An Update from Welsh Government Lisa Howells Senior

An Update from Welsh Government Lisa Howells Senior Dental Officer

What am I going to cover ● Progress with delivering the National Oral Health Plan ● The Primary Care Plan ● Prudent Healthcare

Delivering the National Oral Health Plan Annual progress report on CDO website Welsh Government actions include – • • • WHTM 01 -05 updated and audit published Introduce a new practice inspection programme Revise the private dentistry regulations NHS e- connectivity Care of Vulnerable people – two Welsh Health Circulars issued

Private Dentistry Regulations • Practice registration – not individual dentist • Allow direct access DCP registration • Equalise arrangements for DBS (CRB) checks with the NHS • Equalise quality and safety standards with the NHS • Lasers ! • Consultation - Autumn 2015

NHS e- connectivity • 2 parts to the programme 1. NHS e-mail connectivity to GDS practices 2. Pilot electronic patient referral

NHS e-mail connectivity • Allow access to NHS e-mail and related NHS systems – including HB e-learning • Led by WG and NWIS (NHS Wales Informatics Service) • High level of “sign up” – 70 practices responded in ABMU UHB (89%)as of 23/1/15 • Connection to NHS network from March to June 2015 • Not to be used for patient referral

E-Referral Pilot in Cwm Taf health board 5 practices taking part Testing e-referral for minor oral surgery only Clinical governance systems in place Test for 3 months, followed by evaluation and report • Roll out to Wales “some way off” • • •

Contract Update- pilot results • Very acceptable to patients and dental teams • Marked shift towards stabilisation and prevention • KPIs relating to general health promotion welcomed and implemented • Scrutiny issues- need for scrutiny of clinical practice • Reduced numbers of patients and courses of treatment • Reduced patient charge income

Where are we now • Discussion with Minister in April • English prototypes planned to start Autumn 2015 (about 100 planned). Full roll out 2018/19 at the earliest • Remuneration – capitation and quality payments • WG observing at present • English newsletter : dentalpilots@pcc. nhs. uk with “Pilot Perspectives subscription request” in subject line.

In the meantime……. “Grey areas” WG discussion with BDA – GDPs asked to identify grey areas with NHS regulations • Many grey areas which cause frustration, concern and stress. BUT… • Impossible to have clear “rules” for every situation – every patient is an individual • Not appropriate to make regulations on the basis of a single scenario

Themes • Lack of consistency across LHBs • Patients with urgent problems • Treating casual patients/ occasional attenders • Dealing with patients who return within a short time span with problems from treatment provided • Difficulties arising from infrequently done treatments, EG full dentures • “Band 4” !

NHS DS look for trends / themes / patterns rather than individual “one off” patients. Eg • repeated urgent treatment of a single tooth • routine claim for band 2 for every urgent patient • exempt patients with repeated treatments in short time intervals

Some advice: • Keep accurate, contemporaneous records (it’s an old chestnut but it will help) • Complete the FP 17 in full • Don’t let claiming drive treatment – the priority is patient treatment need • Don’t make inaccurate claims to spare the patient from paying NHS charges. EG claiming suture removal when the patient had a filling

The Primary Care Delivery Plan • £ 3. 5 m investment in primary care autumn 2014 • £ 10 m Welsh Government primary care fund • £ 30 m further investment • 3 year delivery plans

The Welsh Government Primary Care Plan • Published February 2015 • Principles - Prevention, early intervention - Co-ordinated care – closer working across primary care / secondary care / community care - Actively involve patients and carers - Planning at community level of 25, 000 to 100, 000 people (“clusters”). 64 in Wales - Prudent healthcare

Dental involvement in clusters • Possible funding for a GDP ( as LDC/OHAG rep) to attend cluster meetings – including elements of training and development. • Health boards, LDCs and OHAGs work together to ensure that cluster plans include oral health and dental services

Prudent Health Care “……. thinking differently about the services we provide and the relationship between the professional and the individual”

Prudent Healthcare • 5 themes (or possibly 7…. . ) • See www. prudenthealthcare. org. uk - includes Mick Allen’s perspective from general dental practice

• Do no harm • Carry out the minimum appropriate intervention • Organise the workforce around the 'only do what only you can do' principle • Promote equity • Remodel the relationship between user and provider on the basis of co production • Treat the greatest need first • Consistently apply evidence based medicine

Thank you • Any questions? Lisa. howells 4@wales. gsi. gov. uk