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17th November 2008
Dentistry and Oral Health in East and North Hertfordshire and West Hertfordshire PCTs
Jane RobinsonPrimary Care Commissioning Lead
Sue GregoryConsultant in Dental Public Health
17th November 2008
Outline• What NHS Dentistry should provide• Dental Charges• Access to NHS dentistry• What the PCT is doing to improve
access to NHS dentistry• Oral health of children• Customer satisfaction• Emergency/out of hours provision
17th November 2008
Primary Dental Services (2003 Act)
• PCT has a duty to provide or secure primary dental services to the extent it considers reasonable through:
• GDS contracts;• PDS contracts; or• provides them itself
17th November 2008
Commissioning for Oral Health
Influence over where new practices establish
Stronger local relationship with
NHS dentists
Commissioning to meet oral health needs of population
Commissioning to more explicitly address access
17th November 2008
Mandatory Services
• All proper and necessary care and treatment which includes:- the care which a dental practitioner usually undertakes for a patient and which the patient is willing to undergo, including advice and planning of treatment- treatment, including urgent treatment- ..the referral of the patient for advanced mandatory services, domiciliary, sedation…..
17th November 2008
Care and Treatment• Examination• Diagnosis• Preventive care
and treatment• Periodontal
treatment• Conservative
treatment• Surgical treatment
• Supply and repair of dental appliances
• Radiographs• Supply of listed
drugs• Issue of
prescriptions
17th November 2008
Patient charges
• PCT dental commissioning from April 2006
• Changes in patients’ charges– Simpler (3 not 400)– Avoids confusion on private/NHS boundary– Breaks link between dentists’ remuneration
and charges• Money devolved on practice base, not
by address of patient
17th November 2008
• This charge will include an examination, diagnosis and preventive advice. If necessary, this will include X-rays, scale and polish if needed, and
• planning for further treatment.• Urgent and out-of-hours care will also
cost £16.20
Patient Charge Bands-Band 1 £16.20
17th November 2008
Band 2 - £44.60• This charge includes all
necessary treatment covered by the £16.20 charge PLUS additional treatment such as fillings, root canal treatment or extractions.
17th November 2008
Band 3 - £198• This charge includes all
necessary treatment covered by the £16.20 and £44.60 charges PLUS more complex procedures such as crowns, dentures or bridges.
17th November 2008
Population per dentist15, 2006/07 and 2007/08
0
500
1,000
1,500
2,000
2,500
3,000E
ast &
Nor
thH
ertfo
rdsh
ireP
CT
Eas
t of
Eng
land
SH
A
Eng
land
Eas
t & N
orth
Her
tford
shire
PC
T
Eas
t of
Eng
land
SH
A
Eng
land
2006/07 2007/08
Population per dentist E&North Herts compared with the East of England SHA and
England
17th November 2008
Population per dentist West Herts compared with the East of England SHA and England
Population per dentist15, 2006/07 and 2007/08
0
500
1,000
1,500
2,000
2,500
3,000W
est
Her
tford
shire
PC
T
Eas
t of
Eng
land
SH
A
Eng
land
Wes
tH
ertfo
rdsh
ireP
CT
Eas
t of
Eng
land
SH
A
Eng
land
2006/07 2007/08
17th November 2008
Dental contracts in Hertfordshire
Number of
contracts
Number of
dentists
Number of
practices
West Herts 142 367 117
East & North Herts
123 300 88
Total 265 667 205
17th November 2008
Geographical Access to general dental practices in East and North Hertfordshire,3 miles and 12 miles distances
17th November 2008
Geographical Access to general dental practices in East and North Hertfordshire, 5 miles and 12 miles distances
17th November 2008
Geographical Access to general dental practices in West Hertfordshire, 3 miles
and 12 miles distances
17th November 2008
September 08 telephone audit indicated that 62% of practices in E & North Hertfordshire PCT are currently accepting new NHS patients, howeverNumber of patients treated in the
previous 24 months periodMarch 2006 328,002March 2007 332,184June 2007 329,488December 2007 320,112March 2008 316,396June 2008 316,195September 2008 317,253% Change since
March 2006-3.3%
17th November 2008
September 08 telephone audit indicated that 64% of practices in West Hertfordshire PCT are currently accepting new NHS patients,
howeverNumber of patients treated in the previous 24 months period
March 2006 314,537March 2007 307,439June 2007 301,249December 2007 286,192March 2008 275,014June 2008 272,074September 2008 271,659% Change since
March 2006-13.6%
17th November 2008
Total number1 of patients2 seen as a percentage of the population in the previous 24 months ending at the specified dates4,5,7
0%
10%
20%
30%
40%
50%
60%
70%
80%
East & NorthHertfordshire PCT
East of England SHA England
31 March 2006 31 December 2007
17th November 2008
Proportion of Courses of Treatment, October - December 20071
0%
10%
20%
30%
40%
50%
60%
Band 1 Band 2 Band 3 Urgent Other
East & North Hertfordshire PCT East of England SHA England
Distribution of courses of treatment October to December 2007
East and North Hertfordshire
17th November 2008
Distribution of courses of treatment October to December 2007
West HertfordshireProportion of Courses of Treatment, October -
December 20071
0%
10%
20%
30%
40%
50%
60%
Band 1 Band 2 Band 3 Urgent Other
West Hertfordshire PCT East of England SHA England
17th November 2008
Proportion of dentists by age band as at 31 March 2007East and North Hertfordshire
52% 47% 48%
48% 52%53%
0%
20%
40%
60%
80%
100%
East & NorthHertfordshire PCT
East of England SHA England
39 and under 40 and over
17th November 2008
Proportion of dentists by age band as at 31 March 2007West Hertfordshire
47% 47% 48%
53% 52%53%
0%
20%
40%
60%
80%
100%
West HertfordshirePCT
East of England SHA England
39 and under 40 and over
17th November 2008
The Proportion of Adults with No Natural Teeth in England, 1968-1998
Source: National Adult Dental Health Surveys, 1968 to 1998. Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, Pine C, Pitts N, Treasure E and White D (2000).
17th November 2008
Orthodontics: waiting times at October 08
Practice location
Length of time to first
assessment appointment
Length of time to case start
Referral to treatment time
Bishop’s Stortford
10-12 months 4-8 weeks 12-14 months
Royston 4 weeks 4-8 weeks 12 weeks
Ware 6 months 30 months 3 years
Hitchin 6 weeks 4 weeks 10 weeks
Stevenage 10 weeks 3-12 weeks 22 weeks
Source: Practice based Data
17th November 2008
Orthodontics: waiting times at October 08
Practice location Length of time to 1st assessment
Length of time to case start
Referral to treatment time
Boreham Wood 2-3 weeks 44-50 weeks 1 yearSt Albans 1 week 2 years 2 yearsTring 3 months 4 months 7 monthsRickmansworth 6 weeks 6 weeks 12 weeksHemel Hempstead 4 months 6 months 10 monthsHemel Hempstead Not accepting 8 weeks 8 weeksHarpenden 1-14 weeks 1-14 weeks 28 weeksHarpenden 11 weeks 8 weeks 19 weeksWatford 12 weeks 6-8 weeks 20 weeksWatford 4-6 weeks 4-6 weeks 12 weeksWatford 0-7 weeks 6-24 weeks 31 weeks
17th November 2008
Emergency Dental Services: Hertfordshire NHS Direct Triage: July 06 to June 07Call Volume No of Calls
Calls Answered 9071Symptomatic 5954
Health Information 40Other 834
Clinical Sorting of symptomatic calls No of Calls999 - (Emergency) 41 (0.68%)
A & E - (Emergency) 131 (2.2%)
Contact Dentist - <1 hour 177 (2.9%)
Contact Dentist - <4 hours 2255 (37.8%)
Contact Dentist - Routine Appointment 2113 (35.4%)
Contact Orthodontist 84 (1.4%)
Homecare and Pharmacy 1137 (19%)
Contact GP 109 (1.8%)
Other 9 (0.15%)
17th November 2008
Emergency Dental Services: Hertfordshire NHS Direct Triage:
September 08Call Volume No of CallsCalls Answered 631
Symptomatic 478Health Information 9
Other 51Clinical Sorting of symptomatic calls No of Calls
999 - (Emergency) 0 (0.0%)
A & E - (Emergency) 6 (1.0%)
Contact Dentist - <1 hour 14 (2.2%)
Contact Dentist - <4 hours 181 (28.7%)
Contact Dentist - Routine Appointment 133 (21.1%)
Contact Orthodontist 6 (1.0%)
Homecare and Pharmacy 129 (20.4%)
Contact GP 9 (1.4%)
Other 0 (0.0%)
17th November 2008
In hours urgent slots• Welwyn Garden City – daily• Stevenage – daily• Hitchin – daily• South East Herts • St Albans, Harpenden, Redbourn• Borehamwood, Bushey• Watford, Rickmansworth• Tring, Hemel Hempstead, Bovingdon
17th November 2008
Responses to Patient Questionnaires on time taken to get a dental appointment, April 2007 to September 2008
Patient’s opinion of time taken to get appointment
E& N Herts West Herts
number % number %
It was as soon as was necessary 1,309 87.21% 1,338 87.57%It should have been a bit sooner 105 7.00% 98 6.41%It should have been much sooner 23 1.53% 27 1.77%No response 64 4.26% 62 4.06%Invalid 0 0.00% 3 0.20%
Total, Samples: 2,779 and
2,778
1,501 100.00% 1,528 100.00%
Source: DSD data
17th November 2008
Responses to Patient Questionnaires on Patient’s Satisfaction with Dentistry
Received, April 2007 to September 2008.
Source DSD statistics
Patient’s satisfaction with dentistry received
E& N Herts West Herts
Number % Number %
Completely satisfied 1,106 73.68% 1,138 74.48%
Fairly satisfied 275 18.32% 278 18.19%
Fairly dissatisfied 35 2.33% 32 2.09%
Very dissatisfied 26 1.73% 24 1.57%
No response 57 3.80% 53 3.47%
Invalid 2 0.13% 3 0.20%Total: Samples: 2,779 and 2,778 1,501 100.00% 1,528 100.00%
17th November 2008
Responses to Patient Questionnaires on Patient’s Understanding of NHS/Private
Dentistry Received, April 2007 to September 2008.Patient's understanding of
treatment providedE& N Herts West HertsNumber % Numbe
r%
Invalid 7 0.47% 13 0.85%No response 50 3.33% 49 3.21%Just NHS treatment 1,307 87.08% 1,313 85.93%Combination of NHS and Private 70 4.66% 98 6.41%All Private treatment 9 0.60% 6 0.39%Unsure 58 3.86% 49 3.21%Total Samples: 2,779 and 2,778
1,501 100.00% 1,528 100.00%
Source DSD statistics
17th November 2008
East & North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out)
Health Body
Number of patients
% of patients UDA UOA
E & N Hertfordshire 77,859 90.20% 170,267.35 7,354.20Enfield 2,288 2.70% 4,992.80 942
W Hertfordshire 2,201 2.50% 4,449.10 1,497
Non neighbouring 1,628 1.90% 3,919.75 187
West Essex 1,389 1.60% 2,869.70 167
Cambridgeshire 516 0.60% 991.35 3
Luton 400 0.50% 1,003.20 1
Bedfordshire 310 0.40% 563.40 69.8
Total outflow 8,732 10.20% 18,789.30 2866.8
17th November 2008
Patients treated in East & North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In)
Health Body
Number of patients
% of patients UDA UOA
E & N Hertfordshire 77,859 80.20% 170,267.35 7,354.20West Essex 4,832 5.00% 10,229.80 521Bedfordshire 3,706 3.80% 7,680.00 890W Hertfordshire 2,850 2.90% 5,830.50 4Unknown 2,653 2.70% 5,834.70 412Cambridgeshire 2,296 2.40% 4,047.00 454Non neighbouring 1,448 1.50% 3,250.05 78Enfield 1,172 1.20% 3,305.60 78Luton 221 0.20% 436.75 202Total outflow 19,178 19.70% 40,614.40 2639
17th November 2008
West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out)
Health Body
Number of patients % of patients UDA UOA
West Hertfordshire 68,853 86.00% 148,285.30 12,044.00E & N Hertfordshire 2,850 3.60% 5,830.50 4
Non neighbouring 1,985 2.50% 4,701.00 51
Harrow 1,887 2.40% 3,844.65 71
Hillingdon 1,722 2.20% 3,698.85 180
Barnet 1,437 1.80% 2,674.00 1,160
Buckinghamshire 739 0.90% 1,255.65 86
Enfield 492 0.60% 1,117.50 50
Bedfordshire 311 0.40% 735.10 64
Total outflow 11,423 14.40% 23,857.25 1666
Source: DSD Statistics
17th November 2008
Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In)
Health Body
Number of patients % of patients UDA UOA
West Hertfordshire 68,853 84.80% 148,285.00 12,044.00Buckinghamshire 3,143 3.90% 6.55 1,333
E & N Hertfordshire 2,201 2.70% 4,449.10 1,497
Non neighbouring 1,944 2.40% 3,635.00 1,266
Unknown 1,817 2.20% 4,133.45 235
Bedfordshire 1,403 1.70% 2,384.90 1,351
Harrow 739 0.90% 1,592.95 38
Barnet 616 0.80% 1,368.05 3
Hillingdon 363 0.40% 677.75 223
Enfield 100 0.10% 262.20 0
Total inflow 12,326 15.10% 18,509.95 5,946
Source: DSD Statistics
17th November 2008
Oral Health in Children 2005/06Average number of decayed, missing and filled teeth in 5
year old children
1.47
1.13
0.9
1.78
1.23 1.29
0
0.4
0.8
1.2
1.6
2
ENGLAND East ofEngland
Bedfordshire Luton E & N Herts West Herts
Source: Surveys co-ordinated by the British Association for the Study of Community Dentistry
17th November 2008
The proportion of 5-Year Old children with experience of caries, Nationally, Regionally
and Locally 2005 to 2006
41.1
26.7
32.1
3834.1 34.8
0
10
20
30
40
50
Source: Surveys co-ordinated by the British Association for the Study of Community Dentistry
17th November 2008
School Dental Inspections
• Research in the 1980s started to question the aims and effectiveness of the screening examinations. The results of a large Randomised Control Trial have demonstrated that school dental screening is ineffective at a population level in reducing levels of untreated disease and increasing attendance of those who need treatment.
17th November 2008
• On 7 November 2006, the UK National Screening Committee recommended to the UK Chief Dental Officers that there is no evidence to support the continued population screening for dental disease among children aged 6 to 9 years.
• The Committee’s recommendation was based in part on the view that the resources currently used for screening could be used more effectively in other ways to tackle oral health inequalities
17th November 2008
Improving Children’s Oral HealthRequires partnership working from the
following stakeholders:• Dental teams• Public Health specialists• Oral Health Promotion Team• Health visitors• Health improvement specialists• Sure start and children’s’ centres• Healthy schools programmes• Local authorities• Voluntary groups
17th November 2008
Oral Health Promotion Activities Aimed at Reducing
Oral Health Inequalities in Young Children TOPIC FOCUS GOOD PRACTICE
DIET A
ND
NU
TRITIO
N
INFANT FEEDING Promote breastfeeding Coma recommendations Oral Health input into local infant feeding strategies and guidelines
POLICYGUIDELINES
Promote the development and adoption of nutrition and healthy eating guidelines
SUGAR CONTENT Discourage addition of sugars to weaning foods/drinks and vitamin supplements Encourage reduction in sugar content of soft drinks/breakfast cereals,
confectionary, etc. Encourage caterers to reduce sugars in prepared foods Encourage vending machine providers to include sugar-free choices
PUBLICINFORMATION AND SUPPORT
Improve consistency of all dietary messages re: importance of reducing the frequency of consumption of sugary drinks and foods
Ensure effective dietary education for those at risk of dental caries and erosion Restriction of promotion of food and drinks high in sugar, particularly for children
OR
AL H
YGIEN
E
EARLYTOOTHBRUSHING
Encourage parents and carers to start toothbrushing with fluoride toothpaste within the first year of a child’s life
BODY ANDORALHYGIENE
Incorporate oral hygiene teaching into Personal and Social Education teaching
TRAINING ANDSUPPORT
Improve the effectiveness of oral hygiene instruction provided by oral and health professional
17th November 2008
Hertfordshire Oral Health Strategy and Commissioning
Group• Primary & Secondary dental care commissioning is outside of Practice Based Commissioning
• Integrated approach to budget and decision making
• Engagement of primary and secondary care clinicians in assessing needs, developing care pathways and commissioning decisions
• Lay representation
17th November 2008
Dept of Health additional growth funding 08-09
Indicative Gross
Allocation£000s
Indicative Patient Charge
Revenue£000s
Net Allocation
£000s
UDAs – Indicative Planning Assumpti
on
East & North Hertfordshire PCT
1,292 258 1,034 55,355
West Hertfordshire PCT
1,998 600 1,398 79,945
17th November 2008
Additional Growth from PCTs
West Hertfordshire and East and North Hertfordshire PCTS have added an additional recurring allocation to total £2million to further improve access to general dental services
17th November 2008
West Herts - HertsmerePractices in Potters Bar, Borehamwood
and Bushey have received the following additional growth:2008-09 16,700
Units of Dental Activity
5,567 patients
2009-10 31,400 UDAs
10,467 patients
17th November 2008
West Herts – St Albans and Harpenden
2008-09 18,500 Units of Dental Activity
6,167 patients
2009-10 36,400 UDAs 12,133 patients
Practices in London Colney, St Albans and Harpenden have received the following additional growth:
17th November 2008
West Herts- Watford and 3 Rivers
Practices in Watford, Rickmansworth, Croxley Green, Chorleywood and Abbots Langley have received the following additional growth2008- 09 15,275 Units
of Dental Activity
5,092 patients
2009-10 36,325 UDAs 12,108 patients
17th November 2008
West Herts- DacorumPractices in Tring and Hemel
Hempstead have received the following additional growth:2008- 09 5,600 Units of
Dental Activity
1,867 patients
2009-10 14,000 UDAs 4,667patients
17th November 2008
East and North Herts – SE HertsPractices in Ware, Hoddesden,
Waltham Cross, Hertford, Flamstead End, Cuffley and Cheshunt have received the following additional growth:2008- 09 22,550 Units
of Dental Activity
7,517 patients
2009-10 35,400 UDAs 11,800 patients
17th November 2008
East and North Herts – N Herts & Stevenage Practices in Baldock, Stevenage,
Hitchin and Letchworth have received the following additional growth:2008- 09 21,465 Units
of Dental Activity
7,155 patients
2009-10 44,980 UDAs 14,993 patients
17th November 2008
East and North Herts – Welwyn/HatfieldPractices in Welwyn Garden City,
Hatfield, Panshanger and Welham Green have received the following additional growth:2008- 09 6,400 Units of
Dental Activity
2,133 patients
2009-10 17,424 UDAs 5,808 patients
17th November 2008
East and North Herts- RBBSPractices in Bishop’s Stortford and Buntingford have received the following additional growth funding:
2008- 09 8,800 Units of Dental Activity
2,933 patients
2009-10 18.102 UDAs 6,034 patients
17th November 2008
Total Hertfordshire Growth allocated to date
West Hertfordshire PCT2008-09
56,075 UDAs
18,693 patients
£1,345,800
2009-10
118,125 UDAs
39,375 patients
£2,835,000
East and North Hertfordshire PCT2008-09
59,215 UDAs
19,738 patients
£1,421,160
2009-10
115,904 UDAs
38,635 patients
£2,781,744
17th November 2008
Supporting Patient Access• PCT telephone number for
information• Up to date information on individual
practice’s capacity• NHS Choices website• Increasing public awareness• Communications plan (December
2008)
17th November 2008
Reconfiguration of Acute Services
• In patient beds for oral and maxillofacial surgery were centralised at Luton & Dunstable Hospital in 2004. This serves Bedfordshire, Luton, east and North Herts and the northern part of West Herts.
• Most oral surgery and all orthodontics is undertaken as out patient or day stay at the local district general hospital
• Reconfiguration will have little effect