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
6 dimensions of quality
Safety Effectiveness Pt centredness Timeliness Efficiency Equity
What is quality assurance?
Activities that are carried out to set standards and to monitor and improve performance so that care provided is effective and safe
How can quality be assessed?
Benchmarking; audits Pay for performance; DQOF Performance Mx; GDC, NHS Commissioners QA: CQC, clinical governance Accreditation: BDA Good Practice, Denplan Excel Regulation: GDC Commissioning: NHSE
How is prevention provided on NHS? How is it measured?
Implementation of DBOH toolkit
Measured: % of FP17s reporting delivery of best practice prevention + FV
