Primary Care Commissioning

The primary care team in Direct Commissioning South West commission pharmacy, dental and optometry services and have delegated the commissioning of general practice medical services to Clinical Commissioning Groups (CCGs). The team also working with local systems (Integrated Care Systems) to support primary care transformation, the development of Primary Care Networks (PCNs) and plan the future delegation of the remaining three primary care functions.

Dental Reform Programme

In 2020, the NHS England and NHS Improvement South West Dental team launched the

Dental Reform Programme to improve the oral health of our population and their access to NHS dental services. The programme’s board brings together representatives from Public Health England South West, Health Education England South West, Local Dental Network representatives, patient representatives and Sustainability and Transformation Partnerships (STPs).

Under the programme, an independent Oral Health Needs Assessment (OHNA) was commissioned to describe the oral health profile of the South West footprint, including the prevalence of oral diseases, the range of dental service provision currently commissioned and any gaps in the service provision across the region. The OHNA involved 56 stakeholder interviews, 221 completed stakeholder and oral health practitioner surveys and 802 patient and public surveys and will help shape a future dental strategy that meets the needs of our population across the South West by identifying key priority areas.

The full report can be read here.

Supervised Tooth Brushing Pilot

In 2019, the NHS England and NHS Improvement South West Dental team commissioned a two-year pilot running a supervised tooth brushing scheme in 54 primary schools across Devon. Due to the coronavirus pandemic and the closure of schools, it has not been possible to run and evaluate the scheme, so the team have extended the pilot to test it as a potential option for other areas in the region under the Dental Reform Programme.

The initiative supports children to brush their teeth with fluoride toothpaste after lunch each day at school, with supervision from staff. Supervised tooth brushing schemes for nursery and reception age children are evidence-based and are endorsed by NICE as a priority oral health improvement initiative for areas where children are at high risk of poor oral health.

Supporting Dental Practices through the COVID-19 Pandemic

The pandemic presented significant challenges to dental providers due to the proximity between a dental professional and a patient’s airway and the relatively high

proportion of aerosol generating procedures (AGPs) they undertake. When dental care providers were asked to pause all routine face-to-face dental care, the South West Dental team commissioned over 45 urgent dental centres (UDCs) to provide access to urgent services within infection and prevention control guidelines.

As face-to-face care resumed, infection and prevention guidelines resulted in a reduced number of appointments, but practice income was only protected if they met a national target of delivering a minimum of 20% of commissioned activity volumes (increased to 45% in Jan 2021 and currently at 60% activity). In December 2020 the region’s dental team used a flexible commissioning model to offer more appointments. This meant an extra 49 sessions per week with up to six patients seen at each session.

The team will continue to work with the Government and other key stakeholders to determine safe and reasonable contractual arrangements.

Community Pharmacy Consultation Service

In July 2019, Bristol, North Somerset and South Gloucestershire CCG (BNSSG CCG) and Avon Local Pharmacy Committee (LPC) began piloting the General Practice Referral to Community Pharmacist Consultation Service – or GP Referral to CPCS. The pilot programme connects community pharmacies with GP practices and empowers local pharmacists to use their clinical expertise and support patients with common ailments in order to release GP time and allow them to see more complex patients.

As well as alleviating pressure, the collaboration has also opened up trust and communication between GPs and pharmacists who will alert GP practices when they believe there are any underlying issues that a practice should be aware of.

By August 2020, 45 GP practices and 104 pharmacies were involved in the initiative and 3,765 referrals were made, of which 71% of cases successfully received advice from the community pharmacist with 41% receiving a product also and only 12% of cases sent back to a GP practice. Some patients have automatically sought advice from a community pharmacy in the first instance.

Thanks to its success of the pilot, the service is now being rolled out nationally.