Restorative dentistry clinical networks and workforce in the North of Scotland

1. Restorative dentistry clinical networks and workforcein the North of Scotland Andrew Forgie NHS Education for Scotland 7th February 2012

3. Presentation plan • Restorative dentistry • Networks • A restorative network model? • Training

5. Restorative dentistry • diagnosis & treatment planning • periodontology • conservative dentistry • fixed prosthodontics • removable prosthodontics • endodontics • implantology

6. Specialist clinical staff • Consultant in restorative dentistry • All aspects of restorative dentistry • Oral cancer MDT member • Hypodontia Monospecialist • Periodontology • Prosthodontics • Endodontology

7. Established restorative networks • Cancer MDTs • Multi-disciplinary clinics for • Orthodontics • Oral Surgery • Do we want MCN’s? • complex governance structure

8. Where should the patient go? • General dental practice • Community dental services • Hospital dental service

9. Who should the patient see? • General dental practioner • Salaried dental practitioner • Community dental officer • Hospital trainee • Specialty dentist • Mono-specialist (grandparenting) • Consultant complex care } routine care grey area What about patient management cases?

10. NHS patient pathway in NOS GDP only GDP Community GDP GDP Consultant (treatment/advice) GDP Informal pathway??

12. Presentation plan • Restorative dentistry • Networks • A restorative network model? • Training

13. Tayside Diabetes • A coordinated network of professionals involved in providing diabetes care across the region. Within this network patients and professionals work together to continually develop and improve this care • GMPs Consultants Specialty doctors • Podiatrists Dieticians Clinical assistants • Patients Eye screening Diabetes nurses • IT staff Administration • http://www.diabetes-healthnet.ac.uk

14. Tayside Diabetes • Recognised thresholds for care in different environments • Education/training built into MCN • Recognise different care bundles for children, renal patients, housebound… • Data data data data dataIndustry

15. Tayside Orthodontics • Is a linked group of health professionals from primary and secondary care, working in a co-ordinated manner, unconstrained by existing professional boundaries, to ensure equitable provision of high quality clinically effective Orthodontic services. • Specialist Orthodontists General Dental practitioners with an Interest • General Dental Practitioners Community Dental Practitioners • Practice Managers Consultants in Dental Public Health • Patient Representatives Dental Nurses • Dental Technologists Hygienists • http://www.taysideorthodonticmcn.scot.nhs.uk

16. Tayside Orthodontics • Achieve better, fairer access to our services • Increase flexibility • Reduce waiting and improve the patient's journey of care • Improve communications and break down barriers • Make best use of all skills and resources

17. Key points } } • Common purpose • Between NHS Boards • Between clinicians • Between professions • Compromise – think patient • Clear care parameters • Level of network

19. Presentation plan • Restorative dentistry • Networks • A restorative network model? • Training

20. What is needed in restorative? • Orthodontics are working in networks but middle tier of work delivered by high street specialists – attractive NHS remuneration • Need for local care at a level beyond GDPs but not at Consultant level. Maybe not even specialist level • We need more staff! • We need Dentists with a Special Interest!

21. Bureaucratic hoops • Need to prove need for more staff • No DwSI in Scotland • Data Data Data • Set up formal structure • Many years work

23. We need more staff!!?? • Supply of dentists at all time high • Financial limitations • Dentists enjoy personal development • Lots of restorative work is routine • Hygiene/therapists are coming on stream

24. The alternative view • GDPs become the intermediate care level • GDPs delegate work to hygienist/therapist • Clinical attachments • GDP training in consultant job plans • Value education giving career progression

25. But it won’t work… • Dentists won’t employ therapists • Therapists don’t work as well as dentists • I’m not getting paid for it • I need more surgery space • I will look less busy • Not in my job plan • NHS managers will squeeze me

26. Why can’t it work • Variety in work • Practice enhancement • More patients? • Reduce bureaucracy (practitioner services)? • Referral fee from NHS Board? • Focus on more complex cases • Pleasure in seeing staff development • Not for all dentists

27. Why won’t it work • Common purpose • Compromise • Self interest • No clear care parameters • What about “awkward” patients

29. Training issues • Clinical attachments • Flexibility • Local committed workforce • Cheap(ish) • No dedicated training or structure

30. Training issues • Remote and rural fellows • Recognised qualification • Part-time • Cheap(ish) • No dedicated funding for GDPs

31. Training issues • BUOLD style course • Flexibility • Modular • Not developed in Scotland

32. Presentation plan • Restorative dentistry • Networks • A dental model? • Training

33. Next steps • Work on peoples beliefs – LDC, BDA… • Choose a specific discipline – Perio? • Start collecting better data – R4, SoE..

34. Not covered • Community Dental Service • Mono-specialists

38. This has been the opinion of the presenter not necessarily NES policy