Building a quality improvement culture in primary dental care
Interim Chief Dental Officer Tom Ferris places the safety climate survey in its wider context
Dentists have been undertaking clinical audit for many years and recently have had access to a wider range of quality improvement (QI) activities. They are required under their NHS terms of service to individually undertake QI activities over a three-year cycle.
Willingness to participate with QI by dentists has covered a wide engagement spectrum ranging from the QI enthusiast to the noncompliant. Initiatives to improve engagement have had limited success despite the range of sanctions for noncompliance. Recently, some dentists have been referred by NHS Boards to the General Dental Council due to concerns about 2013-16 QI activities while others have been referred to the NHS Tribunal. Additionally, towards the end of each cycle, there is a high volume of last-minute projects submitted to ensure compliance, which seems to point to a system being in need of change.
This is an exciting QI redesign journey. The end result should be a system that practice teams will learn from, enjoy participating in and find easy to navigate
Primary care dentists in Scotland will be aware that it is my intention to make use of the current QI cycle (2019-22) to redesign and implement improved QI that is relevant and beneficial to patients and practice teams. The discussion about this redesign started at an event on 6 September, which was attended by a wide range of key stakeholders.
However, the existing NHS terms of service remain in place and dentists still have a requirement to undertake QI activity. Therefore, I have decided that the 2019/22 cycle will provide opportunities for dentists to engage in a series of national activities in each of the three years of the cycle. The theme of the cycle will be ‘Building a Quality Improvement Culture’.
Year one (2019/20) will comprise an online Safety Climate Survey (SCS) at dental practice team level, which follows a similar process that has been used by our general medical practice and pharmacy colleagues. The SCS is a partnership between Healthcare Improvement Scotland (HIS) and NHS Education for Scotland (NES) and I am delighted to say that it is supported by the Scottish Dental Practice Committee and Scottish Public Dental Service Committee of the BDA.
It is important to note that the ‘safety climate’ within the practice is team-focused and not just for the dentist. Completion of this survey will result in a report being generated by HIS which should be the focus of reflection at a subsequent practice team meeting. The practice should, through discussion, develop a Practice Action Plan which can be used to implement improvement; the detailed action plan belongs to the practice and will remain with each practice.
The activities for years two (2020/21) and three (2021/22) will be communicated in due course.
During the QI redesign process the Scottish Government will work with practice teams and partners in HIS, NES, NHS Boards and the BDA to design a process for improved QI in primary care dentistry. This will streamline the administrative process and incorporate a productive QI suite of activity for dentists and their teams. The intention is that the new system should come into force from the 2022-25 QI cycle. An important aspect in supporting the whole team approach to QI will be to ensure that practices have access to dedicated learning opportunities and the time to develop informed planning.
I am looking forward to engaging with the dental profession and wider teams as we look to improve the QI process for primary dental care for the longer term. I am clear about the importance of developing reflective clinicians who are keen to improve the service they deliver and to make sure that any learning is shared widely within the profession.
This is an exciting QI redesign journey. The end result should be a system that practice teams will learn from, enjoy participating in and find it easy to navigate through.