There has been a fair amount of talk in the last few months about the NHS dental prototypes, most of which, as far as I can tell, is speculative and very little seems to be coming from people working at the coalface. As the owner of a practice engaged in trialling one of the prototypes, I want to share with others what it has been like for us so far.
We had been one of the first to embrace the piloting scheme and it was natural for us to continue as a prototype, as we were able to make a success of the pilots. Going back to UDAs would have been a retrograde step, in my opinion.
“We had to make changes to the roles of various members of staff, gradually introducing a greater skill mix into the way we deliver care and treatment.”
To make a success of things, we recognised that we needed to get the whole team on board and carried out a lot of in-house training to educate the staff. We had to make changes to the roles of various members of staff, gradually introducing a greater skill mix into the way we deliver care and treatment, since the focus is on prevention rather than treatment, as under the 2006 Contract.
In a nutshell, our dentists plan the treatment for the care pathway, and then delivery of that care is delegated wherever possible. We adopt a minimalist approach to clinical intervention, and the therapist can therefore perform a lot of the necessary treatment. Interim care, in which prevention and maintenance is carried out between oral health reviews, can often be done by oral health educators or the therapist, and recall times can be extended.
“In a nutshell, our dentists plan the treatment for the care pathway, and then delivery of that care is delegated wherever possible.”
Of course, patient acceptance is also key to success. Communicating the changes to them was one of the biggest challenges. Some patients like to read things, others like to talk – it’s a matter of identifying the best methods in each case and repetition is often necessary. We tend to use leaflets supported by a conversation, which is time consuming.
We are a few months in now and we are seeing improvement in the oral health of patients who take the message home, and it is really satisfying to see a patient who has managed to improve their oral health significantly.
“It’s a shame we are still operating within the UDA framework for activity and the patient charges system, but that is because of legislative requirements.”
It’s not all roses at the practice, however. It’s a shame we are still operating within the UDA framework for activity and the patient charges system, but that is because of legislative requirements. I am still unsure about some of the quality indicators, upon which some of the contract payment depends.
Ultimately, I am grateful that I have a great team of people at the practice who work very hard to make the system work, and I hope that our input will help to shape a contract that will be of benefit to both patients and the dental team.
About Paul Worskett
Paul Worskett qualified in 1983 and has worked in London hospitals specialising in oral and maxillofacial surgery. After gaining experience in general practice, in 1988 he became the principal of Amblecote Dental Care in the West Midlands, and has expanded and developed the practice ever since. Paul has extensive experience of dentistry and has a special interest in cosmetic and implant dental care. He has completed numerous courses on advanced dentistry over the years and was awarded a Master’s degree with distinction from the University of Birmingham in Advanced General Dental Practice. Under Paul’s leadership, Amblecote Dental Care is a prototype practice as part of the on-going NHS contract reform process. Paul is also a key member of Practice Plan’s NHS Insights Panel, which meets to explore the results of the NHS Confidence Monitor in greater depth.
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