Prototypes – What do you need to know?
Rehan Ghaffar – Grange Park Practice, Rodericks Dental – provides an update on the Prototypes so far…
How would you summarise the prototypes?
Our practice (Grange Park Dental Practice) is currently trialling the prototype system, which follows the pilot contracts initiated in 2011 that were geared towards a greater focus on prevention. They incorporated a red, amber and green traffic light system based on four key areas identified in an in depth oral health assessment; caries status, periodontal condition, tooth wear and soft tissue.
There is now heavier weighting on capitation relative to patient list size and, to a lesser degree, UDAs. The aim is to identify which areas are at higher risk for each patient, taking the patient through the pathway from red and amber statuses to green, and then maintaining this through oral health education, intervention and a bespoke self-care plan for each patient.
What are the key points your team has learnt from the prototypes so far?
Focus on prevention is prudent for the maintenance and care of a population where life expectancy is increasing and so many people are keeping their often heavily restored teeth for longer. Following the prototype guidelines to achieve this takes a lot of time – the examinations look at lots of different aspects of the patient’s lifestyle and this, combined with the necessary records and detailed questionnaires, will provide one of the biggest changes from current UDA working practices.
There is still much to learn in how to implement it all correctly and efficiently – but as most people already work in a similar manner to varying degrees, the changes should be fairly subtle.
How can practice teams best make the prototype system work if it is to eventually roll out?
Effectively utilising the full skill mix of the team is vital. We have found it an important start to clearly define the role of every professional. One of the challenges we are facing at the moment is timing – careful forward planning that allocates time specifically for treatment and emergencies has helped better organise the appointment books around the increased time needed for exams and consultations.
How do the prototypes affect standard of patient care?
The theory is that we are putting the onus back onto the patient to ensure they are doing their best to look after their oral health in their daily routines, and we only step in for intervention when there is a problem. This has improved patient care in the long-term, as there is less reparative work to do. Patients also respond positively when they realise they have attended a number of times over the last few years and have noticed that changes in their routine have led to tangible results such as no bleeding when brushing, no need for deep cleaning, less need for fillings/treatment etc. Conversely, access has been slightly limited with longer waits for available appointments.
How do the prototypes affect the professional workflow?
The workflow is changed mainly by the introduction of interim care appointments – normally with a DCP – to reinforce oral hygiene techniques, smoking cessation etc. These are added in between examination appointments with the dentist and it works well. Difficulties are sometimes faced when the patient queries why they are not seeing the dentist and why there is a charge if they are just given advice or simple cleaning rather than a full check up. However, these can be avoided by explaining what patients can expect over their next appointments, the purpose of those visits and what the costs are for.
In general, the prototype contracts seem promising, although some fine-tuning is certainly still needed. From a practice’s point of view, there are still a few challenges to overcome in order to make the prototypes work to their full advantage and ensure the best possible care is delivered to all patients. Whilst ensuring ease of access, however, I believe once this method of working has been implemented and all the initial creases ironed out, both practitioners and patients will notice a real improvement in patient care and patients’ attitudes and approach to oral health.