Time for dentistry to join the top table

2 October 2018
Dentistry has been out of the room during discussion of integrated primary care at scale.
 
NHS England’s drive to deliver integrated care has so far focused on GP and community services; with a nod to acute care. However, thinking is starting to emerge around how dental services can work with GP practices to provide more holistic care for patients.
 
Joining up the medical and dental care of patients – particularly for children and deprived populations – makes a lot of sense. Many children attending A&E do so with dental problems. Significant numbers require oral surgery. Such problems mean time off school with a knock-on impact on educational attainment.
 
Better integration of dental and medical services could also improve outcomes for other groups of patients. There is growing evidence to suggest that good oral health
is closely linked with general wellbeing. Poor oral health has been associated with lower education outcomes, increased levels of depression and a worsening of other health conditions.
 
Unlike most of those sitting opposite a GP, the patients that dentists see are usually well. That gives dentists an opportunity to prevent ill-health, identify those at risk or
in the early stages of some diseases and signpost to appropriate support. Wielded effectively, the medical questionnaire used by dentists is a potent weapon in the battle to prevent ill-health and disease.
 
Truly holistic care can help primary care professionals identify patients who should be signposted to other services. As well as improving the oral health of children or patients with – or at risk of developing obesity - related long term conditions – it can ensure they receive consistent health messages to encourage behaviour change.
 
Although thought is now being given to such issues, there is no escaping that the four primary care domains have evolved independently of one another and have different contractual frameworks. Working collaboratively will therefore need a change in mind-set from providers and commissioners alike.
 
Dental service commissioners should now be turning their attention to how dentistry fits into evolving integration models that are designed to. break down the traditional divides between community, primary and secondary healthcare and relevant partners.
 
Commissioners increasingly need to focus on improving service quality and outcomes, ensuring the right services are available at a population level – and particularly for vulnerable groups such as people with learning disabilities and special needs, homeless people and older people with dementia.
 
Encouraging and supporting collaborative working clearly needs to involve the wider integrated care systems commissioners and NHS England local area commissioners and their respective finance teams.
 
The National Association of Primary Care (NAPC) recently published a paper, Primary care home: exploring the potential for dental care to add value. which considers how dental services could be brought under the umbrella of its PCH model.
 
The PCH is intended to serve a population of 30,000-50,000, bringing together a range of health and social care professionals to provide holistic care for specific populations.
 
The paper discusses how collaboration can improve services and looked at the issues facing both the medical and dental professions. Importantly for both sets of professionals, it also highlighted some of the “potential mutual benefits”of working together. Noting that this particular journey is just beginning, it urged doctors to take the first step in starting conversations with other local healthcare providers with the aim of improving the wellbeing of the populations they serve.
 
As well as the benefits outlined above, working in partnership could provide learning opportunities that may inspire dental practice staff, including by opening up new avenues for career development.Integrated care systems are only in their early stages but dental professionals have an important part to play in the delivery of holistic care. PCC is planning a workshop that will consider how dentists themselves can work more closely together – for their mutual benefit and that of their patients.
 
Emulating the federations that enable GPs to take on local contracts for community based services could be an appropriate model for dentistry. This could bring
dentists and dental surgeries together to bid for future contracts.
 
Collaboration could offer the possibility of cost savings in regard to back office functions and improved quality of service.
Resources Primary/Community Services

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