Item 5.1 for 2 Aug 2011 Dental Plan Report

NHS GRAMPIAN DENTALPLAN 2008- 2012

Year 3 Report August 2011

A PLAN FOR IMPROVING ORAL HEALTH AND MODERNISING NHS DENTAL SERVICES IN GRAMPIAN

Table of Contents

Summary outcomes 2010/11

DETAILED OUTCOMES OF ALL RECOMMENDATIONS AND TARGETS 3

1. Involving people, professionals local organisations

2. Oral Health

3.NHS Registrations – Routine Care

4. Workforce

5. Service Developments PArt 1 priority services and service redesign

6. Service Developments Part 2 MCN and MCN priority services

7. Service Developments Part 3 preventive care networks children and adults

8. Premises Developments

9. Quality standards, clinical governance and clinical effectiveness

10. Education and training to develop and enhance the workforcE - DEntists

11. Dental Care professionals

12. Monitoring and evaluation and resources

APPENDIX 1 19Summary outcomes 2010/11

Main achievements 20010/11

• National adult oral health targets 2010 achieved with continued oral health improvement
• National child oral health targets 2010 achieved Primary 1 and Primary 7 with continuedimprovement and further expansion of preventive programmes- Childsmile by CHPs.
• All operational responsibilities for managed dental services devolved to CHPs
• Continued (but slower) increases inNHS registrations.
• Continued predicted increase in dental workforce
• Largest annual impact (decrease) in routine dental waiting list since waiting list establishedin 2005 with estimated waiting list now below 19,000 for first time in 5 years
• Intermediate care specialised dental service network and special care networks developed with referral quality assurance and organisation through a new primary care referral centre.
• Continued improvement in quality and quantity of dental premises with 90% of practices achieving new decontamination standardsprior to target dateof December 2012.

Positive Impact onhealth and services

69.4% of children start school in Grampian with no obvious dental decay compared with 48.9% in 2003, over 20% improvement, with the main improvements seen in the last 3 years

Number of general anaesthetic hospital day cases for tooth extraction in children reduced by over 50% over last 5 years now down to 844 with major revenue savings for the Board

NHS registrations at March 2011increased by 97,774 since June 2007 and on target to reach 124,000 by 2012

Primary care dental waiting list at July 2011 down to lowest for 5 years at circa 19,000. High in 2009/10 of over 32,000.

Ahead of targets on recruitment of all dental professionals including dentists and dental nurses.

Continued interest in opening new dental premises across NHS Grampian. Practices encouraged in Aberdeenshire and Moraydue to an estimated 25,000 Aberdeenshire population travelling to AberdeenCity for dental care.

Primary care referrals to Intermediate and special care networks presently at 3000/yr

Challenges for the Future

Childsmile progress in signing up all dental practices has been slower than planned, although plans now in place to attain all CHP targetsby December of 2011.

Despite being on target to achieve 124,000 additional registrations over 4 yrs of the dental plan,child registration figures are lower than planned and registration levels in all age groups are among the worse in Scotland.

Recruitment of all dental professional groups improved with concern over unfilled senior academic consultant posts in AberdeenDentalSchool

Lack of ability to provide new high quality premisesmay lead to a lack of local posts for emerging graduates from Aberdeen Dental School due to lack of training practiceaccommodation.

Despite a concerted effort at a local and national level with over 90% of practices recording decontamination compliance before the end of 2012, there remains a risk for possibly 3 independent practices and 2 community practices (Appendix 1)

Primary 1 Children in Grampian - no decay on starting school 2003-2010

The latest 2011 statistics are the most comprehensive ever collected with over 96% of schools inspected and gives confidence that the improvements are consistent across the whole of Grampian and the 3 CHPs. A further improvement should occur from this year forward as the Childsmile programme expands targeting preschool and school children.
The above reduction in disease levels has directly contributed (in addition to service redesign) tothe substantial changes in the number of young children requiring a general anaesthetic for dental extractions.

Number of day case general anaesthetics for children for extraction of teeth

2005-2010

NHS dental registration

The number of registrations in total remains on target i.e. an additional 124,000 between June 2007 and March 2012. However the speed of increase in registrations has slowed considerably and there seems to be several unexplained differences in what is happening within CHPs. These include

an estimated 25,000 people from Aberdeenshire attending NHS dental services in AberdeenCity

AberdeenCityrecording the only fall in registrations in an age group primarily in school children aged 6 to 16 yrs with the younger preschool children in AberdeenCityshowing small increases.

The registration statistics whilst encouraging and improving as planned remain well below the Scottish average.The next dental plan 2012 - 2016 may require to set a target to register a further additional 100,000 patients if Grampian is to reach the levels achieved elsewhere in Scotland. Comparison NHS registrations NHSG and Scottish average :-

Children NHSG 70.7% Scottish Av 84.2%.

AdultsNHSG 46.5% Scottish Av 70.5%.

Detailedoutcomes of all recommendations and targets

1. Involving people, professionals and local organisations

Oral Health survey 3300 adults undertaken and shared with population and professionals

Referral guidance published July 2011to ensure clarity of all referrals within dental systems

Children’s annual oral health survey published circulated all dental professionals schools and education authority every 2 years.

TLC – a web based health promotion programme developed and promoting oral health throughout Grampian

Re-established Area Dental Committee as a working group

Set up the Managed Clinical Network for Oral and Dental Health with regular sub group meetings

Public involvement within MCN for oral and dental health committees

Joint developments/ close working relationships with CHPs/Acute Unit /AberdeenUniversity/ NHS Education Scotland

Welcome pack for all new dentists in preparation

2. Oral Health

Whole Grampian 9.1% of adults with no teeth.AberdeenCity just missing target

3. NHS Registrations – Routine Care

NHS Grampian now needs to set new targets for 2012-16 as part of a new dental plan.

Generally disappointing requires more work linked to CHPs /Dental School Childsmile and preschool childrenwith targetingand support for vulnerable groups such as Children in Care.

Target circa 90% by 2014

Need to increase from 46.5% to 70% by 2016 i.e.achieve minimum 100,000 additional NHS reg in next dental plan

4. Workforce

Present estimate circa 330 Local estimate to be confirmed in September census

March 2011 275

Increasing numbers of dentists now working in primary and secondary care/teaching statistics above do not reflect

Cost benefit of database difficult to justify.

AberdeenDentalSchool will graduate first graduates in 2012 andstabilise dentist numbers in North of Scotland

New dental nurse course and dental technician course at AberdeenDentalSchool will help to bolster numbers in Grampian

5. Service Developments Part 1 priority services and service redesign

Need to involve AberdeenDentalSchool as training centre for intermediate care North of Scotland

Referral Centrehas been established and is now processing 60 referrals/week

3 practitioners providing newly established service Further practitionerssupported fordeveloping similar services

Programme now established joint working and training established primary and secondary care

6. Service Developments Part 2 MCN and MCN priority services

Care Pathways

NHS Grampian require to continue the expansion of access to NHS with a further targeted development of up to 10 additional independent practices (30- 40 dentists) over the next 3 years primarily in Aberdeenshire and Moray

7. Service Developments Part3 preventive care networks children and adults

Funding from SG and service redesign will deliver Caring for Smiles which will ensure Oral Health Improvement Services for these and other vulnerable groups across Grampian

Independent Primary Care Practitioners are working within Secondary Care and a range of Salaried Practitioners are working in an intermediate setting

NHS Grampian have not established a contracted (funded) system for Rec 12

8. Premises Developments

Open to full patient care offered by dentist (Aberdeen students) and dental therapist trainees (Inverness)