Monitoring for Performance New Dentistry contracts a PCT view - PowerPoint PPT Presentation

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Monitoring for Performance New Dentistry contracts a PCT view

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is part of the process for ensuring the quality of all aspects of ... Express condolences on behalf of HA. HA had no legal responsibility for clinical standards ... – PowerPoint PPT presentation

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Title: Monitoring for Performance New Dentistry contracts a PCT view


1
Monitoring for Performance New Dentistry
contracts a PCT view
  • Ken Wragg Consultant in Dental Public Health

2
MONITORING
  • …is part of the process for ensuring the quality
    of all aspects of the dental services that we
    commission and provide

3
Broad Structure of this presentation
  • Prevention is better than cure
  • Be proactive
  • When things go wrong
  • Scenarios
  • Where there are continuing problems

4
Prevention not detection
  • Aim to build in good practice rather than inspect
    out poor practice
  • Work with and support practices
  • Work with PALS, consultants, LDC other networks
  • Work through CDPH, DPA, DRO, commissioning
    manager etc
  • Link dentistry to broader primary care
    monitoring, clinical governance arrangements etc
  • Develop local good practice expectations
  • Early detection be proactive

5
Principles
  • Commissioner Led
  • Involves commissioners and providers
  • Involves a broad range of people within the PCT
    / BSA
  • Commissioning
  • Finance
  • Information
  • Public Health
  • Contracts

6
Principles
  • Share good practices within and between PCTs
  • Everybody comes to work to do a good job
  • Make sure people know what is expected of them
  • Make sure that the system enables them
  • Achieved through good management and good
    communication

7
Perspectives of Quality
  •     PUBLIC
  •     PROFESSIONAL
  •     FINANCIAL / ACTIVITY
  • - LEGAL - Regulations
  •     

8
Dimensions of monitoring processes
  •     PEOPLE
  •     SYSTEMS
  •     TECHNOLOGY
  • - PCT CAPACITY?

9
  • Approach
  • Continuous improvement
  • Robust PCT mechanism
  • Work collaboratively with BSA
  • Work with practices
  • Build in good practice
  • Sustainable pace
  • Priorities
  • Planned improvements
  • Realistic Timescales

10
  • Cost of monitoring
  • Developing a robust PCT mechanism
  • Working collaboratively with BSA
  • Working with practices
  • Building in good practice staff time
  • Against a background of achieving financial
    balance

11
  • Cost of not monitoring
  • Loss of PCR
  • Loss of dental capacity
  • Clinical risk
  • Vicarious liability / statutory duty
  • Loss of public goodwill / reputation
  • Financial and emotional cost of dealing with poor
    performance
  • Deterioration in oral health

12
  • Teamwork
  •  
  •            A team can do jobs individuals cant
    do
  •  
  •            A team uses skills of all its members
    to arrive at the best answers
  •  
  •            Each member has been involved in a
    decision they have invested in it they will be
    more committed to it.
  •  
  •            Teamwork builds ownership across the
    dental network.
  •  
  •            Team spirit.

13
  • Maximise the impact of first successes
  • By tackling -
  •  
  •            Problems that pose the biggest threat
    to the PCT
  •            Problems that are important to
    Providers
  •            Problems with high potential for
    improvement
  •            Problems that can be solved easily

14
  • Early detection
  • Examples
  • Excessive referrals for routine extractions
  • Restriction of services provided
  • Generic practice development need
  • Good practice give credit

15
  • Excessive referrals for routine extractions
  • Detection through liaison with consultants /
    specialists
  • General problem or certain practices?
  • DPA visits practice(s)
  • Appropriate action taken
  • Training needs?
  • Contract modification?
  • Commissioning solution?

16
  • Restriction of services provided
  • Detection feedback from public / PALS
  • Evidence verbal statements to patients or sign
    displayed
  • DPA / Commissioning manager visits practice
  • Practice informed that breach of regulations
    asked to cease
  • To be brought up at contract review
  • Monitor feedback from PALS / public

17
  • Generic practice development need
  • Problem affecting many practices
    administrative, clinical (e.g. IOTN) etc
  • Detection feedback from practices and / or
    consultants or problems apparent from BSA or
    other data
  • DPA or CDPH and / or Commissioning manager
    investigated
  • Appropriate form of training to be provided
  • Links with Deanery

18
  • When things go wrong
  • Scenario 1
  • High profile, major case
  • Scenario 2
  • Major untoward incident

19
  • Scenario 1
  • High profile, major case
  • Hypothetical example Serious shortcomings in
    clinical standards or cross infection control or
    fraud etc - with a criminal dimension,
  • Multiple practices, multiple PCTs, multiple SHAs
    implicated
  • Potential risk of significant, rapid loss of
    services as a result of outcome of trial
  • PCT cannot enter into any processes which
    pre-empt the outcome of the trial
  • What can be done in the period leading up to
    trial?

20
  • Scenario 1
  • PROACTIVITY
  • DETAILED PLANNING
  • ONE NHS COLLABORATE
  • Consistent approach
  • Economies of scale
  • Who co-ordinates?

21
  • Scenario 1
  • Objectives
  • Identify stakeholders well in advance
  • Seek commitment of PCTs to joint approach
  • Agree overall approach
  • Agree approach to legal elements of case cost
    sharing
  • Agree approach to communications - consistency
  • Agree a Contingency Plan

22
  • Scenario 1
  • Contingency Plan
  • Patients who are in treatment
  • Plans to replace service if it is lost
  • Plans for timely help and advice for patients and
    employees of practice(s)
  • Ensure legal issues are understood in advance -
    GDS contract regulations, Performers List
    Regulations

23
  • Scenario 1
  • Contingency Plan (continued)
  • Plan
  • Pre-trial,
  • During the trial and
  • Post verdict
  • Scenarios
  • Case thrown out
  • Media enquiries
  • Enquiries from public
  • Monitoring trial
  • Post verdict
  • Performer list and GDS contract issues
  • Provision of services / enquiries from public
  • Media enquiries

24
  • Scenario 2
  • Major, untoward incident
  • Child died under GA at a dental practice
  • High media profile locally and nationally
  • Very active family solicitor, using the press
  • Agenda being driven through media

25
  • Scenario 2
  • Action
  • Express condolences on behalf of HA
  • HA had no legal responsibility for clinical
    standards
  • Early announcement of the setting up of an
    internal enquiry
  • External specialists in the field
  • Await inquest
  • Transcript of inquest
  • Detailed inquiry report with recommendations
  • Make findings public and inform GDC etc

26
  • Scenario 2
  • Lessons learned
  • Act quickly to take initiative
  • Acknowledge public concern
  • Be seen to be acting objectively and in the
    public interest
  • Publish findings
  • Take action

27
BASIC JOB OF THE NHS
  • To invest the publics own money on behalf of the
    public to best effect
  • Maintain and improve the publics health
  • Provide appropriate, high quality, cost effective
    programmes and services
  • Deliver political priorities

28
  • Where there are continuing problems
  • PCT is the customer acting on behalf of the
    public has a right to take its business
    elsewhere
  • Be prepared to disinvest and tender
  • Currently a significant amount of interest in
    tender processes
  • Creates a commercial tension NHS business
    cannot be taken for granted

29
Conclusions
  • Prevention not detection build in good practice
  • Be pro-active
  • Early detection / act quickly
  • Take the initiative if things go wrong
  • Good communication monitoring is everybodys
    responsibility
  • Continuous improvement at a sustainable pace.
  • Be seen to act in the public interest.
  • Is your PCT fit for purpose?
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