“Recall Matters” – appropriate dental recall intervals for people with good oral health

Project initiation document

11 October 2017

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Document filename: RECALL MATTERS – project initiation document

Directorate / programme OCDO Project Recall Matters

Document reference

Project manager Andrew Jones Status <insert>

Owner Rory Deighton SRO

Version Version v4

Author Andrew Jones Version issue date 11/10/2017

Document management

Revision historyVersion Date Summary of changes

v1 13 June 2017

Initial project plan inserted into NHS E PID format (Kate Jones Public Health England)

v23 September 2017

PID re-worked and aligned with project plan and limited distribution for consultation (Andrew Jones, Project Manager Healthwatch Kirklees)

v3 25 Sept. 2017

Feedback incorporated into final draft (Andrew Jones, Project Manager Healthwatch Kirklees)

v4 11 October 2017

Changes made following discussion and comment in Project Board meeting 5 October 2017

ReviewersThis document must be reviewed by the following people:

Reviewer name Title/responsibility Date VersionKate Jones Public Health England 6 Sept 2017 V3

Emma Wilson NHS England West Yorkshire 3 Sept 2017 V2

Shan Ellahi Office of Chief Dental Officer (CDO) 3 Sept 2017 V2

Approved byThis document must be approved by the following people:

Name Signature Title Date VersionSara Hurley CDO

Rory Deighton SRO

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Related documentsTitle Owner LocationDental Recall Survey research report 21 April 2017

General Dental Council, Community Research

Dental checks: intervals between oral health reviews, clinical guideline (CG 19), 27 October 2004

National Institute for Health and Care Excellence (NICE)

https://www.nice.org.uk/guidance/cg19

“Is there a scientific basis for six-monthly dental examinations?”

Sheiham, A Lancet. 1977 Aug 27;2(8035):442-4

West Yorkshire Oral Health Needs Assessment (2015)

Public Health England https://www.gov.uk/government/publications/oral-health-needs-assessment-for-yorkshire-and-the-humber

Document controlThe controlled copy of this document is maintained by Healthwatch Kirklees. Any copies of this document held outside of that organisation, in whatever format (e.g. paper, email attachment), are considered to have passed out of control and should be checked for currency and validity.

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ContentsDocument management..............................................................................................2

Revision history........................................................................................................2Reviewers................................................................................................................2Approved by.............................................................................................................2Related documents..................................................................................................3Document control.....................................................................................................3

1 Purpose....................................................................................................................6

2 Project definition and scope.................................................................................6

2.1 Project summary.............................................................................................62.2 Business requirement.....................................................................................62.3 Commissioning organization...........................................................................82.4 Primary funding organization..........................................................................82.5 Scope..............................................................................................................82.6 Project approach...........................................................................................10

3 Project organisation............................................................................................13

3.1 Senior responsible owner (SRO)..................................................................133.2 Project governance.......................................................................................133.3 Project board.................................................................................................133.4 Project resources and responsibilities...........................................................14

4 Resource plan....................................................................................................14

5 Key stakeholders................................................................................................14

6 Initial business case...........................................................................................15

7 Benefits...............................................................................................................15

8 Project controls...................................................................................................17

8.1 Reporting......................................................................................................178.2 Tolerances....................................................................................................178.3 Delivery assurance.......................................................................................178.4 Risks and issues management.....................................................................178.5 Business change strategy.............................................................................178.6 Change control..............................................................................................178.7 Information management..............................................................................178.8 Quality management.....................................................................................17

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8.9 Benefits management...................................................................................188.10 Communication and stakeholder engagement..............................................188.11 Initial project plan..........................................................................................19

9 Assumptions, dependencies and constraints.....................................................19

9.1 Assumptions.................................................................................................199.2 Dependencies...............................................................................................199.3 Constraints....................................................................................................20

10 Risk and issue log............................................................................................20

11 Lessons learnt..................................................................................................21

12 Acceptance criteria and handover to live service.............................................21

12.1 Acceptance criteria.......................................................................................2112.2 Handover to live service................................................................................21

Appendices

Appendix 1 – data supporting section 1 (Project background)...............................22Appendix 2 – Stakeholder analysis........................................................................28Appendix 3 – Evaluation of project.........................................................................31Appendix 4 – Risk register.....................................................................................32

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1 Purpose

This project initiation document outlines the direction and scope of the dental recalls project known as “Recall Matters” and forms the ‘contract’ between the project management team and the senior responsible owner (SRO) and project board.

The PID outlines:

What the project is aiming to achieve (Section 3)

Why the project is required and why it is important to achieve (Section 3, section 6, and section 7)

Where the project and its outputs or assets will be developed (Section 3)

Who is involved in managing the project and their responsibilities (Section 3, section 4, and section 5)

How and when the project will happen? (Section 2 and section 8)

2 Project definition and scope

2.1 Project summaryThe purpose of the project is to work with dental practices and the public to ensure dental recall intervals between routine dental check-ups fit with the guidance for the National Institute for Health and Care Excellence and to explore whether additional capacity can be released in NHS general dental services in West Yorkshire.

2.2 Business requirementAttending the dentist every six months has been a widely disseminated health message for many years. However the evidence base behind this message has long been questioned (Sheiham, 1977). The National Institute for Health and Care Excellence has published evidence based guidelines for dental recall intervals (NICE, 2004). The guidelines were reviewed in February 2014 and no additional major studies were identified that would affect the recommendations in the next 3–5 years. Adults should be seen for dental recall at intervals from 3 months to 24 months and children should be seen for a dental recall at an interval from 3 months to 12 months depending on their level of risk of oral diseases. Patients should understand the clinical decision making to decide their dental recall interval and feel engaged in this discussion with their dentist. Dental record keeping should support this process.

Local anecdotal information suggests that some patients expect a dental recall interval of 6 months regardless of risk. Extending dental recall interval for people at low risk of oral diseases in line with the NICE guidance would increase the availability of dental services. The West Yorkshire Oral Health Needs Assessment (PHE, 2015) highlighted that, based on the available information at the time, it was not possible to describe the dental recall interval for patients with a low risk of oral disease (interval between band 1 courses of treatment). The report highlighted that

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dental practices should be supported to ensure that the evidence based dental recall guidance is implemented in practice.

Nationally, in 2015/16, the average re-attendance intervals across England between band 1 treatment was 8.1 months. Review of the West Yorkshire dental re-attendance data for adults for the same period of time, highlighted that the average re-attendance interval was 7.8 months for all patient groups, (children, exempt and non-exempt patients).

Since 2013, equity of access to dental services in West Yorkshire has been raised as an issue by a number of stakeholders including Healthwatch Kirklees, Healthwatch Bradford, West Yorkshire Overview and Scrutiny Committee and local MPs. NHS England is currently leading a work stream to inform a better understanding of access to NHS dental services across Yorkshire and the Humber, including equity of access. This will inform the commissioning of high quality, equitable, patient centred, safe, effective services that provide value for money.

The General Dental Council, NICE and NHS England were keen to collate information describing patients’ experience on dental recall. A short online survey was conducted with the GDC’s Word of Mouth Panel during April 2017. Key findings included:

Respondents understood the rationale for visiting the dentist regularly; Respondents who experienced good oral health felt comfortable in asking

their dentist for a recall interval longer than 6 months; Four fifths of respondents felt comfortable in asking for recall interval between

9-12 months; Almost half of respondents were uncomfortable asking for a 24 month gap,

particularly people aged 55+ where 21% were very uncomfortable; Over a third of respondents raised concerns regarding being given a 2 year

recall interval as they were concerned their oral health status would deteriorate.

Appendix 1 to this document gives more specific data that form part of the background to this work. Additional highlights from these data are:

People from the most deprived two deciles ranked by Indices of Multiple Deprivation (IMD) have, on average for all practices in West Yorkshire, shorter recall intervals than people from the least two deprived deciles of patients. This reflects the gradient of oral health in the wider population.

Re-attendance intervals for patients in different groups in West Yorkshire in 2015/16 varied from 7.5 months for children, 7.6 for exempt adults and 8.1 months for non-exempt adults.

Looking at data for all practices across West Yorkshire the percentage of claims with no recall interval given varies between practices from 0% to 100%. 24% of all claims had no recall interval noted. (This may suggest an area of focus).

The distribution of UDAs between the three bands of treatment for all patients in West Yorkshire for 2015/16 was –

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Patient Charge Band

Total UDAs Percentage of Total UDA for Bands 1-3

Band 1 1,139,565 30.54Band 2 1,611,177 43.17Band 3 981,024 26.29Sum: 3,731,766

Based on this business requirement, a project led by Healthwatch Kirklees and working in partnership with the Office of the Chief Dental Officer (CDO), NHS England (national and local office), Public Health England and the General Dental Council will explore the implementation of the NICE dental recall guidance. A representative from the West Yorkshire LDCs will be asked to join the working group. Kirklees Healthwatch and the other four Healthwatch organisations in West Yorkshire are keen to work in partnership with NHS England - Yorkshire and the Humber to ensure a shared understanding of dental recall attendance in West Yorkshire.

The project will run as a pilot for 18 months, exploring these issues, with a view to sharing its learning across England.

2.3 Commissioning organizationHealthwatch Kirklees.

2.4 Primary funding organization Healthwatch Kirklees will fund the costs of project management and have a budget for social marketing advertising. Partner organisations are responsible for their own overheads, budgets and other resources for the duration of the project.

2.5 Scope2.5.1 ObjectivesIn summary the objective of the project is to work with dental practices and the public to ensure dental recall intervals between routine dental check-ups fit with the guidance for the National Institute for Health and Care Excellence and to explore whether additional capacity can be released in NHS general dental services in West Yorkshire.

Specifically the project will explore:

If the recall interval between routine dental check-ups for people assessed at low risk is in line with the recommendations in NICE guidelines on recall intervals by reviewing practice level data across West Yorkshire;

The reasons for any large variations in average recall intervals between different NHS practices, gaining an understanding of the main influences on recall intervals for orally healthy adults;

What motivates behaviour change amongst both dentists and patients with regards recall intervals;

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A range of interventions that might be expected to influence re-attendance intervals between routine dental check-ups for patients who experience good oral health;

If capacity can be made available within existing resources to enable more people to access NHS general dental services.

The project will be fully evaluated and has the potential to be extended nationally to inform best practice. NHS England will ensure that key stakeholders are updated on the details of the project which will include formal communication with all West Yorkshire dental practices.

2.5.2 ScopeThis project will focus on adults who are orally healthy who may be attending NHS general dental services more frequently that NICE guidance recommends and who could safely have their dental recall interval extended. The project will work with general dental services in West Yorkshire, their professional networks, the public in West Yorkshire, key NHS bodies and relevant partners. A full stakeholder analysis has been carried out and is attached as appendix 2.

2.5.3 Exclusions from scopeExcluded from the scope of this project will be:• Children who are orally healthy;• Adults or children considered to be at risk of developing oral diseases; • NHS community dental services, urgent dental care, minor oral surgery, orthodontics, hospital dental services.

2.5.4 Expected outcome and scale of business change

Increasing the average band 1 to band 1 re-attendance interval to 9 months from the current 7.8 months across West Yorkshire would free-up an estimated 105,484 UDAs or £2,637,090 within the current general dental services contract configuration for practices to provide care for new patients. Increasing re-attendance intervals to an average of 12 months over the longer term would free up an estimated £6,839,730 or 273,589 UDAs, (NHSBA estimates on 2015/16 baseline and using average of £25 per UDA – more information in appendix 1).

Learning from the West Yorkshire work will be used to explore opportunities to roll out of the project across England.

Increasing the England average band 1 to band 1 re-attendance interval to 9 months from the current 8.1 months across would free up an estimated £35,445,825 or 1,417,833 UDAs to increase access to general dental services. Increasing re-attendance intervals across England further to an average of 12 months over the longer term would free up an estimated £118,770,469 or 4,750,819 UDAs. This has the potential to increase the capacity of the system at no additional cost.

2.6 Project approach

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The overall strategy for this project is in six main parts with the significant section “interventions” further subdivided into four. This may be expanded over the course of the project if the Project Board chooses to initiate additional interventions. The approach is summarised below with more detail in the schedule of delivery.

1. Project initiation

This phase includes the initial development of the key objectives, interventions and required outcomes of the project across different agencies, the development of the draft Project Initiation Document (PID), discussion by the Project Board, any required amendments and final sign off of the PID by the Board.

2. Research

Includes the gathering and interpretation of key data on recall intervals in West Yorkshire in the wider context of dental services and oral health, national policy and best practice guidance, research into patient attitudes to recall (conducted by the General Dental Council), discussions with the Local Dental Networks and some individual practitioners, views from local Healthwatch organisations on patient experiences and current public communication work relating to dentistry.

3. Design

Further design work will refine the key interventions of the project, ensuring that these take into account the views and experiences of local dental practitioners relating to dental recall. Specific discussions are taking place about the appropriate level and detail of practitioner level data on recall intervals and these will be designed into the project. Other interventions to support dental practices to move towards NICE guidance will be discussed with the LDC and LDN and members of the Project Board and, when agreed, will be incorporated into future versions of this Project Plan. Additional design work will be done on public and patient communications. Design work will also include identification and agreement of key measures to enable effective evaluation of the project.

4. Governance and oversight

The “Recall Matters” Project Board will oversee the delivery of the project. The project is led by Healthwatch Kirklees and their Director Rory Deighton is the named Senior Responsible Owner (SRO), working in partnership with the Chief Dental Officer, NHS England (national and local offices), Public Health England, and the General Dental Council, all of whom have been involved in initiating the project. The Project Board will also include representatives from the Local Dental Committee, the NHS Business Authority, the Care Quality Commission and the project manager. Meetings will take place every two months to ensure effective and timely delivery of the project.

5.1 Intervention 1 – data for dental practices

The project will send to all dental practices at monthly intervals benchmark data on recall and re-attendance intervals at practice level across West Yorkshire. It will also maintain a central closed webpage will all data and documents relating to the project will be held and visible to all practices. This will support the process of increasing band 1 to band 1 recall intervals and add value for practitioners. NHS England are

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carrying out further work with the Local Dental Committee to agree the level and content of the information and how it will be provided to practices, with the support and input of Public Health England. NHS Business Authority will bring together the agreed data at the agreed timescale. This tailored report will be piloted in the period October 2017 to March 2018, prior to refinement and a formal launch in April 2018.

5.2 Intervention 2 - engagement with the dental profession and NHS partners

Engagement with the dental profession in West Yorkshire is a fundamental part of the strategy for this project. There must be good communication with practitioners about the aims and objectives of the project, both through the Local Dental Network and the Local Dental Committee, and also via NHS England who are already engaging on the key data set. This engagement needs to be completed by mid-October 2017 to enable the pilot stage to start. Other key NHS partners will also be briefed and this will include communication through the Sustainability and Transformation Partnership. When benchmark data on recall have been shared with practitioners for an agreed period the success of practices with good or improving recall intervals can be both celebrated and analysed.

The project will engage with dentists to understand the opportunities and obstacles, the motivations and difficulties in extending intervals between band 1 recalls and hear their perspectives on what would support the move towards more consistent implementation of NICE guidelines. A number of approaches could be considered including telephone interviews, focus groups (perhaps attached to existing dental network meetings), case studies, face to face 1:1 interviews.  The rich data this could yield would need to be balanced by the time and cost of doing and analysing these detailed qualitative data.  The Project Board will need to agree the appropriate interventions based on the resources, people and time available to implement these. Public Health England would be well placed in terms of skills, knowledge and position in the NHS structure to lead this work on engaging with dentists about motivations for behaviour change, but this would depend on capacity and no decisions have been taken about responsibilities.  

Other interventions with dental practitioners will be considered by the Project Board and if approved incorporated into future versions of the project plan.

5.3 Intervention 3 - engagement with the public and patient targeted communications

ACORN classification can help identify preferred methods of communications for different segments of the public throughout West Yorkshire areas. Patients, carers and the public will be informed and communicated with using a variety of approaches. There will be specific targeting of seldom heard groups and those identified in all of the protected characteristics groups as defined by the Equality Act 2010. Consideration will be given to the appropriate use of community languages.

Patient targeted communication will use animation and social media advertising, including the Healthwatch animation https://www.youtube.com/watch?v=QF9KlmNdhjE to raise the issue of asking for a longer recall intervals. Healthwatch Kirklees have identified and committed resources for a social media

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campaign across West Yorkshire. Covering the initial 2 months of public engagement on social media this has the potential of daily reach of between 6,700 – 29,000 people and daily engagement/post likes of 180 – 800 people. Changing patient behaviour will be explored over the first two months of engagement via responses and comments posted. Healthwatch organisations in Bradford, Wakefield, Leeds and Calderdale have agreed to use common patient focussed communications in their localities.

Joint press releases will use a variety of other media to communicate core messages about recall intervals to the public, utilising existing linkages between communications teams and media. Healthwatch organisations will use websites and mailings to reach their memberships, and other partner organisations and NHS providers will use their public facing communications to further promote co-ordinated public messaging.

5.4 Intervention 4 - contract management, CQC inspections and other interventions

This area includes a number of potential areas of work designed to facilitate more consistent progress towards implementing the NICE guidelines and releasing more capacity by increasing band 1 recall intervals. These would need to be fully scoped and approved by the project board prior to implementation. Options under consideration include:

Explore options for embedding recall in NHSE contract management, including focussed contract management visits;

Explore options with the CQC, agree approach, targeted piece of CQC carried out on recall practice – summary report produced, consideration given to embedding recall practice in all CQC inspections; 

Exploring options relating to training, specifically for the whole dental team through the Multi Professional Education (MPE) programme and through the Dental Foundation Training programme. Embedding best practice on recall will be discussed with Health Education England Yorkshire and Humber Dental Dean and other key people.

6. Monitoring and Evaluation

There will be interim areas of monitoring and evaluation specific to particular interventions and a set of data reviewed at the conclusion of the project to assess the impacts as a whole. Project progress monitoring will take place continually through Rory Deighton SRO, the project manager and overseen in progress monitoring reports every two months by the project board.

Interim evaluative work includes:

Questionnaire to all dentists in West Yorkshire to assess the utility of the pilot data set, seeking ideas for improvement before the re-launch in April 2018, and also seeking ideas about what else would help to ensure appropriate recall intervals;

Monitoring of the effectiveness of public communications, evidencing whether the project has achieved the communications objectives by engaging with our target audiences successfully. We will constantly monitor our activity to

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ensure we are reaching our audiences effectively. Through social media monitoring and evaluation we will be able to learn lessons and gain valuable insight particularly into public behaviour, allowing us to tailor our methods accordingly.

Evaluation at the end of the project will focus on the changes in recall interval patterns, assessment of any changes in use of UDAs, numbers of new patients including an analysis of which communities, changes in the numbers of people getting band 1 treatment but also band 2 and 3, patient satisfaction, oral health measures.

The evaluation will also need to describe and understand the variations in how practices use any extra capacity.   

A set of data for evaluation purposes is proposed at appendix 3 – this should be developed and agreed by members of the project board to enable pre, interim and post project monitoring data to be recorded. As far as possible, evaluation should use data that are already collected, for example through the FP17s and the Dental Assurance Framework and the Public Health Outcomes Framework.

2.6.1 Commercial considerationsThe project board will be aware of the commercial issues faced by dental practitioners and be sensitive to the ways in which their response to this project may be influenced by business and commercial considerations.

3 Project organisation

3.1 Senior responsible owner (SRO)Rory Deighton, Director of Healthwatch Kirklees is the SRO for this project.

3.2 Project governanceThe “Recall Matters Project Board” will oversee the delivery of the project. Meetings will take place every two months to ensure effective and timely delivery of the project. Each member of the project board will be responsible for reporting back to their own organisation and securing the necessary agreements to enable the effective delivery of the project.

3.3 Project boardMembers of the project board to date are:

Rory Deighton, Director Healthwatch Kirklees, SRO Sara Hurley, Chief Dental Officer for England Janet Collins, General Dental Council Sally Eapen Simon, Consultant in Dental Public Health, Public Health England Shan Ellahi, Project Lead, NHS England Kate Jones, Consultant in Dental Public Health, Public Health England Emma Wilson, Head of Co-Commissioning (Yorkshire & Humber), NHS

England

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Additional people invited to join the project board are: Jane Moore, West Yorkshire Local Dental Network and LDC John Milne, Senior National Dental Adviser to the CQC Mick Armstrong, British Dental Association Paul Gray, Senior Clinical Adviser NHS Business Services Authority, Dental

Services

3.4 Project resources and responsibilitiesThe Project Manager, Andrew Jones is contracted to support the project for 2.5 days per month, initially for a period of 12 months, starting in July 2017. Other project resources will be found from within partner organisation.

4 Resource plan

Costs will include: Social media marketing Project management resource Internal staff and time costs for each agency, for example costs of analysis of

data within NHS BSA Time and resources associated with project board and governance Resources for patients around appropriate recall intervals Potential resources associated with training for dental practices in applying

NICE dental recall interval guidance Information for practices in applying the NICE guidance

5 Key stakeholders

The major stakeholders in the project will be: Members of the public who are users or potential users of NHS dental services

in West Yorkshire Local dental practitioners, the Local Dental Network and the Local Dental

Committee Healthwatch organisations in West Yorkshire NHS England Office of the Chief Dental Officer Public Health England General Dental Council West Yorkshire STP NHS Business Services Authority.

6 Initial business case

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See section 2 for more information on the business requirement and the case for extending recall intervals in line with NICE guidelines.

The immediate benefits of the project in West Yorkshire are intended to be: Orally healthy adult patients recalled for a dental check-up according to their

level of risk in line with NICE guidance; Better informed and empowered patients; Knowledge about the motivations and obstacles to increasing recall intervals

and an understanding of what interventions are helpful and effective to achieve this;

Increased capacity released in dentistry; Improved access to NHS general dental services across the area

The following section sets out the potential capacity that could be freed up to improve access to general dental services if the re-attendance intervals are increased.

7 Benefits

The key benefits arise from the released capacity in UDAs in existing general dental service contracts to improve access. This will be measured through FP17 returns alongside other data via NHS BSA and PHE.

The numbers of UDAs that may be ‘freed’ to increase capacity and access by extending the recall interval between band 1 courses of treatment is shown in the table below.

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Estimated released UDAs and associated costs for different increases in recall intervals, West Yorkshire and England

West Yorkshire England

Child ExemptNon-

Exempt All patients All patientsActual number of FP17s 288,792 92,482 396,632 777,906 14,749,776Current re-attendance interval (months) 7.5 7.6 8.1 7.8 8.1

Estimated current spend £7,219,800 £2,312,050 £9,915,800£19,447,65

0£368,744,40

0

Spend at £25 per UDA where average interval is:

9 months £5,980,084 £1,949,947 £8,879,280£16,810,56

0£333,298,57

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10 months £5,382,076 £1,754,952 £7,991,352£15,129,50

4£299,968,71

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11 months £4,892,796 £1,595,411 £7,264,865£13,754,09

5£272,698,83

4

12 months £4,485,063 £1,462,460 £6,659,460£12,607,92

0£249,973,93

1

15 months £3,588,051 £1,169,968 £5,327,568£10,086,33

6£199,979,14

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Cost of UDAs freed up by raising re-attendance

intervals

9 months £1,239,716 £362,103 £1,036,520 £2,637,090 £35,445,825

10 months £1,837,724 £557,098 £1,924,448 £4,318,146 £68,775,683

11 months £2,327,004 £716,639 £2,650,935 £5,693,555 £96,045,566

12 months £2,734,737 £849,590 £3,256,340 £6,839,730£118,770,46

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15 months £3,631,749 £1,142,082 £4,588,232 £9,361,314£168,765,25

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UDAs freed up for new access

9 months 49,589 14,484 41,461 105,484 1,417,833

10 months 73,509 22,284 76,978 172,726 2,751,027

11 months 93,080 28,666 106,037 227,742 3,841,823

12 months 109,389 33,984 130,254 273,589 4,750,819

15 months 145,270 45,683 183,529 374,453 6,750,610Source: NHS BSA 2017

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From this table the following benefits for West Yorkshire are: Increasing the average band 1 to band 1 re-attendance interval to 9 months

from the current 7.8 months across West Yorkshire would release an estimated £2,637,090 or 105,484 UDAs for additional activity within general dental service contracts.

Extending re-attendance intervals to an average of 12 months over the longer term, (if safe and appropriate) would free up an estimated £6,839,730 or 273,589 UDAs to increase access, (NHSBA estimates on 2015/16 baseline and using average of £25 per UDA – more information in appendix 1).

If this was rolled out and scaled up across England these are the projected benefits: Increasing the England average band 1 to band 1 re-attendance interval to 9

months from the current 8.1 months across would release an estimated 1,417,833 UDAs for re-investment in general dental services and increase access.

Extending re-attendance intervals across England to an average of 12 months over the longer term would free up 4,750,819 UDAs within contracts to increase access.

8 Project controls

8.1 Reporting8.1.1 Highlight reporting This will be controlled by the project board which will receive highlight reports every 2 months produced by each participating agency and signed off by the board. Each individual agency has responsibility for reporting back within their own agency, and each has standard processes to do this. For example NHS England has a standard highlight report template.

8.2 TolerancesNot applicable

8.3 Delivery assuranceNot applicable

8.4 Risks and issues managementAn initial list of risks and issues is given at section 10. Appendix 4 also includes a suggested risk register and issue log - this will be maintained by the SRO Rory Deighton and reviewed at each meeting of the Project Board which will consider any appropriate mitigation required.

8.5 Business change strategy

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Learning from the project will be taken forward by the office of the Chief Dental Officer and used to design future guidance and practice relating to recall intervals.

8.6 Change control Changes to the project will be agreed in the short term where necessary by the SRO and CDO on an interim basis, and formally signed off by the Project Board.

8.7 Information managementAll of the information used by the project is publically available and will be shared with stakeholders on request. Decisions of the Project Board and project papers will not be made public.

8.8 Quality managementEach organisation will work to its own quality standards and processes.

8.9 Benefits managementThe Project Board will work to ensure that capacity and resources released from the project are maintained and used to increase access to general dental services in West Yorkshire. These benefits will be managed through NHS England commissioning arrangements.

8.10 Communication and stakeholder engagement Communications are the central to this project and form the basis of many of the project activities. As such the exact communications tasks are embedded in the schedule of delivery, section 11 of the Project Plan which follows. Each of the interventions (for example data, engagement with the dental profession, engagement with the public) are underpinned by specific communications activities.

Underpinning all of the communications and engagement will be the following overarching messages:

National guidance (NICE) says we don’t necessarily need to attend the dentist every 6 months for a check-up, the recall interval should be based on the dentist’s assessment of each individual’s oral health and risk of developing disease.

Patients should be involved in and understand the clinical reasons for the recall interval.

Guidance states that the recall period can be up to 24 months for adults with healthy teeth

Research by the General Dental Council has indicated that 90% of patients would welcome a longer recall interval of 9 months

The messages in the Healthwatch video encourage people to ask for a longer interval period

Emphasise the time and money saved, a “reward” for patients for looking after their teeth and taking care with their diet and health choices

Reassurance that patients are not going to be removed from dental patient lists if they visit the dentist every 9-12 months

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Increasing the dental recall intervals for people at low risk of developing oral disease would give dentists more capacity and increase the availability of dental services.

Communications principles

All communications and engagement activity carried out by and on behalf of the dental recall project group partners will be:

Accessible and inclusive – to all our audiences Clear and concise – allowing messages to be easily understood by all Consistent and accountable – in line with our vision and purpose set out in the

PID Flexible – ensuring communications and engagement activity follows a variety

of formats, tailored to and appropriate for each audience Open, honest and transparent – we will be clear from the start of the

conversations what aim is, the reasons why and ultimately, how decisions will be made

Targeted – making sure we get messages to the right people and in the right way

Timely – making sure people are kept updated on a regular basis Two-way – we will listen and respond accordingly, letting people know the

outcome of the project.

8.11 Initial project planThe project will run for a period of 18 months from 01 July 2017 to December 2018. The success of the project in improving access and extending recall intervals for people with good oral health will determine if the project will be extended nationally.

The delivery plan is shown in detail in a GANNT chart in an Excel spreadsheet. This is structured under the same headings as section 2.6, “Project approach”:

Project initiation  Research  Design  Governance and oversight  Intervention 1 – data  Intervention 2 – engagement with the dental profession and NHS / STP

partners  Intervention 3 – engagement with the public and

patient targeted communications  Intervention 4 – contract management, CQC inspection and other

interventions  Monitoring and Evaluation 

The schedule of delivery GANNT chart will be regularly updated to monitor progress

9 Assumptions, dependencies and constraints

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9.1 AssumptionsUnderpinning the two main areas of activity are the following assumptions:

a) That the publishing of benchmark data on recall and re-attendance intervals at practice level will encourage practitioners to increase intervals for orally healthy adults in line with NICE guidance.

b) That better-informed patients will be empowered to ask their dentist about the clinical decision making behind their recall intervals and feel engaged in this discussion. There is an assumption that patients will feel able to question a dentist who routinely recommends 6 monthly check-ups when their oral health is good. This is likely to be variable.

9.2 DependenciesThe detailed schedule of tasks and project GANNT chart manage the key dependencies. In a simple project of this kind the dependencies are largely self-evident. A key early dependency is agreeing the exact content of recall data that will be sent to all dental practices, how it is presented and distributed – early work on this is being done by NHSE but this needs to be agreed at the October 2017 project board meeting to enable the pilot phase to begin. Whilst there is agreement in principle on the distribution of recall data to practices and public information, other possible interventions have not yet been fully scoped or agreed. A key dependency on these will be the timely evaluation of options and decision making by SRO Rory Deighton and the project board.

9.3 ConstraintsThe following constraints on this project have been identified to date:

Dental contract – some practitioners feel that the current dental contract and the system of UDAs has failed to improve access and failed to deliver preventative dental work. Those holding this view may believe that the contract is a real constraint on improving access for those most in need of dental services. Some dentists have said that the new contract does not fairly reward them for the work they do;

A target driven culture in some national and local organisations may constrain the move towards increasing recall intervals in line with NICE guidance;

The aim of improving access may be constrained by the existing configuration of dental services and capacity relating to areas of need, particularly in localities or with communities with poor oral health and worse access to NHS dental services;

Limitations on commissioning budgets;

The project may also be constrained by the capacity and resources available to all partner agencies.

10 Risk and issue log

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An initial list of risks and issues is suggested below. Appendix 4 also includes a suggested risk register and issue log - this will be maintained by the SRO Rory Deighton and reviewed at each meeting of the Project Board which will consider any appropriate mitigation required.

Possible risks and issues: Recall intervals do not increase significantly; UDAs are not released; Dentists reduce their contract value in line with the reduction in UDAs; Dentists withdraw from NHS dental provision; NHE England recall any unused UDAs and re-distributes the resources to

other areas of commissioning; There are not increases in the number of patients accessing NHS dental

services Patients are not empowered by public communications and do not feel

confident to discuss with or challenge a dentist who is routinely recommending 6 month recalls for people with good oral health;

Any UDAs released will stay within existing contracts – existing pattern of commissioning may not match needs so access may remain an issue in some places

More patients are seen but access is uneven and is not serving those most in need.

11 Lessons learnt

A log of lessons learnt will be maintained and reviewed by the SRO and Project Board. Wider lessons will be drawn from the project evaluation.

12 Acceptance criteria and handover to live service

12.1Acceptance criteriaNot applicable

12.2 Handover to live service12.2.1 Key service management considerationsNot applicable

12.2.2 Expected service ownerNot applicable

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Appendix 1 – data supporting section 1 (Project background)

Band 1 to Band 1 intervals, all Health Bodies England 2015/16 data

Contract Health Body Code

Contract Health Body Name Previous Band 1 Current Band 1 Re-attendance

in days

Average re-

attendance interval

(months)Q44 Cheshire, Warrington and Wirral 239.4 7.9Q45 Durham, Darlington and Tees 238.7 7.9Q46 Greater Manchester 237.6 7.8Q47 Lancashire 236.8 7.8Q48 Merseyside 241.8 8.0Q49 Cumbria, Northumberland, Tyne and Wear 241.4 7.9Q50 North Yorkshire and Humber 240.6 7.9Q51 South Yorkshire and Bassetlaw 242.5 8.0Q52 West Yorkshire 236.5 7.8Q53 Arden, Herefordshire and Worcestershire 250.2 8.2Q54 Birmingham and The Black Country 248.4 8.2Q55 Derbyshire and Nottinghamshire 236.2 7.8Q56 East Anglia 253.1 8.3Q57 Essex 253.7 8.3Q58 Hertfordshire and the South Midlands 254.0 8.4Q59 Leicestershire and Lincolnshire 241.2 7.9Q60 Shropshire and Staffordshire 238.9 7.9Q61 North East London 284.0 9.3Q62 North West London 278.3 9.2Q63 South London 273.3 9.0Q64 Bath, Gloucestershire, Swindon and

Wiltshire244.6 8.0

Q65 Bristol, North Somerset, Somerset and South Gloucestershire

245.3 8.1

Q66 Devon, Cornwall and Isles of Scilly 253.0 8.3Q67 Kent and Medway 249.3 8.2Q68 Surrey and Sussex 251.7 8.3Q69 Thames Valley 249.7 8.2Q70 Wessex 244.4 8.0

England 247.3 8.1

(Source NHS Business Services Authority)

Interval band 1 to band 1 for England was 8.1 months

Interval band 1 to band 1 for West Yorkshire was 7.8 months, 2015/16

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This table shows the distribution of recall intervals in West Yorkshire and England:

West Yorkshire England3 months 6.2% 5.0%6 months 73.6% 71.1%12 months 10.1% 11.2%Recall interval not given 31.2% 34.6%

West Yorkshire intervals in months, band to band, 2015/16Child / Exempt / Non-Exempt

Combined Patient Charge Band of last Visit, including Deletes

Patient Charge Band

Total Non-Ortho Forms

Average re-attendance interval (months)

Child Band 1 Band 1 288,792 7.5Child Band 2 Band 1 60,859 6.6Child Band 3 Band 1 826 6.3Child Urgent/Occasional Band 1 9,997 5.0Exempt Band 1 Band 1 92,482 7.6Exempt Band 2 Band 1 45,144 6.9Exempt Band 3 Band 1 10,884 7.0Exempt Urgent/Occasional Band 1 11,968 5.3Non-Exempt Band 1 Band 1 396,632 8.1Non-Exempt Band 2 Band 1 124,684 7.2Non-Exempt Band 3 Band 1 19,218 7.1Non-Exempt Urgent/Occasional Band 1 30,464 5.4All Patients Band 1 Band 1 777,906 7.8

Focusing on Band 1 to Band 1 treatment (West Yorkshire), re-attendance interval in months:Group Re-attendance intervals, monthsChild 7.5Exempt 7.6Non-exempt 8.1All band 1 to band 1 7.8

This is based on 777,906 FP17 forms for band 1 courses of treatment, West Yorkshire

West Yorkshire 2015/16, Band 1 to Band 1 only, FP17s and estimated spend based on assumption of average of £25 per UDAGroup Number of FP17s / UDAs Estimated spend at £25/UDAChild 288,792 £7,219,800Exempt 92,482 £2,312,050Non-exempt 396,632 £9,915,800All band 1 to band 1 777,906 £19,447,650

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Variation between contracts in West Yorkshire

Dental re-attendance data for 2015/16 for adults receiving a band 1 course of treatment were scrutinised for West Yorkshire dental practices in 2015/16. Average re-attendance intervals varied from 5.2 months to 12.0 months. The average re-attendance interval was 8.0 months and the median was 7.3 months.

The variation between contracts is shown in the following chart but note that this includes a small number of practices with a small number of FP17s in the period and also outliers at the upper end of recall intervals such as Wakefield prison.

1 13 25 37 49 61 73 85 97 1091211331451571691811932052172292412532652772893.0

5.0

7.0

9.0

11.0

13.0

15.0

17.0

19.0

21.0

Band 1 to Band 1 average interval in months, by contract, West Yorkshire

The percentage of claims with no recall interval given varies between practices from 0% to 100%. 24% of all claims had no recall interval noted.

Recall and re-attendance intervals, West Yorkshire, by deprivation decile

Analysis of the recall and re-attendance intervals by deprivation decile of patient residence was undertaken in West Yorkshire. The following table shows the percentage of people in each IMD decile with different recall periods.

For those with a recommended recall of 3 months there was a noticeably higher proportion of people in the first and second deciles of deprivation (i.e most deprived fifth of the patient population) than in the ninth or tenth decile (least deprived). So for example 10.1% of people from IMD decile 1 were recalled at 3 months but only 4.1% of people from IMD decile 10 were recalled at 3 months.

For those with a recommended recall of 6 months, there was a less obvious tendency for a slight higher proportion of people from deprived backgrounds, (73.9% of people in decile 1 compared to 70.5% of those in the least deprived decile).

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Those people who were recalled at 12 months were more clustered amongst the less and least deprived groups, (7.6% of those in decile 1 compared with 12.6% of those in the least deprived decile).

These data indicate a tendency for people from more deprived backgrounds to have a higher recall rate. This may reflect differences in oral health and DMFTs as it is well documented that people living in more deprived areas are more likely to have poorer oral health.

Band 1 to Band 1 recommended recall interval by deprivation decile percentages (excluding recall not given FP17s) West Yorkshire (Q52) 2015-16

Recall Period (months)

1 2 3 4 5 6 7 8 9 10Patient IMD not known

Total

1.00 0.3 0.2 0.2 0.1 0.2 0.2 0.1 0.1 0.1 0.1 0.2 0.22.00 0.4 0.4 0.3 0.3 0.3 0.2 0.2 0.2 0.2 0.2 0.3 0.33.00 10.1 8.1 6.4 6.7 5.9 4.9 5.0 4.7 4.9 4.1 6.1 6.24.00 1.0 0.8 0.8 0.7 0.7 0.6 0.7 0.5 0.6 0.7 0.7 0.75.00 0.2 0.2 0.2 0.2 0.2 0.2 0.1 0.2 0.1 0.2 0.2 0.2

6.00 73.9 75.6 74.3 74.4 74.0 72.7 72.7 73.3 73.7 70.5 73.8 73.6

7.00 0.5 0.5 0.5 0.3 0.5 0.8 1.2 0.9 1.4 2.6 1.0 0.98.00 0.3 0.2 0.2 0.2 0.2 0.2 0.2 0.3 0.3 0.3 0.2 0.29.00 5.0 5.3 6.6 6.6 6.4 9.2 8.1 7.7 7.4 7.8 6.1 7.010.00 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.111.00 0.1 0.0 0.0 0.1 0.1 0.0 0.1 0.0 0.0 0.1 0.0 0.1

12.00 7.6 8.0 10.0 10.0 10.8 10.3 10.9 11.0 10.5 12.6 11.0 10.1

13.00 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.114.00 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.1 0.015.00 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 N/A 0.016.00 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 N/A 0.017.00 0.0 0.0 N/A 0.0 0.0 0.0 0.0 0.0 0.0 0.0 N/A 0.018.00 0.1 0.1 0.1 0.1 0.2 0.1 0.2 0.2 0.2 0.3 0.1 0.219.00 0.0 0.0 0.0 N/A 0.0 0.0 0.0 0.0 0.0 0.0 N/A 0.020.00 0.0 N/A 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 N/A 0.021.00 N/A 0.0 0.0 0.0 N/A 0.0 0.0 0.0 0.0 0.0 N/A 0.022.00 0.0 0.0 N/A 0.0 0.0 N/A N/A N/A 0.0 N/A N/A 0.023.00 0.0 0.0 0.0 N/A 0.0 0.0 N/A N/A 0.0 N/A N/A 0.024.00 0.2 0.2 0.2 0.1 0.3 0.1 0.2 0.2 0.2 0.1 0.1 0.2Recall not given 27.2 30.5 29.0 32.7 34.

3 30.4 32.9 34.4 33.4 27.5 28.7 31.2

Total (excl. recall not given)

100.0 100 100 100 100 100 100 100 100 100 100 100

There was also a trend for people living in the 255 most deprived areas to be more likely to have a recall period of 6 months or less than people living in less deprived areas:

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Split between treatment bands, England and West Yorkshire, 2015/16

These data are presented because the distribution of dental activity between treatment bands 1, 2 and 3 should form part of the project evaluation.

Data based on year-end methodology. Year-end methodology will include all activity data (including amendments) collected from FP17s scheduled in any of the fifteen schedule months from April to June, where the date of completion is on or between 1 April and 31 March of the year. For example 2015-16 will include all activity data (including amendments) collected from FP17s scheduled in any of the fifteen schedule months from April 2015 to June 2016, where the date of completion is on or between 1 April 2015 and 31 March 2016. Where FP17s do not have a date of completion, e.g. where the patient has failed to return to complete the treatment, the date of acceptance is used.

Contract Country

Patient Charge Band

Total UDAs Percentage of Total UDA for Bands 1-3

England Band 1 22,115,110 27.49Band 2 33,165,015 41.23Band 3 25,156,620 31.28Sum: 80,436,745

Contract Health Body

Patient Charge Band

Total UDAs Percentage of Total UDA for Bands 1-3

West Yorkshire

Band 1 1,139,565 30.54

Band 2 1,611,177 43.17Band 3 981,024 26.29Sum: 3,731,766

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The percentage of band 1 treatments for individual practices in West Yorkshire varies from 0% to 100%, reflecting in part specific treatment priorities at each end of the scale. The average percentage of band 1 treatments for practices is 32.3% with a median value of 31.5% (2015/16).

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Appendix 2 – Stakeholder analysisGiven the geography and number of potential stakeholder groups within project, this stakeholder map is both vast and complex. As our communication and engagement approach is underpinned by making best use of existing communication and engagement networks, for the purposes of this strategy, it is more appropriate to identify the high-level stakeholder groups and the implications behaviour change has for them. A description of each of these is given below:

Stakeholder group

Considerations/expectations Channels of communication

Responsibility

Overview Scrutiny Committees

Need to be fully briefed on progress - specifically on the anticipated impact of service change and our plans to engage/consult patients and the public.

They have a duty to scrutinise plans to ensure they are in the best interest of the public. If they are not assured of this they have the power to refer the issue to the Secretary of State for Health which may lead to a review by an Independent Review Panel.

Presentations at committee meetings

Written briefings and updates as required

Healthwatch Kirklees

Health and Wellbeing Boards, including the regional chair network

Health and wellbeing boards are a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. It is therefore important for them to be aware of how the dental re-call project fits with their plans and for any communication or engagement activities to be coordinated.

Regional network planning meetings

Presentations at board meetings

Written briefings and updates as required

RD, RW through West Yorks. STP & KC

LA council leaders

Local authority leadership Presentation and meetings

Written briefings on request

Regional council leaders meeting

RD, RW through WY STP & KC

MPs and Councillors

Our political stakeholders will have a keen interest in dental re-call rates due to the rising pressure within the NHS dental system, in some areas of West

Written briefings Face-to-face

meeting at their request

Attendance at

RD, RW through WY STP & KC

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Yorkshire. They will wish to ensure plans are in the best interests of their constituents and will be expected to be kept updated on progress.

local council Health and Wellbeing Board where appropriate

Healthwatch The role of Healthwatch is to represent the patient voice and should therefore be considered a key partner in delivering this strategy. The six Healthwatch organisations in the West Yorkshire footprint have audiences they regularly communicate to. We will need to explore opportunities for how we can continue to work together through the delivery of the wider work.

Regular contact with Healthwatch.

Regular updates for them to cascade to members, including through newsletters/websites etc. to promote engagement opportunities

RD

Community and voluntary sector organisations

Will be able to provide representative views towards proposals on behalf of the people they represent and also act as channel for us to target specific patient groups.

Involvement in the delivery of communication and engagements

RD & STP

Patients/ carers, people who use health and social care services and the public

Patient, carers, public etc. will need access to clear information about what the dental recall project and what it means for them.

Articles in partner media channels – newsletters, websites, social media etc.

Focus groups, engagement events and surveys to inform specific elements of the draft STP

Statutory consultation

Campaigns

Healthwatch Kirklees

Media The media will play a key role in helping us communicate with the wider public. Early briefing of key media will help to ensure they understand the context of the project and ultimately lead to more accurate reporting of stories.

Media briefing pack developed containing background to dental recall and key messages

Press releases published to raise awareness of engagement opportunities and report progress

Project board, SH and comms. leads

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CCG member practices

Awareness Through communications leads in each CCG

Comms. leads

Governing body members of all CCGs in West Yorkshire

Future primary commissioning duties of all CCGs

Public engagement video and adverts to be sent to local place-based leads and communication and engagement contacts

Healthwatch Kirklees

Named people:SH – Sara HurleyRD – Rory DeightonRW – Rob WebsterKC – Karen Coleman

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Appendix 3 – Evaluation of projectThis section lists some options for data to compare across the lifetime of the project, starting with benchmark data prior to outset. These are chosen to help understand the degree to which the objectives of the project have been achieved. It uses the Dental Assurance Framework March 2014 and associated quarterly reports. These data are supplemented and triangulated with a number of other sources.

Data recall interval patterns re-attendance intervals between band 1 courses of treatment proportion of FP17s with no recall interval stated assessment of any changes in use of UDAs  numbers of new patients including an analysis of home localities, communities

of interest changes in the numbers of people getting band 1 treatment the distribution of treatment between bands 1, 2 and 3 the rate of consumption of UDAs per patient patient satisfaction with recall intervals, Dental Assurance Framework (patient

Experience domain) E1. NHS BSA Dental Services patient survey - % of patients satisfied with the time they had to wait for an appointment

relevant oral health measures from the Public Health Outcomes Framework (attribution to this project will not be possible)

The evaluation will also need to describe and understand the variations in how practices use any extra capacity.   

As far as possible evaluation should use data that are already collected, for example through the FP17s and the Dental Assurance Framework and the Public Health Outcomes Framework.

The Project Board will wish to make early decisions about the key data that will enable the overall evaluation of the project, with expert advice from Public Health England.

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Appendix 4 – Risk register

Initial risks identified Recall intervals do not increase significantly UDAs are not released Dentists reduce their contract value in line with the reduction in UDAs Dentists withdraw from NHS dental provision There are not increases in the number of patients accessing NHS dental

services Patients are not empowered by public communications More patients are seen but access is uneven and is not serving those most in

need.

Recall Matters – Risk RegisterID

Date raised

Risk descrip-tion

Likelihood

Impact

Severity

Owner Mitigat-ing action

Contin-gent action

Progress on actions

Status

H/M/L H/M/L H/M/L. Open, Waiting, Closed

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