NHS GRAMPIAN. NHS Grampian Dental Plan 2020 and the Current Challenges within Grampian
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1 NHS GRAMPIAN Board Meeting Open Session Item 7.3 NHS Grampian Dental Plan 2020 and the Current Challenges within Grampian 1. Actions Recommended The Board is asked to: Note the continued improvements in oral health and access to dental services in Grampian. Consider the progress made towards implementing the Dental Plan 2020 action plan. Note the current challenges across the dental health system and to receive regular updates on actions to address them. Endorse and support (along with the Integrated Joint Boards) the continued implementation of the NHS Grampian Dental Plan Strategic Context The NHS Grampian (NHSG) 2020 Dental Plan which was approved by the Board in 2013 provided a framework for the continued improvement of oral health and the development of quality assured dental services in Grampian. The plan had a vision which was centred on two main pillars of continued oral health improvement and reducing health inequalities. In essence the plan proposed that the Grampian population would be able to develop and maintain their dentition and oral health in a good state with minimal intervention from dental services. The previous plan, the Dental Plan set out a wide ranging infrastructure programme to modernise dental services in Grampian, including the Aberdeen Dental School and Hospital new build. In order to consolidate the remarkable achievements of the plan, the NHSG 2020 Dental Plan aims to: Help and support people to sustain and improve their own oral and dental health Enhance and prioritise the support given to disadvantaged individuals and disadvantaged communities. Ensure high quality, local NHS dental services are accessible to all who request and need such care Ensure that services are delivered through clear patient-focused standards Success is to be measured through progress against the aims set out in the action plan as follows: Aim 1 Continued Improvement in Oral Health of Children and Adults Aim 2 Continued Increase in NHS Dental Care and Services Aim 3 Maintain and Improve the Dental Care Infrastructure in Grampian Aim 4 Structure and Organisation Clinical Networks Delivering Quality Services for Dental Care Aim 5 Introduce a Revised Quality Framework for all Dental Practices and Services in Grampian Aim 6 Ensuring Good Communication and Feedback on the Dental Plan This high level summary paper will highlight the progress made so far towards meeting these aims and highlight other emerging challenges in dentistry in general. 1
2 3. Key matters relevant to recommendation Aim 1 Continued Improvement in Oral Health of Children and Adults NHS Grampian has seen a trend of oral health improvement for children and adults over the last 20 years with sustained continuous improvement most obvious in the last 8 years. These improvements have come about due to a range of interventions delivered through the Childsmile, Priority Groups and the Caring for Smiles programmes. For instance 299 pre-school establishments (87%) were participating in daily tooth brushing exercise as part of the Childsmile Core programme in Grampian (July 2014). Local improvement and equity targets have been set in the action plan to drive continued improvement in the oral health of the Grampian population. CHILDREN S ORAL HEALTH The impact of a range of interventions delivered through the Childsmile programme has resulted in dental health in both Grampian and across Scotland reaching levels never previously recorded. NHS Grampian has exceeded the national targets set for 2010 for children in Primary 1 (P1) and Primary 7 (P7) i.e. 60% of children with no obvious dental disease (at the start of primary school and when they are leaving as well). Local Health Improvement Target By 2016 (2020), 75% (80%) of P1 children will have no obvious dental disease. Current Status In the 2014 National Dental Inspection Programme (NDIP), 73.2% of P1 children in Grampian had no obvious dental disease. This is a considerable improvement of 5.4 percentage points over the 2012 results. Within Grampian there was some slight variation at Community Health and Social Care Partnership (CHSP) level. In Moray 75.7% of P1 children had no obvious dental disease, whilst in Aberdeenshire and Aberdeen the figures were 72.4% and 72% respectively. The results indicate that Moray has already met the 2016 target. It is also important to emphasise that inequalities still exist in oral health with the most deprived children having the greater burden of the disease. Nationally there is an absolute difference of 30% between P1 children in least deprived SIMD 5 and P1 children in most deprived areas SIMD1. It is anticipated that these health inequalities will be addressed and the improvements in oral health maintained as the Childsmile programme is refined and implemented. Local Health Improvement Target By 2016 (2020) 75% (80%) of P7 children will have no obvious dental disease. Current Status In the 2013 NDIP, 73.7% of P7 children in Grampian had no obvious dental disease. This was an improvement over the 2010/11 inspection figure of 70.5%. As above there was some variation at the CHSP level with 77.8% of P7 children in Aberdeen City having no obvious dental disease, whilst in Aberdeenshire and Moray the figures were 70.8% and 72.4% respectively. Progress against the target will be determined when the results of the ongoing 2015 NDIP are published later in the year. 2
3 Local Health Improvement Equity Target By 2016 (2020) 70% (75%) of P1 and P7 children in all CHSPs will have no obvious dental disease. Current Status The three CHSPs have already met the 2016 target and in some instance the 2020 target as well. Despite this achievement there are still wide variations within the CHSPs which will require targeted interventions to remedy. ADULT ORAL HEALTH The target for adult oral health is proposed to be measured by determining the particular outcome related to a single age group, the year olds. Target By 2020: Less than 15% of adults aged year olds will have need for artificial teeth replacement i.e. partial or full dentures. Over 70% of adults aged years old will have retained 20 or more natural teeth. Current Status these targets are over a 6 year period and progress will be determined by undertaking an adult oral health survey closer to Aim 2 Continued Increase in NHS Dental Care and Services NHS Dental Registrations Targets NHS dental registrations are an indicator of uptake of dental services and are a key stage in the care pathway. In NHS Grampian 7 out of 10 people are now registered with an NHS dentist, the highest ever reported rate (69.9%; almost 405, 000). Registration has been on the rise since 2007 and the percentage of the Grampian population registered with an NHS dentist increased from 35.2% to 69.9% between March 2007 and September Despite this huge increase in registration NHS Grampian still has the lowest NHS dental registration rates in Scotland, particularly amongst adults. This may be explained by the differing population and service profiles across NHS Boards leading to differing use of private dentistry across the Boards. There are indications that the proportion of the Grampian population who have had dental treatment on a private basis is higher than the Scottish average. The NHSG Dental Plan has set some ambitious local registration targets which we are working towards achieving. Target - By 2016 (2020), 87.5 % (93%) of children aged 3-5 years are registered for NHS dental care. Current Status There was a HEAT target for children of this age group which required 80% of them to be registered with a NHS dentist by March That target was achieved in March 2013 when 81.5% of 3-5 year old children were registered in Grampian. Registration has continued to increase and the current registration rate is 85.2% as of September Target - By 2016 (2020), 90% (93%) of all children aged 0-17 years are registered for NHS dental care 3
4 Current Status The registration rate for all children in Grampian currently stands at 85.5% as at September This is an increase of 5 percentage points since March It is likely that the target will be met at the current rate of growth. Target By 2016 (2020), 70% (75%) of adults aged 18 years and over are registered for NHS dental care. Current Status The registration rate for adults in Grampian currently stands at 66.2% as of September This is an increase of 8.7 percentage points since March If registration continues to grow at this kind of pace the target is likely to be achieved sooner rather than later. Although achievement of these targets is likely to leave NHS Grampian below the national average it is important to recognise that we started from a much lower base than most of Scotland and that a larger proportion of the Grampian population compared to other Board areas in Scotland use private dental services. Aim 3 Maintain and Improve the Dental Care Infrastructure in Grampian Dental practices across Grampian are inspected on a three year rolling programme to provide assurance of compliance with the national dental standards and other clinical governance standards including infection control and child protection. There are currently 120 modern dental practices in Grampian with 308 dentists working in the independent general dental services and the Public Dental Services (March 2015) providing high quality NHS dental services across the region. ABERDEEN DENTAL SCHOOL The establishment of the Aberdeen Dental School in September 2008 has led to the annual graduation of new dentists since 2012 and this is contributing to the provision of a suitably qualified dental workforce for the North of Scotland. The School also trains other dental care professionals such as nurses and technicians leading to an increase in the complementary dental workforce in the region. NHS Grampian continues to develop the collaborative partnership with the Dental School with the aim of further improving the standards of education and training provided at the institution. We are currently working with the Dental School and NHS Education for Scotland on a review of its governance and management structures including the development of a Memorandum of Understanding to agree the roles and responsibilities of the key stakeholders. PAEDIATRIC DENTISTRY GENERAL ANAESTHETIC SERVICE The number of children requiring dental extractions under general anaesthetic has been falling since In the last two years the numbers have remained stable (approximately 650). This is being investigated but factors such as Grampian s increasing population and increased access to NHS dental services may create more referrals. 4
5 The issue of children waiting too long for this service was raised with the Board a year ago. The care pathway has been redesigned. Patients deemed not suitable for extractions under local anaesthetic alone due to age, anxiety, number of extractions or medical complications are referred to the Public Dental Service. Patients are then pre-assessed and referred to RACH General Anaesthetic Service if appropriate. Challenges around recruitment are contributing to the situation. A number of theatre sessions have had to be cancelled due to anaesthetist availability and appropriately qualified nurses. The Women and Children Services division have recruited to three out of six nurse vacancies, however it usually takes a further nine months of post registration training to ensure competence. Patients are assessed and if emergency treatment is required will be seen on the next available visit. A short life working group has been established to consider options to improve access time for patients. In the short term until staffing reaches desired level, the Board will receive regular updates on progress made. Aim 4 Structure and Organisation Clinical Networks Delivering Quality Services for Dental Care The Managed Clinical Network for Oral and Dental Health (MCN) in Grampian plays a vital role in developing and integrating primary and secondary oral and dental care services through clinical pathway development and a quality improvement process. The MCN acts as the co-ordinator of service planning to ensure symbiotic and collaborative services between the Public Dental Services (PDS), independent general dental services and the secondary care services. There is a wide range of developing dental specialty groups/networks which make up the MCN and who work in a multidisciplinary way to improve patient care, including: Children's Dental Services Network Dental Anxiety and Sedation Network Dental Special Care Needs Network Emergency/Unscheduled Dental Care Network Oral Health Improvement Strategic Group Orthodontic Network Quality and Clinical Governance Network Referral Management Group The MCN also has strong links with the North of Scotland clinical networks in restorative dentistry and oral and maxillofacial surgery. Key successes Improved Service Pathway for Dentally Anxious Patients ensuring patients needs are assessed by the appropriate clinician in the right place at the right time and care is provided according to needs reducing waiting times from 18 months to approximately 8 weeks. Children's Dental Services increased access across Grampian for general anaesthetic pre-assessment has led to some improvements in the care pathway but as previously noted patients are waiting longer for general anaesthetics 5
6 treatment due to challenges associated with recruitment of qualified anaesthetic nurses. Improved links with Independent Practices working to ensure availability of slots for unscheduled dental care within hours resulting in improved access to unscheduled care within hours and a reduction in the number of unscheduled dental care sessions on week nights from 2 to 1 Pan Grampian Audit on Fluoride Varnish (FV) Application which saw a 20% improvement in the proportion of 2 to 5 year olds who had at least one FV application amongst the dentists participating in the audit process. NHS registration continues to rise September 14 saw of our population registered with an NHS Dentist. Improved access to required dental treatment as part of a medical treatment plan for patients diagnosed with cancer. Aim 5 Introduce a Revised Quality Framework for all Dental Practices and Services in Grampian NHS Grampian already has in place the key components of a quality assurance system for dentistry including: Decontamination standards for dental practices A structured approach to quality and clinical governance in which the practice inspection process is a core part Standardised local induction for dental professional new to the area. We are working with the Scottish Government to develop a set of quality indicators for dentistry and NHS Grampian intends to pilot the patient experience element later in the year. Aim 6 Ensuring Good Communication and Feedback on the Dental Plan The NHSG Dental Plan 2020 recognises the importance of communication with key stakeholders within and out with the organisation as vital to the successful implementation of the plan. The advent of integration of health and social care services in Scotland offers us the opportunity to look at how oral and dental services are planned and organised. We are holding an event next month to look at the future of dentistry and oral health in the North of Scotland at which the Chief Dental Officer for Scotland will give a keynote address on the vision for oral health and dental services in Scotland. We envisage that the outcomes from the event will help shape the future direction of dentistry in Grampian. Key Successes- Introduced an information technology support programme to link all dental services to NHS net to improve secure communication between services and providers. Developed an online resource for informed self care to complement the oral health improvement programmes. 6
7 4. Impact Assessment The plan emphasises the need for equity and complements the previous plan with significant targeting for those groups with highest need. 5. Risk Mitigation Risk Partnership working with local authorities, third sector, independent contractors and community. Oral health has improved considerably since In order to maintain the momentum it is essential that NHS Grampian pursues implementation of the Dental Plan 2020 with partners in Integrated Joint Boards and Community Planning. Risk 851 Delivery Strategies to meet the future health of the population. Health and Social Care Integration offers the opportunity to revisit the organisation of Dental Services to address the challenges raised in this paper. More specialised roles will planned on a North of Scotland basis. Clinicians, Manager and partners from across the North will come together in June to shape the future direction of dentistry. 6. Responsible Executive Director and contact for further information If you require any further information in advance of the Board meeting please contact: Responsible Executive Director Susan Webb Acting Director of Public Health Susane.webb@nhs.net Contact for further information Jonathan Iloya Consultant in Dental Public Health jiloya@nhs.net 22 nd May
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