Dentistry and Oral Health in East and North Hertfordshire and West Hertfordshire PCTs

1. Dentistry and Oral Health in East and North Hertfordshire and West Hertfordshire PCTs Jane Robinson Primary Care Commissioning Lead Sue Gregory Consultant in Dental Public Health

2. What NHS Dentistry should provide Dental Charges Access to NHS dentistry What the PCT is doing to improve access to NHS dentistry Oral health of children Customer satisfaction Emergency/out of hours provision Outline

3. PCT has a duty to provide or secure primary dental services to the extent it considers reasonable through: GDS contracts; PDS contracts; or provides them itself Primary Dental Services (2003 Act)

4. Commissioning for Oral Health Influence over where new practices establish Stronger local relationship with NHS dentists Commissioning to meet oral health needs of population Commissioning to more explicitly address access

5. Mandatory Services • All proper and necessary care and treatment which includes:- the care which a dental practitioner usually undertakes for a patient and which the patient is willing to undergo, including advice and planning of treatment- treatment, including urgent treatment- ..the referral of the patient for advanced mandatory services, domiciliary, sedation…..

6. Examination Diagnosis Preventive care and treatment Periodontal treatment Conservative treatment Surgical treatment Supply and repair of dental appliances Radiographs Supply of listed drugs Issue of prescriptions Care and Treatment

7. Patient charges • PCT dental commissioning from April 2006 • Changes in patients’ charges • Simpler (3 not 400) • Avoids confusion on private/NHS boundary • Breaks link between dentists’ remuneration and charges • Money devolved on practice base, not by address of patient

8. This charge will include an examination, diagnosis and preventive advice. If necessary, this will include X-rays, scale and polish if needed, and planning for further treatment. Urgent and out-of-hours care will also cost £16.20 Patient Charge Bands-Band 1 £16.20

9. This charge includes all necessary treatment covered by the £16.20 charge PLUS additional treatment such as fillings, root canal treatment or extractions. Band 2 - £44.60

10. This charge includes all necessary treatment covered by the £16.20 and £44.60 charges PLUS more complex procedures such as crowns, dentures or bridges. Band 3 - £198

11. Population per dentist E&North Herts compared with the East of England SHA and England

12. Population per dentist West Herts compared with the East of England SHA and England

13. Dental contracts in Hertfordshire

14. Geographical Access to general dental practices in East and North Hertfordshire, 3 miles and 12 miles distances

15. Geographical Access to general dental practices in East and North Hertfordshire, 5 miles and 12 miles distances

16. Geographical Access to general dental practices in West Hertfordshire, 3 miles and 12 miles distances

17. September 08 telephone audit indicated that 62% of practices in E & North Hertfordshire PCT are currently accepting new NHS patients, however

18. September 08 telephone audit indicated that 64% of practices in West Hertfordshire PCT are currently accepting new NHS patients, however

20. Distribution of courses of treatment October to December 2007East and North Hertfordshire

21. Distribution of courses of treatment October to December 2007West Hertfordshire

24. The Proportion of Adults with No Natural Teeth in England, 1968-1998 Source: National Adult Dental Health Surveys, 1968 to 1998. Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, Pine C, Pitts N, Treasure E and White D (2000).

25. Orthodontics: waiting times at October 08 Source: Practice based Data

26. Orthodontics: waiting times at October 08

27. Emergency Dental Services: Hertfordshire NHS Direct Triage: July 06 to June 07

28. Emergency Dental Services: Hertfordshire NHS Direct Triage: September 08

29. Welwyn Garden City – daily Stevenage – daily Hitchin – daily South East Herts St Albans, Harpenden, Redbourn Borehamwood, Bushey Watford, Rickmansworth Tring, Hemel Hempstead, Bovingdon In hours urgent slots

30. Responses to Patient Questionnaires on time taken to get a dental appointment, April 2007 to September 2008 Source: DSD data

31. Responses to Patient Questionnaires on Patient’s Satisfaction with Dentistry Received, April 2007 to September 2008. Source DSD statistics

32. Responses to Patient Questionnaires on Patient’s Understanding of NHS/Private Dentistry Received, April 2007 to September 2008. Source DSD statistics

37. Oral Health in Children 2005/06Average number of decayed, missing and filled teeth in 5 year old children Source: Surveys co-ordinated by the British Association for the Study of Community Dentistry

38. The proportion of 5-Year Old children with experience of caries, Nationally, Regionally and Locally 2005 to 2006 Source: Surveys co-ordinated by the British Association for the Study of Community Dentistry

39. Research in the 1980s started to question the aims and effectiveness of the screening examinations. The results of a large Randomised Control Trial have demonstrated that school dental screening is ineffective at a population level in reducing levels of untreated disease and increasing attendance of those who need treatment. School Dental Inspections

40. On 7 November 2006, the UK National Screening Committee recommended to the UK Chief Dental Officers that there is no evidence to support the continued population screening for dental disease among children aged 6 to 9 years. The Committee’s recommendation was based in part on the view that the resources currently used for screening could be used more effectively in other ways to tackle oral health inequalities

41. Requires partnership working from the following stakeholders: Dental teams Public Health specialists Oral Health Promotion Team Health visitors Health improvement specialists Sure start and children’s’ centres Healthy schools programmes Local authorities Voluntary groups Improving Children’s Oral Health

42. Oral Health Promotion Activities Aimed at Reducing Oral Health Inequalities in Young Children

43. Primary & Secondary dental care commissioning is outside of Practice Based Commissioning Integrated approach to budget and decision making Engagement of primary and secondary care clinicians in assessing needs, developing care pathways and commissioning decisions Lay representation Hertfordshire Oral Health Strategy and Commissioning Group

44. Dept of Health additional growth funding 08-09

45. West Hertfordshire and East and North Hertfordshire PCTS have added an additional recurring allocation to total £2million to further improve access to general dental services Additional Growth from PCTs

46. Practices in Potters Bar, Borehamwood and Bushey have received the following additional growth: West Herts - Hertsmere

47. Practices in London Colney, St Albans and Harpenden have received the following additional growth: West Herts – St Albans and Harpenden

48. Practices in Watford, Rickmansworth, Croxley Green, Chorleywood and Abbots Langley have received the following additional growth West Herts- Watford and 3 Rivers

49. Practices in Tring and Hemel Hempstead have received the following additional growth: West Herts- Dacorum

50. Practices in Ware, Hoddesden, Waltham Cross, Hertford, Flamstead End, Cuffley and Cheshunt have received the following additional growth: East and North Herts – SE Herts