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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 ServicesDental 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
TeamTraining
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 £1,5MIncreased undergraduate intake3 years to develop a 6 month prog.
2009 38 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; 31:850-856Wilcox 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)
Dentures 6 14
Endodontics 7 15
Extractions - simple
44(4)
66(4 in children)
Fissure sealants
18 20
Pt appointments
280 410
Sheffield Outreach
Recently published *
requirements
Restorations- simple plastic
195(29 in children)
~70
Dentures 14 ~2 to ~8
Endodontics 13 ~ 6 or ~8
Extractions - simple
67(7 in children)
Fissure sealants
26
Pt appointments
461
Clinical Activity * Lynch & Allen 2007 Br Dent J, Youngson et al. 2007 Br Dent J
Communication
• Formal channels
• Informal
• Time consuming…
… but vital
Holloway & Dixon, BDJ 1977; 143: 146-150.
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
Placements Travel allowances
Administration Meetings
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!
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