Orthodontics and 18 weeks

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Orthodontics and 18 weeks

• Eric Rooney
• Consultant in Dental Public Health
• Cumbria and Lancashire

Cumbria and Lancashire
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Strategic approaches

• Short term fixes, long term planning
• Understanding the whole system and the patient
  pathways
• Teams and Networks
• Doing things differently

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Short term fixes

• Large waiting list in hospital
• PCT and Trust agreed to move waiting to primary
  care
• PCT Procured fixed term contract with existing
  providers
• Quality standards
• New players in the market

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Long term planning case starts
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Long term planning -Assessments
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Understanding the whole system and patient
pathways
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Teams and Networks

• PCTs and Trust/s
• Booking and Choice
• Clinicians

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Morecambe Bay Orthodontic Clinical Network

• Consultant Orthodontist
• Consultant in Dental Public Health
• Specialist Orthodontic Practitioners
• PCT Commissioners
• (more than 1 PCT)

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Network referral form and pathways

• Developed by clinicians
• Piloted in supportive practices
• Signed off by PCTs
• Being issued to all practitioners with Network
  and PCT branding

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NHS ORTHODONTIC REFERRAL GUIDELINES
TO SPECIALIST PRACTICE, HOSPITAL AND PCT DENTAL
SERVICES
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Specialist practices

• Referrals accepted
• For child patients (lt 18 years)
• Assessment of malocclusion and advice
• Treatment of moderate malocclusions patients
  under 18
• Overjet 6.5-9mm
• Moderate/severe crowding (gt4mm contact pt
  displacement)
• Hypodontia involving only 1 tooth in any quadrant
  (not 8s)
• Crossbites with gt2mm displacement on closure
• Partially erupted teeth, impeded eruption
• Overbite complete to soft tissues /- trauma
• Lateral or anterior open bite lt4mm
• Treatment of mild malocclusion with IOTN 3, AC
  gt6
• Contact point displacement 2.5-4mm viewed
  occlusally
• Overjet 4-6mm, incompetent lips
• Relocation transfers from specialist practice

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Doing things differently

• Review existing pathways
• Redesign if necessary
• Identify key control points
• Work as teams to develop and agree the pathway
  and protocols and guidelines
• Commission according to the pathway design

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North Cumbria

• Hospital based
• New specialist appointed
• Patients from existing hospital assessed waiting
  list
• Further specialist provision planned
• Hospital waiting list (18 weeks issue)
• Traditional model creates provider waiting list
• New approach required
• Be clear before tendering process

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General Dental Practitioner
Patient referral guidelines
18 weeks
Hospital Consultant
Advice only
Specialist Practice
Not ready
No treatment required
Assessment
Specialist Practice
Suitable for primary care
Require Consultant led care
Case Starts
Case Starts
PCT Orthodontic waiting list
Hospital Consultant led service
Specialist Practice
Case Starts
Case start
PCTDS
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Each table to consider

• Main challenges for providers commissioners in
  meeting the 18 weeks target
• AGREE 3 KEY CHALLENGES
• Main steps/solutions to help meet the 18 weeks
  target
• AGREE 3 KEY STEPS/SOLUTIONS

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Feedback from previous event

• Manchester Event 11th March 2008
• Birmingham Event 17th March 2008
• Key Challenges
• Batching and waiting lists (long short term
  issues)
• Clarity over rules and process
• Capacity issues (resources, training quality)
• Communication issues (incl patient perception
  and collaboration between trusts and PCTs)

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Feedback from previous event

• Manchester Event 11th March 2008
• Birmingham Event 17th March 2008
• Key Solutions
• Introduction of Clinical networks involving
  primary and secondary care commissioners and
  providers
• Clarity via production of the pathways,
  supplementary information, examples of good
  practice and improved IT (e.g. choose and book)
• Investment in and improved commissioning of
  workforce / training
• Sharing good practice of achievements elsewhere
  using additional resources wisely in long short
  term to support waiting list reduction.
• Additional training for SpRs and increased
  recruitment where needed (e.g. commissioning of
  new providers and improved skill mix), and
  training for GDPs re referrals and their
  engagement in the production of local referral
  protocols.
• Improve communication and collaboration, inc. a
  national coordinated approach re patient
  communication