'Digital systems are the foundation upon which we will build a modern, efficient and responsive health service. Enabling information to flow between care providers within and beyond organisational boundaries, and between care providers and patients, is a key means by which we will achieve a safe, convenient and personalised health and care service.'
This is what it says on the NHS Digital Technology page of the NHS England website. Sounds good, great even, to me. There's more: an Integrated Digital Care Technology Fund, a Digital Maturity Index, Local Digital Roadmaps and so on. Exciting, or what? There's even a list of 'key deliverables' within Digital Technology (initial capitals as per website).
A Digital Primary Care Operating Model
Tracey Grainger is Head of Digital Primary Care Development at NHS England with responsibility for the digital primary care strategy. She wrote recently about Health and Care Innovation Expo 2015 in Manchester where innovative digital approaches to healthcare were discussed. At this event she made a presentation entitled 'Clarity and Opportunities for GPIT Assurance' and talked about evolving to a Digital Primary Care Operating Model.
So far, so exciting. But hang on, where's the mention of dental practices? I searched for dentistry and for dentists on the NHS Digital Technology page but the three results related only to SMS mail provision – for which central funding ceased in March 2015.
Why am I banging on?
It's easy to be critical so now I'll be positive. Why does the apparent exclusion of dental practices from the digital revolution matter? Because I see dentistry as a fundamental cornerstone of primary care, not just a token member.
Consider this. Many, many people visit their dental practice regularly regardless of whether they have a tooth-related problem. If the dentist says return in three, six or nine months many people make the appointment before departing the practice. Rarely does a GP say: "Pop back in six months whether or not you have anything wrong with you".
So dental patients are or could be or should be regularly exposed to healthcare information. Not just oral health matters but broader issues such as smoking, sugar consumption, obesity and so on – whatever messages are on the notice boards in a practice and whatever topics are covered in the leaflets on display. And remember that dentists see (or should see) patients from an early age to old age.
Dentists can also identify or at least alert to the possibility of diseases beyond those concerned with oral health – such diabetes, anaemia, lupus, Crohn's disease, obstructive sleep apnoea and so on.
I do concede that general practice has one advantage over dental practice – it's free to all-comers. NHS dentistry is only free to certain groups within the population. I believe research has shown that some people are put off visiting a dentist because of the cost, although whether it's the £18.80 Band 1 charge or the potential expense of treatment, I don't know. Nevertheless, according to the GP Patient Survey Dental Statistics; January to March 2015, England (http://www.england.nhs.uk/statistics/2015/07/02/5694gpps_dentw21415/), of all respondents asked 'three fifths (60%) tried to get an NHS dental appointment in the last two years'. Extrapolate that to the adult population of the UK (about 50 million) and that's around 30 million people age 15 and over seeking an NHS dental appointment in the last two years.
This compares with an estimated 300 million GP consultations a year in England alone; with the average patient have 5.5 consultations each year (http://www.hscic.gov.uk/catalogue/PUB01077/tren-cons-rate-gene-prac-95-09-95-08-rep.pdf).
Nevertheless, dentists see a significant proportion of the population on a regular basis and should surely be more highly regarded for their role in primary care.
It's not as though dental practice staff lack digital skills and information technology knowledge. Dental practices have, for some time, been required to uphold information governance requirements and complete the IG Toolkit regularly.
Many of the items of equipment in a modern practice are digital – X-ray imaging, intra-oral cameras, digital software and more. Then there's digital practice management software, appointment scheduling, bookkeeping and compliance systems – some of which are cloud based.
While the CQC makes no specific references to digital systems, it does in its key lines of enquiries (KLOE) require good governance which includes that: 'Care and treatment records are complete, legible and accurate, and are kept secure'.
Over to you CDO
In the announcement of the appointment of Sara Hurley as Chief Dental Officer for England earlier this year, it said she would: 'work in partnership with other directorates, domain leads and other clinical leaders in regional and local area teams to … champion the role of dentists and dentistry within the health system'. She is quoted as saying: "I am determined to use this position to articulate the dental health needs of our patients and … present directly to Ministers and NHS leaders our fresh ideas; ideas that will contribute to achieving our shared goals of quality health outcomes and better oral health for all.”
I for one look forward to her action resulting in dentistry becoming integral to all primary care developments and particularly those involving innovation – with digital communication systems between healthcare providers top of the list.
As I am writing this, NHS England has just published Integrated Urgent Care Commissioning Standards (publications Gateway Reference 04020). Skipping to Annex A, Integrated Care Advice Service Roles, I note a section entitled Dental.
It begins: 'Dental pain without injury remains one of the highest reasons for calling NHS 111. NHS England is responsible for commissioning all NHS dental services and CCGs will need to work with NHS England Area Teams to ensure that dental services are commissioned in local areas.'
It continues: 'The dental case mix needs to be managed by suitably trained dental professionals, which may include dental nurses trained in triage. This will usually be once anything requiring urgent [Emergency Department] ED attendance has been ruled out by a clinical algorithm – see next section. Ideally there would be the capability to book treatment slots direct with dental treatment providers [my italics]'.
The section then has a number of bullet points regarding the Management and Referral of callers with dental symptoms and there's mention of a Dental Assessment Service.
London is used as evidence for the approach because about 1750 callers per week with urgent dental problems are being routed away from 111 (and potentially Emergency Departments and Urgent Care Centres) to the Dental Hub (winter resilience Dental Nurse Triage service) via Interactive Voice Response (IVR). It seems: 'There have been instances of patients who have gone to ED with an urgent dental problem, seen the posters to call 111 and had a positive outcome via the IVR'.
And patient experiences are 'positive overall, callers would use the service again and satisfaction was high, although service seemed variable in terms of call handler helpfulness and outcome'.
There are other positive statements in the document, including that dental professionals should be included in the integrated urgent care clinical hub and that: 'Clinicians within the Integrated Urgent Care service must have access to relevant aspects of patients’ medical and care information, where the patient has consented to this being available.'
It this breaking news a sign that dentistry could become integral to primary care and share in the exciting innovations enjoyed by GPs? Let's hope that Sara Hurley does indeed champion the role of dentists and dentistry within the health system.
About the author
Amanda Atkin is a change management consultant, focusing on the healthcare sector in which she has considerable expertise and experience. Amanda's skills range across contractual management, performance management, operational delivery and leadership development to strategic planning as well as governance and regulatory compliance.