Information for PCTs
Note: The information below is not designed to be prescriptive; it is anticipated, however, that it will give PCTs a starting point when considering some of the processes involved in implementing a DwSI scheme.
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Why are DwSIs needed?
PCTs now have the responsibility for reviewing oral healthcare needs in the area and commissioning services accordingly. They may need to consider how to improve access to NHS dentistry and make effective use for the range of skills available locally. Contracting DwSIs is therefore one option they could consider.
What are the benefits of contracting a DwSI?
Contracting a DwSI could have a number of benefits, including:
- Bringing dental services closer to the local community
- Increasing capacity
- Reducing waiting times
- More patient choice
- Encouraging dentists to develop with the NHS.
How does a DwSI differ from a dentist on the specialist register?
DwSIs will provide a service that is complementary to secondary care services, but will not replace those practitioners who have undergone training required for entry to the specialist lists. The DwSI should provide services within the limits of their competency and refer on to a specialist if necessary.
How do we find out if we need a DwSI?
PCTs could undertake an oral health needs assessment for the area. An oral health needs assessment toolkit is available on the Primary Care Contracting website at www.primarycarecontracting.nhs.uk. Existing services can be mapped against across the primary and secondary care sector. DwSIs should normally only be contracted where there is a local need. Further information on reviewing services can be found in the Step-by-step guide to setting up a DwSI service.
What will we need in order to implement a DwSI scheme?
PCTs may wish to establish a commissioning panel to consider how a DwSI scheme could be implemented to best meet local needs. The panel could consider:
- Resource issues such as staffing and equipment. An impact assessment could assist with this.
- Ensuring access to appropriate premises.
- If sufficient funds are available.
PCT staff and advisors may also benefit from undertaking the FGDP(UK) Certificate in Appraisal of Dental Practices, which focuses on practice visits.
How long will it take to set up a scheme?
There is no prescribed timescale for implementing a scheme, although it should be noted that this service is not a 'quick fix' option. It is likely to take a minimum of three months to set up the service, but in some cases, particularly if the DwSI contracted requires training, it could take up to two years.
How do we assess and select DwSIs?
The FGDP(UK) and the Department of Health have produced national guidelines for the appointment of DwSIs. Practitioners will need to demonstrate competency in their area of special interest against a national framework. The first frameworks have recently been published and are in the fields of minor oral surgery, orthodontics, periodontics and endodontics, with a framework in conscious sedation published in January 2008.
In November 2007, the FGDP(UK) and NHS Primary Care Contacting also published competency frameworks for the appointment of prison dentists.
In April 2008, the FGDP(UK) also published its own guidance for competencies and standards in both research and leadership and management.
In order to be contracted as a DwSI, a practitioner will also need to show evidence of generalist primary care competencies. Evidence of this should be provided through a portfolio of evidence and should demonstrate competence in the seven key skills:
- Clinical record-keeping
- Infection control
- Legislation and good practice guidelines
- Medical emergencies
- Radiography
- Risk management and communication
- Team training
One means of demonstrating competency would be to complete the FGDP(UK) Core Skills assessment as part of the MJDF Portfolio of Evidence.
What should we do once we have decided to contract a DwSI?
The contract agreed with GDPs will depend on whether the DwSI is a generalist providing additional special interest services or solely providing the special interest service they are contracted for. In the case of the former, the special interest services commissioned can be added to the existing GDS contract. In the case of the latter, a PDS contract should be given.
The contract is agreed between the practitioner and the commissioning PCT, however it may specify:
- Core activities and competencies required
- Types of patients and clinical problems suitable for treatment
- Facilities and staffing needed
- Clinical governance, accountability and monitoring arrangements.
A sample service level agreement is available in Appendix F of the Step-by-step guide to setting up a DwSI service.
How should we structure our referrals network?
There are no specific recommendations here - the PCT should structure the referrals network appropriately for local resources and needs. It may be that the dentist will refer patients to a DwSI and the DwSI would then refer to the secondary care sector if necessary. However, in some PCTs, referrals may be made directly to the secondary care sector where the consultant will decide which patients to refer to the DwSI.
How do we monitor and evaluate the service once we have contracted DwSIs?
PCTs will decide on clinical governance arrangements and define the lines of accountability.
The contracted DwSI should receive regular CPD in their area of special interest and an annual appraisal, alongside the appraisal for their generalist work. In addition to this, the PCT may wish to review the service as a whole to ensure that it is meeting its defined objectives.
Detailed information on clinical governance and evaluation can be found in the Step-by-step guide. Please also see the clinical governance framework developed by the Department of Health which can be found at www.primarycarecontracting.nhs.uk.
Further information
 A step-by-step guide to setting up a DwSI service
This is a more comprehensive set of guidelines produced by Primary Care Contracting. It also contains suggested templates for:
- Letters to primary care dentists
- Primary care dentist questionnaire
- A referral pro-forma
- Referral guidelines
- Patients leaflets
- Service Level Agreement
- Report to a clinical governance lead for accreditation
- Sample patient questionnaire.
Primary Care Contracting website
Information for dentists
Information for patients
PCTs might find this section useful when explaining the scheme to patients.
Implementing a scheme for DwSIs
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