Good practice in dental commissioning

Involving patients and the public in dental commissioning

Summary

Patients and the public took part in the development of new dental commissioning guidance. Patient and carer representatives were involved in an online survey, a patient review group and a range of engagement and partnership events. There was also targeted communications work to engage children and young people including tweet chats.

Situation

Involvement of patients and public in development of four new dental commissioning guides. The public engagement process is described in detail in Appendix three of the Introductory Guide to Commissioning Dental Specialties

There was also a legal duty to involve the public. This piece of work relates to planning activity in relation to commissioning dental services, therefore the duty set out in section 13Q of the NHS Act 2006 applies.

Overview of public involvement activity

Patients were actively involved in the development of the commissioning guides. There were at least two patient/carer representatives on each of the four working groups involved, a dedicated Patient Review Group, and events held focusing on patient/carer experiences and views.

“Think I made a difference to the Oral Surgery/Medicine Commissioning Guide as we questioned lots of the decisions – patient reps were fully involved and made a difference.”

The first patient involvement event gathered patient views on current dental services provision and aimed to understand the priorities for the commissioning guides from a patient perspective. Around 50 patient/carers/members of the public (including people from ‘seldom heard’ groups) were invited, with the aim of achieving a geographical and demographic spread. The invitation was circulated to many different stakeholders/networks including (but not limited to):

  • Healthwatch England and local Healthwatch
  • CCG Lay assessors and Clinical Reference Group patient representatives
  • Voluntary Sector Strategic Partners
  • British Dental Association
  • National Association for Patient Participation
  • Regional Patient/Public Voice Leads for NHS England
  • Strategic Clinical Networks – Patient Engagement Leads
  • Care Quality Commission
  • Other voluntary and community organisations

The second event was to gather patient/public views on the redrafts of the commissioning guides to ensure concerns/issues had been addressed.  The second event was attended by 20 patients/carers. People said they felt genuinely engaged in the future work on dental services.

The attendees were asked:

  • To discuss which of the top two Patient Related Experience Measures (PREMs) they would prefer to give feedback on, to allow us to monitor and improve the experience of care for patients.
  • To agree the top four Patient Reported Outcome Measures (PROMs) they think would allow us to measure and improve the quality of care more effectively.
  • What they would like to change about NHS dentistry services.
  • What they liked about NHS dentistry services.

An online survey asking the same questions was also undertaken to gain additional insight and involvement. Several of the attendees on the day were from patient advocacy groups who, after the event, circulated the list of PROMs and PREMs to their members to get additional views. This aspect of involvement reached hundreds of patients/members of the public.

As a result of the initial patient engagement event, a large number of people asked to become patient/carer representatives on the four working groups. As there were limited spaces on the working groups, and to accommodate the views of as many people as possible, it was decided to establish a Patient Review Group.  This included patients, carers and voluntary/community organisations supporting potentially excluded groups for example homeless people. This group focused on the illustrative ‘patient journey’ and the ‘vulnerable patients’ sections of the commissioning guides.

Children and Young People – a targeted approach

 In the development of the Orthodontics Commissioning Guide, a targeted approach was undertaken to ensure the views of children and young people were obtained. This involved a combination of digital involvement and face-to-face focus groups.  The digital involvement comprised of tweet chats which attracted small numbers of young people and their parents but yielded some useful insights that were then discussed further in subsequent focus groups. Two focus group discussions were then held in different parts of the country, with approximately 16 children and young people participating, aged between nine and 21, and a separate group for parents/carers to share their experience. The valuable insight gained has been used in the development of the orthodontics commissioning guide and it is intended that it will also inform specifications, tender and monitoring processes, and development of PREMs.

Who carried out the activity? 

The work was led by the NHS England National Dental Commissioning Group, with specialist advice and support from the Public Participation Team in the national support centre.

What difference has the activity made?

  • The four commissioning guides were published in September 2015 and are informing the commissioning of dental services with the aim of making this more consistent and clear on a national basis. They are intended to be used by commissioners as a support tool, with guidance on improving access to care, based on needs.
  • We expect local commissioners to work 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.
  • There is evidence of good engagement with ‘seldom heard’ and potentially excluded groups, who sometimes have the greatest health needs
  • A targeted approach was taken to engagement with children and young people, using social media.
  • Patients and carers involved in the process felt involved, listened to and that their suggestions were taken notice of:

“I’ve put forward views of under 16s, vulnerable and younger people with long term health conditions who are often overlooked and not asked their views.”

“Think I made a difference to the Oral Surgery/Medicine Commissioning Guide as we questioned lots of the decisions – patient reps were fully involved and made a difference.”

Who should I contact for more information?

Andrew Taylor
Programme Manager (Office of the Chief Dental Officer)
Medical Directorate
NHS England
andrew.taylor42@nhs.net

Frances Newell
Patient and public partnerships specialist
NHS England
frances.newell@nhs.net

How were people told about the difference their participation had made?

Copies of the guides were circulated to Directors of Commissioning Operations and Heads of Primary Care, NHS England Commissioners and Dental Local Professional Networks, and the Patient Review Group.