LDN Conference Dental Education: Present and Future Nicholas H Taylor Postgraduate Dental Dean - HEE NW Chairman of COPDEND - UK Chairman of English Dental Deans - HEE 27 th June 2017
Aim To improve understanding of the role of Health Education England in providing the workforce for NHS service provision.
Objectives • Need into Numbers - the need for a more holistic strategy to meet current and future health care needs • Understand central decision making based on local evidence of need and national HEE workforce plan • Demographic, geographic and requirement factors • Signposting & support to the prospective “Tier Two” cadre of providers • Future NHS workforce provision
HEE Mandate https://hee.nhs.uk/ Health Education England (HEE) exists for one reason only: to support the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place. www.gov.uk
Currently delivering • Foundation Training – Satisfactory completion • Dental Core Training – Certificated years of personal training • Specialty Training – 13 disciplines • Workforce Development & Transformation – Local Professional Networks – Appraisal, mentoring – Bespoke courses • Restoration of Efficiency of Registrants • Dental Care Professionals
Tax payer funding Current funding streams for training: • Health Education England • Joint Funding (HEE/Trust) • National Institute for Health Research (NIHR) • Trust Funded • University Funded • (Self-funded) All Quality Managed by HEE staff
Self-funding • Workforce Transformation & Development • Performer List Validation of Experience (PLVE) • Remediation and support (NHSE & GDC) • Specialty Training (London) • Other certificate, degrees and masters
General Dental Council • Quality Assurance Undergraduate Specialty Training • Specialty curriculum review (13) ‘On pause’
Dental Disease is changing
The population is changing
Technology is changing
Current workforce
Current issues • GDS/PDS UDA Contract • History of dental service provision • Vested and conflicts of interest • Primary Care Business models • DFT – competence and experience • Dentistry outside main body of NHS provision • Division between Primary & Secondary Care • Mixed dental economy – NHS & Private • HEE Investment plan
HEE Comprehensive Spending Review (CSR) • HEE Programmes £4.9bn • HEE Administration £71m Programmes- Flat Cash till 2019/2020 Administration - 2019/20 £57.9m CUTS Educational Support – 30% Administration – 20% (already 20%)
Comprehensive Spending Review English Dental Deans • Regionalisation of HEE Provision • Foundation Review • Non-NHS funding
Commissioning Guides NHS Commissioning Guides Proposed clinical pathways to cover complexity of care • Tier 1- • Tier 2- • Tier 3- DCPs to Specialist/Consultant to Deliver
Workforce
GDC Scope of Practice - Team Approach to Primary Dental Care Diagnosis & Fluoride varnish, Periodontal Routine Extractions, treatment oral hygiene treatment restorative, advanced planning instruction, deciduous restorative, Specialty areas radiography extractions MOS, Prosthetics Screening Dental Nurse Hygienist Tier Direct II Access Therapist Ortho Therapist Dentist DES Specialist CDT F/F CDT
Boundaries • NHS GDS/PDS mandatory contract • What should a generalist (Provider) be doing? o Avoiding the NHS (tax payer) paying twice • What is the remit of the specialist? • Where does tier II fit?
Reducing priority for public funding (Steele Report 2009)
Current Tier II Service Educational Element Lancashire Model • Selection • Contracting • Triage • Delivery • Training
Changes to the skill mix in the practice as a consequence of the pilot care pathway PROVIDERS Q19. Consider changing the skill Q20. In what way? mix? 85 % Q19. Would you consider changing the skill mix of staff at some point if the new way of working becomes permanent? Base: All providers (40). Q20. How might your practice change the skill mix of staff in the future to help deliver the new way of working? Base: All provi ders who say ‘yes’ at Q19 (34).
The pilot contract Has been exceptional opportunity to: • Improve the quality of dental care • Better value for money for tax payers • Engender patient compliance • Re-structure the dental workforce • Public health approach to delivery
Local Dental Networks and their constituent Managed Clinical Networks What do you need?
Workforce Planning OCDO – Dental Strategy Department of Health - Contract Reform Local Dental Networks • Managed Clinical Networks University Requirements – Under/post graduate Workforce planning team (HEEAG/DWAG Report) All drive HEE Investment Plan
HEE training numbers - the HEE Investment Plan 1907
Critical Activities Opportunities • “Putting the mouth back in the body” • DH Contract Reform • Skill mix and multi professional & multi disciplinary working • Leadership from LDN & MCN, STPs, LWABs Challenges • Influx of European & RoW Dentists (PLVE) • The business of dentistry • Have we the correct specialties? • Complexities of change management
Educational Pathways to Provide High Quality Care Level III Primary Care ACF(CL) Academia Community Responsibility Level II contract Specialty contract modules modules Training Smile4Life, Epidemiology, E.g. OS, SCD, Endo, Fluoride progs, Out of hours, Perio, Pros, ortho, etc. Children Centres, care/nursing Postgraduate homes , schools etc. Recognition Inside Specialty of Dental Core envelope General Training Primary Level I - core capitation contract provision Dental 3 Years available Care Dental Team – Dentist as Leader Practice* (Workforce Development HEE remit) PLVE Dentist 2 Dentist 1 Undergraduate Joint Foundation Training Clinical 2 -Therapist Outside envelope Clinical 1- CDT or Hygienist HEI, DH & DGH Basic Dental Science *Rotations in DGH, DH, GDS and CDS
Workforce Restructuring and Reform Project • To support Contract reform • Geographical and demographical need • Provide equity of HEE funding • Dental Team with the right skills • DCPs • Dentists • Specialties • Academics
Stakeholders
This is a great opportunity to do something different! For Patients For the Profession For the NHS
Thank you for listening
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