PHEBD Flashcards
Aims of the 2006 dental contract
Improve equity of services: inc. access
Encourage fewer interventions, more T for preventive care
Remove fee per item + simply payment and pt charges
Commission locally delivered dental services
What are the types of dental contract currently available?
General Dental Service contracts - given to 2/+ individuals in partnership — 1 dentist — NHS, PDS/PMS, HCP, provider - no T limit - must provide mandatory services
Personal Dental Service agreement
- CDS, non-mandatory services (ortho, sedation)
- awarded to individuals or corporations or trusts
- T limited; often 5yr
- no mandatory services
- KPIs
Criticism of 2006 contract
More likely to under Tx
Red. no complex Tx + inc. XLA and referrals (CDS/HDS)
Max. UDAs; prescribe techniques/Tx inc. UDAs (freq. recall, higher band Tx)
Pressure to meet UDA target; red. prevention + skill mix
Poor commissions + unrealistic and inflexible targets
Fears of financial insecurity + uncertainty -> leaving NHS
Outline the clinical care pathway piloted in the new contract
New pt OHA
Risk + Needs assessment; assigned RAG for all major disease
Personalised prevention
Advanced restorative Tx; when risk managed
OHR
Explain RAG rating system
Red: active disease can’t be modified by pt factor
Amber
- amber clinical factor
- green clinical factor + coexisting pt factor inc. risk
Green: no clinical or pt factors which inc. risk
What is DQOF?
Dental Quality + Outcomes Framework
Measures pt outcomes
Proportion of practice’s remuneration based on score out of 1000
Indicators
- clinical effectiveness (60%); red. caries, improved BPE
- pt experience (30%); independent survey
- pt safety (10%); 90% pt have up to date MH
+/- attributes of contract pilots
+
- pt appreciate care pathway + RAG rating
- pt like individualised care plan
- pathways make professional sense
- red. risks + OH improvements
-
- different use of RAG; needs clarity
- use skill mix more effectively
- inc. waiting T
- limited capacity to see new pt
- red. access
- red. pt charges
- IT/software problems + medicolegal concerns
Potential impacts of dental contract form
Reorientation of services towards
Changes to traditional ways of working + focus on skill mix
Scope of dental nurses extended; X-rays, FV (prevention)
Use appropriate skills at right time to improve outcomes
Broaden team skills + experiences
Little attention on vulnerable groups unable to access
Similar level of funding
Discuss different dental services
GDS
- majority; high street dentist
- most offer NHS + P
- must offer full range of NHS Tx
- dentist responsibility to inform pt of Tx cost
CDS
- specialised service for those unable to access GDS
- Paeds: extensive unTx’d caries + anxious/uncooperative, referred, at risk
- physical/learning difficulty
- complex MH
- phobia
- severe mental health (dementia)
- drug/alcohol abuse
- frail /housebound, homeless
HDS
- hosts to uni
- specialist care, pt referred in
Discuss the definitions of access
Those who need care get into the system
Requires services to be available
Function of supply (location, availability, cost, appropriateness) + demand (burden of disease, knowledge, attitude, skills of pt)
5 As of access
Availability: adequate vol. + type of services vs vol. + type of needs
Affordability: in/direct cost implications
Acceptability: attitudes/beliefs of user + clinician
Accessibility: location of service vs location + mobility of pt
Accommodation: service organised in relation to pt needs + appropriateness
How is access to NHS dental services measured?
No. adults access dental service over 24/12
No. children access dental service over 12/12
Done using FP17 forms
Potential barriers to accessing NHS dental care
Can’t find dentist Afraid/phobia Can’t afford Previous bad experience No problem/don’t see point No time Difficult to get to Embarrassment
How can barriers to access be overcome?
Domiciliary care Book transport/translators Extend opening hours Engage w/ local communities to address culture needs + beliefs Child friendly practices
Define quality of health services
Degree to which health services for individuals/popn. inc. likelihood of desired health outcomes and are consistent w/ current professional knowledge
