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All together now in the north-west
2 October 2018
The world of dentistry can be a fairly isolated workplace.
While dentists do have their local dental committees, akin to local medical committees, there are generally fewer fora for bringing dental professionals together and the typical dental practice has only one or two dentists.
Speaking about his role in supporting the formation and work of the Cheshire and Merseyside Managed Care Network, PCC adviser Rob Haley says: “Just getting dentists into a room together as primary care professionals and then to have conversations with their secondary care colleagues in a safe environment is initially an obstacle but eventually becomes a key factor in improving local dental health.”
That step provided the launch pad for the managed clinical networks (MCNs) developed by the local NHS England office, with support from PCC.
Haley explains: “Having that mix of secondary and primary care is really important because as in GP-land primary care is the starting point of referral. If you want to move treatment out of hospital you must ensure that primary care has the skills to take it on.
“The commissioners in Cheshire and Merseyside clearly understand the need to support clinical colleagues and they provided the funding that allowed clinicians the time and space
they needed to contribute to this work. They understand the value and importance of the clinical voice in improving service quality and patient care.”
With the NHS England local office laying the groundwork for managed clinical networks in Cheshire and Merseyside through the work of task and finish groups, Haley and his PCC colleagues were handed the task of cementing new relationships and putting the drive for change on a more permanent footing.
MCNs are taking a leadership role in improving the efficiency of dental provision locally by establishing referral management systems and moving care to the most appropriate providers.
Their focus runs from prevention through to a range of specialist provision – which means it’s important to have public health officers, commissioners and a wide range of dental professionals in the room. Haley says: “Public health people in Cheshire and Merseyside were already recognised as part of the dental leadership team so they could drive some of those changes. Public health and commissioning colleagues attended each session.”
As with any change that means educating the relevant professionals in change management and, as Haley says, “taking people along with you”. The actual work was then divided into dental specialties.
Having supported the writing of NHS England’s guides on this work, Haley is well placed to advise how it is delivered locally.
“We looked at what the direction of travel should be according to the guides and where local commissioners and dentists felt they were, where they wanted to be and where there were gaps that needed to be addressed. That leads to an action plan to provide direction for change.”
Haley and colleagues worked with the NHS England local office to develop and deliver a series of meetings and learning sessions – some of which brought together all those involved in establishing the MCN. Other sessions supported sub-groups looking at the individual specialties. Haley supported the development of common terms of reference across the subgroups and a code of behaviour during meetings.
Again with a nod to the stresses that can come with change, one session led by PCC focused on training in change management, influencing skills and facilitation. Haley and his colleagues then worked with the sub-groups to establish their baseline and develop their action plans as part of a functioning MCN. This helped ensure consistency of plans across the larger group.
Session dates were set at least six weeks in advance to boost attendance by clinicians while minimising disruption to patient care.
Both NHS England and Haley acknowledge that some clinicians didn’t fully understand the commissioning process and they are now considering how they can continue developing the necessary relationships and collaborative working.
Participants also had to overcome the unfamiliarity of clinical dental colleagues working together – and leaving at the door the organisational and business interests that can understandably surface when talking about new ways of working.
With the action plans now starting to produce results on the ground, improvements in patient care and experience are already noticeable. It is expected that such results, as the evidence builds up, will mean that commissioners can influence change in a positive manner – rather than through challenge.
Haley notes: “There is much greater peer engagement and support across the different organisational boundaries.”
The public health consultants are now working on plans for a wider northwest forum that will bring together the MCNs to share their work and learning.
Already the network is making the dental workplace a little less lonely.
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