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DENTAL PRACTICE A


Providing information, direction, education and entertainment for the dental team


Dental Quality and Outcomes Framework to be piloted


S part of its proposed reform of NHS denti stry, the government will allow


denti sts a great deal more freedom to make their own decisions, using their own clinical judgment about what is in the best interests of their pati ents.


The pilots, though, as well as


testi ng ways of paying denti sts, will also develop a new Dental Quality and Outcomes Framework (DQOF) which will measure the quality of their work, and the clinical outcomes they achieve. The government believes that such a framework is a bett er way of holding denti sts to account, rather than simply measuring the number of units of dental acti vity they provide. The intenti on is to put in place “an NHS dental service delivering high quality clinically appropriate preventi ve, routi ne and complex care for those who choose it”. This should be achieved through a new nati onal contract based on registrati on, capitati on and quality. The Department of Health last


month published its initi al proposals on quality indicators, covering clinical eff ecti veness, pati ent experience and safety. This was developed by a group containing members from dental public health and general dental practi ti oners


nominated by the Briti sh Dental Associati on. The intenti on is that payments in the pilots will represent 10 per cent of the practi ce contract value. There will be 1,000 points available, with 600 for clinical eff ecti veness, 300 for pati ent experience and 100 for safety. These fi rst proposals will be refi ned in the light of experience in the pilots and so should not be regarded the last word on the DQOF as it will be applied across England, probably from 2014.


Clinical effectiveness A key component of all pilots will be the implementati on of oral health assessments and a pathway approach to care, supported by evidence-based clinical guidelines where available. The initi al assessment of a pati ent’s oral health status is carried out when a pati ent fi rst visits a practi ce. It involves taking a full pati ent history and carrying out a thorough dental and head and neck examinati on. Standardised informati on is


collected which supports decisions about preventi on, treatment and recall frequency. The DQOF aims to measure maintenance or improvements in oral health in respect of dental caries and periodontal conditi on. To


earn points, the denti st must demonstrate that, for instance, three-quarters of adults show no deteriorati on in acti ve decay or that a similar proporti on show maintenance or improvement of their BPE scores.


Patient experience and safety Pati ent experience is seen as a fundamental part of the quality framework; there is a need to ensure that the service delivered is in line with pati ent expectati ons and that outcomes are in line with what pati ents want and need. However, the way in which such


data are collected has yet to be defi ned. In the pilots, questi ons to pati ents will cover issues such as whether they are sati sfi ed with the treatment received, how helpful staff were and whether pati ents were sati sfi ed with the cleanliness of the practi ce. On pati ent safety, the DQOF


says that most safety measures come under the remit of the Care Quality Commission and General Dental Council. Overall therefore it says that pati ent safety should not be rewarded, but points will be available for demonstrati ng that up-to-date medical histories are maintained.


NHS dentistry to be commissioned centrally N


HS denti stry in England will be commissioned by the NHS Commissioning Board


when Primary Care Trusts go, rather than by GP consorti a. This was forecast in the


Government’s White Paper in July last year, but is confi rmed by the Health Bill, introduced into Parliament by Health Secretary, Andrew Lansley. Most of the comments and


criti cism of this measure revolve around handing over 80 per cent of NHS spending to the GPs. A few days before the Bill was published the Health Select Committ ee, chaired by a former Conservati ve


Health Secretary, Stephen Dorrell, warned that the aboliti on of Primary Care Trusts and the transfer of commissioning to GP-led consorti a “came as a surprise to most observers”. The committ ee said it intended to


review the arrangements proposed in the Bill for the commissioning of primary care services. The Department of Health has sought to justi fy its decision to give commissioning of primary care, including NHS denti stry, to the new board.


The board will be responsible


for maintaining lists of dental contractors and the recogniti on


Full details on page 36 or at www.elitepracticeawards.com www.dental-practice.org


of local contractor representati ve committ ees. Responsibility for developing dental needs assessments, however, will be part of the Public Health Service functi on of Local Authoriti es, as well as other Continued on page 4


Entries are now invited for... Vol. 49, No. 2 FEBRUARY 2011


INSIDE THIS ISSUE CLINICAL


Robinson’s Referrals ...page 10


FEATURE From the ground


upwards...page 24 LAB TALK


A technique to help get the bite right...page 28


REPORT The Premier


Symposium...page 38


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