• 1% are non-white ethnic origin

• 2,306 people aged over 65 in care homes (2007)

• 115 care homes in the county

• Prior to pilot SDS carried out a limited number of domiciliary visits


Background

• PCT Local delivery Plan highlights need to improve access to NHS dentistry for vulnerable groups

• Questionnaire sent to Care Homes in 2006• Needs assessment carried out by previous SpR• Focussed on dependant elderly institutionalised

population


Needs Assessment 1

• 91 residents had a clinical examination

• Mean DMFT was 27.24 (22.93MT)

• 38% of sample were edentulous

• Only 43% of dentate patients with dentures were wearing them

• 30% said their oral health was very good, 55% said good and 15% said fair – no-one said very poor


Needs Assessment 2

• Focus group – 2 residents, 2 carers

• Themes included:

Training and support for staff

Access to basic NHS dental care, including domiciliary

• Results were for the most “mentally able” residents


Pilot project

Decision was made to involve local practices rather than commissioning a single service or contracting with the SDS.


Pilot service specification

• The aim of the service is to improve the access to NHS dental care, oral health advice and offer support to the staff and residents of care homes in Northamptonshire.



• All residents would be offered an oral health assessment

• Clearly defined what an assessment included• Where treatment is required this will be offered• Requirements of the 2005 mental capacity Act

were stressed• Need for a dental nurse and reference to the

protection of vulnerable adults was also made.



• If the assessment suggests treatment may be needed the patient is offered an appointment for a comprehensive oral health review (full clinical examination)

• If patient can travel then review and Tx will be done in providers surgery

• Tx that is appropriate for a dom setting was clearly described.

• In-hours urgent care included



• Patients requiring specialist care referred to SDS

• Pathway drawn up

• Evidence-based referral criteria developed

• Referral form

• Assessment of ability to co-operate

• Monitoring of referrals


Pilot service specification (Non-clinical)

• Dental advice to care home staff

• 2x annual training sessions for care home staff (evidence-based)

• Practice information leaflet

• Ensure access to emergency drugs

• Operate during own normal working hours


Care Home responsibilities

• Engage with practice• Encourage residents and carers• Pass on information about patients (e.g.

who can travel)• Facilitate travel• Make staff available for training• Provide suitable rooms• Look after the oral health of residents


Conditions of participation

• Full existing NHS contract

• On performer list

• Attendance at training day

• Participation in evaluation

• DDA compliant premises

• Awareness of “person centred planning”

• Completion of monthly activity form


Financial arrangements

• Provider collects (and keeps) patient charges

• £50.00 per resident participating in pilot

• unified UDA rate

• Payments made through BSA

• Separate contract numbers


Setting up the pilot

• As a pilot a full tender process was not necessary

• Specification sent out to providers

• Asked for expressions of interest

• Pilot to run from 1st February to 31st July

• Training day organised


Training Day

• Held on 22nd February

• Mandatory for the performer who would be participating in the pilot

• Nurses and contract holders also attended

• 6 hours 15 mins CPD (1 hr 45 mins core topics)


Training day Programme

• Guide to care homes• Medical problems in the elderly• Alzheimer’s and dementia• Delivering Better Oral Health• Protection of vulnerable adults• Consent• Risk assessment• Infection control• Data collection


Issues arising from training day

• Care homes do not have emergency drugs (including oxygen)

• Cost of portable sharps containers• Cost of business insurance• Access to consent form 4• Insurance for clinical waste carriage• Development of a discussion forum• What is the best way to carry out the service if

you do not have a car?


Pilot

• 47 care homes participating

• 9 providers

• Homes matched to providers, where could by locality

• Providers have between 1-10 homes each

• External evaluation


Issues so far

• 1 provider has dropped out (one without a car!)• Data collection form is complex and not always

completed well• Data submission is variable• Discussion forum is not used effectively• Consent and collection of charges difficult• Everything taking longer than expected (pilot extended

by 3 months)• UDA rate needs further thought• Incorrect submission of data (wrong contract number

used)• Incorrect charging of patients• Co-operation from care homes is variable


BUT

Most dentists are really enjoying the challenge and the break in routine.

There is renewed respect for the staff working in care homes.


Evaluation

• Started this month

• Will use interviews and focus groups as well as data

• Will look at why homes and practices did not want to participate

• Will help determine future commissioning plans


Thank you for listening

Documents

Provision of dental services to care homes