A lot of discussion has taken place around the financial aspect of contract reform, as well as the affect it may have on the patient care pathway. However, here we look at what changes any new contract will have on the daily administration of running an NHS practice.
Reform, if it happens, will by its nature affect the way the practice team works. With a more preventative clinical approach in place and different remuneration for capitation and activity, it’s extremely unlikely that daily practice management could remain the same. But the question remains, how much will the level of administration and, therefore, the way the practice works, change following any reform?
To find out the answer, I asked Natalie Stavri, Practice Manager, and Len D’Cruz, Practice Owner, both at Woodford Dental Centre, which was involved with the pilots and is now a prototype B practice, about their experience.
They said: We’ve been in a pilot and are now a prototype practice, and our level of administration has definitely been affected by this. It began to increase before the start of the pilot programme for the reformed NHS dental contract in 2011.
Certain levels of administration are, of course, associated with both NHS and private dental contracts. It’s inevitable that there would probably be more administration on a day-to-day basis today, compared to the start of the 2006 NHS dental contract, as times change and dentistry evolves, e.g. the mandatory Friends and Family Test feedback forms. From our experience, the increase in administration directly relating to the pilots and prototypes affected the whole team.
One example is that we needed to extend routine examinations (now called Oral Health Examinations or OHAs) from their previous 15-minute appointment length to 30 minutes. This was to allow enough time for dentists to navigate their way through the challenge of familiarising themselves with a new version of the software. It also provided extra time for filling in each part of the OHA. Within that time slot they also needed to deliver key prevention messages, generate a care plan with the patient’s RAG score and communicate this to the patient.
Technology glitches soon after the transition to being a pilot practice meant that at times it was long-winded to use the software. It could affect the whole computer, meaning it had to be switched off and it taking longer for staff to carry out other work such as printing leaflets, and booking routine appointments.
Before taking part in the pilot, the practice had around a two-week wait for any NHS appointment. In the early days of the programme this increased drastically to a peak of around 12 weeks for an NHS check-up and longer for treatment. We were promised by the Department of Health that this was anticipated and our waiting times would drop back to normal after six months. They never did, and even now in the prototypes, our waiting times are still in excess of four to five weeks
To enable us to keep on top of our appointment books we started a system of zoning appointments into different slots. For example, an OHA slot, daily problem slots to ensure that we could still see patients in pain or with broken teeth, etc, treatment slots and private slots. The zoning took time to set up and for staff to adapt to the new approach. It also meant that new software advances, such as a feature which suggested when the next available appointments were (to avoid scrolling through the list), could not be used as they couldn’t look at specific zones and would only show daily problem slots as the next available appointments.
This increased the amount of time that receptionists would spend booking even routine OHAs. The increased wait and time to book an appointment resulted in more patient queries, and sometimes complaints. Receptionists would spend longer explaining to patients why the waiting times had increased so much, what the NHS pilot meant for the patients and, perhaps most importantly, convincing the patients that our new way of working was worth the long wait!
Patients who were not satisfied with the receptionists’ explanations were referred to the practice manager. Dealing with these complaints, in turn, increased admin time.
We should point out, however, that much of these changes were anticipated to an extent, as we had been to various meetings prior to commencing the pilot and, subsequently, the prototype contracts. Furthermore, many patients who had been with us through the pilot were accustomed to the waiting times and our way of working, meaning less queries/complaints and we received lots of positive feedback.
“The general administration is fortunately now nowhere near the levels we experienced during the transition period in 2011.”
Due to these reasons, and our ability to acclimatise to the changes over the past six years, the general administration is fortunately now nowhere near the levels we experienced during the transition period in 2011.
Examinations at our practice have now been reduced to 20 minutes, if the patient has been seen by the particular dentist in the last couple of years, or 30 minutes if the patient is new to that dentist. This has reduced the OHA waiting time. After a while staff were able to remember the pre-set questions for each section in the OHA, such as ‘does the patient have an unsatisfactory tooth brushing technique?’, which also saved time.
The software is more streamlined and has largely had its glitches resolved and the whole team is now familiar with it. Everything is slicker and if a practice moved into the new contract now, most of the problems which the pilot practices experienced have been ironed out.
The extra time spent in administration is definitely worth it, as patients now have much better care with a focus on prevention.
“The extra time spent in administration is definitely worth it, as patients now have much better care with a focus on prevention.”
Introducing new systems and processes will inevitably result in changes to how much administration members of the team undertake, and how long it takes them to complete such tasks. It can also often increase running costs, as I believe has been the case in some prototypes where the welcome focus on prevention and patient care has also come at an unwelcome impact on practice profitability.
Any transition period often brings a certain amount of pain but, as has been the case for Natalie and Len, once that has been overcome, and people adjust to new ways of working, there are also rewards to be reaped.
I’d like to thank them for sharing how they overcame these challenges from an administrative point of view, and I’d like to thank them for providing a deeper understanding of the reality of daily life within their prototype practice.