Plymouth University Peninsula School of Dentistry & Peninsula Dental Social Enterprise CIC. Clinical Activity Report Academic year 2016/2017

Transcription

1 Plymouth University Peninsula School of Dentistry & Peninsula Dental Social Enterprise CIC Clinical Activity Report Academic year 2016/2017 1

2 Contents Introduction... 3 Aims of the report 3 Clinical activity and services provided.. 4 Corporate and clinical governance... 5 Patient safety... 6 Patient satisfaction... 6 Community Engagement... 7 Specialist services. 9 Student numbers and course update. 10 Exeter Dental Education facility. 11 PDSE Dentists, Therapist and Hygienist. 12 NHS emergency support.. 12 Clinical activity 13 Postcode analysis by treatment site.. 15 Summary.. 19 Appendix A, Consultant and Specialist level care by clinical category. 20 Appendix B, Treatment numbers and type by academic year Appendix C, Treatment numbers and type, PDSE clinical staff 23 2

3 Introduction Peninsula Dental Social Enterprise CIC (PDSE) is now in its 4 rd year of operation. Working in partnership with Health Education England, the NHS and communities in Devon and Cornwall it continues to support oral health across the Peninsula via innovative clinical education of Dentists, Dental Therapists/Hygienists and Dental Nurses. Across its four sites in Derriford, Devonport, Exeter and Truro, PDSE offers access to free dental care for all, whilst improving awareness of oral health for the benefit of local communities by growing and developing its expertise in community engagement. Aims of the report To provide an overview of service delivery for the academic year To provide a description of governance arrangements To provide clinical activity data in accordance with our education mission 3

4 Clinical activity and services provided PDSE provides a comprehensive range of dental care free of charge, most of this is delivered by students under close supervision by qualified dentists. Patients can be self referred or recruited through our community engagement activity. They will initially receive a triage appointment in which treatment need is assessed. Adults will receive a single course of treatment however as many of these individuals are from what are considered hard to reach groups, they will frequently have complex treatment needs and can often take many sessions before treatment is completed. General A full range of primary care dental services aligned to NHS dental practice Community engagement Oral health education and improvement services Specialist interest, Specialist and/or Consultant level Restorative dentistry (endodontics, periodontics, prosthodontics and implant dentistry) Minor oral surgery Special care dentistry Dental public health Paediatric dentistry Inhalational sedation Referrals out of the school are minimised as a result of the range of clinical specialists, however orthodontics, patients requiring general anaesthesia and/or maxillofacial services are referred outside because these services are not currently provided by PDSE. 4

5 Corporate and clinical governance To ensure the delivery of effective and safe clinical activity PDSE operates a comprehensive clinical governance framework. This is supported by Directors in Clinical Dentistry and Community-based dentistry as well as a dedicated Clinical Governance and Operations Manager ensures compliance with NHS, GDC and CQC regulations. Each dental education facility (DEF) has a Consultant clinical lead/cqc registered manager responsible for overseeing high standards in clinical education and service delivery in each locality. This is supported by an excellent team of administrative, nursing and technical staff. Each educational facility also has nominated leads for radiography, safeguarding, infection control and information governance. All processes, protocols and policies are regularly reviewed to ensure they are current, functional and in line with any recent changes to legislation etc. A rigorous internal audit process is also employed in line with CQC regulations and fundamental standards. The results of which are continually reviewed and disseminated to ensure on going development and support to the PDSE quality improvement plan. This supports other audits such as Infection Prevention and Information Governance Toolkit. The GDC regularly inspects PDSE to quality assure the education programmes against Standards for education and to ensure clinical care meets the objectives set out in its Standards document. 5

6 Patient safety Patient safety is always a priority. PDSE operates an effective report, review and action process and with sophisticated incident reporting system and dedicated lead to prompt immediate action and investigation where necessary This process ensures any learning from an event is cascaded through the organisation to staff, students and clinical supervisors via the most appropriate route. This includes a Patient Safety and Governance Report, distributed monthly and covers incident trends and statistics as well as any other governance information such as results of audits, and updates from NHS or other bodies. Patient satisfaction PDSE collects feedback from patients via patient satisfaction surveys and through Family and Friends Test. These consistently demonstrate a high level of satisfaction with the quality of patient care, clinical treatment staff interaction and our facilities at Peninsula. Our most recent survey saw over 99% of participants give a positive response to the family and friends question How likely are you to recommend the Peninsula Dental School to your friends and family if they needed similar care of treatment? All patient responses are evaluated and areas of potential improvement highlighted and discussed. Any learning or necessary actions are implemented across all sites promptly. 6

7 Community Engagement Open Wide and Step Inside The past year has been one of change and development for the Community Engagement Team. They will now transition into a new charity; Creative, Connected Communities which will trade under the name of Well Connected. The Team acts as the link to many different population groups to support positive lifestyle choices as well as accessing dental care via the Dental Education Facilities across the region. Support is provided via a number of interventions such as: Community based triage sessions Provision of oral health resources Help and advice to access a range of providers including the dental school Development of programmes Outreach and community engagement activities Over the past 12 months the team have developed and maintained a variety of projects in the region, these include Dental ambassador projects This project is supported by the Wrigley Company Foundation and is in its 4 th year. The team have now engaged with approximately 25 schools (approximately 2,000 children) with less affluent areas of the city being targeted. Children are invited to visit the Immersive Vision Theatre at the university campus and view a 12 minute animated film which shares key oral health messages. The project is fun and enjoyable, encouraging children to share key messages at home. This year, the film is having a facelift in a more contemporary style with the ambition to develop a product which has a sustainable element, being delivered within the school setting. Millfields Inspired The team have partnered with Millfields Inspired to deliver a project aimed at the 7 primary schools [127 children] in Plymouth which encourages aspiration; builds knowledge and confidence as well as introducing key oral health messages. This included a session in the clinical area using a simulated dental training unit, investigating how much sugar is in foods and drinks as well as exploring key oral health messages. A Dental Ambassador training programme was delivered for the second year in This supports adults with learning difficulties improve oral health through effective brushing, teaching how to reduce sugar in the diet and how to access dental services.

8 Cornwall Healthy Workplace Award This award for employers in the county includes oral health as part of the award criteria. A variety of Cornwall based businesses both large and small, are involved in the initiative which is recognised as one of the best in the country. The community engagement team deliver workshops which ensure companies reach the criteria required and are able to offer advice and support in their workplace. Brushing clubs The team have continued the support for established brushing clubs and have been able to expand training to other schools and settings. Several of the schools have asked for more resources to expand the brushing clubs to other year groups. Well Connected, has been commissioned by Plymouth City Council to deliver training across 32 primary schools and other settings during the next academic year to help establish supervised brushing clubs in the more disadvantaged neighbourhoods providing resources and equipment. Active Plus The team have been commissioned to deliver 20 oral health awareness sessions across Cornwall with established groups of older people with the aim to encourage them to share the key messages with friends and family. North Yard Community Trust We were successful with a bid to the North Yard Community Trust to help raise the profile of oral health in their area of benefit by providing early years venues with a Creating Smiles box. Each box contains fun and colourful resources which support and promote oral health; this includes amongst other things a puppet, giant teeth, jigsaw puzzle. Dental Champion workshops Training workshops have been delivered to variety of groups, sharing oral health messages to various groups and organisations including: Family Intervention Service School Nurse Team Looked after children service team Health Visiting teams Plymouth Foodbank Plymouth Big Issue 8

9 Specialist services Academic staff continue to provide direct care to patients in PDSE. The sessions can be observed by students for teaching purposes and are led by specialist and consultant level staff. Internal referrals are made when: The patient s treatment need or history is too complex for students to manage Where treatment has run into technical difficulties or may give rise to a complaint The treatment needs to be completed in a short time period In addition to this, staff provide consultant opinions and assessments to aid student treatment planning and to advise on complex cases. The care described is provided at tier two and three in the following disciplines with funding from the NHS Area Team: Periodontology Prosthetics Endodontics Conservation Minor oral surgery Paediatric Special care (A breakdown of consultant and specialist level care can be seen in appendix A) At present NHS funding supports level two and level three clinical services to prevent patients being referred out of the school to local intermediate and tertiary services. In this academic year specialist and consultant staff has delivered over 1000 items of advanced care and consultant opinion with associated lab costs. 9

10 BDS (Bachelor of Dental Surgery) BSc (Hons) Dental Therapy and Dental Hygiene There are currently 229 students on the BDS programme. In 2013, the BDS program was changed from a 4 year to a 5 year undergraduate course therefore there were no graduating cohort this year and there will be an additional year of students in training in the next academic year. This will increase the clinical activity provided by Peninsula substantially with an additional 56 students undertaking treatment on 4 days per week using a full range of skills. The BSc (Hons) Dental Therapy and Dental Hygiene programme has now completed the first full final year and has now been approved and accredited by the GDC saw 100% students graduating, all of which already securing employment. Next year will see our intake on this programme increase, again enabling further capacity to provide more treatment across the Peninsula. The table below shows the number of students in each year group and pathways. Programme Year Total No of students Dentistry 1 58 Dentistry 2 59 Dentistry 3 56 Dentistry 4 56 Dental Therapy 1 17 Dental Therapy 2 11 Dental Therapy 3 9 Total

11 New Exeter Dental Education Facility In September 2016 PDSE opened its new Exeter Dental Education Facility to the public. This facility has 42 chairs, and for the next academic year will host year 3 BDS students and final year students undertaking dental practice experience. It has been an incredibly positive year and the facility has provided over 1800 patient appointments as well as supporting local population through PDSEs community engagement activity. The new facility also has a 16-chair Simulated Dental Learning Environment, where students can hone their clinical skills on phantom heads. 11

12 PDSE Dentists, Therapist and Hygienists In August 2016, PDSE expanded the existing team and recruited its first employed Dentist. This team has now expanded to include one further full time Dentist, Therapist and Hygienist. This multi disciplined team will now significantly improve the patient care pathway by increasing capacity to see patients that may be too complex for the student, and to support where waiting times for a particular treatment could be reduced. NHS emergency support For the last academic year, PDSE have provided additional capacity to the Dental Access Centre in Plymouth. Since this time over 350 patients have been treated for dental emergencies, and we are now looking to expand this support further in other areas of the peninsula. This service has been delivered by both students and PDSE employed Dentists, giving the students a broader experience of emergency dentistry whilst providing support for the local service. Trainee Dental Nurses This year PDSE supported a further 6 trainee Dental Nurses, 4 in Plymouth and 2 in Truro, all of whom successfully qualified this year. One of which has secures permanent employment with PDSE and another will be commencing a Dental Therapy degree in September. The main Dental Access Centre in Plymouth was severely damaged by a fire at the beginning of August this year. Since this time PDSE have offered to accommodate the team to enable the service to continue to function and see patients. 12

13 Clinical Activity The following is a summary of clinical activity data for academic year 16/17 There are a number of caveats to allow for when considering the data: 1. Student clinical activity is a by product of dental education and should not be considered against NHS standard performance measures. 2. Activity is reported by academic year, not financial year. 3. We are able to report on data from a number of sources the dental software system and from an electronic assessment database (ADB). The ADB provides a comprehensive and validated real-time overview of each student s clinical progress. The data is robust and provides an accurate and up to date report of clinical output. 4. Consultant and Specialist Level care data is recorded via internal systems. This year also saw an increase in the number of children treated with over 2000 appointments attended in the academic year. Unlike adults, PDSE do not hold waiting a waiting list for children, instead ensuring that they are offered an appointment at the next available clinic. Clinical activity in academic year 16/17 was consistent in line with 2015/16 (ADB data). This is now likely to increase substantially over the next academic year due to the first cohort of the 5 year program reaching their final year, an additional 56 students undertaking clinical work 4 days per week during term time. This will be supported further by a larger number of DTH students overall. 13

14 Summary of total number of patients treated by academic year 15/16 and 16/17 Summary of total number of patients treated in academic year 16/17 by site Number of patients treated Number of appointments Number of items provided Academic year 2015/ Academic year 2016/17 DEF Number of patients treated Number of appointments Derriford Devonport Exeter Truro Total Number of items of treatment The above data is reported from the SOEL Health dental software system and provides a cumulative total of clinical activity provided by dental students for the period. Number of children accepted for treatment 16/17 Appendix B provides a breakdown of the clinical activity (by procedure) provided by students from the ADB. The number will differ from above as some items are recorded as procedure on the dental software such as patient consent and treatment plan. This is for audit purposes and to ensure compliance and comprehensive record keeping by students. 14

15 Postcode analysis by treatment site The following provides an overview of a postcode analysis of patients treated in Devonport DEF from 1 st September 2016 to 12 th July 2017 and total number of appointments attended Devonport DEF Total 2095 patients, 7019 appointments 15

16 Postcode analysis by treatment site The following provides an overview of a postcode analysis of patients treated in Exeter DEF from 1 st September 2016 to 12 th July 2017 and total number of appointments attended00 Exeter DEF 922 patients, 1833 appointments 16

17 Postcode analysis by treatment site The following provides an overview of a postcode analysis of patients treated in Derriford DEF from 1 st September 2016 to 12 th July 2017 and total number of appointments attended Derriford DEF Total 1187 patients, 3016 appointments 17

18 Postcode analysis by treatment site The following provides an overview of a postcode analysis of patients treated in Truro DEF from 1 st September 2016 to 12 th July 2017 and total number of appointments attended00 Truro DEF Total 603 patients, 3938 appointments 18

19 Summary PDSE CIC continues to make a significant contribution in improving oral health across the peninsula completing over 16,000 patient appointments over the year. The organisation remains focussed on improving access to services for the full spectrum of society including those traditionally considered hard to reach groups. Through its specialists and consultants, PDSE has provided over 1200 items of advanced care which may have otherwise been referred out of the school to local services. This represents significant clinical delivery and supports capacity of NHS services locally in the region. PDSE continues to build on strong partnerships with the local NHS, public health, specialist dental providers in primary and secondary care and community dental services. The current partnership with NHS England via the Local Area Team is fundamental to PDSE continuing to provide a comprehensive NHS care service to patients treated in the dental education facilities across the region. 19

20 Periodontology Non Surgical: Appendix A: Consultant and Specialist level care, academic year 2016/17 Chronic periodontitis Aggressive periodontitis Systemic antibiotics Local antibiotics Surgical: Flap surgery Removable prosthodontics Partial dentures: 24 Acrylic Consultant Endodontics opinion 0 De Novo treatment: Consultant opinion 18 Single rooted 7 5 Cobalt Chromium 7 Multiple rooted 9 3 Complete dentures: Retreatment: 4 Conventional 5 Single 2 13 Copy Overdentures: Surgical Gingival hyperplasia Simple Ultrasonic 1 Multiple rooted Root resection Precision retained Total Mucogingival surgery Regeneration surgery 1 Implant retained 4 Obturators: Crown lengthening (cases) 9 Clefts 1 Oncology (cancer Crown lengthening (teeth) 5 patients) 3 Implant 28 Totals Atraumatic tooth XLA 2 Bone grafting 7 Sinus lift Totals

21 Appendix A: Consultant and Specialist level care, academic year 2015/16 Fixed prosthodontics Oral Surgery Paediatric Special Care Plastic restorations: Amalgam Composite (Build Ups) Veneers: Composite Porcelain Crowns: Extraction 18 Surgical Extraction 135 Behaviour management 6 Medically compromised 4 91 Inhalation sedation 12 Physical disability 6 39 Bone Grafting Pre-cooperative child Phobic patients 7 23 Medically compromised Complex caries patients 34 management 1 Vulnerable groups Oral Medicine/pathology 30 Extractions 7 Gerodontology 2 Soft Tissue Surgery 30 Advanced paediatric care 1 Total 46 Apicecetomies/regrade Trauma root filling 4 1 Gold 14 Total 331 Total 28 Bonded 4 Resin Bonded Post Bonded Implant retained Bridges: Adhesive Conventional Implant retained 2 Full arch reconstruction Conventional Adhesive Splints (Michigan) 9 Total

22 Appendix B: Total numbers of each procedure provided by students from 01/09/16 to 30/06/2017 (from ADB) Year Group Procedure Year 1 DTH (17 Students) Year 2 DTH (11 students) Year 3 DTH (9 Students) Year 1 BDS (58 Students) Year 2 BDS (59 Students) Year 3 BDS (56 Students) Year 4 BDS (56 Students) Total Full Examination/Assessment Radiographs Fissure Sealant Periodontal part I: Supragingival Scaling Periodontal part II: Periodontal Debridement Amalgam Adhesive Restorations RCT Prosthodontic fixed Resin Retained Bridge Denture Fit Orthodontic Assessment Paediatric 0-12 yrs Management Technique Paediatric Operative Procedure (exc extraction) Paediatric Extraction Dental Emergency Prevention (OH, Smoking Cessation, Fluoride Treatment, Diet) Anaesthesia Prescription Referral Letter (internal or external) Non-Surgical Extraction Surgical Extraction Periodontal Assessment Special Investigations and Diagnosis Total

23 Appendix C: Total numbers of each procedure provided by PDSE Dentists, Hygienists and Therapists from 01/09/16 to 12/07/17 (from SOEL Health) Procedure PDSE Dentists PDSE Hygienists & Therapists Total Full Examination/Assessment Radiographs Periodontal part I: Supragingival Scaling Periodontal part II: Periodontal Debridement Amalgam Adhesive Restorations RCT Prosthodontic fixed Resin Retained Bridge Denture Fit Extraction Dental Emergency Prevention (OH, Smoking Cessation, Fluoride Treatment, Diet) Anaesthesia Total