With the key aims of providing a preventive focussed approach to dental care, making use of the wide and varied skill set within the dental team and using evidenced approach to dental care the Welsh Government, led by Chief Dental Officer in Wales, Colette Bridgman, commenced a contract reform programme in September 2017. The reform programme would change the focus of delivery of care from being based on activity to being based on risk and need with a focus on prevention and patient centred care and improving access to care. These aims will lead to improving the overall health and wellbeing of Welsh citizens.
In the first six months of the programme 21 practices joined the programme and this has continued to increase and now 173 practices, 40% of NHS dental practices in Wales participating in the programme. There is representation across all seven local health boards.
Clinical care – Practices who have joined the programme now base their care around a patient centred risk and need based assessment. Practices were provided with the Assessment of Clinical Oral Risks & Needs (ACORN) toolkit which provides an annual assessment of the patient. The assessment leads to a personalised care plan both for what the dental team will do but also what the patient can do for themselves as well. Patients who are low risk are now encouraged to attend annually but patients with dental need or risk can be seen more frequently, based on their personalised plan.
Whole team working – A key aim of reform was also to better utilise the skill mix of the whole dental team. Health Education and Improvement Wales (HEIW) alongside the programme team have implemented a Making Prevention Work in Practice Course. This course was originally developed by PCC and we were delighted to be able to support the role out of this course by HEIW dental educators. This course means that staff members can be trained on preventive messaging, allowing them to provide tailored and personalised messaging to their patient. Additional training on the application of fluoride varnish is also included which enables them to provide this preventive treatment.
The clinical care becomes a pathway for the patient and the whole dental team.
Dental access to patients – During reform it is key that dental access remains available to patients in Wales and there was an expectation of practices that access did not decrease and would look to increase when the practices were established in the programme.
To support the new clinical approach and to help support access, practices in the reform programme initially had a 10% reduction of the expected activity that practices were contractually obliged to deliver, which could increase to a 20% reduction when practices were more established in the programme. This reduction created the freedom within practices to implement the new approach.
Outcomes – The first annual report on the programme was published in 2019 (data based on a full year of programme activity) and was able to show the risk and need status of patients seen within that year, that access is maintaining or improving and that for children is at it’s highest level. Clinically the level of Fluoride varnish has increased in both adults and children with the latter increased to 45%. There is encouraging signs that the oral health is improving with decreases in active disease.
Impact of Covid-19 – With the pandemic all dental care had to change and the programme was suspended in March 2020. With all practices using the principles of a risk and need assessment for prioritising patients during the pandemic it will support all dental practices from being familiar with this way of working when services resume fully. The aim is that the programme will restart in October 2021.
Further information on the Welsh reform programme including programme updates, annual report and patient survey can be found https://primarycareone.nhs.wales/topics1/dental-public-health/dental-reform/