NHS GRAMPIAN

NHS Grampian Dental Plan 2020

A framework for continued improvement in Oral Health and development of quality assured dental services in Grampian

Aim

NHS Grampian Board is asked to endorse the plan to continue to improve oral health and dental services in Grampian.

Strategic Context

The NHS Grampian Dental Plan 2008-12 was completed successfully last year with the headline achievements highlighted below. The dental plan 2012-2016 was widely consulted on and has now been revised in light of feedback to become the Dental Plan 2020.

Main achievements of 2008-12 Dental Plan

Target - 60% of children with no obvious dental disease in Primary 1 and Primary 7.

Outcome-Target exceeded.

Primary 1 (Deciduous teeth) 2012 - 67.8% of children no obvious decay.

Target - 120,000 additional NHS registrations between June 2007 and March 2012.

Outcome-Target exceeded

March 2012 - 131,000 additional NHS registrations (based on June 2007)

March 2013 - 169,000 additional NHS registrations (based on June 2007)

Target - Eliminate the waiting list for primary care dentistry

Outcome - The dental waiting list in 2009 exceeded 32,000 and is now at less

than1500, mainly in Aberdeenshire and with some smaller numbers in Moray

Target – Modernise the infrastructure of dental services across Grampian

The plan was supported by a range of infrastructure programmes including workforce and facility development which has resulted in:

  • an increase of over 80 dentists by March 2012 (2013 – 91 dentists) and an increase in the associated support staff, dental nurses etc
  • Aberdeen Dental School and Hospital built, 2 academic cohorts having already graduated
  • over 12 new dental facilities to support NHS Grampian’s salaried dental services
  • over 10 new independent NHS practices and the majority of the original NHS practices modernised through capital grant aided schemes
  • a clinical network structure in Grampian and associated developments across North of Scotland linking primary and secondary care services

Need for new Dental Plan

There have been considerable achievements over last 6 years which now need to be consolidated and fully integrated with NHS Grampian strategic plans.

The plan will:

  • Guide our population towards continued oral health improvement to 2020, targeting those with the greatest needs in our society.
  • Guide the development of quality assured dental services towards 2020, with patient centred services, defined care pathways and full integration of services between primary, intermediate and secondary care.
  • Align with the NHS Grampian Quality Plan, Healthfit 2020, Grampian Health Plan and various national strategies
  • Highlight a high level Action plan / Framework for NHS Grampian dental services which will be taken forward through the managed clinical network.

Discussion

Strategic targets are proposed:

  • To increase NHS Dental registrations by a further 81,000 by 2016
  • To continue the improvement in oral health by setting clear new targets for children and adults in 2016 and 2020. For example – 75% of Primary 1 children with no obvious dental disease by 2016 (80% by 2020)
  • To develop a quality plan for dental services in NHS Grampian with a comprehensive quality assurance and monitoring system by 2016

Stakeholder Involvement

  • This plan has been extensively consulted on with dentists, dental team members,Area Dental Committee, public and professional consultative meetings.
  • Compared with the previous dental plan consultation meetings attendance was far lower despite efforts to encourage attendance. This may reflect service improvements and increased patient satisfaction with dental services since 2007.
  • The largest attendance was with the Grampian (North East) British Dental Association meeting with over 50 dentists. Their main concern was a growing scarcity of patients to maintain the expanded services and workforce especially in Aberdeen City. Aberdeen City was the first CHP in Grampian to eliminate its dental waiting list in 2012 and has remained at zero for over a year.
  • The meetings reflected the considerably reduced concern by patients and public about dental service delivery and availability. Helpline calls and our out of hours GDENS servicehave shown reduced demand levels.

Impact Assessment

The plan emphasises the need for equity and complements the previous plan 2008- 2012 with significant targeting for those groups with highest needs.

Resource implications

  • The continued improvements in infrastructure with the building of numerous new NHS and independent practices, the development of Aberdeen Dental Hospital and School along with approximately 100 additional dentists since 2006 has resulted in a more stable dental system in Grampian.
  • There is continued concern that salaried dental service budgets will now be set annually with Scottish Government and that there may be further restrictions on primary dental care funding in future.
  • However, dental services are considered as a far more stable funding system than that experienced in 2007/8 when there was a large backlog of refurbishment and modernisation required.

Key Risks

Relevant risks from the Strategic Risk Register are:

Risk 586 – Partnership working with local authorities, third sector, independent contractors and community.

Risk 851 – Delivery Strategies to meet the future needs of the population.

Other risks include:

  • Patients do not attend the new services created in sufficient numbers to maintain the new services with an estimated 20,000 NHS places available in Aberdeen City at present.
  • Scottish Government removes the links between funding and service delivery by cash limiting the dental services at its present level in Grampian i.e. only 63.3% of the population registered with the NHS.
  • The present improvements in oral health, primarily through self care programmes are not maintained leading to increasing need and costs of services.
  • A quality plan is not accepted by the independent practices due to poor rewards and remuneration.

Conclusions

Dental services have changed and improved considerably since 2007. In order to maintain the momentumit is essential that NHS Grampian pursues quality improvement to consolidate the considerable improvements already achieved.

Recommendations

The Board is requested to:

  1. Note the considerable improvements in dental services since 2007/8.
  2. Endorse the Dental Plan 2020 as a framework for continued improvements in Oral Health and modernising dental services in Grampian.
  3. Note the developingclinical networks across the North of Scotland particularly between the 3 Island Boards, NHS Highland and NHS Grampian.

Executive Lead

Sir Lewis Ritchie, Director of Public Health

Person submitting paper

Ray Watkins

Consultant in Dental Public Health

Head of Health Improvement

July 2013

1