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Delivering Better Oral Health: 3rd Edition

Public Health England have published a third edition of ‘Delivering Better Oral Health’. It is available to download from:

 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/357835/DBOHv3SEP2014MainDocument.pdf

 

The summary guidance tables can be found at the following link:

 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/357838/DBOHv3SEP2014SummaryTables.pdf

 

The main changes relate to children and fluoride application. This can be found in Section 3 –pages 19 – 30.

 

The guidance includes the following updates:

Advice on the use of fluoride, tooth brushing, and prevention of gum disease/tooth erosion/tooth wear;

An extended section on improving periodontal health;

Additional advice about healthy eating, a balanced diet;

Guidance on smoking and alcohol misuse;

New advice on helping patients to change their behaviour; and

Revised summary tables reflecting emerging evidence base.

 

They will be releasing a version of the guidance tailored to the public to help them better understand the preventive messages.

 

Dental content on NHS Choices and Change 4 Life is also being amended to reflect this update.

CQC is changing

In January this year, the CQC announced that Inspections are moving away from the current model of using Essential Standards of Quality and Safety, to an alternative approach that asks 5 fundamental questions about whether or not the service should be considered:

1. Safe

2. Effective

3. Caring

4. Well led

5. Responsive to patients’ needs

As a result of this change a National Reference Group has been set up to develop an assessment framework for dental practice looking at what a safe, caring, effective, well led and responsive practice might look like (the Group has five dentists on it, in addition to representation from NHS England, the GDC and CQC staff and is chaired by Professor Steve Field)

 

Consultation

The CQC have published ‘A fresh start for the regulation and inspection of primary dental care services’ which can be found here:

http://www.cqc.org.uk/sites/default/files/CQC_A%20fresh%20start%20Dental%20signposting%20statement%20August%202014.pdf

 

There will be an official consultation on this document this Autumn, if you would like to read it and give your own views.

 

Duplication

They have said they will be looking to work with other national organisations (NHS England, Business Services Authority, General Dental Council), dental care providers and people who use dental services to develop a new approach to regulation and inspection, is an effort to avoid the duplication that has been happening and identify areas each organisation can take responsibility for and focus on. This, they have said, is their number one priority.

 

Registration

They have said they do not wish their registration process to discourage innovation of good quality care but rather discourage poor quality care. They have recognised that there are aspects of their registration process that are unnecessarily cumbersome and complicated for providers – e.g. taking on a partner – and they have said they are hoping to work with

NHS England to ensure this is not unneccesarily complicated.

 

Making changes to the registration process is their second priority, as it follows work from their first priority – reducing the unnecessary duplication.

 

Inspections

Since the start of CQC regulation of the dental profession, dental practices have generally been quite high in CQC compliance compared with other health care services. Due to the low risk amongst dental care providers, they are also looking at employing ratings, accreditation schemes and self-assessment. However, they have said that they will not implement this in their 2015/16 changes and are seeking feedback and views on this type of approach.

 

CQC are considering inspecting only 10% of providers and focussing on those who may have issues of concern or are ‘high risk’ (determining those who are ‘high risk’ will rely on information sharing between CQC, NHS England and the GDC). Some of the things they are looking at are whether inspections should include people with extensive understanding of dental practice, and dental specialist advisers. Inspectors will be geographically aligned and supported by dental bank inspectors (regional dentist advisers).

 

Currently, dental bank inspectors accompany inspectors on visits where problems or possible problems have been highlighted as a result of the initial inspection.This will be their third priority.

 

Themed Inspections

The CQC are looking at whether to focus on certain things during inspections, e.g. out of hours provision at the practice, integration with other services, prevention, dental decay in under five year olds. This has already been done to an extent, in an unofficial and unstructured way due to the varied approach and focus between inspections so far. This is their fourth priority. The following is the timeline for the work they have said they will be doing over the next year or so:

 

September 2014 onwards:

Ongoing engagement with internal and external stakeholders.

Tripartite Programme Board meeting.

Ongoing meetings with our internal and external advisory groups.

Development of inspection methodology for the sector.

 

July to October 2014:

Formal 12-week consultation on new guidance for all providers on how to comply with the new regulations and on CQC’s enforcement policy.

 

November 2014:

Formal 8-week consultation on CQC’s provider handbook for our new approach to inspecting and regulating primary care dental services.

 

November 2014 to February 2015:

Wave 1 and 2 inspections: testing our new inspection approach for the sector. This will include evaluation

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