Dental Branch by nyut545e2

VIEWS: 27 PAGES: 68

									Dental Branch

    Annual Report 2004/2005
Dental Branch                                                 Annual Report 2004/2005

Foreword
                 Within the overall mission of the DHSSPS to improve the health of the
                 people of Northern Ireland, the focus of Dental Branch is to improve and
                 reduce inequalities in the oral health of the whole population. The
                 policy to achieve this was set out in the Oral Health Strategy, which was
                 published in September 2004.
                  I hope the new Strategy will be used to underpin other areas of oral
                  health or dental planning which require modernisation. I hope you have
                  had an opportunity to read a copy of the Strategy because it was
deliberately written in plain English that could be readily understood outside of the dental
profession. It has a relevance to everyone who is working in health or has a caring role.
If we could make a difference in the oral health of the very youngest of our population
then we would reap the benefits for years to come, not just in financial cost and improved
oral health, but also in improved self-esteem and confidence. Sometimes we are not
aware just how important teeth, or the lack of them mean to a young adult.
However, here in Northern Ireland we are working against some of the most obstinate of
factors – diet, deprivation and lack of fluoridated water. They are not easily addressed by
the dental team but require society as a whole to take some of the responsibility. It is a
duty on us all to lobby for such things as healthy schools, affordable food, a curb on
advertising to young children and looking after those unable to do so for themselves.
I am optimistic that we are beginning to see a very small improvement – it will need
another year before we can say that improvement in decay rates is for real and not just a
blip in our information-gathering. This is why it is very important that the information we
do collect and use is accurate and consistent across Northern Ireland. Trusts are urged to
ensure that the quality of data is maintained by regular training and calibration of staff.
Clinical governance has become increasingly important across all of health, and dental
services are no exception. Patient safety is paramount and anyone attending for dental
treatment wants to be assured that all the team are working with this aim.
Decontamination is an important issue and the compliance of practitioners in general
practice and in Trusts is to be applauded. However, we cannot be complacent and think
that governance is an issue which can be ‘done and dusted’. It is ongoing with the need
for regular assessment of patient safety, working within one’s competency and complying
with a whole raft of legislative requirements.
It is in recognition of the extra time needed for carrying out these requirements that the
DHSSPD is funding the Quality Improvement Scheme for general practitioners and has
allocated extra funding for training through NIMDTA.
I hope you enjoy and are informed by this Annual Report.
The world of dentistry, like the rest of the health service is changing all the time. It is
never dull!




Doreen Wilson
Chief Dental Officer

                                           page 1
Dental Branch            Annual Report 2004/2005




                page 2
Dental Branch                                                               Annual Report 2004/2005
Contents
Foreword................................................................................................... 1
Background ................................................................................................ 5
  Policy .................................................................................................... 5
  Referral Dental Service ............................................................................... 5
  Prison Dental Service ................................................................................. 5
  Staffing Structure...................................................................................... 6
  General, Dental & Ophthalmic Services ........................................................... 7
     Background........................................................................................... 7
     Structure ............................................................................................. 7
Policy ....................................................................................................... 8
  Oral Health Strategy .................................................................................. 8
  Primary Dental Care Strategy........................................................................ 9
  Review of Statement of Dental Remuneration.................................................. 11
     Background......................................................................................... 11
     Process.............................................................................................. 11
     Changes to SDR Items ............................................................................ 12
  Priorities for Action (PfA) .......................................................................... 14
     Registration ........................................................................................ 14
     Caries Rates........................................................................................ 16
     Evidence Based Caries Reduction Programme ............................................... 17
     School Dental Screening (SDS) .................................................................. 17
  General Anaesthetics ............................................................................... 18
  Review of Community Dental Service ............................................................ 20
  Dental Nurse Training ............................................................................... 20
     Background......................................................................................... 20
     Review Process .................................................................................... 21
     Summary of Findings ............................................................................. 21
     Preferred Qualification .......................................................................... 22
     Conclusions ........................................................................................ 22
  Supplement for Undergraduate Medical & Dental Education................................. 23
  Hospital Dental Service Workforce Planning .................................................... 23
  General Dental Council Visitation................................................................. 23
  Sedation Survey ...................................................................................... 24
  Decontamination Audit ............................................................................. 24
  National Clinical Assessment Authority (National Clinical Assessment Service)........... 26
                                                    page 3
Dental Branch                                                             Annual Report 2004/2005
  PCD Road show ....................................................................................... 26
  Northern Ireland Medical & Dental Training Agency ........................................... 27
     New Agency & Board.............................................................................. 27
     Accountability Arrangements.................................................................... 27
     New Dental Dean .................................................................................. 27
     Extra Allowances for Vocational Trainers ..................................................... 28
     Extra Funding For NIMDTA ....................................................................... 28
Referral Dental Service ................................................................................ 29
  Positive Assurance ................................................................................... 29
     Final Evaluation Report .......................................................................... 30
     Development of New System .................................................................... 30
  RDS Protocols ......................................................................................... 30
     Sampling ............................................................................................ 31
     Data Analysis of RDS Activity .................................................................... 31
Prison Dental Service................................................................................... 32
  Magilligan Contract .................................................................................. 32
  Service Delivery Models at Maghaberry and YOC ............................................... 32
  Future Monitoring .................................................................................... 33
Appendix A – Quantitative responses from the Oral Health Strategy consultation........... 34
Appendix B – Summary of responses from the GDS to their PDCS questionnaire ............. 38
Appendix C – Summary of responses from the CDS to their PDCS questionnaire ............. 48
Glossary .................................................................................................. 62




                                                   page 4
Dental Branch                                                Annual Report 2004/2005

Background
Dental Branch is one of five Professional Groups within the Department of Health, Social
Services and Public Safety (DHSSPS, hereafter referred to as the Department). As the
Chief Dental Officer, Mrs Doreen Wilson provides advice to the Minister, discharges
functions on behalf of the Department, provides services for the wider NICS and delivers
dental services to the Prison Service.
The main areas of work within Dental Branch are:
 •   Policy
 •   Dental Referral Service
 •   Prison Dental Service


The Chief Dental Officer (CDO) is a member of the Departmental Board and as such has a
corporate role.
There is increasing multi-disciplinary working across the Department and cross-
representation on all the major committees. Dental Branch endeavours to contribute to as
many areas of health as appropriate and plays a full part in the corporate agenda of the
Department.
Dental Branch works closely with colleagues in General Dental & Ophthalmic Services
(GDOS) with shared work on many policy issues.

Policy
Mrs Doreen Wilson (CDO), Mr Donncha O’Carolan (Policy Officer), Mrs Jennifer McAdams
(PS), Mr Liam McGuckin (EO II), Michael Donaldson (Specialist in Dental Public Health – on
secondment)

Referral Dental Service
Mr Brian Gormley (Dental Officer), Mr John McGrath (Dental Officer), Mrs Catherine
McQuillan (Dental Officer), Mrs Donna McNeill (AO), Darren Rea (AA).

Prison Dental Service
1.5 WTE locum dentists, Mrs Jennifer Hood (Dental Nurse), Mrs Cathy McWhirter (Dental
Nurse)




                                          page 5
Dental Branch                                                      Annual Report 2004/2005
Staffing Structure



             Mrs Doreen Wilson
              Chief Dental Officer



                                      Mr Donncha O'Carolan
                                          Policy Officer

                                       Mr Michael Donaldson
                                     Specialist in Public Health
                                              Dentistry
            Policy
                                                                   Mrs Jennifer McAdams
                                                                         PS to CDO
                                                                     Mr Liam McGuckin
                                                                     Information Officer




                                        Mr Brian Gormley
                                          Dental Officer
                                     Mrs Catherine McQuillan
                                          Dental Officer
                                        Mr John McGrath
                                          Dental Officer
            Referral
            Dental Service                                           Mrs Donna Mc Neill
                                                                    Administrative Officer
                                                                       Mr Darren Rea
                                                                   Administrative Assistant




                                             1.5 WTE
                                              Locum
                                             Dentists
            Prison
            Dental Service                                          Mrs Jennifer Hood
                                                                       Dental Nurse
                                                                   Mrs Cathy McWhirter
                                                                       Dental Nurse




                                              page 6
Dental Branch                                                             Annual Report 2004/2005

General, Dental & Ophthalmic Services
Background
General Dental and Ophthalmic Services forms part of the Department’s Primary Care
Directorate.   The branch has responsibility for strategy, policy development and
determination of legislation in respect of General Dental Services and Ophthalmic Services
including terms and conditions of services of general dental practitioners and ophthalmic
opticians. Other areas falling to the branch include: -
 •   Community Dental Service policy
     (terms and conditions are dealt with by the Human Resources Directorate)
 •   Statement of Dental Remuneration for General Dental Practitioners
 •   Statement of Fees for Sight Testing
 •   Sight Test Surveys
 •   Dental and Optical Charges
 •   Help with Health Costs scheme


Structure


                                   Dr Jim Livingstone
                                  Director of Primary Care




                                          John Farrell
                               Assistant Director of Primary Care
                               (General Dental and Ophthalmic Services)




                                         Denis O’Hara
                                         Deputy Principal




                                           David Hood
                                            Staff Officer


                                       James Magennis
                                        Executive Officer I



                                         Eddie Murphy
                                      Administrative Officer




                                              page 7
Dental Branch                                                 Annual Report 2004/2005

Policy
Oral Health Strategy
The new Oral Health Strategy (OHS) for Northern Ireland was launched for consultation by
the Minister, Angela Smith, at the Star of the Sea primary school in North Belfast on 21
September 2004. The school was chosen because, although it is in one of the most
deprived areas of Belfast, it is a model of what can be achieved when education and
health sectors combine to promote oral health and health in general. The school has a
programme of healthy snacks and oral health promotion and the Minister was impressed by
her visit.
The oral health of Northern Ireland’s population is the worst in the United Kingdom and
this has been the case for many years. While there have been improvements in the oral
health of the Northern Ireland population as a whole over the past decade, the dental
health gains among Northern Ireland children have, at best, been modest and the problem
is particularly marked in the most deprived groups in our society. The poor state of oral
health is particularly apparent when we compare the caries experience of Northern Ireland
children with the South of Ireland and the rest of the United Kingdom; the average 5-year-
old child in Belfast has approximately 3 teeth affected by decay. The same aged child in
London has around 1.5 teeth affected by decay and for a 5-year-old in Dublin the figure is
only 1 tooth affected by decay. This new OHS is a 10-year public health plan and replaces
the 1995 OHS. Speaking at the launch, the Minister said,

  ‘…the consequences for Northern Ireland children of such high disease levels are more
 pain and suffering, more missed school days, more hospital general anaesthetics [8000
 last year] and a dental service that spends more money per child than any other
 country in the UK’.

The strategy attempts to close the oral health gap with our neighbours and to improve the
quality of life for all our people by:
 ●   Improving the oral health of the Northern Ireland population;
 ●   Reducing the inequalities in oral health within our society.
The strategy sets out a series of interlinked recommendations to achieve these aims. Oral
health professionals are required to focus more on prevention, to link with other
complementary health promotion programmes in order to maximise efficiency and to
further develop partnerships with those outside the health sector such as schools, local
councils and community groups. It is this strong emphasis on intersectoral working, use of
the common risk factor approach and the need to utilise evidence based interventions to
improve oral health that sets this new strategy aside from the 1995 strategy.
Speaking on the launch of the consultation the Chief Dental Officer said,

 ‘…we now have a new Oral Health Strategy which I hope will be the reference book for
 everyone interested in improving the oral health of the population of Northern
 Ireland’.

The strategy was sent out for consultation until 31 December 2004. Copies were sent to
all Northern Ireland dentists, PCD’s, health bodies and local councils as well as patients
groups, voluntary and community groups and other interested parties. In all 77 replies
were received to the consultation. For all the recommendations, the majority of
                                           page 8
Dental Branch                                                  Annual Report 2004/2005
respondents either agreed or strongly agreed.         These have been collated and are
reproduced in Appendix A.
In all, over 50 recommendations are made in the OHS and the Chief Dental Officer is
planning to incorporate these into the relevant policy areas over the coming years to
ensure their effective implementation. Already several of these have been put in place,
such as the evidence-based caries reduction scheme for pre-school children
(recommendation 3.6) and the fissure sealant scheme introduced into the General Dental
Service (GDS) in April 2005 (recommendation 3.7).
The Oral Health Strategy is available on the Departmental website:
www.dhsspsni.gov.uk/pgroups/dentalpubs.asp

Primary Dental Care Strategy
Following the publication of the OHS, work commenced immediately on the Primary Dental
Care Strategy (PDCS).
The reasons for developing the strategy are:
 ●   The effective implementation of the new OHS is reliant on effective delivery
     mechanisms if the oral health needs of the Northern Ireland population are to be met;
 ●   New contractual arrangements are to be introduced for the GDS in England and Wales.
     This will be the first time since the inception of the NHS that Northern Ireland has not
     been part of a national GDS contract. It will, therefore, be important to have a
     strategy in place that can help to inform the most appropriate method for
     remunerating dentists in the future.
The objectives of the strategy are:
 ●   Produce a plan for the delivery of dental care services to meet the outcomes of the
     new OHS;
 ●   Produce a plan for the delivery of primary care dental services for the next 10 years.
In order to meet these objectives the development of the strategy will take account of:
 ●   Recommendations from the OHS;
 ●   Recommendations from the CDS Review;
 ●   Workforce planning review;
 ●   Current provision of dental services in Northern Ireland;
 ●   Approach to the delivery of dental services in other parts of the UK and Republic of
     Ireland;
 ●   Implications from the report by CDO (England) NHS Dentistry: Delivering Change, July
     2004;
 ●   Analysis of the types, volumes and costs of treatment currently provided;
 ●   Definition of a core dental service;
 ●   Roles of the Professionals Complimentary to Dentistry (PCD's);
 ●   Views of the public;
 ●   Current and evolving models for remunerating dentists;
 ●   Finance resource availability and constraints;
 ●   Northern Ireland’s changing population profile;
 ●   The Departments equality obligations under Section 75 of the Northern Ireland Act.




                                            page 9
Dental Branch                                                Annual Report 2004/2005
A Project Board was established in September 2004 to assume authority for the project,
represent the interests of the organisations affected by the project and to monitor project
progress against requirements. The Project Board comprises representatives from the
Department, Health and Personal Social Services (HPSS), the Central Services Agency (CSA)
and the profession and is chaired by Dr Jim Livingstone, Director of Primary Care, who, in
turn, reports to the Departmental Board.
The Project Board agreed a work plan, which would last through to summer 2005 and
would result in a report to the Departmental Board setting out options and
recommendations. The Project Board appointed Michael Donaldson, Specialist in Dental
Public Health, as the project manager and agreed the setting up of a multi-disciplinary
project team to take forward the project. The Project Board meets regularly to monitor
the progress of the project and provide direction and advice to the Project Manager and
Team.
The Project Team had a wide and flexible membership drawn from Primary Care
Directorate (DHSSPS), Dental Branch (DHSSPS), General Dental Practice, Community Dental
Service, Health & Social Services Board Dental Directors, CSA and Information & Analysis
Unit (DHSSPS).
The Project Team first met in October 2004 and have met regularly with the Project
Manager to advance the work on the Strategy. Among the areas that have been included
are:
 ●   Workforce
 ●   Training and learning
 ●   Delivery systems
 ●   Remuneration models
 ●   ICT
 ●   Monitoring and evaluation
 ●   Specialist services and referral pathways
 ●   Communication
 ●   Clinical Governance
 ●   Dental Health Promotion
 ●   Resource and funding implications.
In addition to the areas mentioned above, a survey of all general dental practitioners on
the dental list and community dentists was undertaken in November 2004. This survey
covered such areas as remuneration, funding, workforce, work/life balance and improving
the oral health of patients. A high response rate was achieved and a synopsis of the
findings of these two surveys are included as appendices B and C. A user survey was
undertaken in January 2004 to inform both the OHS and PDCS. The findings of these
surveys helped to inform the work of the Project Team.
To further investigate the views of user groups, the Project Board asked the Southern
Health & Social Services Council (SHSSC) to commission focus groups to explore the
experience of patients and their families in using General Dental Service, produce a report
and make recommendations. In undertaking this exercise, the SHSSC ensured that
patients from all sections of the community were represented including minority ethnic
communities, women’s groups, older people and families living with disability as well as
those from different geographical settings. A series of nine focus groups were undertaken
between February and April 2005.
In order to keep the profession informed of the objectives and methodology in undertaking
the strategy, presentations were given to all four Local Dental Committees during October
                                           page 10
Dental Branch                                                Annual Report 2004/2005
and November by Departmental officials involved in the project. In addition, updates
were provided in the CDO’s Newsletter, which is published quarterly.
In developing the strategy, the Project Manager and Team developed four delivery models,
agreed an options appraisal and tested these models against the options appraisal.
The Project Manager commissioned independent consultants to test these four models
individually at a series of focus groups that were scheduled for April 2005.
It is proposed to have the PDCS consultation document out for consultation in Autumn
2005. Following the consultation period, negotiations can begin with the profession to
develop a new GDS contract.

Review of Statement of Dental Remuneration
Background
Representatives from Department met with Dental Practice Committee (DPC) and LDC
members in June 2004 to discuss possible interim measures that could be introduced into
the GDS before a new contract could be agreed. It was realised, at that stage, that it
would probably be 2007 before any radical change to the GDS could be implemented, in
the form of a new contract, as the latter depends on completion and consultation on the
PDCS and any necessary legislative changes. The Department was aware that the
profession wanted more immediate changes to the GDS and it was against this backdrop
that we commenced work on the review of the Statement of Dental Remuneration (SDR).
We also agreed with the representatives of the profession that we would consult with
them on any changes and would aim to implement the changes in April 2005.
Process
In reviewing the SDR, there were 3 main objectives:
 ●   Simplify the items;
 ●   Direct the SDR towards prevention;
 ●   Redistribute some of the spend from Item of Service (IoS) to block payments.
In undertaking the review, we were fortunate to have the services of two statisticians
from Information and Analysis Unit, Penny Murray and Alison Dunwoody, who spent many
hours reviewing, cleansing and presenting the GDS data into a format that could be
modelled for the purposes that we required. This data exercise took up the lion’s share of
the time dedicated to the project but now means that we hold valuable data in a format
that will allow any further modelling to be effected more quickly.
Having defined our objectives and collected the necessary information it was apparent
that, in order to meet the April 2005 deadline, only a limited number of areas could be
looked at in this round and we decided to focus on:
 ●   Sealant restorations
 ●   Sedation
 ●   Capitation payments
 ●   Practice allowance
Having worked up detailed and priced changes to the SDR on these areas, the Department
held meetings with DPC in February and March 2005 at which the changes to the SDR,
detailed below, were agreed.




                                          page 11
Dental Branch                                                 Annual Report 2004/2005
Changes to SDR Items
1. Preventive Sealants; A targeted fissure sealant scheme will be introduced aimed at
   children under the age of 12. Dentists, hygienists and therapists will be able to apply
   preventive sealants to the occlusal surfaces of first molar teeth of children under the
   age of 8, and to the occlusal surfaces of second molar teeth of children under the age
   of 12 and unfilled third molar teeth within 2 years of eruption. Any preventive sealants
   on molar teeth outside these age groups will require prior approval. These sealants are
   described in Section 111 of the SDR (Preventive Care) under item code 0701 and will
   attract a fee of £8.85. This expansion of item 0701 supports recommendation 3.7 of
   the OHS and requests from DPC for a caries prevention scheme. The changes are
   evidence-based and it is hoped will help to reduce the very high levels of caries that
   these age groups currently experience.
2. Restorative Sealants; Items 1442 (sealant & composite), 1443 (glass ionomer &
   sealant) and 1444 (glass ionomer, composite & sealant) have all been deleted. Instead,
   all restorative sealants will be paid as one single fee under Item 1441 at a rate of
   £8.85. Analysis of past claims for these items showed that they tended to be placed in
   age groups older than the caries pattern would have suggested. Monitoring by the
   Referral Dental Service indicated that there was much confusion within the profession
   both in relation to interpretation and appropriate claiming of Item 14(e). Simplifying
   Item 14(e) should overcome these problems and allow resources to be transferred to
   the changes to the SDR that are detailed in this article.
3. Sedation; Previously inhalation (Items 2571 & 2573) and intravenous (Items 2572 &
   2574) sedation were paid on a two-tier basis and this had led to confusion as to which
   of these levels should be claimed and has proven difficult to monitor. Requests have
   come from the profession and indemnity organisations to remove this grey area.
   Therefore, Items 2573 and 2574 have been deleted. All inhalation and intravenous
   sedation will now be paid under Items 2571 and 2572 respectively. Both these items
   will be paid at the higher fee (Item 2571 @ £16.10, Item 2572 @ £26.30).
4. Capitation Payments; For children under the age of 5 years, capitation payments have,
   in the past, been paid under two separate bands. In the new SDR, one single band will
   be used for 0 to 5-year-old children and paid at a rate of £1.35 per month. It is hoped
   this increased capitation payment for very young children will help to increase
   registration rates for this age group.
5. Practice Allowance; The Department recognises the additional administration burden
   facing practice owners, largely because of regulatory and clinical governance
   requirements and the impact this has on the effective management of practices. To
   this end, a new Determination XI has been inserted into the SDR to allow the payment
   of a practice allowance. The aim of this allowance is to assist with the costs associated
   with running a health service dental practice. The amount of allowance is detailed in
   the table below and is based on the average gross income for a practice, a concept that
   has been successfully used for the payment of a practice allowance in Scotland. The
   bandings are based on those used for the commitment payments and the allowance has
   been designed to provide a greater financial reward to practices providing higher levels
   of health service treatment. The amount of allowance paid to a practice is specified in
   column 2 of the table below. It is determined by the average gross earnings of the
   practice as specified in column 1, multiplied by the number of dentists within the
   practice on the 1 April in the financial year in which the allowance is to be paid. When
   applied to the current GDS data, the payments to practices would range from £500 to
   £24,000.
                                          page 12
Dental Branch                                                 Annual Report 2004/2005

         Column 1                              Column 2

         Average Gross Practice Earnings       Practice Allowance Per Annum

         £1 - £24,199.00                       Nil

         £24,200.00 - £56,499.99               £500 per dentist

         £56,500.00 - £77,999.99               £750 per dentist

         £78,000.00 - £101,499.99              £1,250 per dentist

         £101,500.00 - £123,999.99             £2,000 per dentist

         £124,000 or over                      £3,000 per dentist

Provisos (paraphrased) to claiming the allowance include:
 • The practice has been satisfactorily inspected by the appropriate Board within 3 years
   prior to the claim;
 • Maintenance of existing list size by individual dentists within the practice subject to a
   tolerance of -5%;
 • Notwithstanding regulation 2(2) of the Health Services (Choice of Dental Practitioner)
   Regulations (Northern Ireland) 1998, the practice gives an undertaking to make
   available all proper and necessary care and treatment under GDS (except for specialist
   services on referral) to the full range of health service patients for the following 2
   years.
The changes outlined above will inject in excess of £2 million pounds into the current GDS
spend.
We will monitor the in-year effects of these changes and will look at making other positive
changes in the coming year, budget permitting.




                                           page 13
Dental Branch                                                Annual Report 2004/2005
Priorities for Action (PfA)
Dental PfA's for 2004/05 were:

  ●   Boards and Trusts should continue to work towards increasing the % of 0-2 year old
      children, and the percentage of 3-5 year old children, living in the 20% most
      deprived wards, registering with general dental practitioners, from the level at
      September 2003 to the NI average target of 30% and 68% respectively by 31 March
      2005.
  ●   Boards and Trusts should, by 2006, reduce the difference in dental decay levels
      between 5 year old children living in the 20% most deprived wards and the NI
      average by 5%; and by 2010 increase the percentage of 5 year old children with no
      decay experience to 50% and reduce the difference in decay levels between the
      20% most deprived wards and the NI average by 20%.
  ●   Working together, Boards and Trusts should have implemented an evidence-based
      caries reduction programme amongst pre-school children by 31 March 2005.


Registration
The targets for registrations were set in the mid-term evaluation of the 1995 OHS. The
CSA produce detailed data on registration rates categorised by age group, Board, Trust and
Ward. This data is produced quarterly and is sent to the Department, Boards and Trusts to
enable monitoring of the registration rates. The registration rates of young children tend
to be significantly lower in areas of social deprivation and the CDS in Trusts affected by
low registrations have developed a variety of schemes to encourage uptake of dental
registration. Despite best efforts, the improvement in registration rates across the Boards
has been modest.




                                          page 14
Dental Branch                                                                                                                                                                                                                    Annual Report 2004/2005
                                   December 2004 Dental Registrations
                                                                                           0 to 2 year olds                                                                                                                                  3 to 5 year olds




                                                                                                               No. needed to raise rate


                                                                                                                                          Improvement In Rate†


                                                                                                                                                                     needed to meet target




                                                                                                                                                                                                                                                                                                             needed to meet target
                                            Medical Registrations




                                                                                                                                                                                              Medical Registrations




                                                                                                                                                                                                                                                                                       Improvement In Rate
                                                                    Dental Registrations




                                                                                                                                                                                                                      Dental Registrations




                                                                                                                                                                                                                                                                 No. needed to raise
                                                                                                                                                                      % of Unregistered




                                                                                                                                                                                                                                                                                                              % of Unregistered
                                                                                           Registration Rate




                                                                                                                                                                                                                                             Registration Rate



                                                                                                                                                                                                                                                                    rate to target
                                                                                             (target 30%)




                                                                                                                                                                                                                                               (target 68%)
                       Location




                                                                                                                      to target
                     EHSSB                21,403                    5,898                   27.6%                          523             0.9%                            3.4% 23,796 14,680                                                 61.7%                 1,501               3.2%                  16.5%

                     NHSSB                14,765                    4,049                   27.4%                          381             2.6%                            3.6% 16,518 10,999                                                 66.6%                       233           1.0%                       4.2%

                     SHSSB                12,490                    3,306                   26.5%                          441             2.8%                            4.8% 13,752                                8,752                   63.6%                       599           4.0%                  12.0%

                    WHSSB                 10,580                    2,375                   22.4%                         799             -0.8%                            9.7% 12,081                                7,061                   58.4%                 1,154               1.5%                  23.0%


                      ZZZZ                           367                             95                                                                                                                 399                    214


                  N.IRELAND               59,605 15,723                                     26.4%                  2,159                   1.4%                           4.9% 66,546 41,706                                                  62.7%                 3,545               2.5%                  14.3%




                     EHSSB                21,403                    5,898                                                                                                                    23,796 14,680

               DOWN&LISBURN                6,184                    1,719                   27.8%                         136              1.9%                            3.1%               7,106                   4,343                   61.1%                       489           2.8%                  17.7%

                 N&W BELFAST               5,045                    1,160                   23.0%                          354             2.4%                            9.1%               5,527                   3,164                   57.2%                       594           4.9%                  25.2%

                NDOWN&ARDS                 4,619                    1,412                   30.6%                                   0     -0.6%                            0.0%               5,188                   3,394                   65.4%                       134           5.9%                       7.5%

                 S&E BELFAST               5,555                    1,607                   28.9%                              60         -0.3%                            1.5%               5,975                   3,779                   63.2%                       284          -0.2%                  12.9%



                    NHSSB                 14,765                    4,049                                                                                                                    16,518 10,999

                  CAUSEWAY                 3,200                             824            25.8%                          136             5.5%                            5.7%               3,766                   2,656                   70.5%                              0      4.2%                       0.0%

                  HOMEFIRST               11,565                    3,225                   27.9%                         245              1.7%                            2.9% 12,752                                8,343                   65.4%                       328           0.0%                       7.4%



                     SHSSB                12,490                    3,306                                                                                                                    13,752                   8,752

           ARMAGH&DUNGANNON                3,981                    1,076                   27.0%                          118             0.5%                            4.1%               4,394                   3,008                   68.5%                              0      2.0%                       0.0%

          CRAIGAVON&BANBRIDGE              4,549                    1,230                   27.0%                          135             1.7%                            4.1%               5,046                   3,184                   63.1%                       247           4.1%                  13.3%

               NEWRY&MOURNE                3,960                    1,000                   25.3%                          188             6.6%                            6.4%               4,312                   2,560                   59.4%                       372           5.8%                  21.2%



                    WHSSB                 10,580                    2,375                                                                                                                    12,081                   7,061

                     FOYLE                 6,421                    1,138                   17.7%                         788             -0.2%                       14.9%                   7,259                   3,810                   52.5%                 1,126               2.9%                  32.7%

             SPERRIN LAKELAND              4,159                    1,237                   29.7%                              11         -1.5%                            0.4%               4,822                   3,251                   67.4%                           28       -0.9%                       1.8%



                      ZZZZ                           367                             95                                                                                                                 399                    214



●   ZZZZ = unknown Health Board and/or Trust                                                                                                                     ●          A small number of dental only patients have been excluded from the
●   Health Board is derived from the home address postcode of the patients.                                                                                                 results
    Local Government District are based on the 1992 boundaries.                                                                                                  ●          †Improvement in rate refers to change since February 2001
●   Only Live Valid dental registrations where the patient also has a medical
    registration are considered.




                                                                                                                              page 15
Dental Branch                                                                                                                                                                                                                                                                                                        Annual Report 2004/2005
Caries Rates
While this target is a long term one, data from the school screening has been used to
provide each Trust with a baseline against which they can measure improvement.

                                                                                                                                                                          Caries Prevalence Primary 1

               4.50

               4.00

               3.50

               3.00
    Mean dmf




               2.50

               2.00

               1.50

               1.00

               0.50

               0.00
                         2002/03
                                      2003/04
                                                   2004/05


                                                               2002/03
                                                                            2003/04
                                                                                        2004/05


                                                                                                    2002/03
                                                                                                                2003/04
                                                                                                                            2004/05


                                                                                                                                        2002/03
                                                                                                                                                    2003/04
                                                                                                                                                                2004/05


                                                                                                                                                                              2002/03
                                                                                                                                                                                          2003/04
                                                                                                                                                                                                      2004/05


                                                                                                                                                                                                                 2002/03
                                                                                                                                                                                                                             2003/04
                                                                                                                                                                                                                                         2004/05


                                                                                                                                                                                                                                                    2002/03
                                                                                                                                                                                                                                                               2003/04
                                                                                                                                                                                                                                                                          2004/05


                                                                                                                                                                                                                                                                                     2002/03
                                                                                                                                                                                                                                                                                                2003/04
                                                                                                                                                                                                                                                                                                           2004/05


                                                                                                                                                                                                                                                                                                                     2002/03
                                                                                                                                                                                                                                                                                                                               2003/04
                                                                                                                                                                                                                                                                                                                                         2004/05


                                                                                                                                                                                                                                                                                                                                                   2002/03
                                                                                                                                                                                                                                                                                                                                                               2003/04
                                                                                                                                                                                                                                                                                                                                                                         2004/05


                                                                                                                                                                                                                                                                                                                                                                                   2002/03
                                                                                                                                                                                                                                                                                                                                                                                              2003/04
                                                                                                                                                                                                                                                                                                                                                                                                        2004/05


                                                                                                                                                                                                                                                                                                                                                                                                                  2002/03
                                                                                                                                                                                                                                                                                                                                                                                                                            2003/04
                                                                                                                                                                                                                                                                                                                                                                                                                                      2004/05
                                Armagh &                                 Causeway                           Craigavon &                Down & Lisburn                                       Foyle                          Homefirst                    N&W Belfast                 N.Down & Ards                              Newry &                   S&E Belfast                          Sperrin              NI TOTAL
                                Dungannon                                                                    Banbridge                                                                                                                                                                                                         Mourne                                                        Lakeland
                                                                                                                                                                                                                                      Trust and Year




                                                                                                                                                                          Caries Prevalence - Primary 2

               4.50

               4.00

               3.50

               3.00
    Mean dmf




               2.50

               2.00

               1.50

               1.00

               0.50

               0.00
                      2002/03

                                   2003/04

                                                2004/05



                                                             2002/03

                                                                          2003/04

                                                                                      2004/05



                                                                                                  2002/03

                                                                                                              2003/04

                                                                                                                          2004/05



                                                                                                                                      2002/03

                                                                                                                                                  2003/04

                                                                                                                                                              2004/05



                                                                                                                                                                            2002/03

                                                                                                                                                                                        2003/04

                                                                                                                                                                                                    2004/05



                                                                                                                                                                                                                2002/03

                                                                                                                                                                                                                            2003/04

                                                                                                                                                                                                                                        2004/05



                                                                                                                                                                                                                                                   2002/03

                                                                                                                                                                                                                                                              2003/04

                                                                                                                                                                                                                                                                         2004/05



                                                                                                                                                                                                                                                                                    2002/03

                                                                                                                                                                                                                                                                                               2003/04

                                                                                                                                                                                                                                                                                                          2004/05



                                                                                                                                                                                                                                                                                                                     2002/03

                                                                                                                                                                                                                                                                                                                               2003/04

                                                                                                                                                                                                                                                                                                                                         2004/05



                                                                                                                                                                                                                                                                                                                                                   2002/03

                                                                                                                                                                                                                                                                                                                                                               2003/04

                                                                                                                                                                                                                                                                                                                                                                         2004/05



                                                                                                                                                                                                                                                                                                                                                                                   2002/03

                                                                                                                                                                                                                                                                                                                                                                                             2003/04

                                                                                                                                                                                                                                                                                                                                                                                                        2004/05



                                                                                                                                                                                                                                                                                                                                                                                                                  2002/03

                                                                                                                                                                                                                                                                                                                                                                                                                            2003/04

                                                                                                                                                                                                                                                                                                                                                                                                                                      2004/05
                                Armagh &                                 Causeway                           Craigavon &                 Down & Lisburn                                     Foyle                           Homefirst                     N&W Belfast                  N.Down & Ards                  Newry & Mourne                          S&E Belfast           Sperrin Lakeland                  NI TOTAL
                                Dungannon                                                                    Banbridge
                                                                                                                                                                                                                                       Trust and Year




                                                                                                                                                                          Caries Prevalence - Primary 7

               4.50

               4.00

               3.50

               3.00
    Mean DMF




               2.50

               2.00

               1.50

               1.00

               0.50

               0.00
                      2002/03

                                   2003/04

                                                2004/05



                                                             2002/03

                                                                          2003/04

                                                                                      2004/05



                                                                                                  2002/03

                                                                                                              2003/04

                                                                                                                          2004/05



                                                                                                                                      2002/03

                                                                                                                                                  2003/04

                                                                                                                                                              2004/05



                                                                                                                                                                            2002/03

                                                                                                                                                                                        2003/04

                                                                                                                                                                                                    2004/05



                                                                                                                                                                                                                2002/03

                                                                                                                                                                                                                            2003/04

                                                                                                                                                                                                                                        2004/05



                                                                                                                                                                                                                                                   2002/03

                                                                                                                                                                                                                                                              2003/04

                                                                                                                                                                                                                                                                         2004/05



                                                                                                                                                                                                                                                                                    2002/03

                                                                                                                                                                                                                                                                                               2003/04

                                                                                                                                                                                                                                                                                                          2004/05



                                                                                                                                                                                                                                                                                                                     2002/03

                                                                                                                                                                                                                                                                                                                               2003/04

                                                                                                                                                                                                                                                                                                                                         2004/05



                                                                                                                                                                                                                                                                                                                                                   2002/03

                                                                                                                                                                                                                                                                                                                                                               2003/04

                                                                                                                                                                                                                                                                                                                                                                         2004/05



                                                                                                                                                                                                                                                                                                                                                                                   2002/03

                                                                                                                                                                                                                                                                                                                                                                                             2003/04

                                                                                                                                                                                                                                                                                                                                                                                                        2004/05



                                                                                                                                                                                                                                                                                                                                                                                                                  2002/03

                                                                                                                                                                                                                                                                                                                                                                                                                            2003/04

                                                                                                                                                                                                                                                                                                                                                                                                                                      2004/05




                                Armagh &                                 Causeway                           Craigavon &                 Down & Lisburn                                     Foyle                           Homefirst                     N&W Belfast                  N.Down & Ards                  Newry & Mourne                          S&E Belfast           Sperrin Lakeland                  NI TOTAL
                                Dungannon                                                                    Banbridge
                                                                                                                                                                                                                                       Trust and Year




                                                                                                                                                                                                                   page 16
Dental Branch                                                Annual Report 2004/2005
Evidence Based Caries Reduction Programme
CDS staff have for years undertaken a wide variety of programmes aimed at improving the
oral health of their local population, especially children. Up until this year’s PfA, there
was no specific stipulation as to what type of oral health improvement programme Trusts
were to run and it was left to each individual Trust to undertake such programmes, as they
felt appropriate for their area.
In 2003, an analysis of the various programmes run at Trust level revealed that no fewer
than 39 schemes operating under 17 different programme types were ongoing across the
province aimed at everything from caries reduction to smoking cessation.
The major oral health problem facing children in Northern Ireland is dental caries. Despite
the myriad schemes aimed at reducing the caries rates in children, there has been little
improvement in disease levels over the past 10 years, and this is particularly so in the
under 5 year olds.
It was therefore decided to target a caries reduction programme at pre-school children,
and importantly, this programme was to be evidence based.
In the absence of water fluoridation, the majority of other evidence-based schemes
involve the use of fluoride toothpaste.
A workshop to discuss evidence based caries reduction programmes was organised by the
Department in August 2004 for CDS staff who are involved in operating these schemes. All
Trusts confirmed in writing to the Department by the end of September 2005 that they had
an evidence-based programme in place and detailed the nature of that programme. Caries
rates will be measured against the baselines provided to monitor the effect of these
schemes.
School Dental Screening (SDS)
While there is no longer a statutory requirement for Northern Ireland children to receive
dental screening, the CDS still carry out the screening for P1, P2 and P7 by agreement with
the Department. In 2001/2 the Department, Boards and Trusts in collaboration produced
guidelines for a standardised school dental screening programme. This was fully
implemented in 2003/04. A series of focus groups were undertaken by Catalyst
Consulting, on behalf of the DHSSPS, in March 2004 to gather feedback from the CDS and
GDPs on the working of the new screening guidelines and the findings were subsequently
published in a report.
All Trusts send yearly returns on school screening to the Department. These are collated
and analysed at the Department and are particularly useful for monitoring trends in caries
rates. The annual School Dental Screening returns are the main source of information for
assessing Trusts’ progress against PfA dental health targets.
The major issue facing school dental screening now is that of consent. Up until recently,
most Trusts used negative (or implied) consent when undertaking screening. However,
advice from the Department is that current guidance would suggest that positive (or
written) consent would normally be required for all forms of physical examination,
including dental screening.
This determination has had a negative effect on the uptake of dental screening and has led
to a drop of in the number of children screened (a drop of 10.9% in P7 children for year
03/04 compared to 02/03). Feedback from the CDS suggests that it tends to be children
from the more deprived social groups, and hence those with most treatment need, that
have fallen off the screening programme. This issue is being pursued through the Consent
Working Group at the Department in an effort to rectify the situation.
                                          page 17
Dental Branch                                                                     Annual Report 2004/2005
The Department facilitated a School Dental Screening Seminar in November 2004 for CDS
staff where feedback on screening data, discussion on consent issues and current thinking
on the value and future of SDS was presented. The future and extent of school screening
is currently under discussion. We realise that much time in the CDS is taken up with the
school screening programme while there is little change in the caries rate. We believe
that if the CDS were to reduce their commitment to the programme they could devote
more the time to other activities.

General Anaesthetics
General anaesthetic services for dental treatment are provided at 13 sites with critical
care facilities across Northern Ireland. The vast bulk of dental treatment under general
anaesthetic is for the extraction of teeth in young children, by and large under 8 years of
age. The large number of extractions under GA reflects the poor oral health of our
children and is the reason why recent policies with a preventive focus such as the evidence
based caries reduction programme and the fissure sealant scheme have been introduced.
The table below shows the most recent figures for GA dental extractions (2004).
                                  NHSSB                 WHSSB                 SHSSB                  EHSSB                      NI
                                 AAH 51                 EH 103                ST 46                 UHD 176
       Total number of GA
       sessions carried out      MUH 48                 TC 122                 C 49               RBHSC 101
                                 COL 85               Foyle 116               DH 89                 MIH 88
                                                                                                    LVH 86
                      TOTAL          184                    341                  184                          451              1160
                                 AAH 302                EH 550                ST 322                UHD       1245
          Number of cases
                                 MUH 258                TC 512                 C 492              RBHSC       1012
                                 COL 605              Foyle 862               DH 879                MIH       792
                                                                                                    LVH       800
                      TOTAL          1165                   1924                 1693                         3849             8631
                                 AAH 5.92               EH 5.34               ST 7.00               UHD       7.07
      Average case/session
                                 MUH 5.38               TC 4.20                C 10.04            RBHSC       10.02
                                 COL 7.12             Foyle 7.43              DH 9.88               MIH       9.00
                                                                                                    LVH       9.30
           Teeth extracted:                                                                                                       15
                Permanent        AAH 134                EH 671                ST 282                UHD      498
                                 MUH 147                TC 76                  C 257              RBHSC      494
                                 COL 146              Foyle 274                D 435                MIH      1306
                                                                                                    LVH      317
                  Deciduous      AAH 1551               EH 3392               ST 1048               UHD      5939
                                 MUH 1319               TC 639                 C 1630             RBHSC      3809
                                 COL 2497             Foyle 4171              DH 3356               MIH      3015
                                                                                                    LVH      2279
  TOTAL teeth extracted              5794                      9223              7008                        17657           39682
  Average number of teeth
                                   4.97                    4.79                4.14                       4.59                  4.60
              per patient
AAH       Antrim Area Hospital              TC      Tyrone County Hospital            RBHSC   Royal Belfast Hospital for Sick Children
MUH       Muckamore Hospital                ST      South Tyrone Hospital             UHD     United Hospitals Dundonald
COL       Coleraine Hospital                Foyle   Altnagelvin Hospital              DLT     Down & Lisburn Trust
EH        Erne Hospital                     C       Craigavon Area Hospital           MIH     Mater Infirmorium Hospital
                                            DH      Daisy Hill




                                                           page 18
Dental Branch                                                                                         Annual Report 2004/2005


                  General Anaesthesia for Dental Treatment 2002-2004


                          5000
                          4500
                          4000
                                          Number of cases
                          3500
                          3000            Total number of GA sessions carried out
               Count




                          2500
                          2000
                          1500
                          1000
                           500
                             0
                                   2002

                                           2003

                                                  2004

                                                         2002

                                                                2003

                                                                       2004

                                                                              2002

                                                                                     2003

                                                                                            2004

                                                                                                   2002

                                                                                                           2003

                                                                                                                  2004
                                      NHSSB                WHSSB                 SHSSB                EHSSB
                                                                 Board & year




                         16000
                                                   Teeth extracted – permanent
                         14000
                                                   Teeth extracted – deciduous
                         12000
       Number of teeth




                         10000
                         8000
                         6000
                         4000
                         2000
                            0
                                 2002 2003 2004 2002 2003 2004 2002 2003 2004 2002 2003 2004

                                     NHSSB                 WHSSB                 SHSSB                    EHSSB
                                                                  Board & year




                                                                       page 19
Dental Branch                                                  Annual Report 2004/2005
Review of Community Dental Service
The Review of the Community Dental Services Report was sent out for consultation in
December 2003 with the consultation period ending in March 2004.
In total, 72 replies to the consultation document were received. Overall, the replies were
strongly in agreement with the recommendations contained in the CDS Review. However,
three issues were raised consistently in the responses:
1. The value of undertaking a review of the CDS without reviewing the GDS at the same
   time
2. The cost associated with implementing the recommendations
3. The danger that the time available to CDS staff to deliver clinical dental care will be
   diminished by:
     a. Trying to quality assure existing processes
     b. Providing training for service development or trying to close identified skill gaps
     c. Trying to improve information management systems
A document summarising the responses received is now available from Dental Branch.
Action on bringing forward the recommendations has been delayed due to the
development of key strategies and reviews, such as the Oral Health Strategy, the Primary
Dental Care Strategy, the Review of Public Administration and Agenda for Change, which
have a direct bearing on the future direction of the CDS. As the impact of these strategies
on the future direction of the CDS becomes clearer, a work programme to bring forward
the recommendations will be developed.

Dental Nurse Training
Following on from the work undertaken by CAPITA Consultants, on behalf of the
Department, on the workforce review of PCD’s, it was concluded that a Review of Dental
Nurse Training was required urgently in order to inform future planning of regional training
for this group of PCD’s.
Background
The PCD workforce Review revealed that the great majority of dental nurses are trained in
the Further Education (FE) sector, with only a small proportion graduating from the School
of Dentistry (SoD) at the Royal Group of Hospitals (RGH). The figures for summer 2004
show 190 trained by the FE sector and 5 trained at the SoD.
The Department has, for a number of years, provided funding to support the training of
dental nurses at the SoD. The numbers graduating from the SoD have however been
consistently low for several years. The average number of dental nurses graduating from
the SoD is four per year. This very low output has been accompanied by a high attrition
rate from the course, thus raising concerns about the value for money and viability.
The PCD Workforce Review examined qualitative aspects of the workforce along with
statistics. Feedback from the Review indicated that part-time training was the preferred
option for the vast majority of dental nurses.
Training in the FE sector is a mixture of full time, part-time day release and part-time
night classes and is provided at six sites across the province by a variety of Higher and
Further Education establishments. The vast majority of the trainee dental nurses in the FE
sector opt for part -time training, thus enabling students to work and train at the same
time. The course provided at the SoD is full time and student dental nurses are financially
supported by means of a bursary, funded by the Department.

                                           page 20
Dental Branch                                                                                 Annual Report 2004/2005
The PCD Workforce Review recommended that, given the substantial investment made by
the Department in this training, and the very limited maximum capacity at the SoD in
relation to the regional supply requirements, a review should be carried out as a matter of
urgency. This piece of work needed to be undertaken before the final draft of the PCD
review could be signed off.
To this end, a working group was set up to undertake the Review of Dental Nurse Training
at the Department.
Review Process
The key aim of the Review was to establish accurate data on the current regional needs
for dental nurse training, to identify the range of providers of this training and to
recommend a preferred model for dental nurse training.
The model would indicate the preferred training route way to:
    ●   Secure value for money;
    ●   Secure an adequate regional supply of professionally trained dental nurses;
    ●   Offer accessible and flexible training arrangements to meet the needs of most
        trainees;
    ●   Secure adequate training capacity to meet both current known and future anticipated
        workforce requirements.
The working group was set up in June 2004 (when the objectives and terms of reference
were agreed) and completed its work by October 2004. Given that there were providers of
dental nurse training in both the Health and FE sectors and that any changes to training
arrangements could have reaching implications, it was decided to hold separate meetings
with representatives from the SoD and FE sector. This facilitated full and frank
exploration of the issues, views and concerns of both stakeholders.
Three groups were established, comprising representation from:
    ●   School of Dentistry
    ●   Further Education establishments across Northern Ireland, outside the greater Belfast
        area
    ●   Belfast Institute of Further and Higher Education (BIFHE)
    ●   Department of Health, Social Services and Public Safety.
Summary of Findings
School of Dentistry
    ●   Has capacity to recruit nine students each year to a two-year full time course.
        Students successfully completing the course are awarded an NVQ Level 3 in Oral
        Health Care;
    ●   The School has a teaching staff of four, plus administrative support;
    ●   For the last three academic years, the School has been unable to recruit the maximum
        number of students.
          The School has a high attrition rate from the course, detailed below
                      Intake Year               Initial Number            Number Qualifying          Percentage Drop-out
                          2001                          8                        2(1)                       75%
                          2002                          8                        6(2)                       25%
                          2003                          8                    5(to date)                    37.5%




1
    Although the two students passed the qualifying exam, both failed to complete the required duration of the course.
2
    Although six students passed the qualifying exam, only two completed the required duration of the course.
                                                                 page 21
Dental Branch                                                  Annual Report 2004/2005
BIFHE
 ●   Trains around 120 students both at the Belfast campus and at outreach sites in the
     North and West of the province
 ●   Full time, part-time day release and part time evening classes are offered
 ●   Qualification – National Certificate
North Down and Ards Institute
 ●   Currently training 20 students with capacity for 20 further places
 ●   Part time evening classes
 ●   Qualification – National Certificate
Upper Bann Institute
 ●   Capacity to train 25 –28 students
 ●   Part-time evening classes
 ●   Qualification – National Certificate
Newry & Kilkeel Institute
 ●   Capacity to train 15 students per year
 ●   Part-time evening classes
 ●   Qualification – National Certificate
Fermanagh College
 ●   Capacity to train 20 students
 ●   Part –time evening classes
 ●   Qualification – National Certificate
Preferred Qualification
The Review considered the relative merits of the NVQ and National Certificate and, for the
purposes of comparison, explored training provision in the rest of the UK. While both
qualifications have their strengths and weaknesses, feed back from the Training
Institutions (with the exception of the SoD) indicated their preference for the National
Certificate. Feedback from the rest of the UK also favoured the National Certificate over
the NVQ level 3.
In addition, the Review looked at post-qualification training and continuing professional
development for dental nurses.
Conclusions
The final Report, published in February 2004, made a series of recommendations, the most
significant of which was that the future training of dental nurses should be provided by the
Further Education Sector and that the Department should no longer fund this training
provision at the School of Dentistry.
The Department has informed the School of Dentistry of this decision and there will be no
further intake of student dental nurses to the existing course.
A Dental Nurse Workforce Advisory Group has been set up in order that representatives
from the FE sector and the Department can address issues arising in relation to the
demand, supply and training of dental nurses.




                                              page 22
Dental Branch                                                Annual Report 2004/2005
Supplement for Undergraduate Medical & Dental Education
The Department contributes to the funding of undergraduate teaching at the Belfast
Dental Hospital through the Supplement for Undergraduate Medical & Dental Education
(SUMDE). The Belfast Dental Hospital is benchmarked with Cardiff, Dundee and Glasgow
Dental Hospitals by an independent consultant who analyses the Schools’ data on teaching
and service activity. In February 2005 at an event facilitated by the Northern Ireland CDO,
the Deans of the four schools (with their finance and administrative representatives) met
in Belfast with their Northern Ireland counterparts from the Royal Group of Hospitals
(RGH) Trust and representatives from the Department for the inaugural meeting of the
Celtic Dental Benchmarking Group. Each Dean/Clinical Director gave a short presentation
on their respective dentals hospital/school setting out the challenges facing them in the
short and long term. During small workgroup discussions, the delegates were able to share
ideas, problems and successes, suggest means to help each other, discuss challenges and
ways to improve working practices. The feedback from the event was very positive with
most people suggesting that it should be repeated next year with a more focussed agenda.
A report of the event was sent to all the delegates.

Hospital Dental Service Workforce Planning
The report titled Review of Consultant Staffing in the Hospital Dental Service, issued in
December 2003 by the Hospital Services Subcommittee of Central Dental Advisory
Committee, identified significant shortfalls in staffing levels within the Hospital Dental
Service (HDS) in Northern Ireland. This report also identified the need for extra training
posts to be put in place to meet the future needs of the service.
In order to redress the current problem, the Department agreed to fund two new
Specialist Registrar posts one of which was allocated to orthodontics and the other to
restorative dentistry.
Dental Services Group and Human Resources Directorate have engaged with
representatives from the HDS over the year to plan the future workforce needs of the
service.

General Dental Council Visitation
The General Dental Council (GDC) visits all the UK dental schools on a 6-year cycle to
assure that the curricula of these schools meets the requirements of The First Five Years;
A Framework for Undergraduate Dental Education.
The Belfast School of Dentistry was visited over 3 days from 4th to 6th October 2004, and
included meetings with the Chief Dental Officer, representatives from Human Resources
Department and the Board Dental Directors.
The final report was issued in March 2005. The GDC commented in their report that
 ‘Students receive good academic, clinical and pastoral support from hard-working,
committed staff’.
In a recent educational survey for a national newspaper, the Belfast School of Dentistry
was recorded as 2nd out of the 13 United Kingdom dental schools for undergraduate
teaching.




                                          page 23
Dental Branch                                                  Annual Report 2004/2005
Sedation Survey
In the financial year ending 2004, General Dental Practitioners claimed some £722K for
52,893 RA items and almost £266K for 10,940 IV sedation items. In order to gather further
information on the coverage, availability, split, type and other qualitative factors relating
to sedation, the Department issued a postal questionnaire to over 367 General Dental
Practices in Northern Ireland in June 2004 with a reply date in July 2004. There was an
excellent response to the survey with a 66% return rate.
Some of the key findings from the report were:
 ● 57.5% of respondents carry out sedation;
 ● 94% of sedating practices provide RA sedation and 35% provide IV sedation;
 ● An average of 12 patients per practice per week are treated using IV with 15 patients
   per week per practice treated with RA;
 ● Over 75% of respondents expressed an interest in provision of more training in
   sedation, and the majority wanted this training for the whole team;
 ● Referrals for sedation:
      61% of referrals are to other GDPs
      37% to CDS
      27% to hospitals
 ● Almost 2 out of 3 respondents felt that there was adequate provision of sedation
   services in their area.
The Department intends to use the information collected to help inform the Northern
Ireland Medical & Dental Training Agency’s (NIMDTA) decisions on training needs. It also
provides baseline information for bidding for extra resources for dental sedation services.
The full report of the survey is available on the Dental Services Group website.

Decontamination Audit
In light of the problems that had been experienced with the adequacy of the
decontamination life cycle processes used in relation to flexible endoscopes, the
Department sought to ensure that decontamination policies, procedures and practice
across all clinical services reflect, as far as possible, best practice.
To this end, a letter was issued to all Health Service general dental practitioners in August
2004 advising them of the lessons learnt from the quality assurance of the processes
involved in decontaminating flexible endoscopes and advocating best practice in the
decontamination of reusable medical devices. Along with this letter was reissued A
Protocol for the local Decontamination of Surgical Instruments, (July 2001) with a request
that dentists comply with this guidance.          The letter also indicated that further
communication on the matter would be issued in due course in order to assure the
decontamination processes in dental surgeries.
The Department was aware that a comprehensive cross infection control training package
was being developed by Caroline Pankhurst (GKT London), Dr Wil Coulter (QUB Belfast) and
Dr Heather Clarke (SHSSB). This package was to comprise an audit tool and a detailed
manual, with an accompanying CD-ROM. The audit tool was at an advanced stage of
development in September 2004 and, after consultation with the Board Dental Directors, it
was decided that all dental practices would be required to complete the audit
questionnaire. While the initial concerns about reusable surgical instruments was purely
concerned with decontamination procedures, it was felt that the questionnaire provided
the opportunity to look at all aspects of cross infection control within dental surgeries.
This would provide greater public assurance on the safety of these surgeries.

                                           page 24
Dental Branch                                                   Annual Report 2004/2005
This self assessment audit questionnaire was specifically developed to take account of
Northern Ireland’s legislation in relation to health and safety and other relevant areas and
covered every aspect of cross infection control. Given the comprehensive nature of the
audit, the time involved in completion and the associated learning exercise, continuing
profession development (CPD) allowance and verifiable CPD points were to be awarded for
completion of the audit.
The CDO issued a letter to all general dental practitioners in December 2004 asking them
to undertake an audit using the documentation provided, review their current policies and
procedures and work towards conforming to the recommendations contained in the British
Dental Association guidance Infection Control in Dentistry (A12).
All audits were to be returned to the relevant Health & Social Services Board (HSSB) by the
end of January 2005 and their Chief Executives were to assure the Department that all
practices had undertaken the audit and that every practice was actively working towards
achieving the standard set out in the British Dental Association’s A12 guidance.
There was a 100% response rate to the audits and Board Chief Executives were able to
provide the Department with the assurances that were required. In addition to the
assurances received, the analysis of the audits provides the Department and Boards with
baseline information on the training and development needs of dental practices in relation
to cross infection control procedures.
The initial results show that compliance with cross infection control procedures is very
good in Northern Ireland. A working group comprising Dr Caroline Pankhurst, Dr Wil
Coulter, Dr Heather Clarke and the Dental Practice Advisers (DPA's) from the four Boards
analysed the anonymised returns and agreed the high priority questions. They then set
traffic light levels with any less than 40% of the high priority questions answered
satisfactorily being classified as Red, 40 -70% answered satisfactorily as Amber and >70%
answered satisfactorily as Green. Amber is considered good but room for improvement
while green is considered a high standard of cross infection control. Using this system, the
results have shown, reassuringly, no red returns, 53% Amber and 47% Green.
In addition, this analysis has also highlighted some priority areas:
 •   Amalgam separators: these are now required to be fitted in all practices to comply
     with disposal of toxic waste legislation
 •   Chart recorders for autoclaves: Nearly 60% of practices did not have a chart recorder
     fitted. Chart recorders are necessary to fulfil the requirement that every production
     cycle must be fully documented.
 •   Independent water bottles: 40% of practices did not have independent water supply
     and this is necessary to prevent back- siphonage into the mains water supply and
     assists the delivery of antimicrobials to control growth of biofilm in waterlines.
 •   Dedicated rooms with sinks and extraction ventilation for washing and sterilisation of
     instruments: Almost 70% of practices currently do not have this facility which though
     not essential would be the preferred option where possible
 •   Washer Disinfectors: the majority of practices currently do not possess washer
     disinfectors, although they are now recommended by the Medical & Healthcare
     products Regulatory Authority (MHRA) and the BDA (A12), as automated washing is
     more consistent than manual cleaning and can be validated
 •   Disposables: Burs, endodontic files and matrix bands can be difficult to decontaminate
     and greater use of disposables will reduce the risk of cross infection control.
The next stage in the process is a programme of intensive training focussed on the
deficiencies revealed by the audit over the next 12 months. Dr Wil Coulter and his team

                                            page 25
Dental Branch                                                  Annual Report 2004/2005
propose to run workshops across the province to enable one dentist and one dental nurse
from each practice to attend.
As part of this training programme, Dr Pankhurst, Dr Coulter and team will use the Cross
Infection Manual and CD-ROM that they have developed to complement the training
programme.

National Clinical Assessment Authority (National Clinical Assessment Service)
The NCAA was set up as a special health authority in April 2001 and it provides a service to
support the NHS in its responsibility for doctors and dentists whose performance gives rise
for concern. The Department has signed a service level agreement (SLA) with the National
Clinical Assessment Authority (NCAA), which came into effect on 1 October 2004.
Under the terms of the SLA, the Authority will exercise the following functions:
 • To provide an advisory service to the Department, HSS Trusts, HSS Boards, HPSS
   Special Agencies and Local Health and Social Care Groups;
 • To support local efforts to resolve difficulties and disputes between doctors and
   dentists and their employers and contractors;
 • To provide, support and quality assure assessment services, remedial action planning
   and reporting, ensuring compliance with EC requirements, employment law, section
   75 of the Northern Ireland Act 1998, and natural justice.
This agreement is a welcome development and will greatly assist HPSS Boards and Trusts in
their management of performance issues of dental professionals. The NCAA can provide
advice about the local management of cases and, where necessary, carries out clinical
performance assessments to clarify areas of concern and make recommendations to both
the referring organisation and the individual. The NCAA can also advise HPSS organisations
about setting up and running effective local performance procedures.
The work of the NCAA covers dentists working in the hospital, community dentistry and
general dental practice. The NCAA employs trained dental assessors, including a Northern
Ireland based assessor, to help with poorly performing dentists. If a problem is identified
with a dentist’s performance, the HPSS body responsible for the dentist may seek the
advice of the NCAA in order to effect local resolution. If it is deemed necessary, the NCAA
may undertake a full clinical assessment. It is important to stress that the NCAA does not
take over the role of the employer, nor does it function as a regulator (which is the role of
the GDC). The NCAA is an advisory body and the appropriate HPSS organisation remains
responsible for resolving the problem once the NCAA has produced its assessment.
The NCAA accepts referrals from the dentist’s employer or a self-referral, but it does not
take referrals from members of the public.
Under the Special Health Authorities Abolition Order 2005, the NCAA was abolished and all
liabilities transferred to the National Patient Safety Agency (NPSA). The NCAA was
renamed National Clinical Assessment Service (NCAS) and this came into effect on 1 April
2005. The services offered to the HPSS in the original SLA have not been altered by this
change.

PCD Road show
The General Dental Council, in conjunction with Dental Branch, organised two PCD events
in March 2005 in the west and east of the province. These events rounded off 28 road
shows across the United Kingdom. The purpose behind these events has been to give
existing and potential registrants an opportunity to find out first hand what PCD
registration will mean for them and allow their queries and concerns to be addressed.
                                           page 26
Dental Branch                                                 Annual Report 2004/2005
Both events were well attended. Following a series of presentations from the GDC,
officials from the GDC and Department were at hand to hear the views of the PCD’s and
answer their questions.
Once the legislative framework is in place, registration of the various PCD groups can take
place. It is anticipated that registration of PCD’s will occur in 2006.

Northern Ireland Medical & Dental Training Agency
New Agency & Board
Following on from the report on the Review of Northern Ireland Council Postgraduate
Medical and Dental Education (NICPMDE), the Council was reconstituted as a Special
Agency on 1st April 2004. This special agency has been named the Northern Ireland
Medical and Dental Training Agency (NIMDTA). While the agency will continue to
undertake the education and training of doctors and dentists in Northern Ireland, there
have been significant changes to the structure of the board of this agency. Unlike the
previous arrangement, the board of NIMDTA comprises a non-executive chair and five non-
executive members. These five non-executive members are made up of three lay
members and one with a medical and one with a dental background, appointed with the
approval of the Minister in accordance with the Code of Practice of the Commissioners for
Public Appointments for Northern Ireland.
The senior management team at NIMDTA report to this new Board.
Dr Harry McGuigan has been appointed Chair of the new agency and Dr John Marley has
been appointed as the dental member of the board.
Accountability Arrangements
The change to special agency status has also brought about changes to the accountability
arrangements with the Department. Under the old arrangements, two accountability
review meetings were held with the Department and NICPMDE. There was broad
representation of NICPMDE officers, which included the Medical Postgraduate Dean/Chief
Executive, Dental Postgraduate Dean, the Administrative Director, Finance manager and
representatives from the medical and dental advisers. Similarly on the departmental side,
there was wide representation, which included CMO, CDO, Director of Human Resources,
departmental medical and dental officers and administrative staff from HRD. Under the
new arrangements accountability review meetings will be held once per year and with a
much smaller group from NIMDTA and Department in attendance. NIMDTA is represented
by the Chairman and Chief executive, while the Department are represented by CMO, CDO
and the Director of Human Resources.
However, it is planned than a larger group of NIMDTA and Departmental officials will have
the opportunity to meet prior to these accountability review meetings to discuss any areas
of concern.
Under these new corporate governance arrangements, it is no longer appropriate that the
CDO should attend the dental subcommittees of NIMDTA but the Chairs of these
committees have been invited to meet with CDO informally, if they feel the need arises.
New Dental Dean
Dr David Hussey took up appointment as the new postgraduate dental dean on 1 January
2005. David graduated from Queens University Belfast in 1978. He held house officer
posts in the Royal Victoria Hospital and the Belfast City Hospital before a 2-year period in
general dental practice in North Belfast.


                                          page 27
Dental Branch                                                Annual Report 2004/2005
David went on to pursue an academic career that included a secondment to the University
of Western Ontario in 1986. He was appointed Senior Lecturer/ Consultant in Restorative
Dentistry in 1989 and completed his PhD on Resin Bonded Bridgework in 2000
Speaking on the announcement of his appointment, David said:

 ‘I am looking forward to the challenges of this post for the next 5 years. There is
 already an excellent team in place and I am sure that together we can continue to
 deliver first-rate postgraduate education for the whole profession within the province’.


Dr Hussey replaces Mr Ian Saunders who served as postgraduate dental dean for a long and
successful tenure. In his term of office, Mr Saunders has overseen the introduction of
mandatory vocational training, the development of Northern Ireland’s first general
professional training scheme and the expansion of the dental postgraduate programme.
We thank Ian for his dedication and work in bringing dental postgraduate training to its
current level.
Extra Allowances for Vocational Trainers
The Department is keen to help in the development of vocational training in Northern
Ireland. Funds have been made available to provide additional training allowances for
trainers or for those intending to become trainers to enable them to attend courses
specifically designed for those training to be trainers. These courses cover such areas as
appraisal training, recruitment and selection and training the trainer.
Three extra training days were arranged between October and December 2004 and there
was a large uptake of these courses.
Under new funding arrangements, dentists attending these training days may claim CPDA
from NIMDTA even if they have already claimed their maximum allowance from the CSA.
In addition, under these arrangements all existing vocational trainers are now able to
claim an extra six sessions of CPDA in order to maintain the high standards expected of
them.
These arrangements apply also to trainers on the GPT scheme and became effective from
August 2004.
Extra Funding For NIMDTA
The Department released additional funding in July 2004 to NIMDTA. £34,000 was
allocated towards funding additional postgraduate courses for dentists and the wider
dental team. The funding is recurrent and one third of it has been specifically ear marked
for team-based courses. In addition, the Department committed a further £172,000
towards the GPT scheme, which commenced in August 2003; bringing the total, spend on
GPT to £250,000.
The Department will continue to consider further development of the Vocational Training
and GPT schemes.




                                         page 28
Dental Branch                                                Annual Report 2004/2005

Referral Dental Service
The Referral Dental Service (RDS) monitors the quality and probity of health service
dentistry in Northern Ireland. This role is carried out on behalf of the four Health Boards
who have contracted with dentists in their area to provide health service dentistry.
The principal aim of the RDS is to assure the CSA and the Minister for Health and Public
Safety that:
 • The money from the public purse is paid correctly to dentists and is paid correctly
   according to regulations;
 • The treatment provided was warranted and has been satisfactorily completed;
 • The oral health of the public availing of Health service Dentistry has been secured and
   maintained.
In addition, Referral Dental Officers (RDO’s), when required, provide advice and reports to
the Compensation Agency and advise the DETI regarding dental charges for their overseas
employees.

Positive Assurance
The system of monitoring underwent a significant change in 2003/04 with the introduction
of positive assurance (PA) and the development and problems around this new system have
been detailed in the 2003/04 annual report.
Given the problems that were being encountered, the Department hosted a workshop on
18 May 2004 at which most of the stakeholders in monitoring the GDS were present.
Participants included CSA Dental Director and Dental Officers, all the HSSB Dental
Directors and their Dental Probity Officers, CDO and the Department Dental Officers and
the Head of CFPU. At this workshop eight case studies were presented, two from each
Board (one case involving a patient and desktop examination, the other a desk top only
examination). All eight cases contained significant discrepancies that would call into
question the validity of the claim.
The objective of the exercise was to follow these cases from sampling the claim right
through to final follow up action, including whether the Boards had assured these cases,
and to establish the strengths and weaknesses of the system, along with identifying
improvements which could be made, including better inter-agency working among CSA,
HSSB’s and the Department. All the cases dated from pre Christmas 2003.
The audit trail for each of these cases was discussed by the relevant Board Director with
input from the CSA and RDS. Having undertaken this exercise, it was apparent that the
process was not working efficiently and the system was unable to effectively cope with the
volume of information being generated. In addition, the involvement of three different
bodies in dealing with PA was not conducive to ease of reporting.
After these cases were discussed, a decision was made by the head of CFPU and CDO that
PA would be removed from the remit of the RDS and would transfer back to the Boards. It
was proposed that a steering group would be set up to look at a new system that would be
operational by the new financial year. It was planned that PA in its current form would
cease on 1 July 2004 to allow Boards and CSA to clear the backlog of cases. The RDS and
CSA would revert to their previous monitoring arrangements.
CDO issued a letter to all health service general dental practitioners on 20 May 2004
informing them that the current PA scheme would cease on 1 July 2004.


                                          page 29
Dental Branch                                               Annual Report 2004/2005
Final Evaluation Report
A final evaluation report on PA was issued in October 2004. The conclusion of this report
stated that despite much preparation for the introduction of the scheme, the current
system of positive assurance was not successful because:
 •   The standard of record keeping is extremely poor in general practice making
     reconciliation with claims very difficult;
 •   The complex nature of the SDR and the many forms required to substantiate a claim
     makes the definition of a complete record difficult to define and is open to
     interpretation;
 •   A lack of regional approach among the four Boards has led to confusion both with the
     follow up procedures and among the profession;
 •   Follow-up on any discrepancies discovered by the RDS is extremely slow;
 •   The sheer workload and logistics involved in detailed examination of record cards is
     not an efficient use of RDOs’ time;
 •   The whole quality focus of the RDS was lost to that of financial probity. A balance
     between the two would have been ideal;
 •   There were too many tiers involved in the process. The system should ideally sit at
     Board level with a simple Board/practitioner interface.
Some positive aspects were noted:
 •   Identification of high risk areas;
 •   More detailed scrutiny of claims;
 •   A larger spread of GDS spend examined.
While a new system for the assurance of GDS claims was being developed, ongoing
monitoring of the GDS continued by the RDS, CSA and Health Board probity officers.
Development of New System
Following the cessation of Positive Assurance on 1 July 2004, a dental sub group of the
Regional Probity and Counter Fraud Steering Group was tasked with developing a new
system that would satisfy the requirement to assure the spend on the GDS and be
acceptable to the profession.      There was broad representation from all the key
stakeholders on this sub group and included general dental practitioners from the four
Local Dental Committees, Dental Directors from the 4 HSSB’s, Dental staff from CSA,
Dental staff from the Department and Finance staff from the Boards and Department.
The group first met in July 2004 and continued to meet regularly through the year. After
extensive scoping of the current monitoring arrangements, lessons learned from the
Positive Assurance scheme and identification of gaps in the current monitoring
arrangements, a new system of Claims to Records Checks (CRC) is being developed by the
group. It is anticipated that the new system will commence in the summer of 2005.

RDS Protocols
With the resumption of routine monitoring on 1 July 2004, it was decided to redraft the
RDS monitoring protocols in order to define clearly the roles of the Department, CSA and
Boards in the monitoring process. The RDS monitoring protocols were last updated in 2002
and it was felt that further development of these protocols was required.
Taking on board the issues raised in the final evaluation of PA and the measures
recommended by the Chief Internal Auditors Group in their report System for Payment of
Dental Practitioners, new monitoring protocols were drafted and agreed with the four
HSSB’s and CSA. The protocols were issued to all Health Service dentists in early 2005.
The Department will revise these protocols as necessary.
                                         page 30
Dental Branch                                                                       Annual Report 2004/2005
Sampling
The resumption of routine monitoring also required a change in the way the patient
sample for the referral dental service is selected. For positive assurance, a random
sample was selected to assure the global GDS spend. This meant that that those dentists
who made the most claims were most likely to have patients selected but also meant that
not all health service dentists had patients examined. This prevented the RDS from
assuring the quality aspect of all health service dentists’ clinical work.
The new sampling procedure has been designed to ensure that all health service dentists
who make claims have 4 patients per year selected. Any claim can be potentially
sampled. Initial analysis of the new sampling procedure has revealed that a significant
proportion of the patients sampled have had little or no treatment carried out (e.g.
examinations, re-registrations) and it is intended to review the sampling later in the year.
Data Analysis of RDS Activity

Analysis of RDS Attendances by Health & Social Services Board for 1 April 2004 to 31 March 2005:

   Board       Called              Attended                          Cancelled                        Failed to Attend

     E         1750          498              28.5%            298               17.0%              887               50.7%

     N         1224          477              39.0%            226               18.5%              496               40.5%

     S          615          214              34.8%            85                13.8%              304               49.4%

     W          729          273              37.4%            103               14.1%              342               46.9%

   Total       4318         1462              33.9%            712               16.5%              2029              47.0%



Analysis of RDS Report Codes by Health & Social Services Board for 1 April 2004 to 31 March 2005:

   Board       Called    Examined          A               B              C              D                 E               X

     E         1750         498       186 37.3% 181 36.3% 119 23.9%                 0        0.0%    0         0.0%   12       2.4%

     N         1224         477       186 39.0% 135 28.3% 138 28.9%                 1        0.2%    0         0.0%   17       3.6%

     S          615         214       84      39.3%   55   25.7%     66   30.8%     1        0.5%    0         0.0%   8        3.7%

     W          729         273       86      31.5% 100 36.6%        82   30.0%     0        0.0%    0         0.0%   5        1.8%

    NI         4318        1462       542 37.1% 471 32.2% 405 27.7%                 2        0.1%    0         0.0%   42       2.9%




                                                      page 31
Dental Branch                                                  Annual Report 2004/2005

Prison Dental Service
Dental services are provided at the three prison sites in Northern Ireland, HMP
Maghaberry, HMP Magilligan and HMP Hydebank Young Offenders Centre (YOC).
Prison Services Directorate are responsible for provision of the clinics and all other
facilities necessary to deliver the service. Up until January 2004, Dental Services Group at
the Department were responsible for providing staff for delivery of dental services at all
three sites. However, dental services were contracted out at Magilligan in January 2004 to
the independent sector and the Department continued to deliver services to Maghaberry
and Hydebank YOC.
The Department continues its monitoring role at all three sites.

Magilligan Contract
Following on from recommendations in the first Moseley/Neale Report (February 2002)
and Review of Prison Healthcare Services, April 2002 dental services at Magilligan Prison
were put out to tender in July 2003 and the contract was awarded to a general dental
practice from the North West. The contract commenced in January 2004 and runs for a
minimum of three years with an option of a two-year extension.
An in-year review of the contract was undertaken in September 2004 and a report issued in
the same month. The evaluation revealed a significant increase in clinical activity and
more comprehensive cover than was the case under the previous arrangements. The
waiting list at Magilligan had been cleared and all committals were now being offered a
dental examination (75% uptake). Due to the success of this contract, the necessity to
have a separate contract for emergency cover was no longer necessary and the existing
emergency cover contract has been discontinued.
The Department will continue to monitor the dental service at Magilligan.

Service Delivery Models at Maghaberry and YOC
Taking account of the recommendations from the Review of Prison Healthcare Services,
April 2002 and the second Moseley Neale Report (January 2004), the Department took into
consideration the future of service delivery at Maghaberry and YOC. With Magilligan
contracted out the service was now of such a small size that it was difficult to sustain it in
the long run. In addition, increasing clinical governance requirements would be difficult
to achieve in such a small stand-alone service. There was also a conflict in accountability
arrangements in that the Department was both directly delivering the service and
monitoring the service.
Unlike Magilligan, Maghaberry is a high security establishment and this can lead to
problems with escorting prisoners to the health care unit. In the rest of the UK the dental
service to these high security prisons is generally provided by CDS dentists from the local
Primary Care Trust (PCT). The Department, together with the Prison Service, decided to
investigate the possibility of setting up a similar arrangement for delivery of services at
Maghaberry and YOC, the local Trust for Maghaberry being the most appropriate Trust to
potentially provide the service.
Discussions commenced with the CDS at Down and Lisburn Trust (DLT) in June 2004 about
the possibility of contracting the service to them. Over the next six months, a contract
was agreed between DLT and the Prison Service to provide dental services at Maghaberry
ant the YOC. Staff side at the Department were kept informed of the developments and
raised no objections.

                                           page 32
Dental Branch                                                 Annual Report 2004/2005
The service was formally handed over to the CDS at DLT on 1 April 2005. The Department
will continue to monitor this service.

Future Monitoring
With the responsibility for service delivery now transferred, the Department will
concentrate its efforts on monitoring the service. Three aspects of the service will be
monitored:
Clinical activity: Day sheets detailing clinical activity have always been returned to the
Department for checking. A monthly summary of clinical activity is also returned. This is
currently all by paper although the monthly summaries are put on to an electronic
database for analysis. An Access based database has been developed to accept the
information from the day sheets. Currently the prison dental surgeries are not linked
electronically but it is hoped that this can be developed in the future.
Practice Inspections: A programme of practice inspections, undertaken by a Board
practice inspector has been initiated, with Maghaberry and YOC inspected in December
2004 and a visit for Magilligan planned for later in the year. These visits will ensure that
dental surgeries meet and conform to all regulatory requirements.
Quality of clinical treatment: It is planned to commence a programme of quality of
clinical care checks by the RDS within the next twelve months.




                                          page 33
Dental Branch                                   Annual Report 2004/2005

Appendix A – Quantitative responses from the Oral Health Strategy
consultation




                                 page 34
Dental Branch                                                                                                      Annual Report 2004/2005

                                                                                                         No    Strongly                                      Strongly
                                             Question                                                 response agree          Agree       Neither   Disagree disagree

 There should be a regional expert group for Oral Health Promotion (OHP) that:                        19%        39%         35%         5%         0%        1%

 Is formally linked in with general health promotion through the DHSSPS health promotion
                                                                                                            1%         55%         35%        6%         1%        1%
 forum;

 At a strategic level plans and coordinates OHP in Northern Ireland;                                        1%         47%         42%        9%         1%        0%

 Develops regional OHP programmes and appropriate evaluations.                                              5%         42%         42%        10%        0%        1%

 Each Community Trust should have at least one OHP coordinator.                                             1%         52%         34%        12%        0%        1%

 Preventive interventions should be evidence-based with consideration given to cost-
                                                                                                            1%         55%         29%        14%        1%        0%
 effectiveness.

 Preventing caries in children, particularly among those from disadvantaged backgrounds,
                                                                                                            1%         78%         19%        1%         0%        0%
 should be a key health objective for all Boards and Trusts in Northern Ireland.

 The DHSSPS, Boards and Trusts should work with educational authorities to ensure that all
 schools, including special schools:

 Are free from vending machines selling sugary snacks and drinks                                            3%         77%         14%        6%         0%        0%

 Have a healthy breaks and meals policy.                                                                    3%         78%         19%        0%         0%        0%

 Oral health professionals should build on existing partnership working arrangements to improve
                                                                                                            3%         65%         25%        8%         0%        0%
 children’s diets, particularly those from disadvantaged backgrounds.

 The DHSSPS will work in partnership with other stakeholders to examine the feasibility of
                                                                                                            3%         69%         18%        6%         4%        0%
 fluoridating the public water supplies.

 As 3.5 may take some time, an alternative, evidence-based, regional prevention programme for
                                                                                                            1%         64%         30%        3%         0%        3%
 caries in children should be developed and implemented as soon as possible.

 The new Primary Dental Care Strategy should encourage dentists and PCD’s to provide diet
                                                                                                            3%         68%         26%        4%         0%        0%
 advice, oral hygiene instruction, fissure sealants and topical fluoride where appropriate.

 Producers of soft drinks should investigate ways of reducing their erosive potential.                      1%         73%         19%        4%         1%        1%

 Dentists should be aware of the causes of dental erosion and should offer advice, treatment
                                                                                                            1%         66%         27%        4%         0%        1%
 and referral as appropriate.

 Oral health professionals should work with the relevant bodies to ensure that all contact sports
                                                                                                            1%         61%         29%        8%         0%        1%
 participants wear a mouthguard.

 Oral health professionals should work in partnership with those who teach, train and care for
                                                                                                            1%         52%         36%        9%         1%        0%
 children to improve the immediate management of dental trauma.

 Health Boards should examine the possibility of providing training to highlight the dentist’s role
                                                                                                            3%         32%         43%        17%        4%        1%
 in the detection and multidisciplinary management of suspected cases of child physical abuse.

 Oral health professionals at all levels should work in partnership with schools, local councils
 and other health professionals to ensure that the public are aware of the risks to health caused           4%         29%         45%        16%        4%        3%
 by excessive alcohol consumption.

 The DHSSPS and Health Boards should work with local councils, safety organisations and
                                                                                                            4%         21%         45%        27%        3%        0%
 licensed premises to increase the use of safe glasses.

 Oral Health professionals should be aware of the causes of falls among older people and
                                                                                                            4%         12%         39%        36%        5%        4%
 should support falls prevention programmes.

 The boundaries of orthodontic treatment for health reasons and orthodontic treatment for purely
                                                                                                            3%         25%         44%        22%        3%        4%
 cosmetic reasons should be clearly defined in the strategies for the GDS and the CDS.




                                                                              page 35
Dental Branch                                                                                                      Annual Report 2004/2005
                                                                                                          No    Strongly                              Strongly
                                              Question                                                 response agree      Agree   Neither   Disagree disagree

 Nursing staff and trained carers of children with disabilities should receive an oral health
 module that covers how to prevent oral disease, detecting early signs of oral disease and how
                                                                                                           3%      70%      26%       1%         0%       0%
 to access dental services. Parents and other carers should be given advice on maintaining oral
 health.

 The Care Standards for children’s special schools and residential care homes should require
 that: each child has their oral health assessed by a dentist annually; each care plan has oral
 health input; there is a policy for preventing oral disease; arrangements are in place with local         0%      70%      27%       3%         0%       0%
 dental services to provide dental care and when a need is identified these arrangements are
 put into action.

 Trusts should ensure that appropriate transport is available to allow children and adults with
                                                                                                           4%      52%      34%      10%         0%       0%
 mobility problems to access oral care.

 Oral health care needs assessments for children with disabilities should be carried out to
                                                                                                           0%      48%      38%      13%         0%       1%
 agreed protocols throughout Northern Ireland and reported in a standard form.

 The philosophy of lifelong prevention of dental disease should be adopted by all dentists.                0%      73%      25%       3%         0%       0%

 The DHSSPSNI, Health Boards and General Dental Practitioners should employ innovative
 approaches to increase dental service utilisation among older people. The new Primary Dental              3%      42%      40%      16%         0%       0%
 Care Strategy should facilitate this goal.

 Boards and Trusts should continue to work with residential and nursing home staff to improve
 oral hygiene practices and reduce the decay causing potential of food so that levels of root              1%      58%      35%       5%         0%       0%
 caries are reduced.

 Training should be provided to carers of the elderly on how to prevent dental decay through
                                                                                                           3%      60%      38%       0%         0%       0%
 dietary and oral hygiene measures.

 The Primary Dental Care System should make it feasible for oral health professionals to spend
 time with patients on one-to-one oral hygiene and smoking cessation advice (brief                         1%      55%      34%      10%         0%       0%
 interventions).

 Training in brief interventions for smoking cessation should be widely available to primary care
                                                                                                           3%      47%      39%      12%         0%       0%
 oral health professionals.

 Oral hygiene should be integrated into the teaching of general body cleanliness education at
 both pre-school and primary school. For older children oral hygiene should be promoted as                 1%      75%      22%       1%         0%       0%
 part of grooming behaviour.

 Dentists should opportunistically screen at risk patients for oral cancer.                                5%      65%      21%       6%         1%       1%

 Using interdisciplinary and intersectoral approaches oral health professionals should continue
 to work towards increasing the consumption of fresh fruit and vegetables among all children,              1%      49%      42%       8%         0%       0%
 but particularly those from disadvantaged backgrounds.

 An oral health assessment should form part of the multidisciplinary health assessment given to
                                                                                                           0%      55%      35%       9%         1%       0%
 new residents of nursing and residential homes for the elderly.

 The Care Standards for residential and nursing homes for the elderly currently being developed
 in Northern Ireland should include simple indicators that allow the quality of oral healthcare            0%      45%      35%      18%         0%       1%
 provided by the home to be determined.

 National care standards for disabled adults in residential care should ensure that oral health is
 assessed regularly, that protocols are in place for dental care when it is required and that there        1%      56%      36%       6%         0%       0%
 is a policy on the maintenance of oral health.

 The training of dentists, dental nurses, hygienists and therapists should include practical
 experience in the management of those with special needs. Appropriate postgraduate training               0%      60%      35%       5%         0%       0%
 should be available to those who wish to develop their skills in the treatment of the disabled.

 Nursing staff and professional carers should receive training on simple oral assessment
 criteria, how to prevent oral disease in those with mental illness and how to access dental               0%      53%      39%       8%         0%       0%
 services.

 Professionally trained carers of adults with disabilities should receive an oral health module that
 covers how to prevent oral disease, detecting early signs of oral disease and how to access               0%      56%      36%       6%         0%       1%
 dental services. Other carers should be given advice on maintaining oral health.



                                                                               page 36
Dental Branch                                                                                                    Annual Report 2004/2005
                                                                                                        No    Strongly                              Strongly
                                            Question                                                 response agree      Agree   Neither   Disagree disagree

 The Care Standards for those with a psychiatric illness in residential care should ensure that an
 oral health assessment forms part of the general health assessment, that each individuals care
                                                                                                         1%      49%      40%       9%         0%       0%
 plan should have oral health input and that each residential care home has a protocol to ensure
 all residents with an oral health care need have access to appropriate services.

 In modernising primary care dental services, comprehensive access to appropriate dental care
                                                                                                         4%      52%      40%       3%         0%       1%
 should be safeguarded.

 The Chief Dental Officer should establish a multidisciplinary working group to examine the
 shortfall in dental services for special needs patients and develop an action plan to improve           3%      51%      32%      12%         1%       1%
 services for this group.

 As it may take some time to develop a suitable long-term solution to the shortfall in dental
 services for special needs patients, the working group should also investigate remedial                 4%      42%      36%      16%         0%       3%
 measures that can be implemented quickly.

 A regional oral health care needs assessment and a simple survey of dental service usage
                                                                                                         5%      31%      32%      22%         5%       4%
 should be carried out for homeless, travellers and ethnic minorities.

 The DHSSPS, Health Boards and Trusts should work in partnership to try to improve dental
                                                                                                         4%      40%      40%      14%         1%       0%
 service utilisation levels among those groups with historically low levels of dental attendance.

 Access to, and uptake of, dental care should be monitored carefully during any changes to the
                                                                                                         3%      49%      39%       9%         0%       0%
 primary care dental services.

 The Chief Dental Officer should set up a Strategy Implementation Group to ensure that the
                                                                                                         3%      35%      39%      21%         0%       3%
 Strategy recommendations are enacted and to monitor progress towards Strategy targets.

 Each Health Board and Trust should produce an annual action plan and submit this to the
                                                                                                         3%      25%      39%      29%         1%       4%
 Strategy Implementation Group at the beginning of each financial year.

 There should be a mandatory review of the strategy after 5 years. Recommendations and
 especially targets may need to be revised as new information is received and the Strategy               4%      32%      45%      16%         0%       3%
 Implementation Group should give this consideration on an on-going basis.




                                                                              page 37
Dental Branch                                 Annual Report 2004/2005

Appendix B – Summary of responses from the GDS to their PDCS
questionnaire




                               page 38
Dental Branch                                                  Annual Report 2004/2005
1. Please indicate which category best describes your employment situation:
                                           Count     Percent
Practice owner                               261        54.8
Associate dentist                            197        41.4
Vocational trainee                            18         3.8
Total                                        476       100.0

2. Excluding time spent as a vocational trainee, please indicate when you began working
as a GDP:
                                           Count     Percent
2000-2004                                     92        19.3
1990-99                                      145        30.5
1980-89                                      140        29.4
1970-79                                       49        10.3
1960-69                                       12         2.5
Before 1960                                    1          .2
Total                                        439        92.2
Missing                                       37         7.8
Total                                        476       100.0

3. Please state your sex:
                                           Count     Percent
Male                                         299        62.8
Female                                       177        37.2
Total                                        476       100.0

4. Please indicate which age group you fall into:
                                           Count     Percent
<30                                          112        23.5
30-34                                         81        17.0
35-39                                         90        18.9
40-44                                         80        16.8
45-49                                         55        11.6
50-54                                         24         5.0
55-59                                         23         4.8
60+                                           11         2.3
Total                                        476       100.0

5. Which Health and Social Services Board area do you practice in?
                                           Count     Percent
Eastern                                      188        39.5
Southern                                      89        18.7
Northern                                     118        24.8
Western                                       79        16.6
Total                                        474        99.6
Missing                                        2         0.4
Total                                        476       100.0

                                           page 39
Dental Branch                                                                               Annual Report 2004/2005
Question 6. The average number of sessions worked per week (private AND health service. Mean = 8.99)

   50%


   40%


   30%


   20%


   10%


    0%
            5 or less         6              7             8              9            10         11 or more      Missing




Questions 7 and 8. The bar chart below shows the percentage of each dentist’s working
week which is devoted to the health service.
The mean number of Health Service sessions worked per dentist is projected, on the basis of the questionnaires, to drop from 7.7 per
week to 5.0 per week over the next 5 years. Health service dentistry provision would therefore, in 5 years time, be less than two
thirds of what it currently is.


      80%
                            Now
      70%
                            5 yrs
      60%

      50%

      40%

      30%

      20%

      10%

       0%
                Less than 20%           21% to 40%              41% to 60%             61% to 80%           More than 80%
                                           Proportion of time committed to Health Service


9. What is the most important issue facing you as a GDP today?
                                                               Count          Percent
The current remuneration system                                  161             33.8
Maintaining quality of treatment                                  90             18.9
Pay levels                                                        62             13.0
Burden of legislation                                             58             12.2
Limited clinical freedom                                          36              7.6
Other                                                             19              4.0
Extent of practice allowances                                     12              2.5
Career progression                                                 5              1.1
Total                                                            443             93.1
Missing                                                           33              6.9
Total                                                            476            100.0

                                                               page 40
Dental Branch                                                                              Annual Report 2004/2005
10. As it currently stands, how satisfied are you with General Practice Dentistry in NI?
                                                              Count         Percent
Very satisfied                                                    6             1.3
Satisfied                                                        90            18.9
Dissatisfied                                                    217            45.6
Very dissatisfied                                               134            28.2
Don't know                                                        9             1.9
Total                                                           456            95.8
Missing                                                          20             4.2
Total                                                           476           100.0

11. Within General Practice Dentistry do you believe dentists have a role in helping
prevent oral disease?
                                                              Count         Percent
Yes                                                             449            94.3
No                                                                7             1.5
Total                                                           456            95.8
Missing                                                          20             4.2
Total                                                           476           100.0

Question 12. What are the barriers to effective prevention of oral disease in General
Practice Dentistry today?
Respondents were able to select as many options as they wanted. Denominator is all those who felt that GDPs have a role in preventive
dentistry (Q 11).


      100%
       90%
       80%
       70%
       60%
       50%
       40%
       30%
       20%
       10%
        0%
                 No barriers     A lack of training    The current      Poor attendance Poor compliance           Other
                                  in preventative     remuneration     levels for those at levels for those at
                                      dentistry          system           greatest risk       greatest risk




                                                             page 41
Dental Branch                                                                                   Annual Report 2004/2005
Question 13. Thinking about the current system and also the ideal system, what
proportion of your time would be spent on the following tasks?
Denominator is everyone who answered this question (426 for current system and 424 for ideal).


      70%
                    current system
      60%
                    ideal system
      50%

      40%

      30%

      20%

      10%

       0%
              Examination                      Treatment                           Prevention                 Paperwork/
             and diagnosis                                                                                   administration




Question 14. Under any new system, who should undertake one-to-one prevention (e.g.
fissure sealants, oral health education)?
Respondents were able to selection as many options as they wanted. Denominator is everyone who answered this question (474).


      90%

      80%

      70%

      60%

      50%

      40%

      30%

      20%

      10%

       0%
                General dental       Community dentists    Hygienists/therapists     Hygienists/therapists    Other
                 practitioners                                in the General          in the Community
                                                             Dental Service             Dental Service




                                                              page 42
Dental Branch                                                                                           Annual Report 2004/2005
Question 15. In the future do you think that the General Dental Service (GDS) should have
a role in the following?
Respondents were able to selection as many options as they wanted. Denominator is everyone who answered any part of this question
(461).


      90%

      80%

      70%

      60%

      50%

      40%

      30%

      20%

      10%

       0%
                     School dental screening                           Dental surveys                               Smoking cessation




Question 16. In any new primary dental care system implemented in NI, what level of
importance should be attached to each of the following items? Respondents were to
attribute an importance level to each item but this did not happen in all cases. Individual
counts shown for each item.

                                                  Very important        Important       Low Importance

      500
      450
      400
      350
      300
      250
      200
      150
      100
       50
        0
             Improving     Emphasis on      Increased     Simplified      Reduced           Higher       Patient         Ability to         Greater
             oral health     treatment        pay for   remuneration     workload for   proportion of   access to      adjust to local    integration
                           quality rather    dentists      system          dentists     income from      Health            needs         within Health
                           than quantity                                                   practice      Service                            Service
                                                                                         allowances     dentistry                            family




                                                                       page 43
Dental Branch                                                                               Annual Report 2004/2005
Question 17. In the future, monitoring arrangements should include?

    80%

    70%

    60%

    50%

    40%

    30%

    20%

    10%

     0%
          Quality of last course Securing dental fitness Suitability of treatment   Financial impropriety   Other
              of treatment




19. Should the range of treatments available under the GDS be revised?
                                                                Count       Percent
Yes                                                               360          75.6
No                                                                 95          20.0
Total                                                             455          95.6
Missing                                                            21           4.4
Total                                                             476         100.0

22. Thinking about the GDS, would you prefer to practice from privately owned premises
or Health Service owned premises?
                                                                Count       Percent
Private premises                                                  317          66.6
Health Service premises                                           125          26.3
Total                                                             442          92.9
Missing                                                            34           7.1
Total                                                             476         100.0

23. Please indicate the type of practice you work in:
                                                                Count       Percent
Single-handed                                                      56          11.8
Multiple surgery                                                  402          84.5
Total                                                             458          96.2
Missing                                                            18           3.8
Total                                                             476         100.0




                                                             page 44
Dental Branch                                                 Annual Report 2004/2005
24. Please indicate the type of practice you would prefer to work in:
                                             Count Percent
Singled-handed                                  24       5.0
Multiple surgery                               431      90.5
Total                                          455      95.6
Missing                                         21       4.4
Total                                          476     100.0

25. To ensure equitable access to the GDS, should HSS boards have some control over
where privately owned dental practices are sited?
                                            Count   Percent
Yes                                            93      19.5
No                                            362      76.1
Total                                         455      95.6
Missing                                        21       4.4
Total                                         476     100.0

26. Do you currently employ a hygienist or therapist?
                                            Count   Percent
Yes                                           183      38.4
No                                            275      57.8
Total                                         458      96.2
Missing                                        18       3.8
Total                                         476     100.0

27. Would you consider either increasing their hours of work or employing an additional
hygienist/therapist?
                                            Count   Percent
Yes                                           146      78.9
No                                             39      21.1
Total                                         185     100.0
Missing                                       291      61.1
Total                                         476     100.0

28. Would you consider employing a hygienist or therapist?
                                            Count   Percent
Yes                                           209      78.3
No                                             58      21.7
Total                                         267    100.00
Missing                                       209      43.9
Total                                         476     100.0




                                          page 45
Dental Branch                                                Annual Report 2004/2005
29b. Please rate the support you receive for Continuing Professional Development for
YOUR STAFF:
                                           Count   Percent
Very good                                     12       2.5
Good                                          23       4.8
Fair                                          90      18.9
Poor                                         259      54.4
Don't know                                    32       6.7
Total                                        416      87.4
Missing                                       60      12.6
Total                                        476     100.0

30. Please state whether postgraduate courses currently provided in NI are sufficient to
meet your professional development needs:
                                           Count   Percent
Completely                                    33       6.9
Mostly                                       214      45.0
Partially                                    167      35.1
Not at all                                    46       9.7
Total                                        460      96.6
Missing                                       16       3.4
Total                                        476     100.0

31. In any new dental system implemented in NI, contracts should be arranged between
the commissioner of services (currently the HSS Boards) and:
                                           Count   Percent
The dental practice                          169      35.5
Each individual dentist                      280      58.8
Total                                        449      94.3
Missing                                       27       5.7
Total                                        476     100.0

32. Should patient contributions be limited to a small number of fixed charges dependent
on the extent of treatment?
                                           Count   Percent
Yes                                          243      51.1
No                                           201      42.2
Total                                        444      93.3
Missing                                       32       6.7
Total                                        476     100.0




                                         page 46
Dental Branch             Annual Report 2004/2005




                page 47
Dental Branch                                 Annual Report 2004/2005

Appendix C – Summary of responses from the CDS to their PDCS
questionnaire




                               page 48
Dental Branch                                                                                       Annual Report 2004/2005

       Q1. Please indicate which category best describes your grade of employment
                                  (chart shows numbers of responses in each category)


                          50




                          40




                          30
                Count




                          20




                          10




                           0
                                       Clinical Dir.         Sen. Dental Off.        Comm. Dental Off.
                                                                   Grade




       Q2. Please indicate when you began working in the Community Dental Services
                               (chart show percentage of respondents in each category)


                          40.0%




                          30.0%
                Percent




                          20.0%




                          10.0%




                          0.0%
                                       2000-04           1990-99           1980-89        1970-79
                                                       When began work in CDS




                                                                   page 49
Dental Branch                                                                              Annual Report 2004/2005

                                           Q3. Please state your sex
                    (chart show percentage of respondents in each category)


                          100.0%




                          80.0%




                          60.0%
                Percent




                          40.0%




                          20.0%




                           0.0%
                                               Male                               Female
                                                                 Sex




                     Q4. Please indicate which age group you fall into
                (chart show percentage of respondents in each category)


                          30.0%




                          25.0%




                          20.0%
                Percent




                          15.0%




                          10.0%




                          5.0%




                          0.0%
                                   30-34    35-39     40-44     45-49     50-54    55-59   60+
                                                              Age group




                                                        page 50
Dental Branch                                                                                       Annual Report 2004/2005

      Q5. Please indicate whether you work exclusively for the CDS or for both the CDS
                                       and the GDS
                             (chart show percentage of respondents in each category)

                                       100.0%




                                       80.0%




                                       60.0%
                             Percent




                                       40.0%




                                       20.0%




                                        0.0%
                                                          CDS only                    CDS and GDS
                                                                     Where you work




             Q6. Which Health and Social Services Board area do you practice in?


                        25




                        20




                        15
                Count




                        10




                         5




                         0
                                                Eastern       Southern          Northern            Western
                                                                 HSS Board area




                                                                     page 51
Dental Branch                                                                                       Annual Report 2004/2005

      Q7. Thinking about your work in community dental practice in the last year, can
        you please estimate the average number of sessions you worked per week?


                               30




                              25




                              20
                  Frequency




                               15




                               10




                                5

                                                                                                           Mean = 7.92
                                                                                                           Std. Dev. = 2.376
                                                                                                           N = 61
                                0
                                             2                        4          6          8         10
                                      Average sessions per wk worked in last year




       Q8. What is the most important issue facing you as a Community Dentist today?


                              25.0%




                              20.0%
                Percent




                              15.0%




                              10.0%




                               5.0%




                               0.0%
                                                                      W
                                            C



                                                       C


                                                                      O



                                                                      M



                                                                      C



                                                                      Pa




                                                                      C



                                                                      Bu


                                                                      O
                                             lin



                                                        la




                                                                       ar




                                                                       D
                                                                        bt




                                                                        th
                                                                        ai




                                                                        or




                                                                         rd
                                                                         y




                                                                          S
                                                           r




                                                                          er
                                                                          ai



                                                                          nt



                                                                          ee
                                                ica




                                                                           k/
                                                             ity




                                                                           le




                                                                            en
                                                                            ni




                                                                             fu
                                                                             ai




                                                                             life
                                                                              rp



                                                                              ve
                                                 l/A



                                                               of



                                                                                ng



                                                                                ni




                                                                                nd



                                                                                 of
                                                                                  ls
                                                                                  ro
                                                                                   ng




                                                                                   ba
                                                      dm



                                                                  ro




                                                                                    in
                                                                                     va




                                                                                     le
                                                                                      gr




                                                                                       g
                                                                    le




                                                                                       la
                                                                                        qu




                                                                                        gi
                                                       in




                                                                                        lid




                                                                                         es




                                                                                          nc




                                                                                           sla
                                                                                            al
                                                           ba




                                                                                            sio
                                                                                             co




                                                                                             e
                                                                                              ity




                                                                                               tio
                                                              la




                                                                                                 ns




                                                                                                 n
                                                                nc




                                                                                                   n
                                                                                                   of
                                                                                                    en
                                                                  e




                                                                                                      tre
                                                                                                       t



                                                                                                          at
                                                                                                            m
                                                                                                              en
                                                                                                                t




                                                           Most important issue facing you today




                                                                           page 52
Dental Branch                                                                        Annual Report 2004/2005


              Q9. As it currently stands, how satisfied are you working in the CDS?


                            70.0%




                            60.0%




                            50.0%
                  Percent




                            40.0%




                            30.0%




                            20.0%




                            10.0%




                             0.0%
                                    Very satisfied   Satisfied     Dissatisfied    Very dissatisfied
                                                     How satisfied in CDS




      Q10. Within the CDS do you believe dentists have a role in helping prevent oral
                                        disease?

        100


         90


         80


         70


         60


         50


         40


         30


         20


         10


          0
                                      Yes                                         No response




                                                       page 53
Dental Branch                                                                             Annual Report 2004/2005


      Q11. What are the barriers to effective prevention of oral disease within the CDS
                                           today?
      100%

       90%                 CDS dentists
       80%                 GDS dentists
       70%

       60%

       50%

       40%

       30%

       20%

       10%

       0%
                 No barriers    Lack of training       Inadequate         P attendance
                                                                           oor             oor
                                                                                          P com    pliance   Other
                                                     resources/ the            levels          levels
                                                   remuneration system




             Q12. Thinking about the current system and also the ideal system, what
                 proportion of your time would be spent on the following tasks?




        70
        60
                                                                              Current          Ideal
        50
        40
        30
        20
        10
             0
                 examination and             treatment                   prevention      paperw ork/admin
                    diagnosis




                                                            page 54
Dental Branch                                                                             Annual Report 2004/2005


       Q13. Under any new system, who should undertake one-to-one prevention (e.g.
                         fissure sealants, oral health education)?

    100%
                     D iew
                    C Sv
     90%
                     D iew
                    G Sv
     80%

     70%

     60%

     50%

     40%

     30%

     20%

     10%

     0%
               Ds
              GP              om unity
                             C m dentists     Hygienists/therapists in G S
                                                                        D    H                         D
                                                                              ygienists/therapists in C S    Other




       Q14. In the future do you think that the CDS should have a role in the following?
                                            (% answering yes)



     100%
      90%
      80%
      70%
      60%
      50%
      40%
      30%
      20%
      10%
       0%
              school dental screening             dental surveys                                smoking cessation




                                                 page 55
Dental Branch                                                                                                                      Annual Report 2004/2005


       Q15. In any new primary dental care system implemented in NI, what level of
               importance should be attached to each of the following items?
               (percentage of respondents who felt that these issues were very important)




        100%

        90%

        80%                                                                                           CDS         GDS

        70%

        60%

        50%

        40%

        30%

        20%

        10%

         0%
               Improving oral health Em                  ent
                                       phasis on treatm Ability to adjust to local Patient access to HS Greater integration into   Increased pay for   Reduced workload for
                                      quality not quantity        needs                  dentistry            HS fam  ily               dentists             dentists




         Q16. Should the quality of dental care provided by the CDS be monitored?



                          100.0%



                           80.0%



                           60.0%
                Percent




                           40.0%



                           20.0%



                            0.0%
                                                                          Yes                                                         No
                                                                    Should CDS be monitored




                                                                                   page 56
Dental Branch                                                                                 Annual Report 2004/2005


      Q17. How would you say that the number of people seeking dental care from the
                      CDS over the last twelve months has varied?

                            80.0%




                            60.0%
                  Percent




                            40.0%




                            20.0%




                             0.0%
                                            No change              Increase             Decrease
                                                 Patient levels over last 12m




                              Q19. Under any new arrangements who do you think
                            should be able to receive health service dental care from
                                                    the CDS?



     100%
     90%
     80%
     70%
     60%
     50%
     40%
     30%
     20%
     10%
      0%
            Everyone                u18's   All in F-T   Adults on The elderly (65+) Special needsExpectant/nursing   Other
                                            education qualifying benefit                              mothers




                                                             page 57
Dental Branch                                                     Annual Report 2004/2005


         Q20. Should the CDS be allowed to charge some patients for dental care?


                          80.0%




                          60.0%
                Percent




                          40.0%




                          20.0%




                             0.0%
                                       Yes                        No
                                         Should CDS charge




         Q21. Should the range of treatments available under the CDS be revised?


                             50.0%




                             40.0%




                             30.0%
                   Percent




                             20.0%




                             10.0%




                              0.0%
                                        Yes                       No
                                     Revise range of treatments




                                              page 58
Dental Branch                                                                         Annual Report 2004/2005

      Q24. Do you feel there is a need for additional hygienists/therapists in your trust?




                            100.0%



                             80.0%



                             60.0%
                  Percent




                             40.0%



                             20.0%



                              0.0%
                                                 Yes                             No
                                     Need additional hygienist/therapists in Trust




      Would you consider either increasing their hours of work or employing an additional
                                     hygienist/therapist?



            100
             90
             80
             70
             60
             50
             40
             30
             20
             10
              0
                                        Yes                                             No


      Similar figures for those not already employing a hygienist/therapist




                                                       page 59
Dental Branch                                                                  Annual Report 2004/2005


     Q25. Please rate the support you receive for Continuing Professional Development




        60%
                                                                                    Dentists
        50%
                                                                                    PCDs
        40%

        30%

        20%

        10%

         0%
                   Very good          Good             Fair            Poor        Don't know




      Q26. Please state how well postgraduate courses, currently provided in NI, meet
                          your professional development needs

                          60.0%



                          50.0%


                          40.0%
                Percent




                          30.0%


                          20.0%


                          10.0%



                           0.0%
                                  Completely     Mostly        Partially     Not at all
                                  Postgrad courses sufficient for prof dev needs




                                                    page 60
Glossary
BDA        British Dental Association
BIFHE      Belfast Institute of Further and Higher Education
CDO        Chief Dental Officer
CDS        Community Dental Service
CFPU       Counter Fraud Policy Unit
CPD        Continuing Professional Development
CRC        Claim to Record Check
CSA        Central Services Agency
DETI       Department of Economic Trade and Industry
DHSSPS     Department of Health, Social Services and Public Safety
DPC        Dental Practice Committee
FE         Further Education
GA         General Anaesthesia
GDC        General Dental Council
GDOS       General, Dental & Ophthalmic Services
GDP        General Dental Practitioner
GDS        General Dental Services
GPT        General Professional Training
HDS        Hospital Dental Services
HPSS       Health and Personal Social Services
HSSB       Health & Social Services Board
ICT        Information & Communication Technology
IV         Intravenous [Sedation]
NCAA       National Clinical Assessment Authority
NCAS       National Clinical Assessment Service
NICPMDE    Northern Ireland Council for Postgraduate Medical & Dental Education
NIMDTA     Northern Ireland Medical & Dental Training Agency
OHS        Oral Health Strategy
PCD        Profession Complementary to Dentistry
PDCS       Primary Dental Care Strategy
PfA        Priorities for Action
RA         Relative Analgesia
RDO        Referral Dental Officer
RDS        Referral Dental Service
SDR        Statement of Dental Remuneration
SOD        School of Dentistry
SUMDE      Supplement for University Medical & Dental Education
VT         Vocational Training Scheme
YOC        Young Offenders Centre
                     Produced by:


Department of Health, Social Services and Public Safety,
           Castle Buildings, Belfast BT4 3SQ


              Telephone (028) 90 522710
              Textphone (028) 90 527668
                 www.dhsspsni.gov.uk


                     October 2005
                     Ref: 134/2005

								
To top