The Progress of Oral Health Integration
The Integration of Oral Health
“Improving oral health in England: prevention, contract reform and delivery".
A timely policy conference on the integration of oral health care into the NHS Long Term Plan, promote prevention as part of the whole systems approach to oral health. ©Westminster Health Forum, 4thJuly 2019.
The recognition that oral health is important to general health, lack of integration between oral health and health care services potentially impact negatively on patient care, increasing the need to ‘put the mouth back in the body’ as part of healthcare pathways.
These are the Chair’s opening remarks, summarizing the aims of the conference:
Malcolm Smith, Chair of Advancing Dental Care Review, Health Education England (HEE) & Postgraduate Dental Dean, HEE North East. |
The deputy CDOs for England Janet Clarke and Eric Rooney set out the context and the structure for the integration of oral health into the NHS Integrated Care Systems, part of the NHS Long Term Plan.
This is how Janet Clarke started by asking “how do we integrate oral health into Integrated Care Systemsâ€. It is important that discussions about oral health are done with clear understanding of what’s happening within NHS England. For dentistry to be delivered in an effective way, it is important that dental care professionals are aware of what’s happening and have the necessary skills on how to go about integrating into NHS systems and the NHS Long Term Plan. ‘Putting the mouth back in the body’ has never been more important than in the current context. The development of Integrated Care Systems and Primary Care Networks, are all areas where dentistry and oral health have a part to play, but they are not sufficiently on the agenda yet. It is an important opportunity to put dentistry and oral health in its rightful place within the NHS.
Janet Clarke described Primary Care Networks (PCN) as the building blocks of NHS England, and the smallest denominator. They are networks of practices that are coming together, serving a population in theory of between 30,000 and 50,000. They aggregate up into a place, and the place can be thought of as a larger population probably clustered around for example a district general hospital. A number of Primary Care Networks are coming together and working on a place basis and linking in with a hospital. The Integrated Care Systems cover a larger population, 44 of those are in England and currently they are looking at system strategy and planning. A number of issues in oral health, are actually system problems needing system solutions, and these are the Integrated Care Systems, the level at which oral health must be placed. The focus in Primary Care Networks is on general medical care, and it is the general medical practitioners who have come together to form those Primary Care Networks. It will be useful to explain briefly how medical practices in England came together to form Primary Care Networks, there are 1,200 of them.
It is now possible to have appointments may be out of hours or a weekend, at a different practice that’s within that Primary Care Network. It can be an appointment with a doctor, but it may well be with a clinical pharmacist, a physiotherapist, a nurse or whatever. How did it happen? It is a bit of stick and carrot, the Primary Care Networks have been given a budget, they can employ health care professionals, making that Primary Care Network an entity which has money and can do things.
The raison d'etre for Primary Care Networks is the
delivery of patient centric health care
Though the networks are based around general medical practices, they include other health providers. Services that are community based, are linked to Primary Care Network to help support the GPs to provide patient centric services. Other services within the NHS Primary Care Networks will link to secondary care, delivered by hospitals.The objective is that patients will get their care closer to home and avoid having to go into secondary care by integrating care from providers based in the community. It is critical to bring health care providers together and look at pathways of patient centric care including prevention to help support the GPs to provide patient centric services. Other services within the NHS Primary Care Networks will link to secondary care, delivered by hospitals. The objective is that patients will get their care closer to home and avoid having to go into secondary care by integrating care from providers based in the community. It is critical to bring health care providers together and look at pathways of patient centric care including prevention services. Primary Care Networks (PCNs) created an important opportunity for oral health services.
From 2020, PCNs in order to fulfill their contractual obligations and receive their funding, they must demonstrate that they are involving other providers. The dental profession should be ready to be involved and able to add value.
Eric Rooney Deputy CDO, is also Chair of the Local Dental Network in Lancashire and South Cumbria, his presentation on the ‘Integrating oral health into Integrated Care Systems’ is on the progression of Primary Care Networks, and how they can deploy a local approach. For more on Healthier Lancashire and South Cumbria https://www.england.nhs.uk/integratedcare/integrated-care-systems/lancashire-and-south-cumbria-ics/
Lancashire and South Cumbria have 41 Primary Care Networks. At the very Primary Care Network level there is a primary care strategy in the area which describe the importance of networks and not just about GPs, but about a whole range of people, and dentists are included, and a local dental practice is involved. As the local dental network, and a lot of work have been done to encourage that, and see if this can create a delivery model of how this approach might work in Fleetwood, a small town North of Blackpool. It also has a fairly proscribed population, and has a kind of clear boundaries. The focus of community that they definitely have in Fleetwood, might be difficult to replicate in a place like central London.
Dentistry is now part of the Fleetwood Primary Care Network , which support primary and social care. The non-dental parts of the health and social care system, need to appreciate why oral health is important, and how good oral health can prevent diseases. A form of signposting to ensure that people get directed to dental services when it is appropriate, and health issues flagged by the dentist and directed to appropriate local services. Also general prevention, where common risk factors for oral diseases linked to coronary heart disease, diabetes and other preventable conditions. This will ensure every contact count.
Making every contact count, deliver better oral health.
Eric Rooney, Deputy CDO England
Making every contact count has been implemented with a focus on particular groups of the population identified with issues in Fleetwood. Bespoke services were developed from the start of the Primary Care Network. The following are some of the bespoke services developed:
as expected in a fairly deprived area, children’s oral health is poor; oral health in care homes now have a national profile. The Primary Care Network in Fleetwood is being used as a test bed to build this approach. From what has been learnt so far, it will be rolled out across the integrated care system, developing a Primary Care Network integration toolkit.
The Strategic Approval for this work, part of the Integrated Systems Approach(ICS), was based on the recognition that dentistry has a part to play, placing dentists into the proper structure of the Integrated Care Systems. The Strategic Development aspect is being led by the Local Dental Networks(LDN), it’s important that NHS England provides some support and funding to enable this essential work to continue. It is very different from using the existing Units of Dental Activities (UDAs) in a dental practice, part of the current dental contract.
For workforce development, dental care professionals must go on a journey to be able to work within the Integrated Care Systems, and Health Education England has an important role to play.
The next level is around the Place based activity. Blackpool which is right next to Fleetwood provide a good example, and show why the Place based activity must link with the local council. There is a range of different services, such as the school breakfast scheme with fluoridated milk and teeth brushing in schools. These services come under the governance of local council, including the Smile for Life initiative at a practice level.
Sara Hurley, CDO England focused on the issues relevant to “Developing a holistic approach to oral health – next steps for policy†a logical continuation of the story of oral health.
This is how she summarize her vision:
Increasing access to oral health, it may be that we’ve got to think differently, we’ve got to think outside the traditional clinical dental box. And if we can’t necessarily get people coming to us, maybe we have to go to them and we might have to think about alternative messages.
Sara Hurley, CDO England
On digital technology, the dental sector is significantly behind for example community pharmacy, and there is a lack of community partnerships. But as we heard from Janet and Eric, a structure has been developed, there are integrated clinical pathways, the management of networks, and the Primary Care Networks need to be connected, talking the same language whether that be face to face or whether that be virtually in a digital context. For the development of the dental workforce, it has to meet the needs of the population. There is more than enough work, albeit a different type of work from 10 years ago. Today there is a different set of demands; there are different demographics with different needs. There is a need for a workforce confident and competent to meet those new challenges. And the challenges are there at all levels, including the strategic level. The new structures in terms of NHS England as described by Eric, designed to meet the needs of the population, with emphasis on the education and training of the dental work force.
The integration of oral health and dental services is good news for public health services for children and our collaborative project with Charlton Manor primary school 'Childhood Obesity & Oral Health: A plan for action'. Tooth decay remains the most common reason for hospital admission in children aged six to 10, with those from deprived areas most likely to suffer problems.
For more on the role of local councils on tackling tooth decay:
https://www.local.gov.uk/whole-systems-approach-tackling-childhood-tooth-decay.
Examples of community based oral health services we came across in different parts of the country:
- Tower Hamlets is the first London borough to commission a local GDP to deliver annual dental screening for all primary and nurseries schools in the borough. HAC5433 Healthy Teeth in Schools Programme
- Manchester NHS Community Dental Service
“When the Dental Team comes to School†http://2020dentistry.com/when-dental-team-comes-school
Post contributors:
Samira Salbi Digital Editor
Fiona Flaherty Digital Reporter
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