GIRFT in Hospital Dentistry Elizabeth Jones National Clinical Lead

Aims and Objectives To understand the GIRFT methodology and how it has been applied to Hospital Dentistry To appreciate the limitations for Hospital Dentistry To understand how GIRFT may be used for the future in understanding the role of Hospital Dentistry

What is GIRFT? ‘GIRFT is a clinically led national programme, consisting of a review and implementation team, designed to improve clinical care in the NHS. Through innovative use of data to reduce unwarranted variation in the way services are delivered, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes.’

What is GIRFT contd. ….’ where national clinical leaders engage in peer- to-peer discussions with clinicians and hospital managers…. With a view to encouraging service improvement’ …’the data pack is not used to ‘performance manage’ the unit but uses comparative data to provide fresh insights into the way the department functions’

Particular challenges for dentistry 11 dental specialties rather than 1 No one specialist society to work with, therefore a joint initiative with the RCS Relationship with OMFS

Challenges contd. A mix of surgical and medical Poor OPCS codes particularly for orthodontics and restorative Mostly outpatients so no co-morbidities or diagnoses captured Dental hospitals v very small providers

Timeline Defined the metrics for the four major dental specialties Confidential data pack for 109 trusts Seven questionnaires Deep dive visit to all trusts. Observation notes to with recommendations and notable practice National Report

Questionnaires The four major specialties plus the following as they do not have specific procedures to code Special Care Dentistry Oral Medicine Dental and Maxillo facial radiology

Limitations Many of the treatments we want to look at to determine whether there are outliers are actually diagnoses: TMD Facial Pain Oral Medicine conditions Paediatric dental trauma Tooth Wear

Hospital Dentistry Data Pack for each trust 13 Trust based metrics CQC data Specialty data and procedure data- 359 metrics Finance data Litigation data

Oral Surgery Relationship with OMFS – the role of consultant status Variation in coding for care setting Co- morbidities Sedation The role of HD in treating complex medical patients

Orthodontics Coding Interdisciplinary v non-interdisciplinary Effect of training Effect of commissioning

Restorative Large difference between dental hospitals and trusts ( district general hospitals) RD in oncology units have a specific remit Data pulled for Endo, Perio and Prostho Coding is non specific eg for dentures and obturators

Paediatric Dentistry All dental treatment procedures on children is being captured even in the absence of a PD ‘department’ Role of the CDS Triaging for GA and repeat GA Some trusts are treating large numbers of children under OMFS

Financial data Do the clinicians recognise the Reference Cost Index for each specialty ? Is there a regular meeting with the finance team to ensure the correct apportioning of costs to dentistry?

Conclusion The start, not the finish Clinically led discussions is the most valuable aspect An improvement in codes and their definitions essential Recognition of the wider role of HD within a trust