Recovery, renewal and reform
Scotland’s CDO on the return to a full range of care, dealing with the patient backlog and putting a new system of care in place
Tom Ferris, Scotland’s chief dental officer (CDO), has a focus on three constituencies.
Patients – making sure they get the care they need, when they need it and as locally as possible. The dental team – helping to shape an NHS dental system that is modern and which team members want to work within. Government ministers – providing assurance that NHS services delivered on behalf of taxpayers are safe, effective and value for money.
Ferris is both an adviser to ministers and a lead on policy. Previously, the roles were separate but were combined under his predecessor; an arrangement that works well, he believes. He has a 10-strong civil service team, three part-time deputy CDOs, a DCP adviser and three secondees from the NHS advising on health board administration, inequalities, and practice payments.
His budget is around £400m (health board dental services account for another £500m) and he reports to the Cabinet Secretary for Health and Social Care and to the Minister for Public Health, Women’s Health and Sport.
At a conference on 23 March organised by The Royal College of Physicians and Surgeons of Glasgow, the CDO reviewed the progress that had been made in changing the provision of oral healthcare prior to the pandemic and, looking ahead, outlined what he described as a process of “recovery, renewal and reform.”
The Oral Health Improvement Plan, published in 2018, envisaged a system focused on the prevention – rather than treatment – of disease, the reduction of health inequalities, meeting the needs of an ageing population, increasing services on the high street, improved public understanding of services available, better governance for the sector, and increasing the skills mix of the workforce.
The CDO said that progress had been made on preventative care for children, reducing inequalities through the Community Challenge Fund, and meeting the needs of an ageing population through enhanced skills for GDPs. The pandemic, inevitably, brough that progress to a halt. But, said the CDO, that work was now again under way.
He said that in terms of prevention, there is now a now a renewed focus on the concept of an oral health risk assessment for patients. Frequency of check-ups should be based on need and periodontal care ought to be a priority. There were also valuable lessons to be learned from the Community Challenge Fund, he said, in terms of those initiatives that had been able to adapt to changing circumstances.
The CDO said there had been a very clear need to shift the balance of care from secondary to primary. This needed to be accompanied by a clear understanding of what the NHS offer is, both on the part of the provider and patient. The SNP’s election pledge to abolish patient charges was, he said, clearly a significant change also.
Now, he said, the focus was on recovery, renewal and reform. That means the provision of a full range of care, addressing the patient backlog, and “moving dentistry forward over the next decade”. The CDO said that the independent contractor model “has served us very well” and was “the only game in town”, apart from the public dental service.
“Is there another way of delivering that,” he asked, citing not-for-profit, community interest and an entirely salaried service. “I think we need to think through how we would like to see that looking across Scotland, where probably not one size fits all.”
The CDO also spoke about the ‘new model of care’, work on which had been underway just before the first pandemic lockdown – and was now continuing – which features an oral health risk assessment (OHRA), a prevention and periodontal care pathway, an NHS treatment ‘toolbox’, and a new system of remuneration.
“This is the immediate piece of work for us at the moment,” said the CDO, “where we will be reviewing where we’ve got to in light of the experience of the pandemic.”
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