Quality Improvement Group Reviewing Provision of Salaried Dental Service Provision in Dumfries and Galloway 7th December 2016 Valerie White - Consultant Dental Public Health/Public Health NHS Dumfries and Galloway

Why did we need to review? Scottish Government were requiring us to submit Integrated Financial Plans for the Salaried Dental Service Access to independent contractor dental service had improved significantly There were service pressures within dental services for those with additional dental support needs and additional service capacity was required Good practice to review service provision and have a strategic plan for future delivery

Overview of Current Access to NHS Dental Services 80%% of the population registered with an NHS dentist Local Health Partnership % of the population registered as at 30th September 2010 % of the population registered as at 30th December 2012 % of the population registered as at 31st May 2014 Annandale & Eskdale 63 75 80 Dumfries and Upper Nithsdale 56 73 78 Stewartry 60 Wigtownshire 67 77 81 *3.6% of registrations are not included in the table above

Estimated Percentage of Dental Registrations by Intermediate Geography as at 30th September 2010

Estimated Percentage of Dental Registrations by Intermediate Geography as at 31st December 2012

Estimated Percentage of Dental Registrations by Intermediate Geography as at 31st May 2014

Provision of Salaried Dental Services in D&G The following clinics provided routine General Dental Services: Dumfries Dental Centre (outreach teaching/therapy school and special care) Lochmaben, Lochside, Newton Stewart , Sanquhar Total registrations with the Salaried Dental Service stand at 7,770 as at May 2014* 93% registrations independent dental contract SS 7% Retraction of routine GDS by PDS from CD in 2008 and Stranear in 2012

Overview of the review process Consultation with Salaried Service Staff, Independent Contractors and key stakeholders on future options Data on a number of issues highlighted was reviewed Working Group undertook an initial options appraisal of all options put forward A short list of options was agreed Agreed that an options appraisal exercise for each clinic was required with a wider stakeholder Started in June 2013

Overview of the Review Process Options Considered at each appraisal

Overview of the review process Patients were made aware of the options under consideration via posters at the clinic Individual options appraisal exercises were held with representation from clinic patients, public, Staff Side, Human Resources, Independent Dental Contractors, Salaried Dental Service Management, Finance, Public Health and Primary Care Development The appraisals consisted of a qualitative aspect which involved discussion of the risks and benefits of each options followed by consensus scoring of key themes identified This was followed by a separate financial appraisal which estimated the costs of each option under consideration The results of each aspect were then combined (60/40 weighting) to provide a preferred option for each clinic

Overview of the review process The preferred options were communicated to: Staff Independent Dental Contractors Patients Key Stakeholders

Overview of the review process The Review Team worked very closely with the Scottish Health Council throughout the review process to ensure that proportion public involvement was achieved Following the significant amount of patient feedback obtained it was agreed that time would be taken over summer 2014 to: Reflect fully on the patient comments received between the 29th of January and the 27th June 2014 and consider if any further work is needed before finalising the report and its recommendations. Complete the review of accessibility of Independent Contractor Practices which patients to date have noted as a concern. Repeat the Equality and Diversity impact assessment following the patient feedback and review of accessibility.

Key Themes from Patient Feedback Patients would like to continue with services as they are Level of disabled access, facilities and parking of Salaried Clinics noted Concern over ability to register with an NHS Practice locally Concern over sustainability of other practices to continue to provide NHS services Concern about the level of services provided at other independent contractor practices Concern over increased costs Feeling that changes being driven by finance as opposed to improved patient care.

Final Service Review Recommendations Clinic Final Recommendations Dumfries Dental Centre Withdrawal of the provision of routine NHS general dental services at the dental clinic with patients being transferred to independent contractor practices for continued provision of NHS general dental services at the transferred practices site/premises. Lochmaben Dental Clinic Newton Stewart Further work with local independent dental contractors and Salaried Dental Service staff to be undertaken to ensure sustainable, accessible routine NHS dental services for patients in this area prior to the complete withdrawal of routine NHS dental services by the Salaried Dental Service. Lochside Continued provision of routine NHS general dental services at the clinic site by the independent dental contractor sector. With further service review to be undertaken if this is not possible. Sanquhar Only option changed was Newton Stewart

Final Decision NHS Board agreed to all the recommendations in October 2014 – this went to a vote Dumfries Dental Centre and Lochmaben clinic routine GDS patients transferred April 2015 Sanquhar and Lochside clinic – attempts to lease in 2015 failed Newton Stewart – further work has been undertaken with the local independent dental contractor practices and patients will be transferred spring 2017 Review started in June 2013 2000 patients transferred 600 could not be followed up. Were reviewed by clinicians to see if vulnerable

Sanquhar and Lochside Sanquhar Lochside New independent contractor practice in planning so situation being kept under review Lochside NHS Board agreed to further review in October 2015 Similar process been gone through In November 2016 Integrated Joint Board were asked to approve the move to consultation on the preferred option...............

What have I learnt Service re-design is not easy and it is not quick Communications Senior Management Support Timing Politics TUPE Integration Joint Boards

Any Questions?