Download 1 NHS Grampian Hospital Orthodontic Services Option Appraisal for

Meeting: NoS Maxillofacial, Oral & Dental Health Project Board Date: 13 th May 2013 Item: 17/13
NHS Grampian Hospital Orthodontic Services Option Appraisal for future provision in the West of Grampian (Dr Gray’s, Elgin) Background The Hospital Orthodontic service in NHS Grampian is based in the Aberdeen Dental School and Hospital and currently provides a visiting service to Dr Gray’s Hospital in Elgin. This is on a weekly basis with a current commitment of 2 consultant sessions and 2 Staff Grade sessions. Historically (circa 2000) funding existed for a part time Consultant post based at Dr Grays but there was repeated failure to recruit to this post and a visiting service has continued. Orthodontic Consultant capacity in NHS Grampian has also reduced overall since 2010 with recruitment to a part –time post to replace a previous full time post. This has also had an impact on the visiting service to Elgin with a reduction in consultant sessions from 3/week prior to 2010 to the current 2 session commitment. The demands on the Hospital Orthodontic service in NHS Grampian exceed capacity with continued significant waits for both assessment and subsequent treatment with the service failing to meet the 18 week RTT. The longest waits for new patient assessment stretch to 6 months (with an appointment) to 3 months (without an appointment) and the treatment waiting list is now 18 months for non­urgent patients. There has been discussion previously through the North of Scotland MCN for Dentistry and more recently through the Orthodontic Clinical network about re­establishing the second Consultant Orthodontist post in Highland with the option of a shared (Highland/Grampian) post with provision in Elgin. This would fit well with the current networks being established with OMFS and Restorative Dentistry both of which have included clinical provision at Dr Grays. Appraisal of Future Options 1. No Change: maintaining the status quo and continuing with the current service arrangement and visiting service to Dr Grays from Aberdeen. This may seem the most attractive option financially but will be detrimental to patient care with continued long waits for orthodontic assessment and subsequent treatment. It will also reduce the opportunities for clinical networking with OMFS and Restorative colleagues in Elgin compared to a more locally based service. In addition, a continued commitment to provide a visiting clinical service from Aberdeen may not be sustainable long term as it will potentially have a negative effect on the prospect of recruiting to future substantive Consultant posts in Aberdeen. 2. Part – time Post based in Elgin: re –establishing the previous part –time post in Dr Grays. This would have a positive impact on patient waiting times in NHS Grampian with up to 4 additional treatment sessions (2 Consultant and 2 Staff Grade) being available in Aberdeen. It would also reduce the demands on the Aberdeen service with new patients from the West of Grampian being seen and managed in Elgin. It would also facilitate closer clinical networking with the OMFS and the planned Restorative Dentistry service. It could be potentially be supported by existing support resource in Dr Gray’s without generating a significant cost ‘tail’. However, a significant risk with this option would be failure to recruit to a part – time post as has been the case 1 in the past. Feedback from trainees previously suggested that Moray was seen as a ‘remote’ area and that such a ‘single – handed’ post was viewed as potentially isolated professionally. 3. Substantive Consultant Orthodontist Post Inverness/Elgin: this proposed post would be a shared post with its main base at Raigmore Hospital, Inverness but also providing a clinical service at Dr Gray’s Hospital, Elgin serving the West of Grampian. This post would have a positive impact on patient waiting times in both Grampian and Highland. It would also integrate with the Clinical networks being established in OMFS and Restorative Dentistry across the North of Scotland providing a very attractive multi­disciplinary working environment for clinicians and enhancing patient care through improved access to complex collaborative treatment options. Funding exists within the NHS Grampian Orthodontic service to contribute to this post and there has been funding for a second Consultant post in Inverness previously with a locum in place as recently as 2011. Creating this shared post and the establishment of multi­disciplinary networking across the North of Scotland will also improve future recruitment and retention in Highland and across the region. Recruitment to ‘single handed’ posts is difficult and reliance on this model of working is extremely high risk with the potential for complete collapse of a service if the clinician is incapacitated or leaves the region. This proposed shared post would be an attractive opportunity for Orthodontic trainees and currently there is a senior trainee in the region with significant ties to Inverness who would be interested in such a post and is due to finish training during 2013. This is therefore a rare opportunity to recruit a high calibre individual to the region to contribute to the clinical networks being established and develop a sustainable service across the region.
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