1.0 BACKGROUND INFORMATION

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1 SUMMARY OF PATIENT COMMENTS AND OTHER FEEDBACK RECIEVED REGARDING INITIAL PREFERRED OPTIONS FOR FUTURE PROVISION OF ROUTINE NHS GENERAL DENTAL SERVICES BY THE SALARIED DENTAL SERVICE 1.0 BACKGROUND INFORMATION Health Board managed clinics were established under the guidance of the Scottish Government at a time when access to NHS General Dental Services in Dumfries and Galloway was extremely limited. In 2006, registration with an NHS Dentist in Dumfries and Galloway stood at 33% of the population. The Scottish Government prefers that NHS General Dental Services are provided by the Independent Dental Contractor Sector, in the same way as Medical Practitioners operate, e.g. GPs. The vast majority of people who reside in Dumfries and Galloway are registered to receive NHS General Dental Services by Independent Dental Contractor Practices. NHS dental registration figures for NHS Dumfries and Galloway (at the 31st of March 2014) demonstrated that 80% of the population were registered with an NHS Dentist. With access to NHS Dental Services now greatly improved, with many Independent Dental Contract Practices having capacity to accept new NHS dental patients throughout Dumfries and Galloway, NHS Dumfries and Galloway felt it was necessary to review provision of this service at its own operated and managed clinics. 2.0 WORK PRIOR TO PATIENT CONSULTATION On 26 th June 2013, consultation with staff started. This was followed by individual clinic consultations to consider available options. On 27 th June 2013, consultation with Independent Dental Contractors commenced. A questionnaire was sent to all Independent Dental Contractor practices to seek information, which the Health Board felt was needed to review the service, e.g. if the contractor was interested in offering registration to NHS patients currently registered with salaried dental clinics, an indication of patient numbers and timescale along with any constraints i.e. premise development or recruitment; interest in potentially moving and / or expanding into premises currently occupied by salaried dental clinics; what impact of losing salaried dental services would have; and the opportunity to suggest any other options the review should explore. On 3 rd July 2013, the NHS Dental Service Review Working Group first met. This group completed an initial options appraisal exercise on 14 th August 2013, which resulted in the recommendation that individual clinic options appraisals be carried out, with additional representation from patients, public and Independent Dental Contractors. On 22 nd July 2013, consultation with NHS stakeholders commenced to identify potential impacts of service review options being considered. Page 1

2 3.0 PATIENT CONSULTATION PROCESS 3.1 Overview of Patient Consultation Process From mid September 2013, until each clinic s options appraisal was held, posters were displayed in clinics regarding the review and the proposed options under consideration. Comment forms were also made available. All comments received were made available to those involved in the options appraisal process. In September 2013, an update on the review was circulated to members of the Public Partnership Forum. Two patient representatives from each dental clinic and a public member participated in the qualitative aspect of the options appraisal which took place on 26 th September 2013 (Lochside), 28 th October 2013 (Lochmaben), 30 th October 2013 (Dumfries Dental Centre and Newton Stewart) and 4 th November 2013 (Sanquhar). The options considered for each clinic are shown in Table 1. Table 1 Options considered by the qualitative options appraisals OPTION DESCRIPTION CLINIC OPTION 1 Continued provision of routine general dental services via the salaried dental services. Sanquhar Lochside Lochmaben Newton Stewart OPTION 2 OPTION 3 Retraction of salaried service provision of routine general dental services and leasing the premises to the independent contractor sector. Complete retraction of general dental service provision with transfer of registered patients to the independent contractor sector. Dumfries Dental Centre Sanquhar Lochside Lochmaben Newton Stewart Dumfries Dental Centre Lochmaben Newton Stewart Dumfries Dental Centre Following completion of the qualitative and finance appraisals using a 60/40 split and discussion and debate within the working group, the following options were initially recommended for each clinic site: Dumfries Dental Centre Lochside Lochmaben Option 3 Withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to an Independent contractor practice for continued provision of NHS general dental services at the transferred practices site/premises. Option 2 Continued provision of routine NHS general dental services at the clinic site by the Independent dental contractor sector. Option 3 Withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to an Independent contractor practice for continued provision of NHS general dental services at the transferred practices site/premises. Page 2

3 Newton Stewart Sanquhar Option 3 Withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to an Independent contractor practice for continued provision of NHS general dental services at the transferred practices site/premises. Option 2 Continued provision of routine NHS general dental services at the clinic site by the Independent dental contractor sector. From 29 th January 2014 posters and patient information leaflets advising on the preferred option following appraisal were displayed in clinics and on the Board website. On 4 th February 2014 individual clinic Board Tweets with links to the Board website which contained the patient information leaflets were issued. On 28 th January 2014 an update on the review and the preferred options was presented to the Public Partnership Forum meeting and a summary was also ed to all members of the forum. On 28 th March 2014, it was confirmed that the review report would be presented at the Board meeting on the 2 nd June Posters, leaflets and comments forms, including the Board website were updated to reflect the confirmed date for the Board and that comments should be provided by 22 nd April On 13 th May 2014 NHS Chief Executive, Jeff Ace and Medical Director, Dr Angus Cameron attended the Wigtownshire Area Community Council Meeting to answer questions and receive comments from the community. It was confirmed at this public meeting that the review report would be held until the August Board meeting to allow for the non-exec Board members to be appointed. On 16 th May 2014, posters, leaflets and comments forms, including the Board website were updated to reflect the extension of patient consultation and that comments would be accepted up until the 27 th June In June 2014 it was agreed that due to the level of feedback received, time would be taken over the summer to reflect on the feedback and undertake further work to look at the physical accessibility of independent dental contractor practices and also capacity within the independent dental contractor sector with the final report being presented to the NHS Board in October A press release was issued on 12 th June 2014 to update the media. Throughout the period the story was covered in several local media Dumfries & Galloway Standard, Annandale Herald, Stranraer & Wigtownshire Free Press the Galloway Gazette and the Glasgow Herald. All comments; completed forms, letters, s, telephone calls were collated and summarised into key themes after 27 th June A total of 135 contacts were received. The Scottish Health Council provided support and guidance to the review working group throughout the consultation process and supported the development of a patient engagement plan. A copy of all comments received and the summaries produced were reviewed by the Scottish Health Council and confirmed as an accurate summary. Page 3

4 3.2 Summary of number and source of contacts A summary of the number of contacts that have been received is shown in Table 2. Table 2 Summary of Contacts from Patients following notification of Initial Preferred Options received between 29 th January 2014 and 27 th June 2014 Comment forms / letters returned Other forms of contact e.g. phone call / Total Comments Estimated Patients seen at clinic between 29/1/14 to 27/6/14 1 Estimated Patients Registered at the 2 Dental Centre Lochmaben Lochside Newton Stewart Sanquhar Total In addition we responded to; 4 contacts from NHS stakeholder; 2 contacts from MPs: David Mundell and Russell Brown; 3 contacts from MSPs: Elaine Murray, Dr Aileen McLeod and Alex Ferguson; 2 contacts from local Council representatives: Cree Valley Community Council and Councillor for Annandale North Ward; 1 contact from DG Voice; Several contacts with the press including: D&G Standard, Annandale Herald, Stranraer & Wigtownshire Free Press, Galloway Gazette and DnGMedia. These contacts were mainly to clarify aspects of the review with any direct patients comments being shown in the summary figures and themes where directed at an individual clinic. We also received a petition with 124 names via the Galloway Gazette opposing the recommendation to withdraw salaried dental services from the Newton Stewart Dental. All contacts made using other means e.g. telephone and were provided with an individual response. Patients who raised a question or concern on the comments forms or letter and who had provided their details were contacted with a response. 3.3 Summary of Points Highlighted During the Consultation Period Key themes emerging from the patient feedback are summarised in Table 3. 1 This is the estimated number of NHS primary care dental patients who had a completed appointment in this time period.. Duplicate entries for patients who attended more than once have been removed. 2 Estimates based on R4 figures as at May Page 4

5 Table 3 Summary of Key Themes emerging from Contacts for each Name Contacts 3 Key Themes Dumfries Dental Centre 9 Concern over ability to register for NHS dental services locally (1) Concern over disabled facilities within other NHS dental practices (1) practices (1) Satisfied with existing practice (4) Satisfied with disabled access at existing practice (including general parking) (1) Satisfied with recommendation (2) Satisfied with level of service at existing practice (2) Lochmaben 46 Concern over ability to register for NHS dental services locally (22) Concern over lack of choice for NHS dental services (3) Concern over sustainability of other NHS dental practices to continue to provide NHS services (5) Concern over disabled access to other NHS dental practices (5) Concern over parking at other NHS dental practices (1) Concern over disabled facilities within other NHS dental practices (1) Concern over increased costs for NHS dental services (6) practices (10) Concern that recommendation is driven by financial savings and not improved patient care (5) Concern about increased traffic on high street (1) Concern for staff (3) Concern over ability to travel to other NHS dental practice using public transport (4) Concern of initial start up and maintenance costs being lost if existing practice closed (1) Concern about limited access to dental service at existing practice (1) Satisfied with existing practice (16) Satisfied with disabled access at existing practice (including general parking) (9) Satisfied with level of service at existing practice (23) Close other NHS dental services in favour of retention of this clinic (3) 3 Many of the comments received listed multiple themes so the ratio will not be one to one against the number of contacts received. Page 5

6 Lochside 7 Concern over ability to register for NHS dental services locally (1) Concern over sustainability of other NHS dental practices to continue to provide NHS services (2) Concern over increased costs for NHS dental services (1) practices (2) Concern that recommendation is driven by financial savings and not improved patient care (2) Satisfied with disabled access at existing practice (including general parking) (1) Satisfied with level of service at existing practice (7) Satisfied that recommendation may allow access to closer to home service (1) Newton Stewart 69 Concern over ability to register for NHS dental services locally (30) Concern over lack of choice for NHS dental services (1) Concern over sustainability of other NHS dental practices to continue to provide NHS services (11) Concern over disabled access to other NHS dental practices (4) Concern over parking at other NHS dental practices (3) Concern over disabled facilities within other NHS dental practices (4) Concern over increased costs for NHS dental services (7) practices (15) Concern that recommendation is driven by financial savings and not improved patient care (5) Concern for staff (2) Concern over loss of access to joint services at single site (3) Concern over ability to travel to other NHS dental practice using public transport (3) Concern of initial start up and maintenance costs being lost if existing practice closed (1) Concern about limited access to dental service at existing practice (10) Satisfied with existing practice (10) Satisfied with disabled access at existing practice (including general parking) (5) Satisfied with level of service at existing practice (35) Satisfied that recommendation may allow access to closer to home service (1) Keep the professional and cut the admin staff (1) Advertise for more patients at current practice (1) Page 6

7 Sanquhar 4 Concern over sustainability of other NHS dental practices to continue to provide NHS services (1) practices (1) Concern for staff (1) Satisfied with recommendation (2) Satisfied with level of service at existing practice (2) 4.0 CONCLUSIONS Some general concerns were highlighted about the patient engagement process, in particular by patients attending Lochmaben and Newton Stewart dental clinics. Specific concerns were raised that not all patients were aware that there was a review ongoing and the options that were under consideration were not notified to all patients. The concerns were raised because patients often only attend the practice once every 6 or 12 months for a check up and those who might have attended due to an emergency may not have been in a position to take in information regarding the review. Although not all patients have been contacted directly regarding the preferred options, it is estimated that on average 33% of registered patients (range 32% to 40% at each clinic) would have had the opportunity to see the posters and provide feedback if they wished to do so. Other methods to raise public awareness such as provision of updates to the Public Partnership Forum, use of social media and press coverage should also have brought the consultation to the attention of patients registered with the clinics. It is clear that those patients who commented highly value the service they receive and would like to continue to receive dental services from their current clinic. However, it was also noted by some of the patients of Newton Stewart that they had some concern about the access they had to dental services from the. The level of disabled access, facilities and parking that Salaried s have was noted and concern was expressed about the disabled access to other NHS dental practices. Other key concerns emerged were: ability to register with an NHS practice locally, sustainability of other practices to continue to provide NHS services, level of service provided at other NHS practices and potentially increased costs at other dental practices. There was also a feeling that the changes were being driven by finance as opposed to improved patient care. There appears to be a misunderstanding by patients that Independent Dental Contractors operate as private dentists, which patients associate with increased costs and a reduced level of care. 5.0 ACTIONS TO BE TAKEN IF RECOMMENDATIONS AGREED The summary of patient feedback was used to inform the Equality and Diversity Impact Assessment undertaken regarding this review. The review working group also reflected on the patient feedback received when compiling the final review report. This has lead to a number of actions being identified that will need to be taken forward to address those issues raised by patients. These areas are outlined below: A copy of the summary of patient response is included in the final Board paper. Page 7

8 5.1 Concern over ability to register with an NHS Practice Locally It was noted that sufficient capacity is reported to exist in all localities. Patients would not be expected to find another dentist the Health Board would facilitate the transfer of registration to another dental practice based on the patient s preference of available options. Information regarding the options available to include a summary of the accessibility and disabled facilities at the practice in a similar format to that discussed at the impact assessment. A system will be put in place to follow up patients to ensure continued registration which would include telephone follow up and provision of a telephone number for any enquires. 5.2 Concern regarding Accessibility of Independent Dental Contractors Practices It was noted that alternative accessible capacity existed in all localities, however it was recognised that whilst the alternatives where accessible this was not quite of the same standard as that of the salaried clinics. Whilst the alternatives in other localities were felt to be reasonable this was not felt to be the case in Newton Stewart. Recommendation above regarding provision of summary information regarding accessibility should be included in information provided to patients regarding their options for future care with a helpline available for patients to contact for further information would also be relevant to this area. It was recommended that Independent Dental Contractor Practices which have manual access to the practice should install a system to ensure that staff are aware that a patient is there and needs help to access the practice e.g. an appropriately placed door bell with signage. The recommendation regarding Newton Stewart was amended to recognise that further work is required prior to complete withdrawal of Salaried Dental Services from the Newton Stewart clinic. 5.3 Concern over sustainability of other practices to continue to provide NHS services Monitoring of Access to NHS Dental Services would be ongoing and steps would be taken to address future capacity issues should they arise. 5.4 Concern about the level of services provided at other independent contractor practices Both Salaried Dentists and Independent Dental Contractors have to work to the same terms and conditions of service and services are monitored from a quality perspective by Practitioner Services Division. All Dental Care Professionals are regulated by the General Dental Council. Potential reduction of impact Patients are to be informed of the above. Page 8

9 5.5 Concern over increased costs of NHS Treatment The costs (to the patient) of NHS dental services are defined and constrained by NHS statutory regulations therefore the cost of NHS treatment are the same whether it is provided by an independent dental contractor or a salaried dentist. Patients need to be made more aware of the costs of NHS Dental services and information. Patients informed of the above. 5.6 Feeling that changes being driven by finance as opposed to improved patient care Patients informed of the process undertaken. 5.7 Negative Impacts regarding staff Relevant Health Board Policies/Legislative requirements will be followed. A partnership working group will be established to ensure staff are kept informed and engaged with the change process. 6.0 FINAL RECOMMENDATIONS PUT FORWARD TO THE BOARD OF NHS DUMFRIES AND GALLOWAY Dumfries Dental Centre Lochmaben Dental Newton Stewart Dental Lochside Dental Sanquhar Dental Final Recommendations Withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to independent contractor practices for continued provision of NHS general dental services at the transferred practices site/premises. Further work with local independent dental contractors and Salaried Dental Service staff to be undertaken to ensure sustainable, accessible routine NHS dental services for patients in this area prior to the complete withdrawal of routine NHS dental services by the Salaried Dental Service. Continued provision of routine NHS general dental services at the clinic site by the independent dental contractor sector. With further service review to be undertaken if this is not possible. Continued provision of routine NHS general dental services at the clinic site by the independent dental contractor sector. With further service review to be undertaken if this is not possible. Page 9