DWSI document: How can this help a dentist to set up a contract with the PCT?

1. DWSI document: How can this help a dentist to set up a contract with the PCT? Eric Rooney Consultant in Dental Public Health

2. Outline • The DWSI document • PCT Commissioning • Building evidence for procurement or accreditation

4. Recognition “Prison dentists have to manage a complex agenda in order to deliver optimum care for their patients, and require a range of skills additional to those needed to practise primary care dentistry in a high street or community setting”

5. Use • Guidance to Primary Care Trusts (PCTs) • PCT should define the competencies required for the appointment of a DwSI • Dentists should match their personal development portfolios against the requirements of the role. • Should assist prison dentists and PCTs in identifying any training needs • Prison governors and healthcare teams

6. Generalist competencies • Clinical Record Keeping • Infection Control • Legislation and Good Practice Guidelines • Medical Emergencies • Radiography • Risk Management and Communication • Team Training

7. Competency Domains • Environmental Domain • Clinical Domain • Leadership and Management Domain • Communication Domain

8. Environmental Domain • Security • Ethical issues and safe practice in prison • The prison environment • Prison dentistry in the wider context

9. Clinical Domain • History, examination and diagnosis • Treatment planning and patient management • Medical and dental emergencies • Anaesthesia and pain control • Therapy, treatment and prevention • Management of dental treatment in patients who are substance misusers • Management of dental care in patients with mental health problems or a learning disability

10. Leadership and Management Domain • Clinical governance and audit • Oral health promotion • The role of the dental team • Professional networks

11. Communication Domain • Communication with prisoners, representatives and advocates • Communication with the clinical team, peers and other professionals • Effective management of complaints

12. PCT Commissioning

13. PCT Responsibilities PCT has a duty to provide or secure primary dental services to the extent it considers necessary to meet all reasonable requirements (S.16CA of NHS Act 1977)

14. PCT responsibilities PCT has prescribed functions in relation to dental public health discharged by: • PCT itself • PCTs acting jointly • by arrangements with other agency (S16CB of NHS Act 1977)

15. Vision: World class commissioning will deliver • Better health and well being for all • People stay healthier for longer – “adding life to years.” • People live longer and health inequalities are dramatically reduced – ”…and years to life” • Better care for all • Services are of the best clinical quality and evidence based • People exercise choice and control over the services that they access so they become more personalised. • Better value for all • Informed investment decisions • PCTs work across organisational boundaries to maximise effective care.

16. Commissioning Dental Team Prison Dental Care Prison Health PCT Commissioner

17. Model for commissioning prison and detention centre oral health services

21. PCT Commissioning “You should have a clear procurement strategy for primary care dental services setting out when you will openly tender for new services and when you will expand the existing market. Under the principles and rules for cooperation and competition, the factors a PCT will consider in reaching this decision must be clear and transparent. The PCT Procurement Guide identifies four generic criteria that PCTs should consider when deciding whether or not to issue a formal tender”

22. Working with existing providers • Development of SLA • Re shape and refocus the existing service to deliver the service specification in partnership with the existing provider

23. Market testing • Advert requesting expressions of interest • Quality criteria • Short list • Invitation to present/ interview • Final offers • Scoring • Award • Feedback

24. Service specification • Likely to be based on DWSI document and competencies • Likely to share elements of the new guidance • Is the definition of the product, its quality and the methodology of delivery • Is the document which you need to match your evidence against

25. Accreditation/ Procurement Panel • Prison healthcare representative • Dental public health consultant • PCT commissioner • Dental practice adviser • Dental practitioner contracted as a DwSI in prison dentistry. • PCTs may consider it appropriate to interview potential candidates/ providers

26. Evidence for accreditation or procurement

27. Generalist evidence • The FGDP(UK)’s Key Skills in Primary Dental Care • Diploma of Membership of the Joint Dental Faculties’(MJDF) Portfolio of Evidence • BDA’s Clinical Governance Kit and Smile-on.com’s Clinical Governance Package

29. Environmental Evidence • Evidence of training undertaken (e.g. induction, breakaway, de-escalation) • Reflection on security issues within the prison • Evidence of and reflection on local clinical protocols • Critical incident analyses • Reflection on current issues in dentistry and how they impact on healthcare in prisons

30. Clinical Evidence • Case reviews • Direct observation (testimonial from another suitably qualified professional) • Critical incident analyses • Reflection on training and personal development • Examples of treatment plans • Anonymised patient records • Anonymised referral letters • Evidence of local protocols (e.g. medical emergencies, local urgent care pathways, triage)

31. Management and Leadership evidence • Evidence of a personal development plan • Evidence of having undertaken CPD and reflection on its impact on practice • Evidence of participation in audit and peer review • Evidence of involvement in the prison clinical governance committee • Evidence of knowledge of the evidence base for best practice • Reflection on infection control procedures and infection control issues specific to the prison setting • Evidence of and reflection on oral health promotion in the prison and the practitioner’s role in this • Reflection on the role of the team in the delivery of dental care

32. Communication evidence • Reflection on cases where there have been potential barriers to communication • Evidence of and reflection on training and CPD in relation to communication with patients with a variety of communication needs • Evidence of written communication • Evidence of knowledge of local protocols for dealing with complaints • Reflection on a complaint and what was learned from it/critical incident analysis

33. Conclusion • The DWSI document • PCT Commissioning • Building evidence for procurement or accreditation

34. Contacts • eric.rooney@centrallancashire.nhs.uk