Delivering Better Oral Health in an NHS Dental Practice. Dr Ravi Singh Windsor Dental Practice Manchester M6 5EQ

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1 Delivering Better Oral Health in an NHS Dental Practice Dr Ravi Singh Windsor Dental Practice Manchester M6 5EQ

2 Commissioning - Salford PCT Invited to take part (with Team) in workshops exploring workforce development and service redesign in primary dental care. Aim: to find a method of assessing need, delivering preventive care appropriately and performance managing dental services fairly get beyond UDAs!

3 Windsor Dental Practice

4 Providing General Dental Services in Salford Oral health experience in Salford is poor in comparison to North West and England averages Our perception was: Few incentives in new contracts to deliver preventive care to match oral health needs locally Increased access required difficult in a high need area?

5 What have we been doing? Working closely with the PCT (Dental Public Health and Commissioners) in the service redesign project to integrate prevention in everyday practice within new working arrangements Skill mix and staff development has been supported by PCT The evidenced-based toolkit used to agree content of care pathways see the practice and meet the team!

6 Windsor Dental Practice

7 Windsor Dental Practice

8 Windsor Dental Practice

9 Our Extended Duty Dental Nurse

10 Our Hygienist

11 Our Therapists

12 Smoking Cessation Advisor

13 Description of Model we have developed with PCT An initial patient assessment of need is based on 3 sets of information: Medical history Social history ~ self-care regime; habits/diet Clinical assessment

14 Used Delivering Better Oral Health To inform evidence for interventions in care pathways Agreed clinical indicators to measure outcome Skill mix and staff development required

15 Diagnostic Group Characteristics Example Indicators Green No relevant MH or SH No history of oral disease No recent active disease Regular attendance Maintaining oral health No significant risks Amber Red MH or SH risk factors Minimal active decay or periodontal problems SH risk factors Active periodontal problems Active dental decay Smoking Drinking Sucrose based medicine Moderate BPE Frequent sugar intakes learning disability Active decay High BPE scores

16 Clinical Examination Decay Active decay in more than one tooth Active decay in one tooth No active decay Perio BPE of 2+ in 3 or more sextants BPE of 2+ in 2 sextants BPE of 2 or less in one sextant Soft Tissue Soft tissue lesion/condition requiring active treatment/review Soft tissue lesion/condition requiring review

17 Medical History GRADE 1: allergies, controlled asthma, hay fever, eczema, controlled epilepsy, joint problems, Rh fever, liver disease GRADE 2: HIV, hepatitis, bleeding disorder, diabetes, angina, high blood pressure, stroke, bronchitis, heart surgery, medications GRADE 3: not included

18 Social History Children Dental history Diet Frequency of brushing Fluoride Adults Dental history Diet Frequency of brushing Fluoride Smoking Alcohol

19 Toolkit Preventive Intervention 12 months 6 months 3 months 10+ yrs 16-18yrs Advice F/V x /5000ppm toothpaste Daily fluoride rinse F/Varnish x 3 to 4 Fissure Seal 2800/5000ppm toothpaste Daily fluoride rinse F/Varnish x 3 to 4 Fissure Seal 7+ yrs Advice F/V x yrs Advice F/V x 2 Daily fluoride rinse F/Varnish x 3 to 4 Fissure seal F/V x 3 to 4 Fluoride supplement Daily fluoride rinse F/Varnish x 3 to 4 Fissure seal F/V x 3 to 4 Fluoride supplement 0-3 yrs Advice Advice Advice

20 Recall for examination Diagnostic Group Children Adults Green 12 months 2 years Amber 6 months 12 months Red 3 months 6 months Full assessment reviews to be completed in line with NICE Recall Interval Guidance.

21 Treatment `Locks GREEN: eligible to have any NHS treatment which is deemed clinically necessary e.g. crowns, dentures etc. AMBER: same as green RED: limited restorative work until active disease is stabilised, pain control, prevention

22 Overview This model provides an easy way to meet Gold Standards from the advice and requirements to comply with DOH recommendations - and being evaluated.

23 Benefits in line with PCT Clinical Governance framework Reducing oral health inequalities Increased access to dentistry Improve quality of care Cost and efficiency Developing the dental team Patient experience and satisfaction

24 What is success? For Patients: Improved Oral Health Outcomes Success is measured by clinical indicators which may result in change of clinical pathways. For Team: Being involved in shaping change

25 The Future? There is nothing wrong with change, if it is in the right direction. Winston Churchill