Download The Provision of NHS Orthodontic Care across

Enclosure 2
A Collaboration between Portsmouth City, Southampton City and Hampshire Primary
Care Trusts (PCTs)
The Provision of NHS Orthodontic Care across Hampshire
Service Description
Service Aims and Objectives
This Service Description sets out the general requirements of Hampshire, Portsmouth City
and Southampton City PCTs for the provision of NHS orthodontic services (both primary and
secondary care) across Hampshire.
The main objective of the proposed new service is to provide a single care pathway across
Primary and Secondary care for NHS orthodontic services within the Hampshire community.
The care pathway is to support a flexible, timely, patient-centred orthodontic service for those
eligible for treatment. This will involve the implementation of a revised care pathway for the
provision of NHS orthodontic services which acts to centralise the management of referrals,
utilise the provision of services more effectively and inform the future commissioning of NHS
specialist dental services.
The main aims of the service are:
 To ensure continued achievement of 18 weeks within secondary care and maintain
current waiting times at acceptable levels across both primary and secondary care
 The provision of a service with equitable, high quality and timely access to NHS
orthodontic treatment for all people eligible for NHS orthodontic care.
 Patients being seen in the most appropriate place by the most appropriate
provider(s)/performer(s).
 To encourage efficiency and communication improvements for both patients and
referrers.
 Support the timely advice and completion of NHS orthodontic care in ensuring
efficient and successful outcomes for patients
The Providers and/or Performers of NHS orthodontic care will be expected to deliver NHS
orthodontic services in line with the new care pathway.
Referral Pathway for NHS Orthodontics
Disputes, Transfers
and Second Opinions If Disputes arise, second
opinions needed or
patients to be
transferred – Send
details on referral form
to Central Referral
Centre
Patient with GDP
(Hampshire registered or
resident not registered
with a GP, patients only.)
Patients outside accepted
reference patient flow data.
Children
(Less than 18 years of age
at the point of Orthodontic
referral – see guidance)
GDP with UOAs complete
Assessment/Pre-treatment
Patient is below IOTN 3.6 – Not
Eligible for Treatment
Patient is
IOTN 3.6 or
above
GDP Refers to
Central Referral
Centre using
Standard Referral
Form Provided
Not eligible for
treatment
GDP advises patient
treatment not
available on the
NHS
PCT Area Referral
Panel – Patient’s
case Considered
Central Referral Centre Patient Assessed and
referred to either
Primary/Secondary Care for
Assessment of Eligibility
Secondary Care
Assessment
Very Complex
Treatment Need
– Patient accepted
for treatment in
Secondary Care
Not eligible for
treatment
Where Borderline
GDP may refer patient
to the Area Referral
Panel.
Suitable for
treatment – GDP
advised. PCT refer
to the Central
Referral Centre to
arrange treatment
Patient
below IOTN
3.6. Patient
referred
back to
Centre
Mid - Less Complex
Treatment Need –
Patient referred back to
Central Referral Centre
and onward to Primary
Care Provider
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Adult
(18 years of age or above at the
point of Orthodontic referral – see
guidance)
Patient is
IOTN 3.6 or
above
Patient is
below IOTN
3.6
Not eligible for treatment
GDP advises patient
treatment not available on
the NHS. If appropriate
may refer patient to the
PCT Review Panel
Not eligible for
treatment
PCT advise GDP
that treatment not
available on the
NHS. GDP informs
patient
Primary Care
Assessment
Mid - Less Complex
Treatment Need –
Provider can complete.
Patient accepted for
treatment in Primary
Care.
Very Complex
Treatment Need Patient
referred back to Central
Referral Centre and
onward to alternative
Provider
If patient reviewed and assessed as not ready for treatment, Orthodontic Provider completes form and returns to the Central
Referral Centre, returning patient to their GDP. GDP remains responsible for patient – see service description.
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Patients registered outside of Hampshire seeking to access NHS orthodontic treatment within Hampshire is
dependent upon the patient flow activity data as at 1st April 2006. Please see page 3-4 for further details.
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The Specific Functions of the NHS Orthodontic Care Pathway
Introduction
Referrers (General Dental Practitioners) will assess a patient to define whether onward
referral is needed as part of GDS/PDS mandatory services. A Referrer will refer a patient for
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NHS Orthodontic treatment on the appropriate referral form to the Central Referral Centre
(CRC). Any specific information, x-rays etc should be attached with the referral.
Service Description – Central Referral Centre
The Central Referral Centre (CRC) will log and process all NHS Orthodontic referrals
received on behalf of dentists from registered patients (reference patients GP) or resident not
registered with a GP within Southampton City PCT, Portsmouth City PCT and Hampshire
PCT to determine the most appropriate provider of care. The CRC will ensure the safe and
timely receipt (both paper and Choose and Book in due course) of all NHS Orthodontic
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referrals received within the locality and out of area where appropriate.
The CRC will review the referral on the basis of the Index of Treatment Need (IOTN) to
determine whether the referral is:
- Very Complex Treatment Need - the patients should be referred to a Secondary Care
provider for assessment
- Mid – Less Complex Treatment Need - the patient should be referred to a Primary
Care Provider for assessment on the basis of proposed complexity.
On this basis, should a specific Provider/Performer have been requested on the referral, the
CRC will assess whether the Provider of care is appropriate to provide the complexity of
treatment identified.
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It is noted that some patients can be seen and assessed from outside of the locality .
Referrals will then be referred on to an appropriate Provider/Performer for assessment and
completion of treatment needed.
Reference the Choice of Provider process, the Central Referral Centre will act to advise
patients of the process for NHS orthodontic care in the locality and provide support and
information where appropriate, this is with specific reference to those patients that have
stated a preference of provider and for an appropriate reason the Provider concerned may not
be suitable. It is not the role of the Central Referral Centre to provide information to all
patients, only to facilitate the patient choice process where appropriate.
The CRC will also act to support the PCTs in collating information to inform the management
of NHS orthodontic provision. Information to be collated in line with the performance
monitoring criteria.
Assessment
The CRC will review the referral on the basis of the Index of Treatment Need (IOTN) to
determine whether the referral is:
- Very Complex Treatment Need - the patients should be referred to a Secondary Care
provider for assessment
- Mid – Less Complex Treatment Need - the patient should be referred to a Primary
Care Provider for assessment on the basis of proposed complexity.
The CRC administration team are to assess all referrals (on paper) to determine the quality of
the referral and appropriate Provider of care, according to the agreed protocol.
Onward Referral from the CRC
Referrals meeting the quality standard will be referred onto the appropriate provider.
Poor quality referrals (i.e. insufficient information/incomplete template) will be returned to the
referrer with the information to be provided clearly identified.
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Referral Form – Appendix A
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Please see section “Referrals Out of Area”
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If the provider identified as a preference on the referral form can provide the level of treatment
needed the referral will be forwarded to this provider. If they are unable to provide this level
of treatment then the referral will be forwarded to an alternative provider. If waiting times
offered by the preferred provider are significant the patient will be offered the choice to see an
alternative provider.
Patients under Review
Patients who are not ready for treatment and do not need a short term review should be sent
back to their General Dental Practitioner by the Provider/Performer concerned via the Central
Referral Centre.
If the patient is deemed not ready for treatment but suitable for a short-term review these
patients should be managed by the Provider/Performer responsible for this decision (i.e.
completed the assessment).
Referrals Out of Area
Referrals from outside of Hampshire, Portsmouth and Southampton areas for secondary care
orthodontics are to be forwarded direct to the Secondary Care Provider and should not form
part of the referral management centre process. These referrals should be dealt with by
secondary care under their specific contracting arrangements (Payment by Results). This
does not apply for Primary Care Referrals which should be managed by the Central Referral
Centre.
Primary Care Referrals received from outside of the area should be monitored against
historical patient flow data. This data identifies the flow of patients seeking NHS orthodontic
care out of area, information which informed the financial allocations to PCTs for the provision
of NHS dental care. On the basis of this analysis, referrals should be assessed and either
accepted and processed or returned to the referrer concerned.
General Dental Practitioners with a small contract for orthodontic activity
All Providers and Performers of NHS Orthodontic treatment, contracted to provide Units of
Orthodontic Activity for orthodontic treatment should receive all activity via the Central
Referral Centre.
It is noted that should a provider/performer operate a small NHS orthodontic contract which is
dependent upon internal referrals only the provider/performer can use a template provided to
inform the Central Referral Centre rather than refer via the CRC for the referral to then be
returned. UOAs should not be claimed by such providers for assessment to refer for
orthodontic treatment, as this forms part of their mandatory services.
Private Referrals
Orthodontic Providers cannot take on new patients for NHS orthodontic care via private
referral and assessment. All NHS patients receiving NHS orthodontic care should be referred
via the Central Referral Centre.
For clarification, should a patient be referred for orthodontic treatment privately and after
assessment is deemed eligible for NHS treatment the referral must be processed by the
Central Referral Centre and allocated as appropriate. An NHS Orthodontic Provider cannot
accept patients for NHS care from a private referral or post a private orthodontic assessment.
Private General Dental Practitioners should continue to complete dental work as previously
and refer all patients seeking an NHS orthodontic assessment via the Central Referral Centre.
Disputes, Transfers and Second Opinions
If a referrer or Provider seeks to follow the disputes process, arrange a transfer of care or
second opinion the clinician must complete the referral form to clearly identify this request
with supporting information in Section 5.
If a referral for a dispute is received, the CRC must refer all documentation to the Complaints
Manager for the PCT concerned.
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If a referral for a Second Opinion is received, this should be referred to an appropriate
Provider according to the Clinical Competency section. Note: Patients are only eligible for one
second opinion (per patient).
If a referral for a Transfer of Care is received, the CRC must ensure that the reasons for this
referral are clearly identified. If suitable for transfer of care the case should be discussed with
a suitable Provider who has capacity available and the case discussed with the PCT Dental
lead concerned to ensure activity is awarded within the contracts appropriately.
Management of the Waiting List
It is the responsibility of the Central Referral Centre to manage a central waiting list, should
the number of referrals received be in excess of the capacity available. Should this occur the
appropriate PCT commissioners should be informed.
Information to Referrers and Patients:
To keep the General Dental Practitioner (GDP) and the patient informed of the progress of the
referral the CRC will be required to:
 Provide the patient with an estimated waiting time for assessment (where
appropriate)
 Collate estimated waiting times for start of treatment for all Hampshire orthodontic
practices. The Central Referral Centre should advise patients that this is an estimate
only. It is not the role of the CRC to advise patients of treatment waiting times for
individual cases. This is the responsibility of the Provider/Performer concerned.
 To provide patients with alternative options for treatment should the proposed waiting
time for assessment be deemed unacceptable.
 Where appropriate provide information to patients regarding the process of referral
and eligibility. Provide information where appropriate to patient in an attempt to
manage patient’s expectations.
 Where appropriate, provide patients (and referrers where appropriate) with
information (leaflet to be developed by complaints) concerning the Referral Panel
process.
 Provide useful local information to patients about Orthodontic practices such as the
location, directions and parking facilities.
 Where possible, take into account the location of services to ensure access to care
within a reasonable travel distances (reference patient engagement findings).
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Cases for the Area Referral Panel
Cases for the Area Referral Panel will be submitted to the Central Referral Centre on a
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specific referral form . These referrals should be referred to an appropriate provider for an
assessment only. A report of the assessment should be provided to the Central Referral
Centre.
The findings of this initial assessment should be sent to the appropriate PCT lead who will
seek a report from a PCT Dental Professional. On the basis of these recommendations,
cases will be considered by the Area Referral Panel and the PCT informs the referrer of the
outcome.
The PCT or CRC will not accept direct patient requests, or routinely enter into any
correspondence with patients and/or their families unless as part of the statutory NHS
Complaints Procedure. The referring clinician should act as the patient’s representative as
responses to referrals considered by the PCT Referrals Panel will be made direct to the
referrer. It is the referrer’s responsibility to communicate the outcome of this appeal to the
patient concerned.
Responsibility of Provider/Performers
Providers/Performers will be required to inform the Central Referral Centre when they do not
have any capacity to see patients within the timescales agreed, to ensure that no further
patients are referred at that time.
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5
Please see “Area Referral Panel” Guidance and Referral Form – Appendix C
Appendix B
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When accepting a patient for an assessment, it is the Providers responsibility to ensure that
they have the capacity to commit to treatment at that time, should the patient be suitable for
treatment in line with the agreed timescale of 18 weeks for both primary and secondary care
providers.
When appeal cases are referred to be considered by the Central Referral Centre, it is the
referrer’s responsibility to communicate the outcome of the appeal to the patient concerned.
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