Report of NHS England North (Yorkshire and Humber) to the meeting of the Health and Social Care Overview & Scrutiny Committee to be held on 08 October 2015 Subject: NHS England (West Yorkshire) Dental Commissioning Update 2015/16 O Summary statement: This report provides the Bradford Health and Social Care Overview Scrutiny Committee with an update on the current situation and work progressed to date specifically relating to the 5 resolutions made by the Committee at the September 2014 meeting:- The process for NHS patients seeking a Dentist. Low Income Scheme Unscheduled dental care provision and current position Work programmes undertaken to date by the West Yorkshire Local Dental Network. (Appendix 1 to Appendix A) Contract Reform Kathryn Hilliam Head of Co Commissioning NHS England North (Yorkshire and the Humber) Portfolio: Adult Social Care and Health Report Contact: Caroline Coombes Phone: 01274 432313 E-mail: caroline.coombes@bradford.gov.uk
Report to the Health and Social Care Overview & Scrutiny Committee 1. Summary 1.1 This report provides the Bradford Health and Social Care Overview Scrutiny Committee with an update on the current situation and work progressed to date specifically relating to the 5 resolutions made by the Committee at the September 2014 meeting:- The process for NHS patients seeking a Dentist. Low Income Scheme Unscheduled dental care provision and current position Work programmes undertaken to date by the West Yorkshire Local Dental Network. (Appendix 1 to Appendix A) Contract Reform 2. Report issues 2.1 Appendix A outlines gives information responding to the Committee s resolutions of 25 September 2014. 3. Options 3.1 Members may wish to comment on the information provided in Appendix A. 4. Contribution to corporate priorities 4.1 Bradford District Joint Health and Wellbeing Strategy Priority 6 is to improve oral health of under 5s. 5. Recommendations 5.1 The Committee is asked to consider and comment on the information presented in Appendix A of the report. 6. Background documents 6.1 Report of West Yorkshire Area Team, NHS England and Public Health England to the meeting of the Health and Social Care Overview & Scrutiny Committee held on 25 September 2014 Oral Health and Dental Services in Bradford District Document I 7. Not for publication documents None 8. Appendices 8.1 Appendix A NHS England (West Yorkshire) Dental Commissioning Update 2015/16 2
Bradford Health and Social Care Overview and Scrutiny Committee 8 October 2015 NHS England (West Yorkshire) Dental Commissioning Update 2015/16 1. Introduction and Background Bradford Health and Social Care overview and Scrutiny Committee were presented with a report on NHS Dental Services in 2014. The report outlined the current position and the proposed approach including a two year plan for commissioning dental services. 2. Purpose This report provides the Bradford Health and Social Care Overview Scrutiny Committee with an update on the current situation and work progressed to datespecifically relating to the 5 resolutions made by the Committee at the September 2014 meeting:- The process for NHS patients seeking a Dentist. Low Income Scheme Unscheduled dental care provision and current position Work programmes undertaken to date by the West Yorkshire Local Dental Network.(Appendix 1). Contract Reform In addition Scrutiny Board is asked to note; Priorities agreed further to the launch of the Yorkshire and Humber Oral Health Needs Assessment. 3. Patients Seeking an NHS Dentist Leeds Dental Advice Line (LDAL) The LDAL was established by Leeds South Primary Care Trust in 2006. The service at that time was intended to support patients seeking NHS dental services to find a dentist as geographically close as possible to the patient s home postcode. The service was subsequently transferred to NHS Leeds and NHS England in 2012. During the transition to NHS England it is understood that NHS Leeds was the only Primary Care Trust that maintained this service. All other PCTs disbanded local signposting services. Scrutiny Board will be aware of the cessation of this signposting service.
The following should be noted; It was recognised that the Leeds Dental Advice Line as it currently operated was not the most appropriate process for signposting patients. The Advice line has resulted in inconsistencies, inequity and confusion for patients. It should be noted that the signposting service was inherited and therefore was structured and operated for Leeds residents only. It was not intended to be a West Yorkshire Service in its current form however due to difficulties in accessing routine care coupled with inaccurate NHS Choices information 111 did often refer patients to the Service. Patient Quality and Experience The Dental Advice Line provides callers with limited information about known local dental services available in Leeds only. It cannot provide medical or dental advice often resulting in patients having to make numerous calls to 111, NHS England and Dental Contractors. The advice Line has never been staffed at weekends and bank holidays Lack of timely and accurate data on Contractors accepting new patients again resulting in poor patient experience. All services previously provided by the Leeds Dental Advice Line is provided by NHS 111 and NHS Choices, and callers may find they feel more informed by these national NHS information services compared to the local LDAL line. It is recognised that the lack of local patient information and NHS Choices can make it difficult for patients considering that NHS Choices may not always accurately reflect the current provision in the system. West Yorkshire will be working with other Stakeholders including Healthwatchto consider local options for how to ensure patients can obtain timely information to be able to access services in the most appropriate way. 4. Low Income Scheme NHS Choices provides further information on this scheme including links to patient leaflets and posters. NHS England will discuss with Local Dental Committee s the preferred approach for promoting this information with patients. This information can be accessed via the following; http://www.nhs.uk/nhsengland/healthcosts/pages/nhs-low-income-scheme.aspx 5. West Yorkshire Unscheduled Dental Care Procurement The service was tendered in March 2015. Unfortunately no bids were received. NHS England has approved a 2 year contract extension with the current providers of the service in West Yorkshire. The pressures of the service are recognised and NHS England has committed to working with current providers in describing and piloting some changes that overall will create a basis for a future specification that has been tested to deliver the best optimum outcomes possible. Meanwhile patients will continue to access services as they currently do. The West Yorkshire Local Dental Network have prioritised and will oversee future work with regards commissioning of primary dental care and the broader access agenda which will include Unscheduled Dental Care Provision.
6. Primary Care Dental Contact The final resolution made by the committee in relation to dental issues at the October 2014 meeting was that the Chair would write to the relevant health minister requesting that action be taken to accelerate the introduction of the new dental contract. The response from the Department of Health has been shared with NHS England s West Yorkshire office, and this section is therefore intended to update the Committee on the new Dental Prototypes, set up to further advance the trial of varying proposed elements which may be included in the new national contract. The dental contract reform programme began piloting new models of dental care in 2011, these pilots reflected the need to have a system focused on improving health outcomes rather than solely on treating disease. They piloted preventive focused care pathways and measured the quality of care delivered. In the next stage, building on the learning from the pilots, prototypes will be testing a possible new system with more financial assurance and realism than the pilots which were testing a range of possible options. Training has begun for the practices moving into the prototype phase of the contract reform programme. The initial groups are practices who have moved from the piloting phase and the last tranche will involve practices who are currently operating under the UDA system. Within West Yorkshire there are 5 practices who will work within the prototype testing phase, 1 of which is within Bradford. The clinical philosophy and preventive pathway based on Delivering Better Oral Health remains at heart of the dental contract reform programme. Remuneration within the prototypes is a balance of capitation and activity to support the delivery of prevention and there has been a shift of funding from activity to prevention. 7. Oral Health Needs Assessment The Oral Health Needs Assessment was launched at a workshop in July 2015. The aim of the workshop was to identify and agree a list of the 5 most important areas for NHS England and Local Authorities to work on including 2 agreed priorities for joint working. Top 5 priorities/actions were identified for West Yorkshire: Prevention consideration to be given to incentivising primary care dentistry, focussing on young and elderly (eg extend prevention agenda by identifying people and getting them into a pathway before they enter residential care Establishing OHAGs across WY and strengthening engagement with NHS E WY locality Access to services particularly for vulnerable groups equity of provision requires consideration including Unscheduled dental care is it clear what is provided and for whom? Oral surgery (level 2) what is currently commissioned and what will this look like? Signposting to NHS dental services an issue for all but key in areas of greatest deprivation.
Key actions: Development of an Oral Health Network that will involve all local authorities including Bradford to be coordinated by PHE with DPH chairing October/November 2015 Undertake Health equity audits across primary care, community and specialist dental services commissioned by NHSE and undertaken by PHE October 2015 Oral health needs assessment of vulnerable groups commissioned by NHS England and undertaken by PHE October 2015. This will inform the future commissioning of community dental services and supports the implementation of the NHS England commissioning guide on special care dentistry Kathryn Hilliam Head of Co Commissioning NHS England North (Yorkshire and the Humber) September 2015
Appendix 1 NHS ENGLAND Commissioning Plan Integrated Dental Services September 2015 Kathryn Hilliam Head of Co-commissioning NHS England Jane Moore Local Dental Network Chair NHS England (West Yorkshire office)
Overall Initiative Measures of Success Key Actions Milestones Update September 2015 Appendix 1 1 Commission new national pathways to ensure quality, consistency and value for money Improved quality of care Improved access Improved value for money Roll-out new pathways as they are released by NHS England. Scope capacity and capability in primary care and extended services to deliver minor oral surgery Autumn 2014 onwards July 2014 New national pathways in Oral Surgery & Orthodontics Special care to be released September 2015 which will influence commissioning decisions going forward. Oral Health Needs Assessment launched 8/7/15, scoping capacity and capability in primary care dentistry generally and in relation to specialised services. An NHS Management Graduate is also now in post within the West Yorkshire office focussing on the development and implementation of a Managed Clinical Network (MCN) relating to Oral Surgery (focussed predominantly on secondary care provision, but which will impact on primary care provision of specialised services and orthodontics etc.) 2 Introduce an electronic referral and booking service Improved utilisation of services Improved access Deliver NHS net connectivity for GDP contractors Collaborate in north of England procurement Mobilise new service October 2014 April 2014 NHS net email accounts offered out to all dental practices in West Yorkshire April 2015. Following limited uptake, a further letter to encourage uptake has been sent out to West Yorkshire practices to enhance referral processes. April 2015 A risk assessment on the impact on patient care will be carried out if private primary care patients are unable to use this method of referral into secondary care and how best this can be managed.
Appendix 1 3 Understand implications for workforce and training of pathway redesign Workforce strategy for dental services Safe roll-out of new primary care dental contract. Establish task & finish group of LPN with HEE Scope current workforce and future models of care Link to national work on dental workforce Agree strategy between NHS England (West Yorkshire) and HEE Summer 2014 onwards. The new primary dental contract is still in progress and a further round of test models are now being trialled nationally through practices using a Prototype contract model. (Please refer to additional narrative in Updated)This will further add to the evidence gathered through the earlier round of dental pilot models. In the West Yorkshire area we have 5 practices confirmed as being part of the prototype test models of care and service provision. A Local Dental Network task and finish group has looked at establishing Managed Clinical Networks for Oral Surgery and Orthodontics across West Yorkshire, and further work is now being undertaken to implement a Managed Clinical Network to cover these elements (as stated above in point 1 update). Once established, the MCNs will have full involvement from Health Education England, to ensure that workforce implications and areas of workforce need can be identified and managed within this process, leading ultimately to agreed workforce strategies to reflect the likely work streams going forward. Primary Care 4 Mobilise new urgent care One stop service for patients and public Complete procurement by end March 2014 and mobilise new provider by end September September 2014 Please refer to narrative in Main report update.
Appendix 1 provision Same day access for urgent care Promote a shift from unscheduled to planned care Reduced attendances in other care settings (GP / ED) Improved value for money 2014 Unsuccessful procurement. As this was the second procurement process for this provision, limited interest and insufficient/inadequate bids has led NHS England to extend the contracts that are currently in place, with the intention to fully re-evaluate the service requirements to work up a new service specification/service model for future procurement. Local Dental Network Access Task and Finish Group will be convened with the aim of making commissioning recommendations to NHS England. 5 Improved access to primary dental care Improved patient satisfaction Improved patients seen / 24 months Improved management of contract year-end Additional investment based on health needs analysis at ward level Establish monitoring system for new patients seen / contract May 2014 and on-going Since the previous presentation to Bradford OSC in 2014,NHS England has commissioned an additional 6,100 Units of Dental Activity (at a cost of 156,000), on a recurrent basis, for patients in the Bradford area. This activity has been awarded to existing providers on the condition that, amongst other criteria, they accept new NHS patients. Communication strategy for primary care access. Following analysis of the 2014-15 year end out-turn positions for all practices in West Yorkshire at the end of September some practices may have achieved less than the contracted 96% of commissioned UDAs. These monies would be subject to claw-back in year and NHS England will give consideration to investment priorities for
Appendix 1 improving access. To allow for the commissioning of both recurrent and non-recurrent funding, gaps in primary care access will be identified with the involvement of key stakeholders and funding targeted where most benefit can be identified. Local Dental Network Access Task and Finish Group will be convened with the aim of making commissioning recommendations to NHS England. 6 Review orthodontic serviced provision Improved patient satisfaction Reduced waiting times for treatment Improved utilisation of UOAs Review waiting lists in current providers and identify opportunities to reduce waiting times Establish case for nonrecurrent investment to reduce waiting times. Establish and roll-out assessment protocol for GDPs September 2014 September 2014 April 2015 The Commissioning Guides are to be published on 29 th September. A task and finish group is already in operation. This group will soon begin implementation of the guides commencing with work to set up MCN and Referral Management Service (RMS) for orthodontics in the run up to re procurement of the contracts and to look at training for tier 1 dentists 7 Ensure level 1 procedures carried out in primary care Improved patient satisfaction Reduced utilisation Audit outpatient attendances with no treatment Action plan for individual GDP 6-monthly Part of the Secondary Care Dental Strategic review which is due for completion by the end of November 2015. This will propose a 5 year commissioning plan encompassing oral
Appendix 1 of secondary care contractors based on outcome of audit Develop training and education programme with HEE Autumn 2014 and on-going surgery/medicine, restorative dentistry, orthodontics and paediatric dentistry, and will link to the principles included within the impending national commissioning guides. Initial emphasis will be applied to the development and implementation of Managed Clinical Networks in all disciplines, together with proposals for improved referral management and patient access 8 Strengthen quality assurance and governance of primary care Improved performance against national standards in dental assurance framework Action plans for individual contractors in place June 2014 and on-going Using information from BSA a risk profile of practices is compiled. Letters are sent to individual practices identified as outliers Any practices regarded as high risk are discussed with Dental Advisors and subject to further investigation. NHS England West Yorkshire Management Team are informed of any quality and risk issues. Community Dental Services (CDS) 9 Review current service offer and standardise across West Yorkshire Standard service offer and outcomes in each contract Improved value for money Review of services by LPN and commissioning team (with providers) Identify specialist services that are currently provided and ensure these are specified in detail. Ensure all services are provided in the most appropriate setting for the patient needs and that August 2015 to March 2017 Review completed March 2016 and procurement A service review group has been set up across Yorkshire and the Humber to: review all community dental services; to specify services to meet the needs of the population using the community dental services; and to ensure that there are no vulnerable groups who do not have access to services. Following initial review of services NHS
Appendix 1 gives value for money. Ensure there is robust patient and public engagement and that other stakeholders are identified and consulted on any changes proposed to the services. Notice to providers Procurement process undertaken Revised contracts in place and implementatio n by 1st April 2017 England (West Yorkshire office) has met with all providers in our area to discuss proposals. Variation documents have been issued to all providers to extend current contracts. A single tender waiver to allow extension of these contracts to March 2017 is being progressed. 10 Consider how best to meet the need from the frail elderly, disabled adults & children and looked after children for accessible primary dental care services Improved access to care for patients with specific needs Review of services by LPN and commissioning team (with providers) Revised contracts in place July 2014 April 2015 CDS contractors predominantly provide care to those with specific physical needs, those who are frail and need home visits, for children, and for those with dental phobias etc. to ensure that accessible services are provided for those who may struggle to access services at traditional dental providers/premises. This has been revisited with providers as part of the contract review (see point 9 above) Secondary Care 12 Introduce mandatory tariffs for outpatient procedures Improved value for money Common price irrespective of care setting 2014/15 contracts April 2014 Put in contracts March 2015 but review ongoing by the Local Dental Network 13 Link to specialised commissioning for Improved quality of care for patients Map roll-out of national dental pathways against specialised 2015 Part of the strategic review see point 7
Appendix 1 OMFS (cancer & trauma) pathways requiring specialised services. commissioning plans for oral cancer and trauma. onwards. Procurement of IMOS contracts across WY Sustainable local access to routine care Agree implementation plan for reconfiguration of providers