NHS Leicestershire County & Rutland and NHS Leicester City Specialist Orthodontic Pathway Service Specification

SECTION 1 – SPECIFICATION

Care Pathway/Service / Orthodontic Pathway
Commissioner Lead / NHS Leicestershire County and Rutland
Provider Lead / TBC
Period / 2 years with a one year extension
Applicability of Module E (Acute
Services Requirements) / No

1 Overview

1.1 Introduction

In June 2004 the NHS Improvement Plan announced that no patient would have to wait longer than 18 weeks from referral to hospital treatment. Historically, patients from Leicester City, County & Rutland requiring specialist orthodontic care could access this service from a secondary care provider e.g. University Hospitals Leicester (Glenfield site). As a result, in 2008, patients were waiting in excess of 6 years to access specialist orthodontic provision. In August 2008 NHS Leicestershire County and Rutland and NHS Leicester City jointly commissioned accredited specialist orthodontic providers to review all patients who would have traditionally been referred to UHL. Their role was to assess the patient and determine whether their case required specialist (complex or advanced complex) intervention and if this was the case either treat them in primary care (complex) or refer them on to secondary care (advanced complex). The purpose of the pathway was to reduce waiting times in secondary care by ensuring only those patients who could not be treated elsewhere were placed upon the hospital waiting list. By 2nd September 2010 the waiting list has been reduced to 2 years and the referral rates have been reduced significantly.

The pathway was initially commissioned on a pilot basis. Given the success of the pilot in reducing waiting times and the positive feedback received from secondary care, the specialist providers and the patients, the pathway will be commissioned for a further 3 years (2 years with a 1 year extension).

1.2 Policy and Context

The service must be procured and provided in line with national priorities and the latest guidance of the British Dental Association, British Orthodontic Society and General Dental Council.

1.3 Local Context

The current pilot has been delivered by 6 accredited Specialist Providers/Performers who are located in Hinckley, Leicester, Loughborough, Thurmaston and Oakham. They assess approximately 700 referrals per annum and treat 350 complex patients per annum. The Pathway providers will be expected to treat patients that are referred and meet the criteria whether they require complex or routine orthodontics within their capacity.

Referrals are accepted from all General Dental Practices across Leicester City, Leicester County and Rutland. In line with national guidance the pathway can only be accessed by patients over 18 years where the referrer believes the patient has either complex or advance complex needs that would previously have been treated in Secondary Care. Treatment is only provided in these cases where the patient is assessed as having advanced complex needs.

2 Aims and Objectives

2.1 Development of primary care based services provides care closer to home for patients, increases capacity and decreases waiting times. Furthermore, an important aim of this service is to further develop links between services in primary care and secondary care ensuring patients receive care at the right place and where necessary can move seamlessly between providers without bureaucracy or delay.

2.2 The aims and objectives of this service are to:

·  Enable early identification of patients who are not eligible for specialist (complex or advanced complex) or routine orthodontic care and provide support to the referring GDP/Orthodontist on their future management plan

·  Enable identification of complex cases which can be treated in a primary care setting and those which require secondary care

·  Provide treatment in a primary care setting, to eligible patients

·  Ensure consistent management of all patients with complex and advanced complex orthodontic needs, in line with NHS Leicester City (LC) and NHS Leicestershire County and Rutland (LCR) Orthodontic Pathway guidelines (see Appendix 1)

·  Reduce demand and waiting times for secondary care orthodontic services to assist in the achievement of local and national waiting time standards

·  Work to a 2:1 ratio of assessment to treatment

·  Improve the quality of referrals from General Dental Practitioners

·  Offer high quality, complex orthodontic treatment to all patients who are referred, regardless of age, ethnicity, language, disability, sexual orientation, religious or personal circumstances.

3 Expected Outcomes

3.1 Outcomes

The service will:

·  Provide identification and treatment of patients with complex orthodontic needs whose care can be managed within a primary care setting

·  Complement the existing routine and secondary care (advanced complex) orthodontic provision working as part of an overall pathway of care.

·  Support referring GDP’s on future management plans

For the purposes of this specification:

·  Routine orthodontic care is defined as any patient with an Index of Orthodontic Treatment Need (IOTN) of 3.6 or above

·  Complex orthodontic care is defined as a case which would normally have been referred to secondary care however in the clinical judgement of the assessing orthodontist can be managed in primary care (see Appendix 1)

·  Advanced complex orthodontic care is defined as a case which can only be provided in a secondary care setting due to the complexity of its nature and requirement for multidisciplinary treatment.

The Provider will be required to:

·  Co-operate effectively with other local health service bodies e.g., referrers, other providers, commissioners, PALS

·  Ensure equity of access for patients

·  Support local GDPs in referring appropriately into the service

·  Exclude or accept for treatment patients in line with the guidance included in the LCR Orthodontic pathway

·  Ensure patients and referrers understand and be kept informed of the decision-making process and are aware of the outcome

·  Ensure patients receive care at convenient locations which comply with CQC/HTM0105 requirements and deliver contractual compliance

·  Deliver services in accordance with the highest level of care derived from British Orthodontic Society and GDC Guidance

·  Deliver activity in accordance with quality standards and waiting time requirements as outlined within this specification

·  Deliver high levels of patient and referrer satisfaction.

·  Offer services which are locally accessible for patients and will offer choice of appointments

·  Work in partnership with General Dental Practitioners, providers of routine orthodontic treatment, secondary care consultants, other providers of complex orthodontic treatment and the Commissioners.

3.2  Service Location

The service will be provided from a location convenient for patients within the boundaries of NHS Leicester City and NHS Leicestershire County and Rutland registered to a general dental practice.

The Commissioners are keen to recruit Providers who deliver from service locations which are widespread giving optimal geographical coverage across Leicester, Leicestershire County and Rutland.

The service location should be accessible by public transport. Adequate car parking should be available to patients. Any location should be Disability Discrimination Act compliant. Services must be provided in environments which promote effective care and optimise health outcomes by being well-designed and well maintained.

The clinical and non-clinical areas should be compliant with the standards outlined within:

·  Requirements for Care Quality Commission registration

·  Standards for HTM0105

·  Premises and Infection Control requirements outlined within the Primary Dental Services Agreement (PDS).

3.3 Contract basis

The contract will be a Personal Dental Service (PDS) and will be time limited for 3 financial years.

3.4 Staff Composition / Workforce

The staff composition will be as follows:

·  Suitably experienced and qualified specialist orthodontists with the following qualifications FDS(orth)RCS, M orth or equivalent and must be on the GDC orthodontist specialist list.

·  Suitable trained and experienced dental healthcare professionals i.e. dental nurses/hygienists

·  Reception staff with excellent communication and customer care skills who are able to signpost patients appropriately

·  A qualified dental nurse who will support the orthodontist at all times.

The provider will ensure:

·  That robust practice management is in place to address issues arising from the patient pathway e.g. validation of patient data, management of patient complaints and issues, management of clinical information.

·  Effective management of the waiting list to agreed levels

·  That arrangements are in place to deliver continuity of service during staff absence

·  That all dental/orthodontic staff must have the appropriate clinical indemnity, either through an approved defence organisation or through their employment

·  That all staff supplied have valid registrations and evidence of continuing professional development for ongoing registration including participation in peer review and audit

·  That prior to undertaking clinical work all practitioners will have been adequately inoculated against hep B and tetanus

·  That the performers have the competencies to manage vulnerable patients who may have addiction, mental health illnesses and anxiety/phobia.

Providers will be entirely responsible for the employment and conditions of service of staff employed in the contract and will employ sufficient staff, appropriately registered and qualified, to ensure that services are provided at all times and in all respects in complete conformity with the specification.

Providers will be responsible for any costs incurred in relation to the providers directly employed staff providing services under this specification. This includes the cost of providing cover during absences.

3.5 Accessibility

The service is for patients who would have traditionally been referred to the University Hospital Leicester – Glenfield Hospital Orthodontic Specialty Department for assessment and if appropriate, treatment e.g. those patients that the referring dentist believes to have either complex or advanced complex needs.

·  Providers will ensure that this service is accessible to all those except those listed in the exclusion criteria below and that no patient will be discriminated against based on age, ethnicity, language, disability, sexual orientation, religious or personal circumstances.

The following groups are excluded from the provision of this service:

·  Abusive, violent or threatening patients

·  Patients who require a general anaesthetic or sedation to access dental care

·  Patients who require domiciliary provision

·  Patients over 18 who have routine orthodontic needs.

The following patients are excluded from the treatment element of the service:-

·  Patients who do not have an IOTN score of 3.6 or above

·  Patients over 18 unless they require advanced complex treatment e.g. those requiring secondary care intervention are eligible for treatment

·  Patients who are dentally unfit and/or have poor oral hygiene

·  Patients who require multi-disciplinary management of their care and therefore are more suitable to be managed in a secondary care setting, e.g. patients with cleft palate. (Advanced complex orthodontic cases)

·  Patients who are noncompliant with the treatment.

Days/hours of operations

The service must be provided at times most convenient to patients, including late afternoon appointments to ensure school children are not discriminated, and in line with patient feedback. Consideration should be given to evening or weekend appointments and it is expected that as a minimum 3 after school session should be made available per week.

3.6 Referrals and discharges

3.6.1 Referrals

·  The referring GDP will offer the patient a choice of provider prior to referral and the patient will be asked to sign to agree they have been offered a choice of provider

·  The referring GDP will make the referral to the Provider chosen

·  Providers will contact the patient and agree with them a convenient time for assessment

·  Providers will confirm with the GDP when assessment will take place

·  Following assessment, Providers will either signpost the referral appropriately back to their referring dentist or to secondary care or place the patient on the waiting list to access treatment as soon as an available treatment slot becomes available with the Primary Care Specialist

·  If the patient is identified as having a routine orthodontic rather than complex orthodontic treatment requirement they will either be treated by Providers if they have capacity or referred to another provider with a routine orthodontic contract.

The Provider will accept referrals from:

·  GDPs across Leicester City, Leicestershire County and Rutland.

·  Secondary care, where referrals have been inappropriately sent there.

·  The Commissioners in exceptional circumstances.

Referrals should only be accepted in line with referral guidance within the Orthodontic Pathway (see Appendix 1).

The Provider will be required to accept referrals via:-

·  Safe haven fax

·  Secure email – all referrals must be encrypted

·  Post

·  Hand delivery.

Self referral will not be accepted.

3.6.2 Discharges

Patients will leave the Service by one of the following routes:

·  Referred back to GDP with advice for further management

·  Referred onwards to secondary care due to complexity of treatment requirement

·  The patient condition improves in line with treatment goals such that they no longer require a service

·  The patient chooses to exit the service and declines further support

·  The patient leaves the geographical catchment area and wishes to be transferred to another, more accessible Provider

·  The patient is non-compliant with treatment such that they have a risk of a negative outcome from treatment, e.g. poor maintenance of oral hygiene, none attendance or appointments, regular breakages of appliance due to poor compliance with instructions.

·  The patient treatment is completed

3.7 Response Times

·  Assessment will be provided to the patient within 6 weeks of receipt of referral

·  The referring GDP will be contacted in writing within 15 working days of completion of referral with the outcome of the assessment

·  Patients assessed as eligible for treatment, routine or complex, will be placed on the practice waiting list and the patient given clear advice of the waiting times and when the patient treatment will be started. The Commissioners should be notified where the waiting time exceeds a year

·  If onward referral is required e.g. to secondary care this should be made within 15 working days.

3.8 Patient Focus

Providers will ensure that patients are provided with relevant verbal and written information in a variety of formats, where necessary utilising a translator service, outlining the service. They will also be required to provide information concerning the outcome of the assessment, such that the patient is clear why a specific treatment opinion has been selected.