After the pilots: what next?

John MilneChair GDPC.

Slide 3

CQCHTM 01--05

Information

GovernanceNew Contract

LPNs

What Next!!!!!!

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New Dental ContractRegistrationCapitation

Quality and Outcomes

Oral Health in 12 year olds

Care Pathways

• Oral health assessment• Practical, consistent and achievable.

• RAG scoring• Risk based assessment of caries, periodontal disease, tooth surface loss and soft tissues

• Leads to status and interim care review intervals.

• Care priorities • Drive clinical pathways.

• GDP override• Professional discretion.

Up to date issues.................

Sales of practicesOFT- continuous

tendering of contractsFD training and placesPay and expensesCQC Compliance and

costsHTM 01-05Role of DCPs – Direct

access?Commissioning Board

Transitional ArrangementsLocal Professional

NetworksNHS Offer – core

service?Seniority Pay- new

schemeIT costsAssociate terms and

conditions

Oral Health Assessment: leads to homecare plan and professional care plan.

• Medical History• Alcohol and tobacco• Social History

• Family caries history

• Diet and toothbrushing• Full chart of restorations• Full chart of carious

lesions

• BPE• Bleeding• Pocket chart.

• Tooth surface loss (relative to age)

• Soft tissues.

What’s important?

For the public• Access to quality care

– And urgent care

• Improved oral health outcomes

• Good experience• Clarity of what the NHS

will provide• Simple charging system

For the profession• Improved patient

outcomes• Fair remuneration• Current benefits

preserved• Ability to transfer

contracts (goodwill)• Financial stability in

transition stage.

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Pilots so far..............................

Best thing I’ve ever done, free from UDAs at

last. Can deliver proper

care.

Worst thing possible, no way this system can

work!

What types of practice?

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Satisfaction with NHS dental care in last 9 months

Q4. Overall, how satisfied or dissatisfied are you with your experience of NHS dental care at this dental practice in the last 9 months?Base: All patients and carers/guardian/parents of patients (3,760).

%PATIENTSNet Satisfied: +91

NHS dental care in last 9 months compared to previous experience

Q5. Generally speaking, how does your overall experience of NHS dental care at this dental practice in the last 9 months compare with your previous experience of NHS dental care? Was it better or worse, or about the same?Base: All patients and carers/guardian/parents of patients (3,760).

%Net Better: +46 PATIENTS

15

Overall attitudes towards the care pathway

Q3. To what extent do you agree or disagree with each of the following statements about the care pathway currently being piloted in your practice?Base: All dental care professionals (320)

92

80

55

Total: % Agree

PRACTITIONERS

16

Overall performance of OHA in terms of enabling better care to be provided to patients

Q5. Compared to the previous system, how would you say the Oral Health Assessment (OHA) performs overall in terms of enabling better care to be provided to patients? Is it better or worse, or is it about the same? Base: All dental care professionals (320)

PRACTITIONERS

17

Pilot appointments by appointment type (Source: DPMS data)

87

84

80

Total: % Better

Q6. Compared to the previous system, how would you say the Oral Health Assessment (OHA) performs overall in terms of each of the following?Base: All dental care professionals (320)

Specific aspects of OHA performance

PRACTITIONERS

19

Changes to the skill mix in the practice as a consequence of the care pathway

Q17. Changed the skill mix?

Q18. In what way?

73%

PROVIDERS

Q17. Has your practice changed the skill mix of staff to help deliver the new way of working as part of the care pathway? This could be through up-skilling existing staff or by changing the staffing model. Base: All providers (40)Q18. In what way has your practice changes the skill mix of staff to help deliver the new way of working?Base: All providers who say ‘yes’ at Q17 (29).

20

Changes to the skill mix in the practice as a consequence of the care pathway

Q19. Consider changing the skill mix?

Q20. In what way?

85%

PROVIDERS

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).

21

The care pathway and clinical autonomy

Q4. Compared to before the pilot, would you say you have more or less clinical autonomy, or is it about the same?Base: All dentists (129)

22

PROVIDERS

Q22. Finally, please tell us any other comments you have on the care pathway, including any suggestions for improvement. Base: All dental care professionals (320)

Thoughts on the care pathway & suggested improvements

PRACTITIONERS

23

Patients: Q14. Which of the following best describes your view about the use of ‘traffic light’ ratings? Base: All patients and carers/guardian/parents of patients who can remember using traffic light ratings (2,011)Practitioners: Q10. Which of the following statements best describes your view about red/amber/green status? Base: All respondents (320)

Views about the use of RAG ratings

58%(31%)

The ‘traffic light’ ratings make it easier for me/patients to look after teeth and gums (oral health)

41%(22%)

1%(1%)

The ‘traffic light’ ratings make no difference to how I/patients look after teeth and gums (oral health)

The ‘traffic light’ ratings make it more difficult for me/patients to look after teeth and gums (oral health)

75%

19%

0%

N.B. Figures in brackets refer to data based on all patients (3,760)

PRACTITIONERSPATIENTS

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RAG status breakdowns by practice (Children)

70 pilot practices (in order of % red children)

RAG status breakdowns by practice (Adults)

70 pilot practices (in order of % red adults)

RAG status overall breakdown

There is a clear correlation between IMD score and RAG status but the effect is reasonably small

Responses in second wave pilots.

• Revision of pathway (including IT)• Changes to Pt charges in pathway practices.• Registration simulated in pilots.• Additional pilots (including 3 salaried services)

Evaluation

• DH: Evaluation & Learning.• BDA Shadow group• NSG.

Still to come...............

• Treatment data• Volumes• Types• Advanced Care.

• Modelling of capitation payments• Transitional protections• Avoiding neglect.

Redistribution

• High UDA Value...........................Low UDA value• Transitional arrangements MPIG?• Capitation numbers?• Length of registration period?

• High Access..................................Low Access• Growth funding?

Income

Expenses

• Rising on all fronts• Regulation and compliance• Training• Premises• Staff• Utilities• Materials• Laboratories.

Capital

• Risk v Reward.• Buildings• Equipment• Future investment.• Returns.

We need some honesty in the debate.

• Access• NHS Offer• Scope of advanced care.• Elderly Population• Existing inequalities

The big challenge

• How can a system improve oral health, deliver prevention continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?

The big challenge

• How can a system improve oral health, deliver prevention continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?

Capitation Values.

• £1,000,000• 10,000 pts

• £100 per patient per year.

Is the cake big enough?

Challenge ahead.

• Improved oral health• Sustainability of practice

• Long term future.

• Career pathway for dentists• Practice ownership and

equity

• Proper remuneration

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