LDN Conference Dental Education: Present and Future Nicholas H Taylor Postgraduate Dental Dean - HEE NW Chairman of COPDEND - UK Chairman of English Dental Deans - HEE 27 th June 2017
Aim To improve understanding of the role of Health Education England in providing the workforce for NHS service provision.
Objectives Need into Numbers - the need for a more holistic strategy to meet current and future health care needs Understand central decision making based on local evidence of need and national HEE workforce plan Demographic, geographic and requirement factors Signposting & support to the prospective Tier Two cadre of providers Future NHS workforce provision
HEE Mandate https://hee.nhs.uk/ Health Education England (HEE) exists for one reason only: to support the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place. www.gov.uk
Currently delivering Foundation Training Satisfactory completion Dental Core Training Certificated years of personal training Specialty Training 13 disciplines Workforce Development & Transformation Local Professional Networks Appraisal, mentoring Bespoke courses Restoration of Efficiency of Registrants Dental Care Professionals
Tax payer funding Current funding streams for training: Health Education England Joint Funding (HEE/Trust) National Institute for Health Research (NIHR) Trust Funded University Funded (Self-funded) All Quality Managed by HEE staff
Self-funding Workforce Transformation & Development Performer List Validation of Experience (PLVE) Remediation and support (NHSE & GDC) Specialty Training (London) Other certificate, degrees and masters
General Dental Council Quality Assurance Undergraduate Specialty Training Specialty curriculum review (13) On pause
Dental Disease is changing
The population is changing
Technology is changing
Current workforce
Current issues GDS/PDS UDA Contract History of dental service provision Vested and conflicts of interest Primary Care Business models DFT competence and experience Dentistry outside main body of NHS provision Division between Primary & Secondary Care Mixed dental economy NHS & Private HEE Investment plan
HEE Comprehensive Spending Review (CSR) HEE Programmes 4.9bn HEE Administration 71m Programmes- Flat Cash till 2019/2020 Administration - 2019/20 57.9m CUTS Educational Support 30% Administration 20% (already 20%)
Comprehensive Spending Review English Dental Deans Regionalisation of HEE Provision Foundation Review Non-NHS funding
Commissioning Guides NHS Commissioning Guides Proposed clinical pathways to cover complexity of care Tier 1- Tier 2- Tier 3- DCPs to Specialist/Consultant to Deliver
Workforce
GDC Scope of Practice - Team Approach to Primary Dental Care Diagnosis & treatment planning Fluoride varnish, oral hygiene instruction, radiography Periodontal treatment Routine restorative, deciduous extractions Extractions, advanced restorative, MOS, Prosthetics Specialty areas Screening Dental Nurse Direct Access Hygienist Therapist Tier II Ortho Therapist Dentist DES CDT F/F CDT Specialist
Boundaries NHS GDS/PDS mandatory contract What should a generalist (Provider) be doing? o Avoiding the NHS (tax payer) paying twice What is the remit of the specialist? Where does tier II fit?
(Steele Report 2009) Reducing priority for public funding
Current Tier II Service Educational Element Lancashire Model Selection Contracting Triage Delivery Training
Changes to the skill mix in the practice as a consequence of the pilot care pathway Q19. Consider changing the skill mix? PROVIDERS Q20. In what way? 85 % Q19. Would you consider changing the skill mix of staff at some point if the new way of working becomes permanent? Base: All providers (40). Q20. How might your practice change the skill mix of staff in the future to help deliver the new way of working? Base: All providers who say yes at Q19 (34).
The pilot contract Has been exceptional opportunity to: Improve the quality of dental care Better value for money for tax payers Engender patient compliance Re-structure the dental workforce Public health approach to delivery
Local Dental Networks and their constituent Managed Clinical Networks What do you need?
Workforce Planning OCDO Dental Strategy Department of Health - Contract Reform Local Dental Networks Managed Clinical Networks University Requirements Under/post graduate Workforce planning team (HEEAG/DWAG Report) All drive HEE Investment Plan
HEE training numbers - the HEE Investment Plan 1907
Critical Activities Opportunities Putting the mouth back in the body DH Contract Reform Skill mix and multi professional & multi disciplinary working Leadership from LDN & MCN, STPs, LWABs Challenges Influx of European & RoW Dentists (PLVE) The business of dentistry Have we the correct specialties? Complexities of change management
Educational Pathways to Provide High Quality Care Inside envelope Primary Care Outside envelope HEI, DH & DGH Level II contract modules E.g. OS, SCD, Endo, Perio, Pros, ortho, etc. Recognition Level III Community Responsibility contract modules Smile4Life, Epidemiology, Fluoride progs, Out of hours, Children Centres, care/nursing homes, schools etc. Level I - core capitation contract provision Dental Team Dentist as Leader (Workforce Development HEE remit) Primary Care ACF(CL) Joint Foundation Training Clinical 2 -Therapist Clinical 1- CDT or Hygienist Basic Dental Science Academia Specialty Training Dental Specialty Core of Training General Dental Practice* 3 Years available PLVE Dentist 2 Dentist 1 Postgraduate Undergraduate *Rotations in DGH, DH, GDS and CDS
Workforce Restructuring and Reform Project To support Contract reform Geographical and demographical need Provide equity of HEE funding Dental Team with the right skills DCPs Dentists Specialties Academics
Stakeholders
This is a great opportunity to do something different! For Patients For the Profession For the NHS
Thank you for listening