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
Outline

• 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

3
Primary Dental Services (2003 Act)

• 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

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
Care and Treatment

• 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

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
Patient Charge Bands-Band 1 16.20

• 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

9
Band 2 - 44.60

• This charge includes all necessary treatment
  covered by the 16.20 charge PLUS additional
  treatment such as fillings, root canal treatment
  or extractions.

10
Band 3 - 198

• 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.

11
Population per dentist ENorth 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
Number of contracts Number of dentists Number of practices
West Herts 142 367 117
East North Herts 123 300 88
Total 265 667 205
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
Number of patients treated in the previous 24 months period
March 2006 328,002
March 2007 332,184
June 2007 329,488
December 2007 320,112
March 2008 316,396
June 2008 316,195
September 2008 317,253
Change since March 2006 -3.3
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September 08 telephone audit indicated that 64
of practices in West Hertfordshire PCT are
currently accepting new NHS patients, however
Number of patients treated in the previous 24 months period
March 2006 314,537
March 2007 307,439
June 2007 301,249
December 2007 286,192
March 2008 275,014
June 2008 272,074
September 2008 271,659
Change since March 2006 -13.6
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Distribution of courses of treatment October to
December 2007East and North Hertfordshire
21
Distribution of courses of treatment October to
December 2007West Hertfordshire
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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).
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Orthodontics waiting times at October 08
Practice location Length of time to first assessment appointment Length of time to case start Referral to treatment time
Bishops Stortford 10-12 months 4-8 weeks 12-14 months
Royston 4 weeks 4-8 weeks 12 weeks
Ware 6 months 30 months 3 years
Hitchin 6 weeks 4 weeks 10 weeks
Stevenage 10 weeks 3-12 weeks 22 weeks
Source Practice based Data
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Orthodontics waiting times at October 08
Practice location Length of time to 1st assessment Length of time to case start Referral to treatment time
Boreham Wood 2-3 weeks 44-50 weeks 1 year
St Albans 1 week 2 years 2 years
Tring 3 months 4 months 7 months
Rickmansworth 6 weeks 6 weeks 12 weeks
Hemel Hempstead 4 months 6 months 10 months
Hemel Hempstead Not accepting 8 weeks 8 weeks
Harpenden 1-14 weeks 1-14 weeks 28 weeks
Harpenden 11 weeks 8 weeks 19 weeks
Watford 12 weeks 6-8 weeks 20 weeks
Watford 4-6 weeks 4-6 weeks 12 weeks
Watford 0-7 weeks 6-24 weeks 31 weeks
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Emergency Dental Services Hertfordshire NHS
Direct Triage July 06 to June 07
Call Volume No of Calls
Calls Answered 9071
Symptomatic 5954
Health Information 40
Other 834
Clinical Sorting of symptomatic calls No of Calls
999 - (Emergency) 41 (0.68)
A E - (Emergency) 131 (2.2)
Contact Dentist - lt1 hour 177 (2.9)
Contact Dentist - lt4 hours 2255 (37.8)
Contact Dentist - Routine Appointment 2113 (35.4)
Contact Orthodontist 84 (1.4)
Homecare and Pharmacy 1137 (19)
Contact GP 109 (1.8)
Other 9 (0.15)
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Emergency Dental Services Hertfordshire NHS
Direct Triage September 08
Call Volume No of Calls
Calls Answered 631
Symptomatic 478
Health Information 9
Other 51
Clinical Sorting of symptomatic calls No of Calls
999 - (Emergency) 0 (0.0)
A E - (Emergency) 6 (1.0)
Contact Dentist - lt1 hour 14 (2.2)
Contact Dentist - lt4 hours 181 (28.7)
Contact Dentist - Routine Appointment 133 (21.1)
Contact Orthodontist 6 (1.0)
Homecare and Pharmacy 129 (20.4)
Contact GP 9 (1.4)
Other 0 (0.0)
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In hours urgent slots

• Welwyn Garden City daily
• Stevenage daily
• Hitchin daily
• South East Herts
• St Albans, Harpenden, Redbourn
• Borehamwood, Bushey
• Watford, Rickmansworth
• Tring, Hemel Hempstead, Bovingdon

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Responses to Patient Questionnaires on time taken
to get a dental appointment, April 2007 to
September 2008
Patients opinion of time taken to get appointment E N Herts E N Herts West Herts West Herts
Patients opinion of time taken to get appointment number number
It was as soon as was necessary 1,309 87.21 1,338 87.57
It should have been a bit sooner 105 7.00 98 6.41
It should have been much sooner 23 1.53 27 1.77
No response 64 4.26 62 4.06
Invalid 0 0.00 3 0.20
Total, Samples 2,779 and 2,778 1,501 100.00 1,528 100.00
Source DSD data
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Responses to Patient Questionnaires on Patients
Satisfaction with Dentistry Received, April 2007
to September 2008.
Patients satisfaction with dentistry received E N Herts E N Herts West Herts West Herts
Patients satisfaction with dentistry received Number Number
Completely satisfied 1,106 73.68 1,138 74.48
Fairly satisfied 275 18.32 278 18.19
Fairly dissatisfied 35 2.33 32 2.09
Very dissatisfied 26 1.73 24 1.57
No response 57 3.80 53 3.47
Invalid 2 0.13 3 0.20
Total Samples 2,779 and 2,778 1,501 100.00 1,528 100.00
Source DSD statistics
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Responses to Patient Questionnaires on Patients
Understanding of NHS/Private Dentistry Received,
April 2007 to September 2008.
Patient's understanding of treatment provided E N Herts E N Herts West Herts West Herts
Patient's understanding of treatment provided Number Number
Invalid 7 0.47 13 0.85
No response 50 3.33 49 3.21
Just NHS treatment 1,307 87.08 1,313 85.93
Combination of NHS and Private 70 4.66 98 6.41
All Private treatment 9 0.60 6 0.39
Unsure 58 3.86 49 3.21
Total Samples 2,779 and 2,778 1,501 100.00 1,528 100.00
Source DSD statistics
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East North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) East North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) East North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) East North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) East North Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out)
Health Body Number of patients of patients UDA UOA
E N Hertfordshire 77,859 90.20 170,267.35 7,354.20
Enfield 2,288 2.70 4,992.80 942
W Hertfordshire 2,201 2.50 4,449.10 1,497
Non neighbouring 1,628 1.90 3,919.75 187
West Essex 1,389 1.60 2,869.70 167
Cambridgeshire 516 0.60 991.35 3
Luton 400 0.50 1,003.20 1
Bedfordshire 310 0.40 563.40 69.8
Total outflow 8,732 10.20 18,789.30 2866.8
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Patients treated in East North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in East North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in East North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in East North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in East North Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In)
Health Body Number of patients of patients UDA UOA
E N Hertfordshire 77,859 80.20 170,267.35 7,354.20
West Essex 4,832 5.00 10,229.80 521
Bedfordshire 3,706 3.80 7,680.00 890
W Hertfordshire 2,850 2.90 5,830.50 4
Unknown 2,653 2.70 5,834.70 412
Cambridgeshire 2,296 2.40 4,047.00 454
Non neighbouring 1,448 1.50 3,250.05 78
Enfield 1,172 1.20 3,305.60 78
Luton 221 0.20 436.75 202
Total outflow 19,178 19.70 40,614.40 2639
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West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out) West Hertfordshire PCT residents patient flow report from April 2008 to June 2008 (Flow Out)
Health Body Number of patients of patients UDA UOA
West Hertfordshire 68,853 86.00 148,285.30 12,044.00
E N Hertfordshire 2,850 3.60 5,830.50 4
Non neighbouring 1,985 2.50 4,701.00 51
Harrow 1,887 2.40 3,844.65 71
Hillingdon 1,722 2.20 3,698.85 180
Barnet 1,437 1.80 2,674.00 1,160
Buckinghamshire 739 0.90 1,255.65 86
Enfield 492 0.60 1,117.50 50
Bedfordshire 311 0.40 735.10 64
Total outflow 11,423 14.40 23,857.25 1666
Source DSD Statistics Source DSD Statistics
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Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In) Patients treated in West Hertfordshire PCT patient flow report from April 2008 to June 2008 (Flow In)
Health Body Number of patients of patients UDA UOA
West Hertfordshire 68,853 84.80 148,285.00 12,044.00
Buckinghamshire 3,143 3.90 6.55 1,333
E N Hertfordshire 2,201 2.70 4,449.10 1,497
Non neighbouring 1,944 2.40 3,635.00 1,266
Unknown 1,817 2.20 4,133.45 235
Bedfordshire 1,403 1.70 2,384.90 1,351
Harrow 739 0.90 1,592.95 38
Barnet 616 0.80 1,368.05 3
Hillingdon 363 0.40 677.75 223
Enfield 100 0.10 262.20 0
Total inflow 12,326 15.10 18,509.95 5,946
Source DSD Statistics Source DSD Statistics
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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
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School Dental Inspections

• 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.

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• 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 Committees 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

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Improving Childrens Oral Health

• Requires partnership working from the following
  stakeholders
• Dental teams
• Public Health specialists
• Oral Health Promotion Team
• Health visitors
• Health improvement specialists
• Sure start and childrens centres
• Healthy schools programmes
• Local authorities
• Voluntary groups

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Oral Health Promotion Activities Aimed at
Reducing Oral Health Inequalities in Young
Children
TOPIC FOCUS GOOD PRACTICE
DIET AND NUTRITION INFANT FEEDING Promote breastfeeding Coma recommendations Oral Health input into local infant feeding strategies and guidelines
DIET AND NUTRITION POLICY GUIDELINES Promote the development and adoption of nutrition and healthy eating guidelines
DIET AND NUTRITION SUGAR CONTENT Discourage addition of sugars to weaning foods/drinks and vitamin supplements Encourage reduction in sugar content of soft drinks/breakfast cereals, confectionary, etc. Encourage caterers to reduce sugars in prepared foods Encourage vending machine providers to include sugar-free choices
DIET AND NUTRITION PUBLIC INFORMATION AND SUPPORT Improve consistency of all dietary messages re importance of reducing the frequency of consumption of sugary drinks and foods Ensure effective dietary education for those at risk of dental caries and erosion Restriction of promotion of food and drinks high in sugar, particularly for children
ORAL HYGIENE EARLY TOOTHBRUSHING Encourage parents and carers to start toothbrushing with fluoride toothpaste within the first year of a childs life
ORAL HYGIENE BODY AND ORALHYGIENE Incorporate oral hygiene teaching into Personal and Social Education teaching
ORAL HYGIENE TRAINING AND SUPPORT Improve the effectiveness of oral hygiene instruction provided by oral and health professional
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Hertfordshire Oral Health Strategy and
Commissioning Group

• 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

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Dept of Health additional growth funding 08-09
Indicative Gross Allocation 000s Indicative Patient Charge Revenue 000s Net Allocation 000s UDAs Indicative Planning Assumption
East North Hertfordshire PCT 1,292 258 1,034 55,355
West Hertfordshire PCT 1,998 600 1,398 79,945
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Additional Growth from PCTs

• 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

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West Herts - Hertsmere

• Practices in Potters Bar, Borehamwood and Bushey
  have received the following additional growth

2008-09 16,700 Units of Dental Activity 5,567 patients
2009-10 31,400 UDAs 10,467 patients
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West Herts St Albans and Harpenden

• Practices in London Colney, St Albans and
  Harpenden have received the following additional
  growth

2008-09 18,500 Units of Dental Activity 6,167 patients
2009-10 36,400 UDAs 12,133 patients
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West Herts- Watford and 3 Rivers

• Practices in Watford, Rickmansworth, Croxley
  Green, Chorleywood and Abbots Langley have
  received the following additional growth

2008- 09 15,275 Units of Dental Activity 5,092 patients
2009-10 36,325 UDAs 12,108 patients
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West Herts- Dacorum

• Practices in Tring and Hemel Hempstead have
  received the following additional growth

2008- 09 5,600 Units of Dental Activity 1,867 patients
2009-10 14,000 UDAs 4,667patients
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East and North Herts SE Herts

• Practices in Ware, Hoddesden, Waltham Cross,
  Hertford, Flamstead End, Cuffley and Cheshunt
  have received the following additional growth

2008- 09 22,550 Units of Dental Activity 7,517 patients
2009-10 35,400 UDAs 11,800 patients
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East and North Herts N Herts Stevenage

• Practices in Baldock, Stevenage, Hitchin and
  Letchworth have received the following additional
  growth

2008- 09 21,465 Units of Dental Activity 7,155 patients
2009-10 44,980 UDAs 14,993 patients
52
East and North Herts Welwyn/Hatfield

• Practices in Welwyn Garden City, Hatfield,
  Panshanger and Welham Green have received the
  following additional growth

2008- 09 6,400 Units of Dental Activity 2,133 patients
2009-10 17,424 UDAs 5,808 patients
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East and North Herts- RBBS

• Practices in Bishops Stortford and Buntingford
  have received the following additional growth
  funding

2008- 09 8,800 Units of Dental Activity 2,933 patients
2009-10 18.102 UDAs 6,034 patients
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Total Hertfordshire Growth allocated to date
West Hertfordshire PCT West Hertfordshire PCT West Hertfordshire PCT West Hertfordshire PCT
2008-09 56,075 UDAs 18,693 patients 1,345,800
2009-10 118,125 UDAs 39,375 patients 2,835,000
East and North Hertfordshire PCT East and North Hertfordshire PCT East and North Hertfordshire PCT East and North Hertfordshire PCT
2008-09 59,215 UDAs 19,738 patients 1,421,160
2009-10 115,904 UDAs 38,635 patients 2,781,744
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Supporting Patient Access

• PCT telephone number for information
• Up to date information on individual practices
  capacity
• NHS Choices website
• Increasing public awareness
• Communications plan (December 2008)

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Reconfiguration of Acute Services

• In patient beds for oral and maxillofacial
  surgery were centralised at Luton Dunstable
  Hospital in 2004. This serves Bedfordshire,
  Luton, east and North Herts and the northern part
  of West Herts.
• Most oral surgery and all orthodontics is
  undertaken as out patient or day stay at the
  local district general hospital
• Reconfiguration will have little effect