Dental Access Programme Overview

1

• Dental Access Programme Overview Policy
• Dr Mike Warburton
• National Director for Dental Access Programme
• Department of Health

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Dental Access Programme

• South West Dental Leads Meeting
• 12th May 2009
• Dr Mike Warburton

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Access to NHS dental services is a key priority
for the Secretary of State

• Top health priority for patients - Access to
  Dental Services MORI Regional Polls, 2006
• Half the country hasnt got an NHS Dentist
  Front Page Daily Mail April, 2008
• 2.4 billion spend on NHS Dentistry
• 11 and 8.5 increases in ring fenced funding in
  last 2 years

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The programme has focussed on assessing the scale
of the challenge and raising the profile of
access to dentistry as an issue that needs to be
addressed by the NHS
Work carried out so far...

• WCC event
• Attended by 128 PCTs and all SHAs
• 80 of attendees were Chief Executives, Chairs
  and Directors
• Dentistry workshop scored significantly higher
  than all the other workshops in delegate feedback
  in terms of content, presentation and usefulness
• Dentistry appeared in many of the delegates
  action plans
• WCC guide was welcomed

5
There is a reported gap of 5.8M patients between
the SHA demand assessment and existing provision,
which PCTs anticipate can be narrowed to 2.9M by
March 2010
The size of the gap...
Note that access to NHS dental services is
measured by the number of people who use these
services within a given 24-month period rather
than the total number of people who have an NHS
dentist
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but the gap in demand is generally greater in
the south of England in terms of both size of the
gap and number of PCTs
The size of the gap...
Map shows variation in the PCTs self-reported
percentage gap in NHS demand and capacity as at
Dec 08
Key
Gap to meet demand greater than 20
Gap to meet demand between 15 and 20
Gap to meet demand between 10 and 15
Gap to meet demand between 5 and 10
Gap to meet demand less than 5
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South West SHA assessment of the demand for NHS
dentistry was forecast at 65.4 of the
population, ranging from 60 to 72
NB. 1993 access demand was 60.7 nationally
8
The NHS has resources available to procure new
capacity for the future based on 108M in
additional funding allocated to SHAs for 2009/10
and 45M of their own funding
Closing the gap through procurement...
9
There is a current gap of 722,713 patients across
South West, which will be narrowed to 442,041
patients with planned activity and efficiencies
by 2010
Current Position
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The NHS is forecast to under-delivery on existing
contracts by up to 7 of commissioned activity,
South West SHA is forecast to be worth 15.2M in
2008/09
Closing the gap through contract management...
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and there is scope to use delivered activity
more effectively by reducing the number of
patients unnecessarily re-attending within 9
months through good contract management
Closing the gap through contract management...
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Of all activity across South West, 17.6 of those
patients re-attend within 3 months and 53.2
within 3-9 months
Current Position
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There are four key areas of opportunity for South
West SHA
Underspend (of dental allocation)

• Additional 2009/10 central funding should pay for
  an extra 1.5 million patients nationally
• 14.8m additional central funding has been
  allocated to South West SHA
• PCTs have added a further 5.7M

Investment ( committed)

• Across the country between 80- 120M under-spent
• Some underspend is due to schemes coming on line
• Some underspend could be utilised

• NICE guidance recommends recall intervals of 12,
  18 or 24 months for dentally fit adults,
• Reducing unnecessary re-attendance will realise
  capacity within existing contracts. In South West
  SHA
• 17.6 re-attend within 3 months and 53.2
  re-attend in 3-9 months
• 10 reduction in frequency of attendance for this
  cohort nationally would provide additional access
  for 0.8 million

Delivery against contract ( of activity
delivered)
Patients seen (as proportion of delivered
activity)

• 47 of providers delivered less than 96 of
  contracted activity, Re-basing contracts and
  transferring funding to reliable providers would
  provide services for extra people
• The national value of under-delivery of UDAs was
  158m
• In South West SHA under-delivery accounts for
  15.2m

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The Dental Access Programme will enable the
delivery of improved access to NHS dentistry
through four key areas
Develop a measure for dental access, ensuring
that there is clarity about what the programme is
aiming to achieve and establishing appropriate
and robust measures that are fit for purpose
Developing a measure for dental access
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Developing the packages of support required by
PCTs to effectively procure and bring online new
capacity to meet need locally
Supporting additional procurement of dental
services
Ensure that available capacity from PCT contracts
is being utilised effectively to deliver required
dental services and provide the support to
achieve this end
Supporting possible gains through contract
management
Ensure that the programme benefits are recognised
by the public support the delivery of greater
patient understanding of the scope and
availability of NHS dental services and link
into the independent review of dentistry by
Professor Jimmy Steele
Communications and stakeholder engagement
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The programme, led by the Commercial Team, will
support the NHS throughout the procurement
process through the provision of guidance, advice
and templates
Closing the gap through procurement...
Dental Access Programme
SHAs
Dental Access Team
PCC Elaine Maggs Angela Moon
Mike Warburton Linda Joy
Commercial Partnership Managers (CPMs)

• Commercial Team
• James Gold
• Rupert Dunbar- Rees

Policy David Lye Helen Miscampbell
PASA Commercial Development Managers (CDMs)
Mailbox eg.dentalaccess_at_dh.gsi.gov.uk
Primary Care Contracting Advisors (PCCAs)
PCT Procurement Framework www.dentalaccess.nhs.
uk
PCTs
NHS Peer Support
Regional master-class workshops
Support to regional bidder days
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Procurements will focus on new patients and
ensure quality through the KPIs built into
contracts

• Dentists are looking for contracts which reward
  excellence across a variety of domains including
  oral health promotion
• High quality providers will flourish in such an
  environment/ selection process, as they are doing
  in Primary Medical Care
• Dentists want to feel that this is a first class
  service, not second class
• The procurement framework will ensure
• Additional, new patients seen
• Quality
• Extended hours

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The programme, led by PCC, will provide advice
and support to improving the effectiveness of
contract management approaches to get the most
from existing contracts

• Define good contract management
• Identify barriers to good contract management
• Develop solutions
• Compile case studies
• How to Dont do Briefing notes
• Follow up visits with PCTs
• Local training events
• Regional/ National training events

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The programme, led by communications, will work
with PCTs with sufficient capacity to locally
promote the availability of NHS dental services

• Develop supporting guidance
• Produce best practice case studies
• Regional communications training events
• Communications helpline
• Identify national key themes
• Develop national campaign (when appropriate)

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We have learnt a lot from Primary Care
Procurement

• National and regional support for local
  procurements
• Legal and contracting advice
• KPIs
• Contract clauses
• Dedicated Programme support at SHA and PCT
• Collaborative working
• CPMs
• PASA
• Procurement Hubs
• Timeline and milestones
• North East SHA now working in PCT clusters for
  dental commissioning

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Now is the right time to deal with the dental
access challenge
You have to recognize when the right place and
the right time fuse and take advantage of that
opportunity. There are plenty of opportunities
out there. You can't sit back and wait. Ellen
Metcalf

• Local patient pressure
• Political focus and national support
• Senior NHS leadership at DH and SHA
• Current inefficiency in current contracts
• New money

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Given the size of the challenge we will mobilise
quickly
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We will be most effective by working together
Providers, PCTs, SHAs and the DH