1. GIRFT in Hospital Dentistry
Elizabeth Jones
National Clinical Lead

2. Aims and Objectives
To understand the GIRFT methodology and how it has been applied to Hospital Dentistry
To appreciate the limitations for Hospital Dentistry
To understand how GIRFT may be used for the future in understanding the role of Hospital Dentistry

3. What is GIRFT?
‘GIRFT is a clinically led national programme, consisting of a review and implementation team, designed to improve clinical care in the NHS.
Through innovative use of data to reduce unwarranted variation in the way services are delivered, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes.’

4. What is GIRFT contd.
….’ where national clinical leaders engage in peer- to-peer discussions with clinicians and hospital managers…. With a view to encouraging service improvement’
…’the data pack is not used to ‘performance manage’ the unit but uses comparative data to provide fresh insights into the way the department functions’

7. Particular challenges for dentistry
11 dental specialties rather than 1
No one specialist society to work with, therefore a joint initiative with the RCS
Relationship with OMFS

8. Challenges contd. A mix of surgical and medical
Poor OPCS codes particularly for orthodontics and restorative
Mostly outpatients so no co-morbidities or diagnoses captured
Dental hospitals v very small providers

9. Timeline Defined the metrics for the four major dental specialties
Confidential data pack for 109 trusts
Seven questionnaires
Deep dive visit to all trusts.
Observation notes to with recommendations and notable practice
National Report

10. Questionnaires
The four major specialties plus the following as they do not have specific procedures to code
Special Care Dentistry
Oral Medicine
Dental and Maxillo facial radiology

14. Limitations
Many of the treatments we want to look at to determine whether there are outliers are actually diagnoses:
TMD
Facial Pain
Oral Medicine conditions
Paediatric dental trauma
Tooth Wear

15. Hospital Dentistry Data Pack for each trust
13 Trust based metrics
CQC data
Specialty data and procedure data- 359 metrics
Finance data
Litigation data

16. Oral Surgery Relationship with OMFS – the role of consultant status
Variation in coding for care setting
Co- morbidities
Sedation
The role of HD in treating complex medical patients

19. Orthodontics Coding Interdisciplinary v non-interdisciplinary
Effect of training
Effect of commissioning

21. Restorative
Large difference between dental hospitals and trusts ( district general hospitals)
RD in oncology units have a specific remit
Data pulled for Endo, Perio and Prostho
Coding is non specific eg for dentures and obturators

23. Paediatric Dentistry
All dental treatment procedures on children is being captured even in the absence of a PD ‘department’
Role of the CDS
Triaging for GA and repeat GA
Some trusts are treating large numbers of children under OMFS

27. Financial data
Do the clinicians recognise the Reference Cost Index for each specialty ?
Is there a regular meeting with the finance team to ensure the correct apportioning of costs to dentistry?

29. Conclusion The start, not the finish
Clinically led discussions is the most valuable aspect
An improvement in codes and their definitions essential
Recognition of the wider role of HD within a trust