Organisation of Health Services

Question 1

When was the NHS established?

Answer 1

1948

Question 2

What is the NHS constitution?

Answer 2

Defines common set of values and principles, reviewed every ten years, legally binding on government

Question 3

Name 7 principles underpinning the NHS

Answer 3

1. Provides comprehensive service for all
2. Access to services is based on clinical need
3. Aspires to highest standards of excellence
4. Patient will be at the heart of everything
5. Work across organisational boundaries
6. Committed to providing best value for taxpayers
7. Accountable to the public, communities and patients it serves

Question 4

How is NHS managed at government levels?

Answer 4

The policy and spending decisions have been devolved, leading to considerable divergence over time

Question 5

From NHS England, describe routes the budget can be distributed

Answer 5

1. Specialised services
2. Primary care (directly and via clinical commissioning groups)
3. Better Care Fund via clinical commissioning groups
4. Hospital services via clinical commissioning groups

Question 6

Name 4 examples of commissioners in England

Answer 6

1. Clinical Commissioning Groups
2. NHS England
3. Local authorities
4. Greater Manchester Devolution

Question 7

Name 4 providers of health care in England

Answer 7

1. Private providers
2. Voluntary sector
3. GPs / Primary care
4. NHS Trusts / Foundation Trusts

Question 8

Name 2 regulators of health care providers in England

Answer 8

1. Care Quality Commission

2. NHS Improvement

Question 9

How are dental services organised?

Answer 9

Outcome of health care policy both in financing and service provision

Question 10

Name 3 things that organisation of dental services determine

Answer 10

1. How clinicians are paid for providing care
2. How patients are charged for treatment
3. How services are provided

Question 11

Describe the two scales which determine how health care is provided

Answer 11

1. Public Care to Private Care

2. No patient charges at delivery of service to patients pay all cost at delivery

Question 12

Describe the type of care provided when public care is crossed with patients pay no charge at point of delivery

Answer 12

Public service with universal coverage e.g. Nordic and UK model for children’s dentistry

Question 13

Describe the type of care provided when public care is crossed with patients pay a charge at point of delivery

Answer 13

Public service with some patient co-payments e.g. adult NHS dentistry in the UK

Question 14

Describe the type of care provided when private care is crossed with patients pay no charge at point of delivery

Answer 14

Service choice between public and private, with full public financing or insurance system e.g. many European countries

Question 15

Describe the type of care provided when private care is crossed with patients pay a charge at point of delivery

Answer 15

Service based on full patient payment supplied by private practitioners e.g. most of US system with insurance through employer

Question 16

Describe the population coverage and patient co-payment in the UK

Answer 16

Universal entitlement and co-payment in one of three bands with nurses, pregnant women, children and means-tested benefits patients being exempt from co-payments

Question 17

Describe the population coverage and patient co-payment in France

Answer 17

Universal entitlement under social health insurance which covers 70% of cost of health services including dental care

Question 18

Describe the population coverage and patient co-payment in Germany

Answer 18

Entitlement under social health insurance with co-payments of up to 50% for bridges and dentures

Question 19

Describe the population coverage and patient co-payment in the Netherlands

Answer 19

Universal entitlement to basic package of health services with co-payments of 25% for dentures

Question 20

Describe the population coverage and patient co-payment in Canada

Answer 20

Special groups only e.g. indigenous, armed forces, refugees and some low income groups, where eligible groups may pay user charges which vary

Question 21

Name 3 mechanisms governments use to pay dentists and therapists

Answer 21

1. Fee per item
2. Capitation
3. Salary

Question 22

What is a “fee per item” mechanism?

Answer 22

A charge is made for each item of treatment provided

Question 23

What is a “capitation” mechanism?

Answer 23

The providing dentist receives a lump sum to provide care for a set of patients

Question 24

What is a “salary” mechanism?

Answer 24

Providing dentist is paid as a salary to provide care

Question 25

Name 2 advantages of a fee per item mechanism

Answer 25

1. Provider paid for each item of treatment

2. Provider incentivised to treat all existing disease

Question 26

Name 3 disadvantages of a fee per item mechanism

Answer 26

1. Risks over-treatment
2. Improving health is not incentivised
3. More difficult for commissioners to control cost

Question 27

Name 2 advantages of a capitation mechanism

Answer 27

1. Allows provider and commissioner to plan and budget more easily
2. Results in less clinical procedures

Question 28

Name 2 disadvantages of a capitation mechanism

Answer 28

1. Risks under-treatment (supervised neglect)

2. Financial disadvantages for dentists working in areas where treatment needs are high

Question 29

Name 2 advantages of a salary mechanism

Answer 29

1. Removes time constraints and facilitates providing care for patients which need extra time
2. Supports commissioner to plan service and budget

Question 30

Name 2 disadvantages of a salary mechanism

Answer 30

1. Needs good management

2. No link between activity and pay

Question 31

What was the major change in 2006 in terms of payment in NHS Dental Practice?

Answer 31

Limits were placed on budgets, which were under NHS managements and set locally on existing activity

Question 32

What is the payment system in England for NHS dentistry?

Answer 32

UDAs (Units of Dental Activity)

Question 33

What are 2 drawbacks of current activity driven system (UDAs)?

Answer 33

1. Does not acknowledge population oral health improvements have occurred
2. Does not incentivise future oral health improvements

Question 34

Name 4 stated aims of Dental Contract Reform programme in England and Wales

Answer 34

1. Encourage patients to take responsibility for oral health
2. Reduce need for treatment
3. Prevent future dental disease
4. Transform services to bring prevention to centre of every NHS dental practice

Question 35

Name the 3 steps of the new care pathway

Answer 35

1. Oral Health Assessment
2. RAG system (risk profile)
3. Treatment plan

Question 36

Give 3 examples of components of an oral health assessment

Answer 36

1. Clinical status
2. Medical history
3. Social history

Question 37

Describe the RAG system for risk profiling

Answer 37

• Red, amber, green system
• Green indicates no disease or clinical factors
• Amber indicates risk of disease or clinical factors
• Red indicates disease is present

Question 38

Name 3 components of a treatment plan

Answer 38

1. Prevention
2. Self-care advice
3. Recall time related to risk

Question 39

What 2 contractual measures are being tested as part of the Dental Contract Reform programme?

Answer 39

1. Capitation

2. Non-capitated activity

Question 40

Describe how a mix of capitation and non-capitated activity being trialled as part of the Dental Contract Reform is allowing increased access to NHS dental services

Answer 40

Practices are allowed to exchange non-capitated activity for seeing additional patients to help deliver their overall contract