Transcript Item 06 - Orthodontic Services in South Tyneside

Primary Care & Community
Orthodontic Services
South Tyneside PCT
March 2010
Sheila Lister
Head of Commissioning Primary Care
Services
Orthodontic Service
• The orthodontic service is a service offered to
children under the age of 18 only
• Referrals are made by GDPs
• Patients are assessed by criteria known as
Index of Orthodontic Treatment Need (IOTN)
Scoring
• Patients are offered a choice of provider
including those outside the ST boundaries
• Patients from outside of SOTW can also be
referred into the community services
Current Provision
• Limited providers of primary and community services with
long historic waiting times for some community service
providers
• Current Providers
Primary Care Providers
8 GDP Providers delivering services for their own patients
Community Providers
1 Community provider (PCTDS)
1 provider in North Shields (Mr Osborne)
1 Provider in Whitley Bay (Oraprime)
1 Provider in Hebburn (Smiles Ltd)
1 Provider in Sunderland Road Dental Practice
(Temporary Contract)
Activity undertaken to date
(UOA’s Delivered)
Table 1:
Year
PCTDS
GDPs (inc SRDP Total Activity
and Smiles
Total number
of Patients
(based on
average 21
UOA’s per
patient)
2006/7
1885
2139
4024
192
2007/8
3108
2104
5206
248
2008/9
3282
4094
7376
351
2009/10
(Projected)
2954
7300
10254
488
Regional Service Review
A regional review of the orthodontic service
was undertaken the outcome of which
highlighted that additional services were
required across SOTW
Issues Raised through the review
• History of there being a shortage of orthodontic specialists and
difficulty attracting them to the NE
• Excessive waiting times of up to 4 years in community services
• Suggestion that demand was outstripping capacity
• It has been suggested that due to the long waiting times, children
were being referred into these services too early to ensure they
would be ready for treatment when offered an appointment in
what could be 3-4 years time
• Some children were referred into the service when not ready for
treatment due to caries or poor dental hygiene
• These patients would be kept on the list until their situation
improved and they were ready for treatment creating the long
waits
Progress Update
• The PCTs Oral Health strategy was developed and was
consulted upon through the LEBs where the need for
additional orthodontic services was highlighted
• Development work started during 2009 on the service
specification and tender documentation following the
principles of The Official Journal of the European Union
(OJEU)
• Whilst the above tender was being planned, the PCT
commissioned additional completed courses of activity
with a local provider in 2009/10 – Shown in Table 1.
Progress Update cont.
• In addition to the above the PCT also agreed to the transfer of
a further 50 patients from PCTDS to an independent
contractor
• Validation of the PCTDS waiting list is ongoing. In January 103
of the patients were contacted; of these, 44 people did not
respond and will be followed up; 22 so far have agreed to
transfer to the other service; 35 refused to transfer stating
reasons such as:
they were unwilling to travel ( the other service is 4 miles
from the PCTDS service)
they were already in receipt of treatment from
elsewhere
they were happy to wait on the PCTDS list and
the remaining 2, the service is awaiting further contact
from these patients
Progress Update cont.
• A full validation of their list is expected to be
undertaken by the end of March 2010 with all
patients on the list being contacted
• The waiting list information is currently held
manually, the service are looking to transfer
this to an automated system to support the up
to date information required
2009/10 Additional Investment in
Specialist Orthodontic Services
• £350K recurrent funding was identified
through the PCTs strategic plan for each PCT
and a tender process was subsequently
agreed
• Approx £400K has been committed non
recurrently in 2009/10 whilst the tender
process is undertaken.
Tender Update
• The tender process commenced in November 2009
• The contract is for 5 years and will treat approximately 250 children
each year.
• Referrals for this contract will only be available to SOTW residents
• Waiting times for assessment is stated as within 4 weeks and
treatment within 13 weeks ensuring patients are appropriate for
treatment when referred . This will support the management of the
waiting lists. Those patients that are not in a position to start
treatment will be referred back to their GDP for management until
such a time they are ready.
• The evaluation of the tenders will be concluded in April 2010
• The contract will be awarded in April/May 2010 with a view to
mobilising the service in June/July (dependent on premises
solutions identified)
Update – Current Waiting List
Information (Dec 2009)
Provider
Waiting time
for
assessment
(weeks)
Waiting time
for treatment
(weeks)
Numbers
waiting for
treatment
Sunderland Road
Dental Practice
2
6
100
Smiles Ltd
Carried out by 37
PCTDS
71
Mr Osbourne NS
12
12
Not available
Oraprime WB
104
16
Not available
PCTDS
22
165
619
Next steps
• Continue with the procurement process to secure a 5 year contract
seeing an approximate 250 children each year
• Undertake short term commissioning for the first qtr of 2010 until
the contract above can be mobilised.
• Continue to work with the PCTDS provider to understand the
outcome of the list validation exercise
• The PCTDS to further advertise the vacancies within the
orthodontic service
• Review all providers of orthodontic services with a view to reducing
and standardising waiting lists and times for assessment and
treatment
• Strengthen contracts to ensure delivery of the above
• Ensure all providers can report timely and accurate information