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Draft service specification - NHS Milton Keynes

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					Primary Care Commissioning


 Dental Commissioning Specification
 for the provision of Dental Services
     to specified priority groups in
  Buckinghamshire & Milton Keynes



February 2007
Forward

In April 2006, Primary Care Trusts (PCT) took full responsibility for
commissioning dental services in their area.

This service specification has been written in collaboration with Milton Keynes
PCT and Buckinghamshire Dental Public Health and sets out the level of
service expected by the commissioners and the quality and performance
measures associated with this.
Contents
The Purpose of the Document                                4

Background
     Aims of the Service                                   4


Service objectives                                         5
      Oral health promotion                                5
      Treatment services for patients with special needs   6
      Treatment of patients without a dentist              6
      Epidemiology and screening services                  7

Access                                                     7

Service standards                                          8
      General standards                                    8
      Professional & clinical standards                    8
            Team working                                   9
            Training & development                         9
            Dental inspections                             9
      Records                                              9
      Responding to patients                               10

Performance monitoring targets                             10

Contact                                                    11




                                      3
The purpose of this document
1.       This document sets out the specification for the provision of a primary
         dental care service to specified priority groups and vulnerable patients
         within Buckinghamshire.

2.       The document describes the service level and quality to be
         commissioned. The specification is set out in such a way as to
         encourage innovation on the part of the provider service.

3.       This document constitutes section 6 of the Service Level Agreement
         between the Primary Care Directorate of Milton Keynes PCT and
         Commissioning and Contracting Directorate of Milton Keynes PCT
         working in conjunction with and on behalf of Buckinghamshire PCT.

Aims of the Bucks and Milton Keynes Priority Dental
Service
The overall aim of the service is to reduce inequalities in access to dental care
by providing comprehensive dental care to patients in priority and vulnerable
groups (defined at appendix 1), and urgent care to patients in pain who do not
have a dentist.

The service will provide consistent, high quality primary dental care,
emergency dental care and preventative oral health promotion based on the
principles of clinical governance. The service will also coordinate
epidemiological surveys and screening, according to the British Society for the
Study of Community Dentistry (BASCD) protocols, as agreed with the
Consultant in Dental Public Health.

The service will work in a way that is consistent with the following principles.

         Maintain access to dental services for priority and vulnerable groups
          within Buckinghamshire and Milton Keynes.

         Raise awareness of good oral health and provide a preventative
          service to these groups.

         Respond to the needs of these groups and offer an appropriate range
          of dental services.

         Comply with the General Dental Services (GDS) regulations.

         Recognise that high quality health care is multi-disciplinary and should
          be delivered through good working relationships with others.

         Offer high quality health care with continuing improvement of services
          and support for staff.


                                         4
      To establish a positive working relationship between the provider and
       Buckinghamshire and Milton Keynes PCTs


Service Objectives
1. Oral health promotion

Input will be provided in collaboration with community workers, parents,
teachers and other health professionals endeavouring to develop public
health policy and to increase awareness of the causes and prevention of oral
disease. This will complement the clinical work of the clinicians in the salaried
sector and independent practitioners.

Information, messages and programmes will be evidence based. It is
expected that due account will be taken of the national and local Oral Health
Strategies and other strategic documents as they are published, reviewed and
revised.

The programme provided will be consistent with locally agreed objectives and
priorities and may involve clinic based and community based projects. The
projects will be agreed in advance with the Consultant in Dental Public Health

2. Treatment services for patients (adults and children) with special
   needs

The service will provide a full range of NHS dental care to patients who are
unable to access care elsewhere because of their special needs/
requirements. Access will be by referral. Referrals will be accepted for those
patients who fall into the appropriate criteria as detailed in the
Buckinghamshire referral guidance for the specialised salaried services
(appendix 1). Appendix 2 details the referral process.

Looked after children and gypsies/travellers are considered priority groups in
addition to those listed in the Buckinghamshire referral guidance criteria. So
why don’t we just amend the referral criteria?

3. Treatment of patients without a dentist.

NHS urgent dental treatment will be offered to patients who do not have a
dentist and who are resident within areas covered by Buckinghamshire and
Milton Keynes Primary Care Trusts.

Access would normally be by self-referral although referrals from other
healthcare professionals will be accepted.

Requests for urgent treatment will be triaged according to a set protocol,
prioritised and appointments or advice offered accordingly.


                                       5
Patients will be advised to contact a reasonably available alternative NHS
provider when their urgent care is complete.

The PCTs anticipate that this aspect of work will decline over the coming year.
Check the review to see what’s on.

4. Epidemiology and screening services

Epidemiological surveys, as agreed by the Consultant in Dental Public Health,
will be undertaken according to the BASCD periodic programme of national
surveys of child and adult dental health. For children this will involve sampling
the specified age group, as defined by BASCD protocol, from all state schools
within Milton Keynes and Buckinghamshire.

Screening will be agreed with the Consultant in Dental Public Health, referring
to local policy and priorities.


Access
The service opening hours will be by agreement. As a minimum routine
appointments must available on at least five days during the working week
(Monday to Friday except Christmas Day, Good Friday and Bank Holidays).

In line with local contractual arrangements the Provider will not be responsible
for unscheduled care during the period (1830 to 0800 on working days,
Saturdays, Sundays, Christmas Day, Good Friday and bank holidays). This
will be the responsibility of the PCT.

The waiting time standards below will be met:

Patients not referred to the service
Patients that do not have a dentist
Urgent care for dental pain and minor trauma will have access to an
appropriate practitioner within 24 hours on working days

Patients referred to the service (appendix 1 and 2)
Patients already receiving planned care within the service
Urgent care for dental pain and minor trauma will have access to an
appropriate practitioner within 24 hours on working days even though this may
not be at their usual clinic or with the usual operator

Urgent
Where assessed as urgent, patients will receive an assessment appointment
within 2 weeks

Priority and Routine
Where assessed as priority or routine, patients will receive an assessment
appointment within 13 weeks. Is this the same as GDS contracts?


                                       6
Following assessment the patients will start to receive care in accordance with
the time and distance standards set by the PCT

Referral to Specialist Services
The Provider will adhere to local guidelines for referral to specialist services
and local prescribing policies.


Service standards
1. General Standards

The provider is expected at all times to practice in a way that complies with
the standards set out in the General Dental Council’s document Standards for
Dental Professionals.

Compliance with the requirements of Health and Safety Law, COSHH
regulations and other statutory instruments and regulations (such as those
relating to Ionising Radiation Regulations, Pressurised Vessels Regulations
and Infection Control) as they apply to dental services will be expected.

2. Professional and Clinical Standards

Standards required by the GDC and other recognised professional bodies (for
example The Royal Colleges of Surgeons, NICE, BDA) will be expected to be
observed and in addition, local standards of probity and conduct as defined by
Milton Keynes PCT will apply to all staff within the service.

Whenever practicable treatments should be provided without recourse to
general anaesthesia. Alternative management techniques, such as sedation,
should only be provided by clinicians and nurses who can demonstrate
appropriate /best practice training (as described by the SAC/RCS/GDC for
example).

The service staff will be expected to participate in all quality and clinical
governance initiatives and work in partnership with the PCT. Additional quality
indicators may be put in place in discussion with the provider.

Team Working

The PCT expects the service to work effectively as a team and to liaise and
participate with other dental providers and groups/individuals who relate to the
recipients of dental care.
The PCT is keen to encourage skill mix within all health professions and the
service should demonstrate how the full range of dental professionals – dental
nurses, oral health promotion specialists, hygienists, dental therapists and
dentists – will be utilised to ensure that standards are met.



                                        7
Training and development

The PCT is keen to build on its strong tradition of training and development.
Proposals for any necessary training of clinical professionals should be
identified via an annual PDR, as expected by the PCT, and should reflect the
needs of the service as well as the professional.
The dental team must meet the requirements of Continuous Professional
Development for ongoing registration including participation in peer review
and audit.

Dental Inspections

Dental practice inspections in the service will be undertaken by prior
agreement with the Consultant in Dental Public Health and Dental Reference
Officers may also visit the service from the Business Services Authority
(BSA).

3. Records

The Clinical Director shall ensure the maintenance of full, accurate, legible
and contemporaneous records and IT systems for all patients attending for
treatment.

The service should ensure that confidentiality, data protection and freedom of
information legislation are complied with.

5. Responding to Patients

The service agrees to comply and participate with PCT procedures for dealing
with patient complaints.

Patients should have open access to information about oral health promotion,
services available and treatments.

Performance Monitoring and Targets
Service performance will be monitored at six monthly intervals.
Internal performance monitoring has been agreed as outlined below.

   1. Total contacts (clinical, epidemiological, screening)
   2. Actually clinical contacts
   3. Number of sessions worked
   4. Proportion of time access (%)
   5. Proportion of time priority (%)
   6. % contacts access
   7. % contacts priority
   8. Actual access contacts
   9. Actual priority contacts
   10. Actual sedation & GA contacts


                                       8
   11. Actual GA sessions available
   12. Actual domiciliary contacts
   13. Number of referrals offered assessment appointments
   14. Number of complaints (written and verbal)
   15. Epidemiology contacts
   16. Screening contacts
   17. % patients exempt from charges
   18. Patient charges collected
   19. Value of bad debts
   20. Number of Oral Health Promotion sessions.
   21. % appointments not attended (DNA)
   22. Expected Units of Dental Activity (UDAs)

Contact
Deborah Manger
Specialist Registrar Dental Public Health
Milton Keynes PCT
Tel 01908 243933
Deborah.manger@nhs.net




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