Supporting Quality Practice
An ambitious new pilot project that aims to support dentists in practice and stop them ending up in front of the GDC has been launched
The nightmare of being referred to the GDC has long struck fear into the heart of the profession. Controversial the regulator may be, but it still has the power to end a career.
Now, however, the number of cases coming before fitness to practice committees has reached such a level that the government is taking action to identify concerns as early as possible to provide support and, by doing so, reduce the number of dentists facing the powers that be.
Under the guidance of Scotland’s deputy chief dental officer Tom Ferris, a new pilot has been launched called ‘Quality Improvement and Supporting Better Practice’. The pilot brings together information from a range of sources to get a picture of the quality of dental care that individual clinicians and practices are providing. However, rather than singling out underperforming dentists and failing practices, the pilot is all about early intervention to avoid problems that could lead to, among other things, referrals to the GDC, said Tom.
This is absolutely about supporting practices and about allowing dentists to see their own, and their practice’s, performance
Tom Ferris, Deputy Chief Dental Officer
He said: “This is absolutely about supporting practices and about allowing dentists to see their own, and their practice’s, performance. It will also enable them to benchmark their performance and help them to improve.
“But it is also about assisting a practice that is having problems and assisting individual clinicians at a very early stage. None of this is disciplinary at all. All we want to do is have a consistent approach – that all boards will do all these stages, at the same time, to the same level and with the same trigger.”
The pilot, which is initially being trialled by four NHS boards – Ayrshire and Arran, Dumfries and Galloway, Lothian and Forth Valley – is a combination of the Scottish Government’s quality strategy and a project looking into supporting better practice that was being carried out by speciality trainee in dental public health Emma O’Keefe.
Purely by chance, Emma, who is now a consultant in dental public health at NHS Fife, was working alongside Tom, who was tasked with implementing the quality strategy within dentistry and they discussed what they were each working on. It occurred to them that it would make perfect sense to combine their two pieces of work and form a larger and broader project.
Tom took the proposal to chief dental officer (CDO) Margie Taylor, and a sub-group of the CDO’s quality improvement group was formed to take the project further. The group, chaired by May Hendry, dental practice adviser at NHS Ayrshire and Arran, identified 10 key indicators covering every aspect of clinical practice on a clinician and practice level.
NHS National Services Scotland was commissioned to build an online ‘dashboard’ to bring together and display all the information – which comes from a range of sources such as ISD and NES as well as the health boards themselves – in one place. Tom explained: “These indicators all exist somewhere but at the moment they are not all in one place. The end point is that we will be able to extract data automatically from the various places where it sits and that will feed into the dashboard and get updated as and when is required.”
The indicators are RAG (red, amber, green) scored using the traffic light system with green meaning no issue or concerns, to amber which indicates some concern or a shortfall of some degree, to red, which highlights serious concerns, non-compliance or multiple/major breaches. Amber and red scores would initiate a response, ranging from advice and support for the practice or individual up to referral to an NHS board performance review group, or equivalent, to discuss if further action is needed.
Tom explained that during the pilot the information that is being fed into the dashboard will not be made widely available. In fact, of the members of the sub-group, only the primary care managers currently have access. He said: “We had a long debate about who should access this raw data and we decided that, for the pilot, not many people needed to look at it. So, the only people who have access to it are the primary care managers in each of the pilot health boards.
“If they see a change in performance or something going from green to amber, they would highlight that to the relevant person. So, it would primarily be the dental practice adviser, but it could be the Childsmile co-ordinator and it could be the clinical director for the PDS.”
Tom admitted that he and Margie will never get access to the information in the dashboard and the preview they have seen of how it will look was developed using dummy information. He said: “When it is live, I expect you would primarily see a sea of green, because most dentists are working really well and there are very few dentists getting into trouble.
“This is really important to stress; most dentists do really well and most dentists want to do really well and we have to trust them. But there will be the odd amber, the odd red and that will show up as quite noticeable on the dashboard. Whereas, if that information is kept in a drawer or if it was kept in various places as it is at the moment, it can be difficult to spot if there is something happening there.”
As the pilot progresses and the dashboard is developed, Tom explained that the aim is for the information to be made available for individual clinicians to access and see how they compare with their peers through anonymized benchmarking on a health board and national level. Eventually, he believes that some of the information should be available to the public as well, although that is expected to be much later in the process.
He said: “There will be a discussion down the line, probably when we are well into the pilot and other boards have joined, about extending the level of access. Because, in the end, there should be some level of access for the DPAs, practice owners and individual clinicians. It is important that we get that right and the logical end point is that there should be some way that we can present some of this information to the public.
“But, that is way down the line and it wouldn’t be raw data. There must be a discussion about that. We would need to find a way of presenting the information so that it is understandable and makes sense to the public.”
However, as this is a pilot, the indicators and thresholds that are in place at the start might be altered or removed as the project develops. Tom said: “These indicators are not set in stone, this was what we felt as a group were the right indicators. If we sit down in six months time and discover that one of the indicators is not really telling us anything, we could change it and bring something else in.
“That also goes for the thresholds between green, amber and red – this is the pilot, it’s about learning and the end point will certainly look a lot different to what we started with.”
Tom expects more health boards to come on board, two are currently in discussions at the moment, with the eventual aim of it being rolled out to all 14.
He said: “The pilot has been shared with the lead officers for all of the health boards, so they are all aware of it.
“Two boards have approached us asking if they could start now. But, rather than bring them in straight away, what we may do is offer the new boards the spreadsheet that almost sits underneath the dashboard so they can start to bring things together locally. So, when we decide to go live with the system in their board, the import is that much easier.”
And, rather than being sceptical about the process, Tom hopes that the profession will see this as a powerful tool for developing practices and improving clinicians’ clinical work.
He said: “I am quite excited about the prospect of giving dentists access to the data to allow them to see how they are getting on because I think that is really important. We are only just getting the mechanics of it sorted at the moment, but the next stage for the four pilot boards is opening up access in a secure way to the practice owners and the dentists. They will never see one another’s data, they won’t see their colleagues’ down the road, but it will be anonymised and benchmarked so they can gauge where their data sits within the range. That is thought to be a very powerful way to drive improvement, to see how you are comparing to someone else. So that’s the bit I’m really looking forward to.”
- Practice inspection (general and sedation)
- Out of hours arrangements
- NHS board concern
- Drug prescribing
- Childsmile FVA
- Clinical quality
- Clinical audit
- Patient view (PDS only)
Quality Improvement and Supporting Better Practice working group
- May Hendry – Dental Practice Adviser, NHS A&A (chair)
- Colin Duncan – Lay representative on Scottish Dental Practice Board
- Emma O’Keefe – Consultant in Dental Public Health, NHS Fife
- Valerie White – Consultant in Dental Public Health, NHS Dumfries and Galloway
- Anna Slaven – Primary Care, NHS Ayrshire and Arran
- David Conway – Consultant in Dental Public Health, Information Services Division
- Jill Ireland – Senior Analyst, ISD
- Greg Thomson – Primary Care Strategic Lead, NSS IT
- Tom Ferris – Deputy Chief Dental Officer, Scottish Government
Providing ongoing advice to the group:
- Tony Anderson – Director, NHS Education for Scotland
- Linda Bunney – Primary Care, NHS Dumfries and Galloway
- Alison McNeillage – Primary Care, NHS Lothian
- Evelyn Hadden – Primary Care, NHS Forth Valley
- Alan Whittet – Dental Adviser, Dental Reference Service