2. Henry Clover BDS, Deputy Chief Dental Officer
Denplan
‘Creating and maintaining success through innovation’
Henry Clover BDS, Deputy Chief Dental Officer

3. Driving oral health innovation in the private sector
NHS AHSN Conference
October 2015

4. Agenda Denplan – in context The Denplan Excel Quality programme
Oral Health Score (c)
Denplan Excel Previser Patient Risk Assessment (DEPPA)

5. Denplan – in context?

6. Denplan – a mixed health economy provider
80% of Denplan members have an NHS commitment
Where UDAs are not delivered they revert back to the LAT – to re-commission
Collect £42,000,000 per month to provide access to quality private dental care

7. The Denplan Excel Quality programme
Agenda
Denplan – in context
The Denplan Excel Quality programme
Oral Health Score (c)
Denplan Excel Previser Patient Risk Assessment (DEPPA)

8. The Denplan Excel Quality Accreditation programme
Uniting requirements of both dentists and patients

9. The founding truths of Excel Quality programme - Patients
Patients are generally only aware of their oral health status at extreme ends of a spectrum

10. The founding truths of Excel Quality programme - Patients
Patients are generally only aware of their oral health status at extreme ends of a spectrum
In order to engage with patients – to motivate them to make changes – they require an understanding of their oral health status in a simple format
Change follows engagement and explanation

11. The founding truths of Excel Quality programme - Dentists
There’s nothing that can be done in the surgery that can’t be “un-done” by the patient before their next visit
Increasing range of regulations and professional/clinical requirements have to be taken into account
Risk assessment is key to determining future treatment needs

12. Denplan Excel Quality programme
Launched in 2001 – following pilot in 2000
Provides dentists with complete package;
Oral Health Score (c) for patients
Risk assessment for patients
Supporting patient information cards – with BDHF
Bi-annual patient feedback survey
18 monthly in practice assessment
Detailed audit requirements – Record cards, X rays, Teamwork

13. Meets requirement of regulators/commissioners
NHS England – HTM01-05
GDC
CQC

14. Agenda Oral Health Score (c) Denplan – in context
The Denplan Excel Quality programme
Oral Health Score (c)
Denplan Excel Previser Patient Risk Assessment (DEPPA)

15. WHO – Oral Health
“The ability to eat, speak and socialise without active disease, decay or embarrassment”

16. Oral Health Score – scientific background
Burke FJ and Wilson NH (1995)
Measuring Oral Health: an historical view and details of a contemporary oral health index (OHX) - International Dental Journal 45:
Burke F J T, Busby M, McHugh S, Delagy S, Mullins A, Matthews R. (2003)
Evaluation of an oral health scoring system by dentists in general practice - British Dental Journal 194:
Burke T, Busby M, Mchugh S, Mullins A, Matthews R (2004) - A Pilot Study of Patient’s Views of an Oral Health Scoring System - Primary Dental Care 11 (2) 37-39
Delargy S, Busby M, McHugh S, Matthews R, Burke F.J.T. (2007)
The reproducibility of the Denplan Oral Health Score (OHS) in general dental practitioners - Community Dental Health 24:

18. Max Score
Possible scores
Comfort 8
0 (pain) 4(some pain) 8(no pain)
Function
0(problems) 4(minor problems) 8 (no problems)
Appearance
0 (unhappy) 4(some concern) 8(happy)
Occlusion
0 (less than 10 teeth in each jaw opposed)
8 (at least 10 teeth in each jaw opposed)
Soft Tissues
0 (needs treatment or referral)
4 (needs observation)
8 (healthy)
Tooth health 24
24 (no restorations, caries free)
18 ( sound restorations, caries free)
12 (less than 10% teeth need treatment)
6 (10-30% of teeth need treatment)
0 (more than 30% of teeth need treatment)
Tooth Wear 12
0 (much more wear than expected for age)
6 (more wear than expected for age)
12 (normal wear for age)
Gum Health
0 (severe periodontal disease)
6 (moderate periodontal disease)
12 (mild periodontal disease)
18 (gingivitis only)
24 (healthy)
TOTAL
100

21. Crucial elements of OHS
Patient “evaluation” responsible for 24% of score
Meets requirements of WHO definition of oral health (measurement)
Identifies areas for improvement with resultant score improvement

22. Denplan Excel Previser Patient Risk Assessment (DEPPA)
Agenda
Denplan – in context
The Denplan Excel Quality programme
Oral Health Score (c)
Denplan Excel Previser Patient Risk Assessment (DEPPA)

26. % caries or defective rest’ns
Validating the data
Average Age
% high /
v high caries risk
% caries or defective rest’ns
v high perio
risk
% severe perio disease
DEPPA 55
23%
21%
10% 9%
ADHS* 47
22% 8%
*The ADHS figures are for patients claiming to attend a dentist regularly

27. Validating the data – age differentials

31. Average OHS for patient reported health and lifestyles factors (37,330 patients)

32. Simple audit

33. The detailed audit report

34. Summary of GDC Research (Dec 2009)
5.2.3 Ensure Integration with other Initiatives
It is essential that revalidation ties in with other, already established initiatives to ensure that workloads are minimised for both the individual practitioner and the GDC. On the testimony of dentists themselves, we would recommend that the Denplan Excel certificate is enough to meet the requirements of revalidation as many feel that this covers off all of the outcomes more than adequately. Other popular initiatives such as BDA Good Practice should be considered so that certification from this is enough to meet the requirements of relevant outcomes.
George Street Research, Edinburgh. Final report to GDC.

35. CQC – 17 June 2010
CQC, as far as we can answer at this stage, would view Denplan Excel accreditation as a good proxy indicator of quality and certainly it would be useful as contextual evidence in the QRP. As I understand it, Excel accreditation produces a wealth of data and this would stand the provider in good stead were it able to appear in the QRP. The accreditation flag on the QRP, coupled with the supporting data would go a long way towards satisfying an inspector/assessor that there was widespread compliance and it is likely that only if there were significant gaps, or a body of evidence to indicate non compliance with a regulation, would further investigation be necessary. Even then, this may not necessarily be an inspection Joel Clark, Senior Analyst Information Policy & Research (Intelligence)

36. A growing scientific evidence/review base

37. What has been the feedback?

38. Dentist Research

39. Patient Research
Base: All respondents (90)

40. Patient Research

42. DEPPA key benefits Patient satisfaction Job satisfaction Oral health
Demonstrates competence
Practice Success
Patient satisfaction
Oral health
Profit
Job satisfaction
Supports good communication
Informs risk based prevention `
Reduces risk
Supports quality
Clinical audit
Supports patient retention

44. Conclusion A world-leading scientifically-based innovation to;
Engage dental patients in their own oral health improvement
Support dentists in providing a structured risk assessment
Ensuring dentists meet all of their regulatory and clinical requirements
And all from here in Hampshire...