Ben Atkins was recently the Clinical Director at Revive Dental Care, which had four practices across Manchester. Before he moved on to his next role, he outlined their journey implementing changes to recalls for NHS patients following the NICE clinical guidelines relating to interval periods for dental checks.

Overview

When the NICE clinical guidelines came out around recall interval times being personalised to the needs of the individual, Ben says that the Revive team was keen to be proactive.

“We saw that it was the right thing to do as the guidelines were aimed at ensuring everyone receives an NHS oral health check at the right time,” he said. “We won’t best serve our patients, by seeing everyone every six months, especially if they already have perfectly good oral health. It’s much better that we see those who need additional support more frequently, using the space freed up by longer recall intervals for others who don’t need our services as much.

“This helps us target NHS care in the most appropriate ways and has increased the number of people we can see and treat,” explained Ben. “We free up some of our team’s time to help more patients in our community with urgent or high needs and deliver more work on prevention.”

Background

Revive’s group of practices covers a range of different areas serving different populations with different needs including Salford, which was once one of the most deprived areas in the UK. However, Ben says that this has changed over recent years, especially now with the ‘gentrification’ of the area.

He said: “The risk-based recalls allow us to manage these population changes, as we can place our new patients with good oral health on recall periods of up to two years and focus on the higher needs patients in the area with three to nine-month recall periods.

“When we started making the changes, we found a few patients who still felt they wanted to be seen every six months. We reassured them that our assessment had shown their oral health was good and their risk was low, but if they were worried about their teeth or mouth they could come back sooner.”  

Implementing the guidelines

When the Revive practices first implemented the NICE guidelines on recall intervals for NHS patients, they put in systems to manage the changes in their ways of working.

“We went through our lapsed patients lists to bring people in who were overdue for an NHS check-up and became really busy after the first 12 months, when the number of patient recalls increased all at once,” explained Ben.

“We managed the additional calls coming into the practice by introducing a new automated phone system. This allows for messages on how to access the practice for new patients – around half of the calls coming in previously were clogging up the system with new registration requests – so automating that process made a real difference.”

The practices also increased the number of staff assigned to clerical tasks, while moving to online booking as much as possible.

The process of working with the dentists to implement the guidelines was an ongoing one. Ben explained: “We had many conversations with the dentists initially and they bought in to it for a month or so, then went back to leaving recalls at six months. However, we continued talking within our dentist monthly meetings as part of an ongoing process. The dentists used their clinical training and judgment on whether there was any active disease and how patients needed to be managed. This worked well and our capacity massively changed, with the dentists able to better focus on those patients with active disease or increased risks.”

Within their activity software, the practices have an automated suggested recall date. The dentist has the power to change that and bring patients back in earlier if they feel their risk is increased.

The practices also educated the wider teams in the new recall system, ensuring that whole teams understood what they are doing and can explain it to patients as needed.

In addition to training and working with staff, the practices also developed further education resources for patients and the public to help them manage their oral health better. “Developing our communications journey was critical,” added Ben. “Really buying into digital solutions, such as YouTube videos for education, is time consuming, but essential if you are to support people to take more responsibility for their own oral health.”

Outcomes and results

The practices have been able to take on around 130 new NHS patients per month. These have included a high number of complex patients.

The changes have resulted in improving access, preventive care and education for NHS patients, as well as less frequent visits to the dentist for many individuals.

Ben concluded: “Our dentists are proud of what we have achieved. We are working in different ways for different people, with a balance of population management and patient responsibility.

“While I had to complete a certain number of treatments over a certain period of time, it helped me to spend the time advising patients on how to improve their oral health, then do restorative work as needed.

“We support individuals with complex needs through education before giving dental treatments, so that NHS money spent is supported by ongoing behaviour change and long-lasting self-management.

“By better managing the oral health of their populations, our dentists are making a real difference. No dentist comes into dentistry to hit treatment targets; most join to deliver the best patient care.”

Take away tips

• Hold regular staff meetings and get feedback. Support dentists along a staged journey; make decisions about changing recalls intervals as needed, not just pushing them forward.
• Manage expectations for new patients; create a patient strategy to educate patients, including high needs patients, and managing patient feedback
• Look at your whole system and how to empower patients, for example a new phone system to support patients; be ready for the change, automate what you can
• The dentists felt we were going above and beyond on the NHS, better than anyone else in the area; communicating this to the patients helped

Find out more

To find out more contact: Me@drbenatkins.co.uk