Upload
clara-marrison
View
222
Download
1
Tags:
Embed Size (px)
Citation preview
After the pilots: what next?
John MilneChair GDPC.
Slide 3
CQCHTM 01--05
Information
GovernanceNew Contract
LPNs
What Next!!!!!!
Caption here
New Dental ContractRegistrationCapitation
Quality and Outcomes
Oral Health in 12 year olds
Care Pathways
• Oral health assessment• Practical, consistent and achievable.
• RAG scoring• Risk based assessment of caries, periodontal disease, tooth surface loss and soft tissues
• Leads to status and interim care review intervals.
• Care priorities • Drive clinical pathways.
• GDP override• Professional discretion.
Up to date issues.................
Sales of practicesOFT- continuous
tendering of contractsFD training and placesPay and expensesCQC Compliance and
costsHTM 01-05Role of DCPs – Direct
access?Commissioning Board
Transitional ArrangementsLocal Professional
NetworksNHS Offer – core
service?Seniority Pay- new
schemeIT costsAssociate terms and
conditions
Oral Health Assessment: leads to homecare plan and professional care plan.
• Medical History• Alcohol and tobacco• Social History
• Family caries history
• Diet and toothbrushing• Full chart of restorations• Full chart of carious
lesions
• BPE• Bleeding• Pocket chart.
• Tooth surface loss (relative to age)
• Soft tissues.
What’s important?
For the public• Access to quality care
– And urgent care
• Improved oral health outcomes
• Good experience• Clarity of what the NHS
will provide• Simple charging system
For the profession• Improved patient
outcomes• Fair remuneration• Current benefits
preserved• Ability to transfer
contracts (goodwill)• Financial stability in
transition stage.
Caption here
Pilots so far..............................
Best thing I’ve ever done, free from UDAs at
last. Can deliver proper
care.
Worst thing possible, no way this system can
work!
What types of practice?
14
Satisfaction with NHS dental care in last 9 months
Q4. Overall, how satisfied or dissatisfied are you with your experience of NHS dental care at this dental practice in the last 9 months?Base: All patients and carers/guardian/parents of patients (3,760).
%PATIENTSNet Satisfied: +91
NHS dental care in last 9 months compared to previous experience
Q5. Generally speaking, how does your overall experience of NHS dental care at this dental practice in the last 9 months compare with your previous experience of NHS dental care? Was it better or worse, or about the same?Base: All patients and carers/guardian/parents of patients (3,760).
%Net Better: +46 PATIENTS
15
Overall attitudes towards the care pathway
Q3. To what extent do you agree or disagree with each of the following statements about the care pathway currently being piloted in your practice?Base: All dental care professionals (320)
92
80
55
Total: % Agree
PRACTITIONERS
16
Overall performance of OHA in terms of enabling better care to be provided to patients
Q5. Compared to the previous system, how would you say the Oral Health Assessment (OHA) performs overall in terms of enabling better care to be provided to patients? Is it better or worse, or is it about the same? Base: All dental care professionals (320)
PRACTITIONERS
17
Pilot appointments by appointment type (Source: DPMS data)
87
84
80
Total: % Better
Q6. Compared to the previous system, how would you say the Oral Health Assessment (OHA) performs overall in terms of each of the following?Base: All dental care professionals (320)
Specific aspects of OHA performance
PRACTITIONERS
19
Changes to the skill mix in the practice as a consequence of the care pathway
Q17. Changed the skill mix?
Q18. In what way?
73%
PROVIDERS
Q17. Has your practice changed the skill mix of staff to help deliver the new way of working as part of the care pathway? This could be through up-skilling existing staff or by changing the staffing model. Base: All providers (40)Q18. In what way has your practice changes the skill mix of staff to help deliver the new way of working?Base: All providers who say ‘yes’ at Q17 (29).
20
Changes to the skill mix in the practice as a consequence of the care pathway
Q19. Consider changing the skill mix?
Q20. In what way?
85%
PROVIDERS
Q19. Would you consider changing the skill mix of staff at some point if the new way of working becomes permanent? Base: All providers (40). Q20. How might your practice change the skill mix of staff in the future to help deliver the new way of working? Base: All providers who say ‘yes’ at Q19 (34).
21
The care pathway and clinical autonomy
Q4. Compared to before the pilot, would you say you have more or less clinical autonomy, or is it about the same?Base: All dentists (129)
22
PROVIDERS
Q22. Finally, please tell us any other comments you have on the care pathway, including any suggestions for improvement. Base: All dental care professionals (320)
Thoughts on the care pathway & suggested improvements
PRACTITIONERS
23
Patients: Q14. Which of the following best describes your view about the use of ‘traffic light’ ratings? Base: All patients and carers/guardian/parents of patients who can remember using traffic light ratings (2,011)Practitioners: Q10. Which of the following statements best describes your view about red/amber/green status? Base: All respondents (320)
Views about the use of RAG ratings
58%(31%)
The ‘traffic light’ ratings make it easier for me/patients to look after teeth and gums (oral health)
41%(22%)
1%(1%)
The ‘traffic light’ ratings make no difference to how I/patients look after teeth and gums (oral health)
The ‘traffic light’ ratings make it more difficult for me/patients to look after teeth and gums (oral health)
75%
19%
0%
N.B. Figures in brackets refer to data based on all patients (3,760)
PRACTITIONERSPATIENTS
24
RAG status breakdowns by practice (Children)
70 pilot practices (in order of % red children)
RAG status breakdowns by practice (Adults)
70 pilot practices (in order of % red adults)
RAG status overall breakdown
There is a clear correlation between IMD score and RAG status but the effect is reasonably small
Responses in second wave pilots.
• Revision of pathway (including IT)• Changes to Pt charges in pathway practices.• Registration simulated in pilots.• Additional pilots (including 3 salaried services)
Evaluation
• DH: Evaluation & Learning.• BDA Shadow group• NSG.
Still to come...............
• Treatment data• Volumes• Types• Advanced Care.
• Modelling of capitation payments• Transitional protections• Avoiding neglect.
Redistribution
• High UDA Value...........................Low UDA value• Transitional arrangements MPIG?• Capitation numbers?• Length of registration period?
• High Access..................................Low Access• Growth funding?
Income
Expenses
• Rising on all fronts• Regulation and compliance• Training• Premises• Staff• Utilities• Materials• Laboratories.
Capital
• Risk v Reward.• Buildings• Equipment• Future investment.• Returns.
We need some honesty in the debate.
• Access• NHS Offer• Scope of advanced care.• Elderly Population• Existing inequalities
The big challenge
• How can a system improve oral health, deliver prevention continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?
The big challenge
• How can a system improve oral health, deliver prevention continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?
Capitation Values.
• £1,000,000• 10,000 pts
• £100 per patient per year.
Is the cake big enough?
Challenge ahead.
• Improved oral health• Sustainability of practice
• Long term future.
• Career pathway for dentists• Practice ownership and
equity
• Proper remuneration
Caption here