1. Quality Improvement Group
Reviewing Provision of Salaried Dental Service Provision in Dumfries and Galloway
7th December 2016
Valerie White - Consultant Dental Public Health/Public Health
NHS Dumfries and Galloway

2. Why did we need to review?
Scottish Government were requiring us to submit Integrated Financial Plans for the Salaried Dental Service
Access to independent contractor dental service had improved significantly
There were service pressures within dental services for those with additional dental support needs and additional service capacity was required
Good practice to review service provision and have a strategic plan for future delivery

3. Overview of Current Access to NHS Dental Services
80%% of the population registered with an NHS dentist
Local Health Partnership
% of the population registered as at 30th September 2010
% of the population registered as at 30th December 2012
% of the population registered as at 31st May 2014
Annandale & Eskdale 63 75 80
Dumfries and Upper Nithsdale 56 73 78
Stewartry 60
Wigtownshire 67 77 81
*3.6% of registrations are not included in the table above

4. Estimated Percentage of Dental Registrations by Intermediate Geography as at 30th September 2010

5. Estimated Percentage of Dental Registrations by Intermediate Geography as at 31st December 2012

6. Estimated Percentage of Dental Registrations by Intermediate Geography as at 31st May 2014

7. Provision of Salaried Dental Services in D&G
The following clinics provided routine General Dental Services:
Dumfries Dental Centre (outreach teaching/therapy school and special care)
Lochmaben,
Lochside,
Newton Stewart ,
Sanquhar
Total registrations with the Salaried Dental Service stand at 7,770 as at May 2014*
93% registrations independent dental contract SS 7%
Retraction of routine GDS by PDS from CD in 2008 and Stranear in 2012

8. Overview of the review process
Consultation with Salaried Service Staff, Independent Contractors and key stakeholders on future options
Data on a number of issues highlighted was reviewed
Working Group undertook an initial options appraisal of all options put forward
A short list of options was agreed
Agreed that an options appraisal exercise for each clinic was required with a wider stakeholder
Started in June 2013

9. Overview of the Review Process
Options Considered at each appraisal

10. Overview of the review process
Patients were made aware of the options under consideration via posters at the clinic
Individual options appraisal exercises were held with representation from clinic patients, public, Staff Side, Human Resources, Independent Dental Contractors, Salaried Dental Service Management, Finance, Public Health and Primary Care Development
The appraisals consisted of a qualitative aspect which involved discussion of the risks and benefits of each options followed by consensus scoring of key themes identified
This was followed by a separate financial appraisal which estimated the costs of each option under consideration
The results of each aspect were then combined (60/40 weighting) to provide a preferred option for each clinic

11. Overview of the review process
The preferred options were communicated to:
Staff
Independent Dental Contractors
Patients
Key Stakeholders

12. Overview of the review process
The Review Team worked very closely with the Scottish Health Council throughout the review process to ensure that proportion public involvement was achieved
Following the significant amount of patient feedback obtained it was agreed that time would be taken over summer 2014 to:
Reflect fully on the patient comments received between the 29th of January and the 27th June 2014 and consider if any further work is needed before finalising the report and its recommendations.
Complete the review of accessibility of Independent Contractor Practices which patients to date have noted as a concern.
Repeat the Equality and Diversity impact assessment following the patient feedback and review of accessibility.

13. Key Themes from Patient Feedback
Patients would like to continue with services as they are
Level of disabled access, facilities and parking of Salaried Clinics noted
Concern over ability to register with an NHS Practice locally
Concern over sustainability of other practices to continue to provide NHS services
Concern about the level of services provided at other independent contractor practices
Concern over increased costs
Feeling that changes being driven by finance as opposed to improved patient care.

14. Final Service Review Recommendations
Clinic
Final Recommendations
Dumfries Dental Centre
Withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to independent contractor practices for continued provision of NHS general dental services at the transferred practices site/premises.
Lochmaben Dental Clinic
Newton Stewart
Further work with local independent dental contractors and Salaried Dental Service staff to be undertaken to ensure sustainable, accessible routine NHS dental services for patients in this area prior to the complete withdrawal of routine NHS dental services by the Salaried Dental Service.
Lochside
Continued provision of routine NHS general dental services at the clinic site by the independent dental contractor sector. With further service review to be undertaken if this is not possible.
Sanquhar
Only option changed was Newton Stewart

15. Final Decision
NHS Board agreed to all the recommendations in October 2014 – this went to a vote
Dumfries Dental Centre and Lochmaben clinic routine GDS patients transferred April 2015
Sanquhar and Lochside clinic – attempts to lease in 2015 failed
Newton Stewart – further work has been undertaken with the local independent dental contractor practices and patients will be transferred spring 2017
Review started in June 2013
2000 patients transferred 600 could not be followed up. Were reviewed by clinicians to see if vulnerable

16. Sanquhar and Lochside Sanquhar Lochside
New independent contractor practice in planning so situation being kept under review
Lochside
NHS Board agreed to further review in October 2015
Similar process been gone through
In November 2016 Integrated Joint Board were asked to approve the move to consultation on the preferred option

17. What have I learnt Service re-design is not easy and it is not quick
Communications
Senior Management Support
Timing
Politics
TUPE
Integration Joint Boards

18. Any Questions?