Download Orthodontics Service Specification

Orthodontics Service Specification
5. Orthodontics (SBCH
Service
Ref No. SS_049)
Commissioner Lead
Provider Lead
Period
1. Purpose
1.1 Aims
To provide a Consultant-led service for assessment for referred patients, to advise on
appropriate management and treatment and, where appropriate, provide secondary or tertiary
orthodontic treatment within the Hospital.
1.2 Evidence Base
Major variants in tooth alignment, tooth positioning and facial skeletal and soft-tissue
relationships have adverse effects on dental health and on dental and facial appearance. A
nationally agreed Index of Orthodontic Treatment Need relates dental and occlusal anomalies
with the need for orthodontic treatment.
1.3 General Overview
Orthodontic treatment in the UK is provided by general dentists with a special interest, by
orthodontic specialists in primary care and by Consultants, specialist and training grades within
a hospital secondary care setting. All NHS-funded orthodontic treatment has to be graded
(IOTN) as having a moderate or high level of treatment need.
The appropriate treatment provider is determined by the level of treatment complexity. Within
the Dental Hospital the most complex treatment is undertaken with particular emphasis on
treatments requiring multi-disciplinary planning or treatment delivery.
1.4 Objectives
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To see all appropriate referred patients for Consultant assessment regarding dental and
occlusal anomalies even though active orthodontic appliance treatment might not be
appropriate.
To see such referrals within 5 weeks of receipt.
On assessment to advise patient and, subsequently referring practitioners, of treatment
needs and options so that informed decisions can be made.
Where appropriate advise referring practitioners on simple interceptive and preventive
measures to guide the developing occlusion.
If orthodontic treatment within the Hospital is required, to commence treatment within 18
weeks of referral once the patient is ready to start treatment.
1.5 Expected Outcomes
 Successful completion of planned treatment
 All completed cases will be subjected to PAR scoring and entered on the Regional
database
 There will be a mean reduction in PAR greater than 70%.
2. Service Scope
2.1 Service Description
Orthodontic Treatment
This involves the use of orthodontic appliances (‘braces’) to produce changes in tooth
positioning, alignment and relationships, within a dental arch and between dental arches.
Typically in the late mixed or early permanent dentition (ages 10-14 years) active treatment will
take about 2 years, followed by a period of passive retention; earlier or later orthodontic
intervention might be appropriate.
The orthodontic specialty works closely with other dental specialties to deliver integrated
treatment which requires multi-disciplinary assessment, treatment planning and treatment
delivery.
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Orthodontic treatment in conjunction with Restorative Dentistry
Children and adults with absent or malpositioned teeth may require orthodontic
treatment to change tooth positioning prior to restorative tooth replacement.
-
Orthodontic treatment in conjunction with Paediatric Dentistry
These specialties work closely together in the management of the developing dentition.
Severe Hypodontia (congenital absence of many teeth) requires multi-disciplinary
planning and treatment by the Orthodontic Paediatric and Restorative Dentistry
specialties.
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Orthodontic treatment in conjunction with Oral Surgery
Joint assessment and planning is required in the management, in particular, of unerupted and ectopic teeth, submerging deciduous teeth, supernumerary teeth and
other dental pathology.
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Orthodontic treatment in conjunction with Oral & Maxillofacial Surgery
Major variants in jaw, and therefore tooth, relationships can only be treated with
elective Orthognathic surgery. This requires integrated case assessment and treatment
planning for a phased treatment delivery involving both specialties. Can only be
considered in the adult patient.
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Orthodontic Treatment and Craniofacial Surgery
Birmingham is one of four regional craniofacial referral centres in England. The
orthodontic department aims to be involved in the management of patients with severe
craniofacial deformity.
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Orthodontic treatment of the Cleft Lip and Palate Patient
The orthodontic service is closely integrated with the Regional Cleft Lip and Palate
Centre based at Birmingham Children’s Hospital. The majority of orthodontic treatment
for cleft patients in Birmingham, Solihull and the Black Country is carried out at
Birmingham Dental Hospital.
2.2 Accessibility/acceptability
As a secondary and tertiary treatment service, all referrals are made by primary care
practitioners or consultant colleagues and accepted according to referral criteria. Patients vary
in complexity and many will require multi-disciplinary management.
2.3 Whole System Relationships
The service provision requires close working with other clinical specialties and support services
within the Hospital. The service delivery is also integrated with the West Midlands Workforce
Deanery in the provision of one of the largest postgraduate specialty training programmes in
the country.
2.4 Interdependencies
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Other clinical specialty areas
School of Dentistry University of Birmingham
Schools of Dental Nursing and Dental Hygiene and Therapy
The Workforce Deanery
The Trust Corporate Services
2.5 Relevant networks and screening programmes
Work is on-going in conjunction with the consultants in Public Dental Health for the Birmingham
Solihull & Black Country Area Team’s in the development and strengthening of a managed
clinical network.
3. Service Delivery
3.1 Service model



This is a Consultant-led outpatient assessment and treatment service:
Orthodontic treatment is undertaken by Consultants, Orthodontic Specialists and
postgraduate/Orthodontic Trainees.
The department is heavily involved in postgraduate training and contributes to the
undergraduate training programme.
3.2 Care Pathways
All pathways are initiated by a primary or secondary care referral. Pathways will vary,
dependent on the assessed treatment needs.
4. Referral, Access and Acceptance Criteria
4.1 Geographic coverage/boundaries
Like all Birmingham Dental Hospital clinical services Orthodontics is a regional service but with
a majority of referrals originating in Birmingham, Solihull and the Black Country. There are no
out of region referrals unless a clinical exception has been made.
4.2 Location(s) of Service Delivery
Birmingham Dental Hospital, with the majority of clinical activity taking place in the Department
rd
of Orthodontics (3 Floor).
4.3 Days/Hours of operation
Monday – Friday 9.00am – 5.00pm with some variations.
Bank holidays are closed.
4.4 Referral criteria & sources
For a referral to be accepted it should:
 Include all appropriate demographic information
 Give the reason for referral with an indication as to why this cannot be managed in the
primary care setting
 Provide relevant dental, medical and social history
 Enclose recent relevant radiographs.
4.5 Referral route
Primary or secondary providers refer directly to a named consultant or to the Department of
Orthodontics.
Patient needs to be under a routine dental hospital/specialist. Orthodontic walk-ins are rare but
would be dealt with.
4.6 Exclusion criteria
 Patients will only be accepted for treatment if they are in a position to accept and
support such treatment.
 Adult treatment will only be accepted if multidisciplinary management is required.
4.7 Response time & detail and prioritisation
National targets apply.
5. Transfer of and Discharge from Care Obligations
Following completion of orthodontic treatment patients will be discharged to primary care
practitioners:
- end of active treatment (18-24 months)
- end of period of retention (case specific)
- following post-retention review
- in long-term retention for primary care review
This will be dependent on treatment carried out and consistent with pre-treatment planning.
6. Self-Care and Patient and Carer Information
Patient will be instructed in post-treatment dental care and if appropriate – maintenance of
retention regime.
7. Quality Requirements
Performance
Indicator
Quality
Indicator
Threshold
Method of
Measurement
Threshold
Method of
Consequence
measurement of breach
Performance &
Productivity
8. Activity
8.1
Activity Performance
Indicators
Consequence
of breach
8.2 Activity Plan
8.3 Capacity Review
9. Prices & Costs
9.1 Price
Basis of Contract
Unit of
Price
Measurement
Thresholds
Expected Annual
Contract Value
National Tariff plus
Market Forces
Factor
Non-Tariff Price
(cost per case/cost
and
volume/block/other)*
Total
£
£