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Working In The Dental Pilot

Working In The Dental Pilot. Colin Langley 29 Jan 2014. The Dental Pilot Concept. PRACTICE PROFILE BEFORE PILOT. Single handed. 10,500 UDA’s – Total Contract Value £269k. 4 members of staff of which 3 DCP’s. POSITIVES NO MORE UDA’s! FOCUS ON PREVENTION. MORE TIME WITH PATIENTS (?)

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Working In The Dental Pilot

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  1. Working In The Dental Pilot Colin Langley 29 Jan 2014

  2. The Dental Pilot Concept

  3. PRACTICE PROFILE BEFORE PILOT. • Single handed. • 10,500 UDA’s – Total Contract Value £269k. • 4 members of staff of which 3 DCP’s.

  4. POSITIVES • NO MORE UDA’s! • FOCUS ON PREVENTION. • MORE TIME WITH PATIENTS (?) • PATIENTS BECOME MORE RESPONSIBLE FOR THEIR OWN ORAL HEALTH.

  5. The Oral Health Assesment

  6. THE ORAL HEALTH ASSESSMENT Advantages • Ensures patient receives a very thorough examination. • Robust notes. Disadvantages • Very time consuming. • Data hungry, average assessment = 160 mouse clicks. • Requires fast, networked computer system.

  7. The Effect On The Practice

  8. HOW THE PRACTICE IS DIFFERENT • Skill mix – we are now employing a therapist. • Employed extra part time receptionist. • Cost to Practice - £35,000. • Able to do this due to large Contract Value. • More computers and screens in surgery. • Recall Intervals have increased for many patients. • Patients are registered with the practice for 3 years. • See less patients in a working day.

  9. Recall Interval Examples Patient A 64 Year Old female, non smoker, consumes a ‘glass of sherry on special occasions’ Soft tissues Healthy, BPE 111/121. No caries detectable. Heavily restored dentition. Patient B 28 Year Old Male, non smoker, drinks 4 or 5 pints a week. Soft tissues healthy, BPE 111/121. No restorations present. No caries detectable. COMPUTER SAYS “24 MONTHS”

  10. PROBLEMS ENCOUNTERED • Diary clogging – resulting in less time away from practice. • FTA’s cause proportionally bigger problems. • Access has fallen. • Most patients are happy at increased recall intervals, some are very reluctant. • Patient Charge Revenue has fallen by about 40%. • Potential clawback for failing to maintain capitation numbers. • Transition from UDA’s to capitation. • INVESTMENT IN I.T AND STAFF.

  11. At the moment can override the recall period as dictated by the OHA. • currently do this in around 80% of patients, to a recall that I feel is clinically more suitable. • In the future, this may not be possible. Will it be possible to do this independently of the NHS with-out breaking any regulations for the benefit of the patient?

  12. POSSIBLE SOLUTIONS TO ENCOUNTERED PROBLEMS • The Oral Health Assessment needs simplification. Reduce that number of mouse clicks!! Only capture essential information. • There needs to be a paper version of Oral Health Assessment in the event of IT failure. • Informing/educating the public that NHS dental care is changing. • Allow practitioners long lead in time. • Skill mix – difficult in smaller practices. • Ensure capitation payments are realistic to support quality. • Protected time for prevention and treatment.

  13. Capitation fee per patient needs to be large enough to support more time for quality time and prevention. • The National Average Annual Cost of Care per patient (routine care) is £63.77. • This will include the treatment of high need patients and new patients registered to maintain list size.

  14. Contract value 10% DQOF 90% Capitation

  15. High Number of Patients Low Number of Patients

  16. DENTAL QUALITY OUTCOME FRAMEWORKS. • 10% of Contract Value -1,000 POINTS. • Patient safety – Medical History Updated-100 POINTS. • Patient Satisfaction -300 POINTS. • Patient Outcomes – your ability to convert patients from red to green. 600 POINTS 6% OF CONTRACT. • BPE IMPROVEMENT/ REDUCTION IN SEXTANT BLEEDING SITES/ CARIES REDUCTION. • ARE THE PARAMETERS REALISTIC?

  17. SOLVING ACCESS AND FALLING PCR ISSUES • A staged introduction of the whole process? • Will this bring problems? IT, Patient Charges etc. • No more money from DoH = increased patient charges?

  18. Is this New Contract set out to Achieve: • Quality of care for patients. • Prevention for patients. • Access for patients. • Sensible clinical demands on dentists. • Sustainable business model for practices. • Affordability for the Department of Health.

  19. UDA’s PATIENTS

  20. INFO NEEDED. • ARE THE PILOTS GOING TO BE TWEAKED ? • IS IT GOING AHEAD ? • IF SO , WHEN ? • TRAINING – CLINICAL /NON CLINICAL? • PERIOD OF RING FENCED PRACTICE INCOMES ? • ADVANCED CARE SYSTEM AND FUNDING ? • TIERS OF COMPETENCY ?

  21. In the meantime: • Consider full computerisation – in surgery and reception • The Oral Health Assessment and Care Pathway are based upon “Delivering Better Oral Health.” Prevention is the way forward. Try to work out how this can work in your practice. • Consider how skill mix will affect your practice. Can you afford skill mix? • Communication skills – explaining pathway, relevance of alcohol and tobacco etc.

  22. Manage patient lists. • Reduce FTA’s – texting/ emails. • Research software functionality with regard to patient list management. • Manage lead in time. • Don’t over produce UDA’s. Uncertain if this extra activity will help or hinder.

  23. leedsSOHT@hotmail.com Information event on scope of practice and employability

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