Healthcare Professionals Commissioning Network

1. DENTAL UPDATE Healthcare Professionals Commissioning Network Development meeting 6th September 2011

2. Presenters • Reenapatel • hpcn dental lead • Rachel noble • British Dental Association Policy Manager • Seemasharma • dentist, businesswoman and “disruptive innovator”

3. Agenda • NHS dental services • HPCN Dental update • HPCN Outputs • Oral Health Frameworks in dental practice: • Implementation • Barriers

4. Dentistry: Where are we now? • Represent 23,000 dentists in primary NHS, private practice, hospitals, armed forces, salaried service, public health and academia • Contracts held locally • National level – policy-making committees that represent each of the ‘crafts’ • Piloting a new contract – 68 sites across England • Local level – network of Local Dental Committees • Challenges – dentists have little time to ‘look up’. Tightly regulated and perverse incentives of the 2006 contract have left practitioners chasing targets • We’re ready for change, but DH must get it right

5. Working back from 2013 • Services entirely commissioned by the NCB – contracts held nationally • Developing and implementing new contract • Articulate policy positions and specialty needs -‘Futures’ documents • Working with Local Government Association, PHE, DH and other stakeholders to smooth the transition for dentists and ensure we’re not missed off the agenda • Health Bill – it works well for dentistry!

6. HPCN Dental workstream updateCurrent status:

7. Outputs:Multi-professional collaboration using a robust evidence base

8. Patients with oral complaints attending GPs Understanding the problem • Need to improve access to, and uptake of, oral and dental care for the Lambeth population • Barriers to the uptake of dental care include • Fear • Availability • Accessibility • Cost • Historical studies show that dental attendance at GPs can be significant: out of 1,650,882 patient attendances at 30 medical practices in the study year, 4,891 (0.3%) were for oral/dental problems. 75% of dental attendances were related solely to these problems. • GPs may not be well equipped for managing dental pain Source: Lambeth Oral Health Needs Assessment, March 2010 Mansour and Cox, 2006 Anderson et al 1999

9. Output 1:What do we need? • An understanding of the extent of the problem • Prescribing guidance for GPs? • Enhanced collaboration/communication between local GPs and GDPs? • Provision of information about access to local services • Provision of self care information? • Referral pathway between GP GDP

10. Output 2: Dissemination of consistent evidence based preventative messages • Aim: Dissemination of evidence based preventative recommendations for healthcare professionals – a resource based on: • 2 key documents: • Delivering better oral health: An evidence-based toolkit for prevention (DH 2009) • Prevention and Management of Dental Caries in Children (SDCEP 2010)

11. Evidence based messages • Brush for two minutes twice daily • Spit don’t rinse • Use the correct amount of toothpaste with age-appropriate level of fluoride • Restrict food and drinks containing sugar to no more than four occasions in any one day • Drink only water or milk between meals • Snack on sugar-free snacks between meals • Do not leave squash, fruit juices, sweetened milk, nor soy formula milk unattended in feeding bottles through the night. • Do not eat or drink after brushing at night • Be aware of hidden sugars in food and medicines

12. Output 2: What is required? • What would be useful? • Are there issues around: • Dissemination? • Access? • Uptake and implementation?

13. Summarising dental diseases TOOTH SURFACE LOSS CARIES Diet - sugar consumption 1. AB Brushing technique 2. AT Para function 3. ER Reflux/eat disorder 1.Use of Fluoride TP 2. Sibling exp 3. Xerostomia Age Symptoms Significant PDH Special Care Poor Plaque Control Alcohol PERIODONTAL DISEASE SOFT TISSUE LESIONS Tobacco Diabetes Site

14. Barriers in collaborating with other healthcare providers • Poor communication across organisational boundaries • Over complicated messages • Over simplified messages • Different messages • Boring • Non-inspirational or motivational • Inconsistent

15. Oral Health FrameworkMulti-professional collaboration in practice

16. Appendix 1: BMA GuidanceGPs’ legal and contractual obligations in the provision of treatment to dental patients • Before refusing to treat a patient asking for emergency dental treatment, a GP must ascertain that the condition requires only dental treatment. As always, GPs must put themselves in a proper position to judge the nature of the patient's condition by undertaking reasonable enquiries. • Having established an apparent dental problem, GPs should refer a patient for any further treatment, if necessary, to a dentist or local emergency service. If the patient has no usual dentist, or there is no response from the usual dentist, the patient should contact: PALS or NHS Direct • If GPs choose to treat a patient themselves such treatment would be provided under general medical services and the level of skill and degree of care the GP would be expected to exercise is that of a general medical practitioner. GPs should not, however, attempt to manage a condition requiring dental skills unless they have the appropriate training and expertise. Both the civil courts and the General Medical Council (GMC) require doctors to have appropriate skills for any treatment they offer.