Delivering 18 Weeks in Orthodontics

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Removing Unnecessary Waiting
South Devon Community

• Delivering 18 Weeks in Orthodontics

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• South Devon
• Population 250k
• Coast, rural, urban
• One FT
• 9 community hospitals and intermediate care units
• 2 commissioners
• Largest employer

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South Devon Community

• 18 weeks

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Early Achievers
South Devon Community

• 18 weeks by December 2007
• Tolerances
• 90 for admitted pathways
• 95 for non-admitted pathways
• Clock stops and starts
• the clock will stop at what has been defined
  locally by the Strategic Health Authority as the
  1st definitive treatment
• if the fitting of a medical device is not
  defined locally as the 1st definitive treatment,
  the clock would stop at whatever procedure is
  defined as such ( e.g. extraction)
• SHA have confirmed that if patients are sent
  back to primary care for dental extractions prior
  to the fitting of a brace then the clock stops
  and a new clock is started when they are referred
  back into secondary care for the brace
• How low can we go?

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Changing lives for patients
South Devon Community

• Earlier relief of symptoms, pain or discomfort
• Improved outcomes due to earlier intervention
• Less disruption to normal life through prompt
  attention and convenient appointments
• Fewer hospital appointments as tests/treatments
  are synchronised
• Reduced anxiety due to earlier diagnosis,
  including when no treatment is needed
• Less time spent in hospital for tests and
  treatments, more services provided by GPs and in
  the community
• Greater confidence in NHS the right treatment
  is available without unnecessary delay

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Satisfaction for staff
South Devon Community

• Satisfaction from providing improved services
• More productive use of time, less time spent
  managing queues
• Consultants and specialists only seeing patients
  who require their skills
• Opportunity to improve services in primary care
  and prevent unnecessary referral to hospital
• Closer working between hospital and primary care
  clinicians and staff
• Fewer patient complaints and improved working
  life from dealing with more satisfied patients

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Why us?
South Devon Community

• Good track record of delivering
• Modernised
• Integrated community
• Financial balance
• Blunt instruments
• Commitment

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The system
South Devon Community

• Service Improvement Group
• Executive Director Sponsorship
• Programme Management Team No Delays
• National ISIP input
• Identification of highest risk specialties
• Commitment

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South Devon Community

• Why orthodontics?

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A potted history of dental care
South Devon Community

• 2004/5 c. 200 complaints per month
• January 2005 database of unregistered
  patients
• field site PDS
• April 2006 new contract ? capacity loss
• May 2007 non-UK GDPs
• patients register immediately

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SDHFT
South Devon Community

• Total of 16 clinical sessions per week
• 2002/3 810 - 2006/7 942
• Treatment list 2007 - 240 (projected)

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What we did in May
South Devon Community

• What? - lock in aka an improvement summit
• Who? everyone with an interest
• Where? nice venue
• When? 6 weeks in advance for scheduling
• How? using rapid cycle improvement methodology

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The process
South Devon Community

• Pre-meets with the clinical teams
• Data preparation
• Focus on issues key pathways to map and
  objectives to meet
• Whole community
• Clinical and managerial leadership

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The programme
South Devon Community

• is available to you
• Critical components
• Definition of the scale of problem
• Vision
• Value stream mapping
• Action plan linked to ISIP
• Task group with clear accountability and freedom
  to act
• Follow up

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The action plan
South Devon Community

• Information for GDPs and Patients
• Review information available for GDPs and
  Patients
• Review existing referral template
• Develop Induction Pack for new (individual) GDPs
• Improve the referral process
• Develop supporting role for orthodontists
• Develop proposal for the supporting nurse role

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The action plan
South Devon Community

• Improve quality of information received on and
  compliance with the use of the referral form
• Discharge criteria
• Education and training for GDPs
• Improve productivity to deal with volume of
  referrals
• Manage the expectation of the parents
• Accommodation for Orthodontists

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And since May?
South Devon Community

• Primary Care practitioners with UOA contracts for
  additional orthodontic treatments to reduce
  backlog
• Contract with Specialist Practitioner to take 120
  treatments off the hospital treatment waiting
  list
• Additional Specialist Practitioner into hospital
• Maxed clinic and treatment sessions
• Work begun with independent contractors to reduce
  their waiting time to 18 weeks

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What since May?
South Devon Community

• Analysing referrals to all orthodontic providers
  trends, completed treatments compared with
  expected demand based on population figures
• Network agreement to develop information packs
  for patients and GDPs to improve referrals and
  patient expectations as patients are referred on
• Clinician to clinician process