DEPARTMENT OF HEALTH, LONDON
5TH NOVEMBER 2010
Present: Barry Cockcroft (Chief Dental Officer. CDO)
Sue Gregory (Deputy Chief Dental Officer, DCDO)
Mary Henderson (BSPD)
Zoe Marshman (BSPD)
Helen Rodd (BSPD)
Purpose of meeting
For BSPD to initiate a dialogue about the future of children’s oral health and dental services.
1. Implications of the White Paper for paediatric dentistry
i. Incentives in the new dental contract for prevention and treatment of children
ii. Commissioning of salaried dental services and hospital dental services and interface with primary care
iii. Future of local oral health promotion programmes and possibilities of introducing national programmes akin to Childsmile/Designed to Smile (need to target pre-school children)
iv. Implications of increasing freedoms of Foundation Trusts, GP consortia, and abolishment of Primary Care Trusts for children’s dental services
2. National Child Dental Health Survey, 2013
SG stated that children’s oral health currently has a stronger emphasis than ever before. The Secretary of State for Health had voiced a strong commitment to this in recent White Paper documents.
Summary of discussions
i & ii) Commissioning of children’s dental services
It is still not exactly clear how dental services will be commissioned. Certainly the central National Commissioning Board (NCB) will have ultimate accountability for ensuring robust commissioning. However it is likely that there will be some more local presence of the NCB with specific dental expertise, (yet to be defined) that will also have responsibility for ‘day-to-day’ dental commissioning.
There are likely to be a number of anomalous aspects which will need to addressing, such as Primary Dental Service contracts cannot currently include provision of GA services.
The emphasis of the new commissioning process is on a robust system that ensures the best patient outcomes. Hence, services will be commissioned from providers who can demonstrate outcomes, ie contacts will be driven by these outcome measures rather than activity. It is hoped that, if the NCB has a remit to cover all aspects of dental services (primary, secondary, tertiary etc), the commissioning will be more integrated with a more informed overview, and will ensure services are more homologous throughout different regions. From the DH’s perspective, it wished to commission according to patients’ outcomes rather than to commission specific services (eg specialist services).
ii) The new dental contract
The three elements of the new dental contract will be registration, capitation and quality. Work is still ongoing in developing the ideal model but capitation will be weighted according to patients’ age, gender and level of deprivation. BSPD enquired whether specific weighting would be ascribed for children and was informed that pilot studies were underway to investigate the weighting according to oral health assessments.
iv) Clinical care pathways
Clear clinical pathways are fundamental to effective patient care. It was evident from discussions, that paediatric dentistry needed to have a clear overview of clinical care pathways for children. There needs to be greater emphasis on clinical leadership (which is on the Secretary of State’s agenda) for specialists and consultants to better support local clinical networks and optimise skill mix.
ACTION 1 – MH to lead on developing a clinical care pathway for children’s dental services, which will help inform future commissioning.
v) Health promotion
The DCDP and CDO had recently discussed population, community and practice-based approaches for prevention of oral disease with Lord Howe. Numerous schemes involving children’s centres, health visitors, schools and nurseries, and dental practice-run oral health promotion units were discussed. Currently there are a variety of funding schemes through which such oral health promotion schemes are funded. It was not clear how the new commissioning process would address future funding of such schemes, but the DCDO and CDO had a clear intent to ensure that future schemes should be effective. With the development of the national Public Health Service and location of Directors of Public Health in Local Authorities, it was likely that a separate budget could be allocated for public health interactions. SG stated that she was working on the 3rd revision of ‘Developing better oral health’ which would also have a patient-friendly version. ZM highlighted the need for a patient-friendly version to be developed with children using appropriate methodology. The DCDO and CDO had a strong commitment to ensure prevention was a priority in the new contract.
ACTION 2 – ZM to have further discussions with SG in advising about a child-friendly version.
vi) Child Dental Health Survey 2013
The DCDP and CDO stated that they were seeking to secure a budget for the 2013 child Dental; Health Survey.
vii) Future meeting with Lord Howe
HDR sought advice from the DCDO and CDO as to the most appropriate line of discussion to pursue with Lord Howe, as she was keen to highlight the vision and commitment of BSPD in actioning better oral health for children. The DCDO and CDO stated that Lord Howe was already extremely interested and supportive of this area, and would most likely welcome a meeting with BSPD representatives.
ACTION 3 – HDR to prepare a briefing document, following on from this meeting, to present to Lord Howe. She would seek advice from the CDO and BSPD prior to seeking a meeting with Lord Howe.
HDR thanked the DCDO and CDO for the opportunity to have the meeting and again stressed the commitment of BSPD members to ensure high quality and equitable oral health care for all children.
The DCDO and CDO were keen to work together with BSPD in this endeavour and action points were identified. Despite fundamental changes to health service commissioning and the future of traditional dental care services and infrastructures there was a clear commitment to improve the oral health and dental experiences of children. Paediatric dentistry specialists and consultants have a clear remit to lead in clinical care networks, education and provision of care for children with complex medical, behavioural or dental needs in appropriate settings.
The CDO expressed a willingness to come and discuss these key issues relating to children’s oral health at a national BSPD meeting. HDR will follow up this excellent opportunity by liaising with Prof Welbury, Chair of the 2011 scientific meeting.