1. After the pilots: what next? John Milne Chair GDPC.

3. Slide 3 CQC HTM 01--05 Information Governance New Contract LPNs What Next!!!!!!

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5. New Dental Contract Registration Capitation Quality and Outcomes

6. Oral Health in 12 year olds

8. Care Pathways Oral health assessment Practical, consistent and achievable. RAG scoring Risk based assessment of caries, periodontal disease, tooth surface loss and soft tissues Leads to status and interim care review intervals. Care priorities Drive clinical pathways. GDP override Professional discretion.

9. Up to date issues................. Sales of practices OFT- continuous tendering of contracts FD training and places Pay and expenses CQC Compliance and costs HTM 01-05 Role of DCPs – Direct access? Commissioning Board Transitional Arrangements Local Professional Networks NHS Offer – core service? Seniority Pay- new scheme IT costs Associate terms and conditions

10. Oral Health Assessment: leads to homecare plan and professional care plan. Medical History Alcohol and tobacco Social History Family caries history Diet and toothbrushing Full chart of restorations Full chart of carious lesions BPE Bleeding Pocket chart. Tooth surface loss (relative to age) Soft tissues.

11. What’s important? For the public Access to quality care – And urgent care Improved oral health outcomes Good experience Clarity of what the NHS will provide Simple charging system For the profession Improved patient outcomes Fair remuneration Current benefits preserved Ability to transfer contracts (goodwill) Financial stability in transition stage.

12. Caption here Pilots so far.............................. Best thing I’ve ever done, free from UDAs at last. Can deliver proper care. Worst thing possible, no way this system can work!

13. What types of practice?

14. 14 Satisfaction with NHS dental care in last 9 months Q4. Overall, how satisfied or dissatisfied are you with your experience of NHS dental care at this dental practice in the last 9 months? Base: All patients and carers/guardian/parents of patients (3,760). % PATIENTS Net Satisfied: +91

15. NHS dental care in last 9 months compared to previous experience Q5. Generally speaking, how does your overall experience of NHS dental care at this dental practice in the last 9 months compare with your previous experience of NHS dental care? Was it better or worse, or about the same? Base: All patients and carers/guardian/parents of patients (3,760). % Net Better : +46 PATIENTS 15

16. Overall attitudes towards the care pathway Q3. To what extent do you agree or disagree with each of the following statements about the care pathway currently being piloted in your practice? Base: All dental care professionals (320) 92 80 55 Total: % Agree PRACTITIONERS 16

17. Overall performance of OHA in terms of enabling better care to be provided to patients Q5. Compared to the previous system, how would you say the Oral Health Assessment (OHA) performs overall in terms of enabling better care to be provided to patients? Is it better or worse, or is it about the same? Base: All dental care professionals (320) PRACTITIONERS 17

18. Pilot appointments by appointment type (Source: DPMS data)

19. 87 84 80 Total: % Better Q6. Compared to the previous system, how would you say the Oral Health Assessment (OHA) performs overall in terms of each of the following? Base: All dental care professionals (320) Specific aspects of OHA performance PRACTITIONERS 19

20. Changes to the skill mix in the practice as a consequence of the care pathway Q17. Changed the skill mix? Q18. In what way? 73 % PROVIDERS Q17. Has your practice changed the skill mix of staff to help deliver the new way of working as part of the care pathway? This could be through up-skilling existing staff or by changing the staffing model. Base: All providers (40) Q18. In what way has your practice changes the skill mix of staff to help deliver the new way of working? Base: All providers who say ‘yes’ at Q17 (29). 20

21. Changes to the skill mix in the practice as a consequence of the care pathway Q19. Consider changing the skill mix? Q20. In what way? 85 % PROVIDERS Q19. Would you consider changing the skill mix of staff at some point if the new way of working becomes permanent? Base: All providers (40). Q20. How might your practice change the skill mix of staff in the future to help deliver the new way of working? Base: All providers who say ‘yes’ at Q19 (34). 21

22. The care pathway and clinical autonomy Q4. Compared to before the pilot, would you say you have more or less clinical autonomy, or is it about the same? Base: All dentists (129) 22 PROVIDERS

23. Q22. Finally, please tell us any other comments you have on the care pathway, including any suggestions for improvement. Base: All dental care professionals (320) Thoughts on the care pathway & suggested improvements PRACTITIONERS 23

24. Patients: Q14. Which of the following best describes your view about the use of ‘traffic light’ ratings? Base: All patients and carers/guardian/parents of patients who can remember using traffic light ratings (2,011) Practitioners: Q10. Which of the following statements best describes your view about red/amber/green status? Base: All respondents (320) Views about the use of RAG ratings 58% (31%) The ‘traffic light’ ratings make it easier for me/patients to look after teeth and gums (oral health) 41% (22%) 1% (1%) The ‘traffic light’ ratings make no difference to how I/patients look after teeth and gums (oral health) The ‘traffic light’ ratings make it more difficult for me/patients to look after teeth and gums (oral health) 75% 19% 0% N.B. Figures in brackets refer to data based on all patients (3,760) PRACTITIONERSPATIENTS 24

25. RAG status breakdowns by practice (Children) 70 pilot practices (in order of % red children)

26. RAG status breakdowns by practice (Adults) 70 pilot practices (in order of % red adults)

27. RAG status overall breakdown

28. There is a clear correlation between IMD score and RAG status but the effect is reasonably small

29. Responses in second wave pilots. Revision of pathway (including IT) Changes to Pt charges in pathway practices. Registration simulated in pilots. Additional pilots (including 3 salaried services)

30. Evaluation DH: Evaluation & Learning. BDA Shadow group NSG.

31. Still to come............... Treatment data Volumes Types Advanced Care. Modelling of capitation payments Transitional protections Avoiding neglect.

32. Redistribution High UDA Value...........................Low UDA value Transitional arrangements MPIG? Capitation numbers? Length of registration period? High Access..................................Low Access Growth funding?

33. Income

34. Expenses Rising on all fronts Regulation and compliance Training Premises Staff Utilities Materials Laboratories.

35. Capital Risk v Reward. Buildings Equipment Future investment. Returns.

36. We need some honesty in the debate. Access NHS Offer Scope of advanced care. Elderly Population Existing inequalities

37. The big challenge How can a system improve oral health, deliver prevention continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?

38. The big challenge How can a system improve oral health, deliver prevention continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?

39. Capitation Values. £1,000,000 10,000 pts £100 per patient per year.

40. Is the cake big enough?

41. Challenge ahead. Improved oral health Sustainability of practice Long term future. Career pathway for dentists Practice ownership and equity Proper remuneration

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