New in commissioning dental public

health
Commisioning
- ‘A proactive strategic role in planning, designing and implementing the range of services
required in order to meet the needs of the population’
- Department of health – £107bn
- NHS England has a budget of £95.6bn
£3.4bn in dental care

Policy Drivers of Commisioning

Government made a commitment to oral health and dentistry to:

- Introduce a reformed NHS primary dental care contract

- iImprove the oral health of the population, pareticularly children
- Increase access to primary dental care services

The Public Health Outcomes Frameowork (2013-2016) includes ‘tooth decay in five year old
children’ as an outcome indicator – in the wider NHS

The NHS Outcomes Framework (2014-2015) includes indicators related to patients experiences and
access to NHS dental services

Both the above raise profile of dental needs on a NATIONAL BASIS

- NHS England is the national commissioner for NHS dental care in England
o Over 90% of NHS dental care is carried out in primary care settings

NHS commissioning board, now NHS England commissions all NHS dental services as apposed to the
152 PCTs as the PCTs were commissioning themselves and many PCTs were not commissioning in
the correct way.

o Resulted in better integration of primary and secondary services

o Occurred after the Steele report
o NHS CB, as a single commissioner of all dental services , can achieve who-England
strategic planning and consistency in approach and direction. This single
commissioner focus will offer dentistry a unique opportunity to share excellence
across England
 Needs of local
population

Figure 1. The commissioning cycle

All Employed by NHS England for Dental Commisioning

- National support centre + the Chief Dental Officer

- Regional Teams
- Local Area Teams (LATs)
o CCGs are more interested in medical and MAXFAX than dentistry (do not worry
about them)
- Local Dental Network (LDNs)
o A clinically-led network bringing together all dental sectors to support service
commissioners. On an LDN primary care dentists, secondary care dentists, practice
owner etc. and feed in towards commissioners
 LDNs bring everybody together to try and improve health outcomes and
provide a positive healthcare experience

https://www.rcseng.ac.uk/fds/policy/documents/fds-report-on-the-state-of-childrens-oral-health

http://www.local.gov.uk/documents/10180/5854661/L14-
352+Tackling+Poor+oral+health+in+children/3dd8097f-35b7-42ba-b3c7-186266da82db - Local
government and public health England
 - Local Government & Commisioning
o Local Authorities (Las) have a statutory responsibility to provide or commission oral
health improvement programmes to improve the health of the local population
o Marmot Review
 Adopt an integrated approach with partners for oral health improvement
 Give every child the best start in life
 Adopt the priniciple of proportionate universalism

Delivering Better Oral Health and the Dental Contract Reform Prototype

- Prototype
o Clinical Pathway (shows a patient journey from start to finish)
o Set of clinical measures (dental quality and outcome framework (DQOF))
o Payment better aligned with access and clinical outcomes
- A practices contract value and remuneration will be split between:
o A capitation element
o An activity element
o A quality remuneration adjustment (In theory up to 10% of remuneration will be at
risk)
- The prototype quality and outcomes framework
o 30% - Clinical effectiveness
o 30% - Best practice, of which
 15% best practice (DBOH)
 15% best practice (NICE guidance compliance)
o 20% - patient experience
o 10% - safety
o 10% - data quality

READ: LEARNING FROM CONTRACT CHANGE