PLANNING DENTAL SERVICES

GROUP 9
LUCENA
MANJARES
TAN, JANNIE
TAN, MIGUEL
PLANNING IS AN INTEGRAL PART OF DENTAL CARE PROVISION THAT CAN
OPERATE AT MANY DIFFERENT LEVELS.

THE NATIONAL HEALTH SERVICE COMMISSIONING BOARD (NHSCB)

WILL DETERMINE NATIONAL POLICY AND NATIONAL DELIVERY
REQUIREMENTS.
 PRINCIPLES OF PLANNING
IT PROVIDES AN OPPORTUNITY TO BE PROACTIVE IN DECISION-MAKING RATHER THAN

CONSTANTLY REACTING TO PRESSURES AND DEMANDS.

IT ENABLES PRIORITIES TO BE SET.

IT IDENTIFIES WHERE RESOURCES CAN BE DIRECTED TO HAVE THE GREATEST IMPACT.

THE RATIONAL PLANNING MODEL PROVIDES A BASIC GUIDE TO THE PROCESS (MCCARTHY 1982),
AND INVOLVES THE FOLLOWING STEPS:

1. ASSESSMENT OF NEED: E.G. IDENTIFICATION OF THE ORAL HEALTH PROBLEMS AND CONCERNS
OF THE POPULATION.
2. IDENTIFYING PRIORITIES: AGREEING ON THE TARGET AREAS FOR ACTION.
3. DEVELOPING AIMS AND OBJECTIVES: THE AIM IS THE OVERALL GOAL TO BE ACHIEVED,
WHEREAS THE OBJECTIVES ARE THE STEPS NEEDED TO REACH THE AIM.
4. ASSESSING RESOURCES: IDENTIFYING THE RANGE OF RESOURCES AVAILABLE TO FACILITATE THE
IMPLEMENTATION OF THE PLAN; FOR EXAMPLE, PERSONNEL, MATERIALS, AND EQUIPMENT.
5. IMPLEMENTATION: TURNING THE PLANS INTO ACTION.
6. EVALUATION: MEASURING THE CHANGES RESULTING FROM THE PLAN.
 JOINT STRATEGIC NEEDS ASSESSMENT

IN ENGLAND IN 2013, THE HEALTH AND WELL-BEING BOARD (HWBS) WILL BE OBLIGED,
TOGETHER WITH CONSORTIA/CLINICAL CARE COMMISSIONING GROUPS (CCGS), TO
PRODUCE A JOINT STRATEGIC NEEDS ASSESSMENT (JSNA) AND A JOINT HEALTH AND
WELLBEING STRATEGY (JHWS).
 ORAL HEALTH NEEDS ASSESSMENT
Matthew (1971)
Need for medical care exists when an individual has an illness or
disability for which there is an effective and acceptable treatment or
cure.

Culyer (1995)
Individual has the “capacity to benefit” from treatment
Different types of needs (Bradshaw 1972)
Normative need (professionally defined need)
Felt need or wants (patients’ perception of their need, which is usually less
than normative need)
Expressed need or demand (felt need translated into action, by using
services or requesting information)
Comparative need (assessed by comparing the health needs of similar
groups of people)

Carr and Wolfe (1979)

Define unmet need as the differences, if any, between health care that is
judged as necessary for a population and the actual care provided.
 ORAL HEALTH NEEDS ASSESSMENT
Shortcomings:
Normative assessments of need are not objective.
Normative assessments of need do not provide any information on the
impact of disease on an individual’s function and quality of life.
Normative assessments of need rely solely on professional judgments
and the patient’s felt needs are not accounted for.
 IMPACT OF ORAL DISEASE
Locker (1988)
Locker developed a conceptual model of oral health based upon the
concepts of impairment, disability, and handicap
Assessment tools based on this model of health would estimate ‘the
extent to which dental and oral disorders disrupt normal social role
functioning and bring about major changes in behaviour
 Approach to Oral Health Needs Assessement (OHNA)
(Sheiham and Spencer, 1997)

Assessment of normative need

Socio-dental approach – aims to integrate normative assessment of
needs with impact of oral health measures to produce rational
planning model
Steps in undertaking an Oral Health Needs Assessment
1. Assess local needs
2. Identify priorities of local commissioners
3. Review local dental care provision
4. Map and analyse
5. Views of stakeholders
6. Views of patients and service users
7. Views of other stakeholders
8. Synthesize unmet needs and priorities
9. Map current provision and explore possibility for future
provision
10. Synthesize data
11. Develop an action plan and oral health strategy
 ORAL HEALTH PRIORITIES
The Steele review (Steele et al . 2009 )
1. Prevent oral disease and the damage caused
2. Minimize the impact of oral disease on health
3. Maintain and restore quality of life when this was affected by
oral diseases and the condition of the mouth.
Priorities for public investment in oral health
 ORAL HEALTH PLANNING

Needs assessment
Description of population
Resource assessment
Defining the problems
 QUALITY OF DENTAL CARE AND CLINICAL GOVERNANCE

Scally and Donaldson (1998) define clinical governance as a continuous

improvement in the quality of services, where high standards of care are
safeguarded by creating an environment in which excellence in clinical care
flourishes.
Key components of clinical governance include:
Clear lines of responsibility for the quality of clinical care;
A comprehensive programme of activity that improves quality;
Clear policies for managing risk;
Procedures for all health care professionals to identify and remedy poor
performance.
 DEFINITIONS OF QUALITY
Maxwell (1984) has proposed a definition of quality in health
services that has been widely accepted as reflecting the
breadth and complexity of this topic. The definition has the
following components:

EFFECTIVENESS: that services achieve their intended benefit; for

example, that orthodontic treatment produces a long-term,
sustained improvement in malocclusion.
ACCESS: that the services are easily available to users in terms of
time, cost, distance, and ethos; for example, ensuring that
different users of services, such as disabled people, can utilize
dental care.
SOCIALLY ACCEPTABLE: that services are provided to satisfy the
reasonable expectations of users, providers, and the community; for
example, in areas where English is not the fi rst language of many
people, services should recognize this and provide information and
resources in an appropriate language and format.
EFFICIENCY AND ECONOMY: that the services achieve maximum
benefit for minimum cost; for example, by limiting wasteful use of
materials and equipment.
RELEVANCE TO NEED: that the service is what the users actually
need; for example, that the dental services provided reflect the needs
of the local population, such as prosthetic care for an area with a
large number of older people.
EQUITY: that services will be fairly directed to those in need; for
example, dental services should be available to all groups in society,
not just those with private health insurance.
Another popular definition of quality was proposed by the Royal College of
General Practitioners (1985) when they reviewed what would be the core
features of a high-quality service provided by a general medical practitioner.
This definition has more of a clinical focus and encompasses the following
features:
INTERPERSONAL SKILLS: the ability to communicate effectively with users and
colleagues is an essential component of clinical practice.
CLINICAL COMPETENCE: the ability to perform core clinical tasks to a sufficient
standard to ensure the effective and safe delivery of appropriate care.
PROFESSIONAL VALUES: this recognizes the importance of ethical and
professional principles relevant to the delivery of health care. These include
respect for clients’ rights and autonomy, justice, beneficence, confidentiality,
and privacy.
ACCESS: the ability of clients to utilize and benefit from care is a fundamental
requirement.
Donabedian (1974) describes quality of health care as
having three interrelated elements: structure, process, and
outcome:
Structure refers to the physical elements of care, such as
the facilities, equipment, and premises.
Process involves all the various ways in which the system
deals with people using the service. This includes the
clinical techniques employed, the administrative and
management systems, and the appointments procedures.
Outcome refers to the consequences of contact with the
service; in other words, what has changed as a result of
using the service. For example, has the toothache
stopped?
Lord Darzi (2008) described the quality requirements of the NHS as:
safety, effective treatments, and patient care characterized by
compassion, dignity, and respect.

Steele et al . (2009) called for a focus on quality that looked at not

only the technical effectiveness of care provided, e.g. longevity of
restorations, but also the effectiveness of prevention provided:
‘If we are successful in communicating with patients about
decreasing their risk of oral disease, then we should be able to
provide evidence for that, through more patients moving on to
continuing care and more returning patients whose risk is lowered’.
 IMPLEMENTING QUALITY WITHIN DENTAL DERVICES
From 2011, all dental practices in England were required to register with
the Care Quality Commission (CQC). The CQC has the remit of registering
all health and social care providers, monitoring and inspecting providers,
and imposing fines or forcing closure if quality standards are not met. The
benefits of the frameworks are as follows:
they bring all quality assurance processes under one umbrella;
systems and processes are clear, transparent, and accountable;
lines of responsibility are made explicit;
risk management is proactive and explicit;
and the whole team is involved in the process.
Clinical governance is an extremely detailed process that is ongoing.
There are two key aspects: (1) setting standards and clinical policy; and
(2) monitoring and implementation of clinical policy and standards.
The Primary Care Commissioning (2006) outlined a clinical
governance framework for commissioners to assess primary dental
practices’ compliance with clinical governance, identifying eight key
dental themes
The Audit Cycle provides a useful structure to follow when considering
the best means of improving service performance. When establishing a
quality team, it is essential that ground rules are agreed in order to
promote trust, understanding, and respect. Once confidence and
expertise are developed, more challenging areas of practice can be
tackled. Setting and agreeing standards of care is a critical step in the
audit process. This can be a very time-consuming and difficult task,
especially reaching a consensus view. Probably the most problematic
step in the audit cycle is developing and implementing the system of
monitoring practice against agreed standards of care.
 THE AUDIT CYCLE
OR
QUALITY ASSURANCE CYCLE
Conclusion
Within a constantly changing world, planning is an essential activity to
ensure that dental care responds and develops appropriately to the
new challenges presented. Assessing need is at the core of
planning. Socio-dental measures of oral health provide a useful means
of assessing the impact of oral diseases on individuals and
communities. Internationally, health services are striving to improve the
quality of care provided. Within dentistry, clinical governance
mechanisms are now being introduced that seek to review and
implement improvements in the standards and quality of dental care.
Again, it is important that any efforts to improve quality of care
encompass a broad and balanced definition of quality which includes
the perspectives of clinicians, service users, and health service
managers.
T H A NK
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