Scotland's Oral Health Plan: consultation on the future of oral health

5 Professional Leadership, Quality Improvement and Scrutiny

5.1 Territorial NHS Boards have systems in place to provide assurance that service provision is safe and effective; for example, the listing process, practice inspections and disciplinary procedures. NHS National Services Scotland, through Practitioner and Counter Fraud Services ( PCFS) and the Scottish Dental Practice Board ( SDPB), fulfils a governance role to ensure that patients receive high quality treatment, that is clinically necessary, to maintain and secure their oral health.

5.2 However, the existing governance structures vary across NHS Boards. We propose an appropriate system of governance for independent GDPs comparable to that for employed dentists and takes due cognisance of the principles of quality - namely safe, effective and patient-centred care. We will seek to build on the well-established elements of governance currently in existence and bring them together into a coherent and transparent structure.

5.3 There are currently a number of people with responsibility for NHS dentistry at NHS Board level; in most NHS Boards there is not an identifiable individual who leads on all aspects of NHS dental service provision in the Board area. We envisage a Director of Dentistry in each NHS Board who will have strategic oversight of all aspects of NHS dental services and oral health improvement in their area. This individual would be a registered dentist.

The Scottish Dental Practice Board

5.4 The Scottish Dental Practice Board ( SDPB) is a statutory body under the National Health Service (Scotland) Act 1978 accountable to Scottish Ministers, with a range of functions around payments to dentists. The landscape in NHS dentistry has changed substantially and it seems appropriate to use this consultation process to revisit the functions of this body.

5.5 We will revisit the existing remit of the SDPB to determine whether it:

• could be tasked with a revised remit, for example, having a Scotland-wide quality improvement function for GDS;
• would be better placed within another host organisation dependent on its final remit;
• should be abolished and the functions subsumed elsewhere;
• should retain its existing remit.

Clinical Quality Monitoring

5.6 Currently dental clinical quality is monitored in the following ways:

• prior approval of dental treatment plans from dentists operating within GDS in Scotland where either the cost of a treatment plan exceeds the prior approval limit (currently £390) or where a specific treatment requires approval. The Dental Adviser Service answers questions posed by dentists, and considers treatment plans submitted for prior approval;
• monitoring of treatment provided by dentists operating within the GDS in Scotland. The Scottish Dental Reference Service monitors the standard and quality of NHS treatment, pre- and post-treatment.

5.7 The Scottish Government envisages a new Clinical Quality Monitoring Service that will monitor the new preventive care pathway for those patients who require to maintain their good oral health status. This service will also continue to meet its existing responsibilities for patients.

Quality Improvement Activities

5.8 A pilot commenced on 1 April 2015 and is gathering information on a range of quality indicators, both at practice and GDP level. The purpose of the pilot is to determine whether we can identify at an early stage those practices or GDPs that are experiencing difficulties, enabling the NHS Board to offer support. Some of the indicators that are currently being piloted include:

• practice inspection;
• antimicrobial prescribing pattern;
• Childsmile fluoride varnish applications;
• clinical quality.

Protected Learning Time

5.9 The principle of taking time out from clinical practice to allow practice staff to address their own learning and professional development needs is widely accepted in general medical practice as being of benefit. This Protected Learning Time ( PLT) allows medical practices in a locality or within a H&SCP to close for an afternoon to allow for Continuing Professional Development ( CPD) learning activities. Topics can be a mix of clinical and non-clinical areas and there are three main types of meetings:

• H&SCP-wide meetings in large conference/workshop settings;
• a number of practices in the same locality joining together for meetings;
• individual practice-based meetings.

5.10 We believe that PLT could be of benefit to dental practices and teams, to assist them in undertaking quality improvement initiatives.

e-Dental Programme

5.11 The Scottish Government currently chairs the e-Dental Programme Board to determine and prioritise the way forward for eDentistry. Our strategic vision for e-dentistry focuses on eliminating paper based claims by expanding the use of electronic data and communication.

Summary of Proposals:

• Introduce a Director of Dentistry in each NHS Board who will have oversight of all aspects of NHS dental services and oral health improvement within their area.
• Review the role of SDPB.
• Explore options for a new enhanced Clinical Quality Monitoring Service for patients, particularly those patients who follow a preventive care pathway.
• Further develop the concept of a national database of key quality indicators to be rolled-out across Scotland.
• Develop a process which will make protected time available at practice, locality or H&SCP level.