Guides for Commissioning Dental Specialities and their implementation

NHS England’s Guides for Commissioning Dental Specialities relate to the commissioning of NHS dental care in England. This series has been collaboratively produced by the dental profession and commissioners overseen by Chief Dental Officer England. NHS England has worked with Health Education England (HEE), Public Health England (PHE), specialist societies, patients and the public.

Designed primarily for NHS England commissioners; the Guides are intended to address the need for greater national level standardisation in NHS England’s commissioning of dental care as well as providing clarity and consistency around the dental services the NHS provides.

The Guides support the aspiration to breakdown the artificial divide between primary dental care and hospital specialists in order to allow all providers to work together to focus on patients and their needs. To achieve this we will all need to respond throughout the implementation phase by unlocking structural and cultural barriers to support transformational change in dental service delivery.

Context

The Five Year Forward View sets out a shared view of the challenges ahead and the choices about health and care services in the future and applies to all services including dentistry. This shared ambition for the future is the context in which these Guides for Commissioning Dental Specialties have been produced. Clinicians, commissioners and patients have all contributed to the Guides which detail how dental care pathways should deliver consistency and excellence in commissioning NHS dental services for providers to benefit patients.

Aim and intent

The aim of the Guides is to offer a standardised framework for the local commissioning of dental specialties. They are intended to be used by commissioners as a support rather than prescriptive mandate with guidance on improving access to care, based on needs that are criterion referenced, with demonstrable high value health outcomes experienced by our patients and recognisable to the tax payer.

We expect local commissioners to be working closely with the Managed Clinical Networks (MCN), the Regional Dental Public Health Consultants and Dental Local Professional Networks (LPN). Together they will be responsible for delivering the best patient journey possible, supported by mandatory specialist advice and/or access to care, that meets the needs of the local patient population whilst achieving the nationally expected standards of care provision.

Common themes across the Guides for Commissioning Dental Specialities

  • Each guide describes a pathway approach in order to offer clarity and consistency for patients, the profession and commissioners.
  • They have been designed to be used by commissioners to offer a consistent, clear and collaborative approach to commissioning.
  • The Guides detail the mandatory clinical competencies required to deliver the various levels of specialist care rather than prescribing the clinical setting in which it must be delivered. This will allow commissioners to respond more effectively to the needs and complexity of patient care as well as providing greater patient choice by broadening the options to receive the required specialist care in a location that best meets the needs of the patient.
  • The guides explain nationally agreed minimum specifications; best practice; contract content and design; and outcomes and metrics which can be enhanced locally and which are presented in sufficient detail to allow clinical interpretation and application.

Implementation

Implementation of the Commissioning Guides will be a step by step process and we expect the pace of change to vary across England and we expect to learn as we move through implementation. Implementation will require energy, brave decisions and momentum, together with a willingness to share good practice, innovation and learning, as it emerges, to accelerate the speed and impact of change to improve patient care. We recognise that:

  • The pace of implementation of the Guides across each NHS England regions will vary. Many commissioners are already well prepared and will be moving ahead quickly with the implementation of the Guides.
  • We must monitor progress, identify and share best practice and that there will be areas for further development. We have initiated a programme to capture and share learning and highlight examples of best practice. With this information we can review and update the Guides in order to support the improvement of quality, service, value and efficiency.
  • Consultant leadership, support and governance continues to be an essential pillar in supporting the development and improving the quality in commissioning. To gain greater visibility of all the elements of clinical support available to area dental leads NHS England is working with Professor Nigel Hunt (Dean Faculty of Dental Surgeons, Royal College of Surgeons) to compile a national picture of MCN capability and capacity.
  • Commissioners will be measuring themselves against the enablers within each of the guides and they will work with all local stakeholders to agree local priorities. These will be SMART benchmarks for the quality, value and sustainability of the healthcare we strive to deliver.
  • Commissioners will be looking to NHS England Commissioning Operations and the Chief Dental Officers England’s team for guidance and direction on what needs to happen next and what needs to change. We will be establishing a single point of contact for commissioners within NHS England that can assist in finding the right information, resolving issues and critically capture and share the solutions.
  • The initial focus of commissioner activity will be to identify any capability gaps between the quality and quantity of current services, against the described guide compliant services. However, Chief Dental Officer England is clear that a robust assessment of impact and cost, is a key activity before any change in procurement. Similarly, patient and public engagement is also a pre-requisite to change.

Guides for Commissioning Dental Specialties