Primary Care & Community Orthodontic Services South Tyneside PCT March 2010 Sheila Lister Head of Commissioning Primary Care Services

Orthodontic Service The orthodontic service is a service offered to children under the age of 18 only Referrals are made by GDPs Patients are assessed by criteria known as Index of Orthodontic Treatment Need (IOTN) Scoring Patients are offered a choice of provider including those outside the ST boundaries Patients from outside of SOTW can also be referred into the community services

Current Provision Limited providers of primary and community services with long historic waiting times for some community service providers Current Providers Primary Care Providers - 8 GDP Providers delivering services for their own patients Community Providers -1 Community provider (PCTDS) -1 provider in North Shields (Mr Osborne) -1 Provider in Whitley Bay (Oraprime) -1 Provider in Hebburn (Smiles Ltd) -1 Provider in Sunderland Road Dental Practice (Temporary Contract)

Activity undertaken to date (UOA’s Delivered) Table 1: YearPCTDSGDPs (inc SRDP and Smiles Total ActivityTotal number of Patients (based on average 21 UOA’s per patient) 2006/ / / /10 (Projected)

Regional Service Review A regional review of the orthodontic service was undertaken the outcome of which highlighted that additional services were required across SOTW

Issues Raised through the review History of there being a shortage of orthodontic specialists and difficulty attracting them to the NE Excessive waiting times of up to 4 years in community services Suggestion that demand was outstripping capacity It has been suggested that due to the long waiting times, children were being referred into these services too early to ensure they would be ready for treatment when offered an appointment in what could be 3-4 years time Some children were referred into the service when not ready for treatment due to caries or poor dental hygiene These patients would be kept on the list until their situation improved and they were ready for treatment creating the long waits

Progress Update The PCTs Oral Health strategy was developed and was consulted upon through the LEBs where the need for additional orthodontic services was highlighted Development work started during 2009 on the service specification and tender documentation following the principles of The Official Journal of the European Union (OJEU) Whilst the above tender was being planned, the PCT commissioned additional completed courses of activity with a local provider in 2009/10 – Shown in Table 1.

Progress Update cont. In addition to the above the PCT also agreed to the transfer of a further 50 patients from PCTDS to an independent contractor Validation of the PCTDS waiting list is ongoing. In January 103 of the patients were contacted; of these, 44 people did not respond and will be followed up; 22 so far have agreed to transfer to the other service; 35 refused to transfer stating reasons such as: -they were unwilling to travel ( the other service is 4 miles from the PCTDS service) -they were already in receipt of treatment from elsewhere -they were happy to wait on the PCTDS list and the remaining 2, the service is awaiting further contact from these patients

Progress Update cont. A full validation of their list is expected to be undertaken by the end of March 2010 with all patients on the list being contacted The waiting list information is currently held manually, the service are looking to transfer this to an automated system to support the up to date information required

2009/10 Additional Investment in Specialist Orthodontic Services £350K recurrent funding was identified through the PCTs strategic plan for each PCT and a tender process was subsequently agreed Approx £400K has been committed non recurrently in 2009/10 whilst the tender process is undertaken.

Tender Update The tender process commenced in November 2009 The contract is for 5 years and will treat approximately 250 children each year. Referrals for this contract will only be available to SOTW residents Waiting times for assessment is stated as within 4 weeks and treatment within 13 weeks ensuring patients are appropriate for treatment when referred. This will support the management of the waiting lists. Those patients that are not in a position to start treatment will be referred back to their GDP for management until such a time they are ready. The evaluation of the tenders will be concluded in April 2010 The contract will be awarded in April/May 2010 with a view to mobilising the service in June/July (dependent on premises solutions identified)

Update – Current Waiting List Information (Dec 2009) ProviderWaiting time for assessment (weeks) Waiting time for treatment (weeks) Numbers waiting for treatment Sunderland Road Dental Practice Smiles LtdCarried out by PCTDS 3771 Mr Osbourne NS12 Not available Oraprime WB10416Not available PCTDS

Next steps Continue with the procurement process to secure a 5 year contract seeing an approximate 250 children each year Undertake short term commissioning for the first qtr of 2010 until the contract above can be mobilised. Continue to work with the PCTDS provider to understand the outcome of the list validation exercise The PCTDS to further advertise the vacancies within the orthodontic service Review all providers of orthodontic services with a view to reducing and standardising waiting lists and times for assessment and treatment Strengthen contracts to ensure delivery of the above Ensure all providers can report timely and accurate information