Managing Dispersed Outreach: Is it worth it? Michael Smith

Spectrum of Outreach Clinical activity outsourced (piggybacked) Hospital Annexe with the same procedures

High Green Fairlawns Taptonville House Rotherham The Mount, Hemsworth 25km Chesterfield Dearne Valley DAC Southey Green, Firth Park & Wheata Place Genesis Lynton House Salaried Services Dental Practices Sheffield

Content Brief Description Development Operation

Sheffield’s Outreach Aims Professional Responsibility Public Health Dentistry Practice Environment Clinical Skills

The Outreach Year Year 2 H&T Introduction to Primary Care Team Training Outreach Project Audit Project Teamwork Project Work 4+ days a week for 20+ weeks

Content Brief Description Development Operation

Development 2005 Decision to adopt outreach 2006 Funding HEFCE £0.8M, SHA £1,5M Increased undergraduate intake 3 years to develop a 6 month prog chairs across 12 locations 64 supervisors + dental nurses

Selection of Practices ~250 dental practices notified ▼ ~24 expressions of interest ▼ 15 costed outline bids ▼ 6 bids selected ▼ 6 delivered

Management Structure Executive Committee Teaching Committee Outreach Programme Steering Group Outreach Working Party Dental Service Managers Group Independent Outreach Locations

Quality Management Shared understanding Contract Monitoring of outcomes Activity Perception Training days

Enhancements Outreach Project link two case studies to local health data Audit Project design, conduct and report an audit Teamwork Project help develop dental therapy students, assess progress Visits other healthcare services, sedation, GPs, domiciliary

Content Brief Description Development Operation

Preparation Handbook Lecture Programme Introduction / Epidemiology Methods / Project work / Quality of Dental Care / Structure of NHS Dentistry / Health Promotion + Managing expectations Allocations Meet Hosts

Boundary Crossing… Students initially nervous Soon settle Needlestick injuries Cope et al. J Adv Nursing 2000; 31: Wilcox et al. J Hosp Dent Pract 1977; 11:13-17

2008 after 2 blocks n =62 Prediction from Three Block Model Restorations - simple plastic 118 (10) 188 (24 in children) Dentures614 Endodontics715 Extractions - simple 44 (4) 66 (4 in children) Fissure sealants1820 Pt appointments Sheffield Outreach Recently published * requirements Restorations - simple plastic 195 (29 in children) ~70 Dentures14~2 to ~8 Endodontics13~ 6 or ~8 Extractions - simple 67 (7 in children) Fissure sealants26 Pt appointments461 Clinical Activity * Lynch & Allen 2007 Br Dent J, Youngson et al Br Dent J

Communication Formal channels Informal Time consuming… … but vital Holloway & Dixon, BDJ 1977; 143:

Integration Some staff both Outreach and hospital Academics present at development days Students carry (mis)information Visits by the Dean and L&T Advocate Annual Review visits

Managing students Want the practical skills and ‘real’ world Increase competence ‘Stand out’ among applicants

Managing - hosts Altruistic innovators seeking a challenge Initially uncertain - reassurance Wide variation between students Encouraging assessments objective

Managing Recurrent Costs For: supervision, close dental nursing support, additional materials / wear, time for induction, feedback, coaching, local admin and staff training £1m pa – paid monthly BDS travel allowances H&T Bursary awards Training events Office salaries

Summary

Is it worth it? Small and dispersed Variation / scattered Admin complex Service ethos ‘Real’ and broad Boundaries to be crossed – Integration more complex Feel ready for VT and practice Single large Standardised Admin eased School’s ethos School-like Smother transitions within course – Easier integration Less familiar with typical practice

Wider benefits Partnerships developed Partners’ reputations’ enhanced inc. outreach staff CVs Outreach staff want ‘teacher’ training Students better informed re employment (but then make comparisons) University logo seen in new communities Learning kept up-to-date – feedback on currency

Unintended outcomes Partners flexible and innovative School increasingly reliant on outreach Some School staff resistant

Dispersed Outreach: Is it worth it? No! Yes!