Standards Setting in Primary Care Balanced Scorecard Dental Services Paper

STANDARDS SETTING IN PRIMARY CARE –
IMPLEMENTATION OF CONTRACT MANAGEMENT THROUGH A PERFORMANCE

MANAGEMENT FRAMEWORK AND A BALANCED SCORECARD APPROACH FOR
PRIMARY CARE DENTAL SERVICES
1. BACKGROUND
The importance of dental/oral health and the delivery of robust, high quality provision are often
underestimated. Understanding the oral health needs of Luton’s population and ensuring
delivery through local contracts aligned to the health strategy priorities is central to the PCT
becoming World Class Commissioners of dental services. There is clear correlation between
poor oral health and other factors, including material deprivation and learning disability, and
there are significant public health issues including largely preventable dental decay and
periodontal disease. Many of the principal factors that can lead to poor oral health are also risk
factors for other diseases, for example cancer, CVD, obesity and diabetes.
Nationally it is recognised that poor access is detrimental for patients, who then present at a
later stage, because they are not getting timely treatments and interventions. Poor dental health
negatively impacts on patient health and also correlates with the lower life expectancy in Luton.
Health indicators, such as smoking and obesity for adults and poor nutrition in children, impact
directly on dental health.
These specifics could be addressed as NHS Luton’s dentists and dental care professionals (e.g.
dental nurses, dental hygienists and dental therapists) are well placed to provide support,
information and interventions for improving patient’s wider health, including cancer, CVD, obesity
and diabetes. Research has shown that periodontal disease is linked to CVD and diabetes so
patients presenting with confirmed diagnosis of CVD or diabetes will need greater attention to
maintain and improve their periodontal health. For sustainable reductions in oral health
inequalities, it is important to tackle the underlying causes of oral diseases. It is now well
recognised that oral health is determined by a wide range of factors, from individual lifestyle
choices (e.g. amount of sugar in diet), to national policy (e.g. smoke-free environments). A
successful public health approach must focus on these wider determinants.
Good oral health is integral to general health as it ‘contributes to general well being’ and allows
people to “eat, speak, and socialise without active disease, discomfort or embarrassment”.
Dental disease caused by tooth decay or gum disease in many cases if left untreated results in
loss of teeth. Dental caries prevalence within a population is measured by the DFMT (decayed,
missing, filled teeth) the higher the score the greater the level of disease. The salaried dental
service is commissioned to undertake dental surveys in school children which are co-ordinated
nationally by the British Association for the Study of Community Dentistry (BASCD). In a recent
BASCD survey of five year-olds undertaken in 2007/08, NHS Luton has the highest DFMT score
(1.94) within the East of England region and as mentioned before this is because of the higher
levels of deprivation found in Luton compared to other areas of the region.
National and regional evidence suggests PCTs dental contract management has been poor
historically; that there is considerable scope, through effective contract management, to improve
the accessibility and quality of local dentistry while ensuring it is commissioned in a more cost
effective manner.
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2. VITAL SIGNS
NHS Luton has a dental Vital Signs target for financial year 2009-2010 of 56% of the Luton
population accessing NHS dentistry within the previous 24 months. The requirement to meet the
dental Vital Signs target remains a financial challenge for NHS Luton because there is no ‘slack’
in the contracted number of units of dental activity (UDA) commissioned by NHS Luton. In order
to achieve the agreed targets, every contract needs to perform to 100%. However this level of
performance (100%) is not supported by the [national] dental contract, which allows up to a
minus 4% annual variation to be rolled over to the following year. While an underachievement
greater than minus 4% may be recovered during the following financial year, these allowances
undermine the PCT reaching the Vital Signs target. Ideally there would be sufficient funding
available to allow contracts to be set slightly higher than is required to reach our Vital Signs
target, based on the expected annual outcome.
3. CONTRACT VAULES – SPEND
The projected spend on primary care dental services in 2009/10 will be in the region of £9.352
million and, while the PCT can be assured that the residents are well served by the number and
placement of the dental practices providing NHS services, it is recognised that there is a need
for greater understanding of the quality of the services provided and the impact on Luton
residents health. Dentists report activity centrally and there have been recent improvements
made available to PCTs allowing more in-depth access to the data. This, together with a better
understanding of dental public health needs, will underpin the proposed two-pronged approach
to standards setting in primary care dental services.
4. TWO-PRONGED APPROACH - IMPLEMENTATION
NHS Luton is responsible for commissioning high quality general dental services to the
population of Luton and is commencing implementation of a two-pronged approach to standards
setting in primary care using the recently published DH Dental Contract Management Handbook,
a performance management framework (Standards for Better Dental Practice; appendix 1, which
provides Section 1 Standard 1 as an example . The whole document is available on request)
and a dental balanced scorecard (appendix 2) as an approach to quality management. This
process will form a first step towards quality contracts rather than the existing quantity contracts.
The NHS High Quality Care for All, Primary Care and Community Services: Improving dental
access, quality and oral health, World Class Commissioning, How To Guide – published 27th
January 2009 sets out to help PCTs become world class commissioners of dental care services.
The guide, together with the 2009-10 Operating Framework, places the onus on PCTs to assess
current performance, identify their vision for the future and to commission services that meet the
needs of the local community. The guide makes it clear that the PCT will work with all practices
equally, actively managing providers; rewarding and encouraging those that continuously
improve quality. To support this aim, the two-pronged approach will enhance understanding of
the value that can be gained by investment in dental care and how to work with dentists to
achieve continuous improvements in patient experience, safety and the dental/oral health of
individuals (patients).
The How To Guide provides a useful reminder of the levers that the PCT can [intelligently] use to
support rapid improvements together with confirmation of the framework of secondary legislation
which support the PCT powers to manage contracts and it should be noted that the current
general dental services contract does provide for the ‘provision of and access to information:’
under Part 13 clause 211. Additionally NHS Luton is required to develop a performance cycle to
support dental practice registration with the Care Quality Commission.
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However, historically, PCTs have been expected to only assess contractors for half-yearly and
annual reviews of the contract together with a more formal practice visit/inspection by the Dental
Advisor on a three yearly rolling programme.
The expectation of WCC is that the dental team will regularly visit each practice on a quarterly
basis and the team will be working towards that approach, though currently this will mean two or
three visits per year for most practices, with additional contact through normal communication
channels, ad hoc visits, the Dental Liaison Group and the Local Dental Committee (LDC). This
will be a vastly different process, utilising the overall performance management framework
(Standards for Better Dental Practice) and a real step-up in terms of previous performance
management and support across Luton.
It is possible that there may be some resistance to a more formal programme of performance
management and while the use of these tools will allow the PCT to measure practice
performance, and consequently manage practice contracts more closely, the DH guidance is
clear that this process must be undertaken as part of a close working relationship between the
practices and PCT – and this may take time to develop with some practices.
4.1. Contract Management
The DH Dental Contract Management Handbook, published January 2010, was specifically
produced for use by multidisciplinary PCT teams in the management of primary care dental
contracts as part of the Dental Access Programme. Utilising the handbook will support NHS
Luton to effectively manage local dental contracts and ensure quality, performance and value for
money.
The PCT Primary Care Commissioning team has responsibility for this process and this
proposed self-assessment approach will ensure a minimal impact on that staffing resource.
4.2. Performance Management Framework – Standards for Better Dental Practice
Implementing collaborative contract management, focused on quality as well as productivity, will

encourage delivery of contracted activity against recommended timescales (NICE), act as a key
lever for change, and reduce current referral rates to secondary care. Well managed contracts
deliver value for money, improved performance and better oral health outcomes and will
encourage an increase in the ‘preventative’ element of dentistry.
Behind improved management will lay improved clarity regarding evidence of value for money,
whether there are gaps in performance against needs and whether dentists are addressing
access and health inequalities issues or simply increasing treatments for existing patients. This
in turn will prepare the way for changes arising from the Steele pilots (DH web link:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
DH_112295 ) and all innovations, with an overall aim of improving patient care.
The Standards for Better Dental Practice (appendix 1) is a performance management framework
that will provide NHS Luton with a means of assessing compliance with contractual
requirements, statutory/professional regulations and minimum standards, legislation and best
practice. The framework is currently being developed as a self-assessment tool for the dental
practices and will be similar to that implemented for GP practices.
Modelled along the lines of the framework developed for use by GP practices the Standards for
Better Dental Practice self-assessment tool will encourage dental contractors to prepare for
CQC registration (commencing in April 2011) by assessing their compliance against published
CQC guidance. The document has been mapped to the dental services contracts, dental
regulations, applicable national legislation, General Dental Council guidance and publications.
Practices will be supported to complete their self-assessment by their PCT Manager. The self-
assessment results will also feed in to the overall management process.
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4
4.3. Balanced Scorecard
The balanced scorecard (aggregated version, appendix 2) will provide NHS Luton with a
mechanism for utilising existing data to focus on key performance indicators across dental
practice which are considered to be fundamental to continuous improvement to help meet the
Strategic Plan and improve dental health. Those indicators included are considered those most
important to monitor and drive improvements in the quality and cost effectiveness of the services
provided and to improve the dental health of Luton’s population in conjunction with national,
regional and local targets.
The balanced scorecard will be an improving programme and will be updated each year to
represent changing priorities and to drive further improvements in dental care.
The balanced scorecard is intended to:
• Help and encourage practices to put in place systems and processes to achieve
continued improvement in the range and quality of primary care services with a particular
emphasis on key priority areas aimed at improving the oral health of their respective
patient populations
• Provide assurances to the PCT that the quality and range of primary care services is
improving
• Help the PCT and practices develop action plans to deliver improvements in primary care
services
• Help the PCT identify where support and investment may be necessary to deliver
improvements
It will also:
• Promote good quality and support improvement in efficiency and effectiveness

• Detect falling performance early enough to institute preventative action
• Detect failing performance and therefore a first move towards preventing the
consequences
• Highlight good practice
• Enable patients to make informed choices about which practice would best suit their
needs – the balanced scorecard will be a publicly available document on the PCT
website and signposted in key documents. This will help to stimulate quality
improvements through patient choice.
The Professional Executive Committee and Commissioning Sub-Committee have supported

these proposals. Further development will also include input from the SHA, LDC and the Dental
Liaison Group.
5. WHAT DO WE AIM TO ACHIEVE?
For Patients and the PCT:
The introduction of contract management, through a performance management framework and

balanced scorecard, will help the PCT demonstrate that it is a commissioner of high quality
dental services on behalf of the population of Luton. This process will enable the PCT to make
robust decisions about commissioning and decommissioning of dental services and will ensure
appropriate services for local needs. It will also aid in raising the standard of dental care
delivered to patients and contribute towards delivery of NHS Luton’s five year strategic and
operating plans. This regime will allow the managers to oversee more closely individual practice
performance against contract and help ensure a greater number of contracts perform closer to
the 100% achievement against contract that will be necessary for the PCT to reach the Vital
Signs target for new patients accessing NHS dentistry.
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A patient friendly scorecard will be developed in conjunction with patients.
For Practices:
The two performance tools, especially Standards for Better Dental Practice, will support NHS
Luton’s dental practices to produce their annual Quality Accounts from April 2011 and should
help them prepare to be able to register with the Care Quality Commission (CQC) from April
2011 (date to be confirmed). Without CQC registration, independent contractors will not be
allowed to practice.
RECOMMENDATION
This approach has been developed with LDC and Luton dental Liaison Group approval and
input.
Approval has been received from the Executive Committee, the PEC and the Commissioning
Sub Committee.
The Board is asked to agree the proposed approach for managing dental contracts.
Toni Leggate
January 2010
6
DRAFT
Appendix 1
Standards for Better Dental Practice – Practice Self Assessment Form
The legal framework for the regulation of health and adult social care is changing. From April 2010, health and adult social care providers, including
Dentists, will be required to register with the Care Quality Commission (CQC) in order to be able to operate. To do so, they must show that they are
meeting a wide range of essential standards of safety and quality set out under the Health and Social Care Act 2008 (Registration Requirements)
Regulations 2009.
Registration makes sure that regulated health and social care providers are meeting essential standards of safety and quality and that they are building a
firm foundation on which to deliver care. CQC expect providers to make improvements, where they are needed, to meet these standards. By law, CQC are
required to produce guidance about compliance, which makes clear to providers what they must do to comply with the essential standards of safety and
quality. This draft guidance (Guidance about compliance with the Health and Social Care Act 2008 (Registration Requirements) Regulations 2009) can be
found at
http://www.cqc.org.uk/_db/_documents/Draft_guidance_about_compliance_for_website_280509_(2).pdf
The guidance is focused on what constitutes a quality experience for people who use services, rather than the policies, systems and processes used to
deliver care. The guidance is not a checklist but a picture of what compliance with the regulations should look like. There can be a variety of ways that
compliance can be achieved and this guidance does not restrict innovation and best practice where the safety and quality of the service are assured. CQC
will use the guidance in a number of processes in the registration system, including those that are designed to establish whether:
• A provider that has applied to register is suitable and should be granted registration.
• A provider that is already registered continues to be suitable and should be allowed to continue its registration.
• Concerns about a provider should lead to its registration being restricted, suspended or, in the most serious cases, removed.
• To use other enforcement actions against a provider where it has failed to comply with the regulations.
CQC have developed two types of guidance:

1. Generic guidance – for all regulated services across health and social care.
2. Specific guidance – for services that provide a particular service (in addition to the generic guidance).
CQC intend to produce additional documents over time and these will be published on the CQC website at www.cqc.org.uk.
The following framework has been developed to support NHS Luton Dental Practices to self-assess against the guidance in readiness for the required
registration process, expected to commence in January 2011, in April 2011.
The framework is followed by a table listing the regulations (as given in the guidance) which are the subject of recent Department of Health consultation.
This means that CQC were not seeking views on the content of those regulations during the consultation process. There are also some regulations, in the
table, that are not included in the current Department of Health consultation process. However, the Department of Health has provided the tabulated policy
statements about those regulations.
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1. Generic guidance – for all regulated services across health and social care – adapted for Dental practices
GDS Regs = The National Health Service (General Dental Services Contracts) Regulations 2005
Statutory Instrument 2005 No.3361
The National Health Service (Personal Dental Services Agreements) Regulations 2005
Statutory Instrument 2005 No.3373
Section Regulations
1 Involvement • Respecting and involving people who use services (Regulation 15).
and • Consent to care and treatment (Regulation 16)
information • Fees etc. (Regulation 30).
Standard / 1. Respecting and involving people who use services Regulation 15 –
Regulation 15.—(1) The registered person must, so far as reasonably practicable, make suitable arrangements to ensure—
(a) the dignity, privacy and independence of service users; and
(b) that service users are enabled to make, or participate in making, decisions relating to their care or treatment.
(2) For the purposes of paragraph (1), the registered person must—
(a) treat service users at all times with consideration and respect;
(b) provide service users with appropriate information and support in relation to their care or treatment;
(c) encourage service users, or those acting on their behalf, to—
(i) understand the care or treatment choices available to them, and discuss with an appropriate health care professional, or
other appropriate person, the balance of risks and benefits involved in any particular course of care or treatment, and
(ii) express their views as to what is important to them in relation to the care or treatment;
(d) where necessary, assist service users, or those acting on their behalf, to express the views referred to in paragraph (c)(ii)
and, so far as appropriate and reasonably practicable, accommodate those views;
(e) where appropriate, provide opportunities for service users to manage their own care or treatment;
(f) where appropriate, involve service users in decisions relating to the way in which the regulated activity is carried on;
(g) provide appropriate opportunities, encouragement and support to service users in relation to promoting their
independence, community involvement and the way in which they wish to live their lives; and
(h) take care to ensure that care and treatment is provided to service users with due regard to their age, sex, religious
persuasion, sexual orientation, racial origin, cultural and linguistic background and any disability they may have.
CQC 1A Ensure personalised care through involvement
Expectation People who use services are involved with and receive care, treatment and support that respects their right to make or
influence decisions by the service:
• Explaining and discussing their care, treatment and support options.
• Balancing the need for preference and choice against safety and effectiveness, while respecting the right of people to take
informed risks.
• Cooperating with independent advocacy services wherever a person using the service has access to one.
• Promoting and respecting their privacy and dignity by:
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– placing the needs, wishes and decisions of the person at the centre of assessment, planning and delivery of care,
treatment and support
– ensuring that the environment allows privacy in which the person’s intimate care, treatment and support needs are met
– having clear procedures, that are followed in practice, that ensure staff understand the concepts of privacy and dignity and
how they should be applied to the people who use the service
– ensuring that confidentiality is maintained at all times
– taking account of published Government advice about privacy and dignity
– it is not within the provider’s stated aims, objectives and purpose to meet the choice
– they do not have sufficient capacity to make a decision that would avoid unacceptable risk or harm to themselves
– they are subject to a legal restriction that prohibits them making the decision.
• The person’s nominated representatives being involved, provided the person agrees to their involvement, where
appropriate.
• Any necessary adjustments that need to be made in line with equalities legislation, for example the Disability Discrimination
Act 2005, in order for people to be enabled to be involved in decision making.
– actively listening to and involving them, or their nominated representative, in decision-making, unless in doing so their care,
treatment and support needs would not be met
– providing information about their care, treatment and support, and their rights, in a way that the person can understand
– ensuring that staff treat people sensitively by understanding and respecting their diversity.
People who use services have their care, treatment and support needs met because:
• They are listened to.
• They are able, if they want, to assess, plan and carry out their care, treatment and support themselves, or are able to direct
staff in doing so.
• The things that are important to them in relation to their care, treatment and support are established as part of the
assessment, and the support to achieve these needs is provided.
1B Manage risk through effective procedures about involvement

People who use services receive care, treatment and support where clear procedures are followed in practice, monitored and
reviewed. Wherever they are necessary these include:
• Helping the person to become familiar with the service when they begin to use it, preferably in advance of using the service.
• Individualised assessments based on their needs.
• Care, treatment and support options, and the risks and benefits of those options, being explained.
• People being able to express their own choices and preferences.
• People’s choices being respected and accommodated unless:
– the choice places other people at risk of harm or injury
– it would not be realistic for the service to have the resources needed to achieve the choice
1C Promote rights and choices

People who use services receive care, treatment and support that is provided in a way that ensures their choices are
informed by:
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• Giving the information they need to make choices in a format they can understand.
• Discussing the options available with them by a person who:
– understands their individual needs
– knows what the aims and limitations of the service are
– understands the various choices the person could make
– is aware of the consequences of the various choices they could make
– is able to present the risks and benefits of the options based on evidence, research or experience.
• Giving them the time they need to make their decision, taking account of the urgency of the situation.
• Giving relevant information that encourages people to change behaviours that are placing their health at risk so that they
can make informed choices about the way they wish to live their lives.
People who use services receive care, treatment and support that is provided in a way that ensures their independence is
promoted by:
• Involving them, wherever this is possible, in their needs assessment, planning of care and setting of care goals.
• Respecting their choice to care for themselves or manage their own treatment, wherever they can.
• Involving them in how the service should improve to comply with the Health and Social Care Act 2008 (Registration
Requirements) Regulations 2009 after an adverse event relating to their care, treatment and support.
• Enabling people to make informed choices even where there are risks involved with the decision they make.
People who use services receive care, treatment and support that is provided in a way that ensures their human rights and
diversity are respected by:
• Discussing information about choices by a means they can understand.
• Providing information about what their rights are, in a format they can understand.
• Staff who are aware of, understand and are sensitive to the person’s social and cultural values and their beliefs that may
influence their decisions and how they want to arrive at them.
People who use services benefit from a service that:
• Fosters an open culture, so that they feel comfortable to raise specific needs relating to their diversity.
• Takes into account relevant guidance, including that from the Care Quality Commission’s Schedule of Applicable Guidance
appendix B.
People who use services are provided with information, in a format they can understand, about:
• The aims, objectives and purpose of the service.
• The facilities in which the care, treatment and support they receive are provided.
• How their care, treatment and support is reviewed.
• Who is in charge of the service and, where there is a registered manager, what skills, qualifications and experience they
have.
• The cost of the services, where charges are applied.
• How to raise a concern about the service.
People who use services are given encouragement, support and opportunities to:
• Describe their holistic needs and to discuss the impact of their care, treatment and support on them.
• Participate in the activities of the local community where their care, treatment and support is provided in long-term
accommodation so that they can be a citizen.
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People who use long-term services can influence how the service is run as they are given opportunities to take part in
decision-making through:
• General discussions with the provider, on an informal basis, as the person wishes.
• Periodic surveys or gathering of their views.
• A representative user group, unless the service only provides care, treatment and support to people on a single contact
basis.
Possible Treatment plans and referral plans Evidence available Compliant Comment/Actions
Evidence Standard General Dental Services Yes/No
Contract (Revised May 2009) Part 13
204.1
Private area for confidential phone calls to
patients [SfBH C13c]
Practice Information Leaflet (Mandatory:
GDS Regs) [SfBH C16]
Patient satisfaction questionnaire carried out
[SfBH C7, C17]
Freedom of Information Act Compliance
(Publication Scheme) [SfBH C9]
NHS Banding and Charges available to
patients [SfBH C16]
Written Policy Documents including:
Medical history taking (Mandatory:
Department of Health – Health Service
Guidelines/ HTM01-05 2008) [SfBH C9]
Out of Hours Dental Services (Mandatory:
GDS Regs) [SfBH C19]
Patients privacy, dignity & confidentiality
(and a Nominated person) (Mandatory:
General Dental Council – “Standards for
dental professionals”) [SfBH C13a & c]
The practice takes steps to ensure that all
patients and carers are treated with dignity
and respect; acts in accordance to
legislation to meet the needs and rights of
different patient groups with regard to
dignity and respect (policy & training); has
systems in place to identify areas where
dignity and respect may have been
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compromised and take action (complaints
proc & patient survey) (General Dental
Council Standards for Dental Professionals
2.1 & 2.3
As at 20.11.2009
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Draft - Dental Balanced Scorecard (subject to local agreement Appendix 2
Effective
% of FP17s
% of FP17s % of Patients Fluride varnish Fissure sealants management of Effective management of
for the same % of Patients
Change in % of patients seen in the for the same satisfied with the applied to appllied to contract contract throughout the
patient ID satisfied with the % of FP17s
previous 24 months since last patient ID time they had to children's teeth children's teeth throughout the year so that the amount
Re-attending dentistry they submitted late
Quarter Re-attending wait for an at least twice at least twice year ensures of contracted activity is
between 3 have received
within 3 months appointment yearly yearly compliance by achieved at year end
months and 9 months
mid year
Dental Practice Identifier
Year End 2008-09
PCT
PCT
PCT
PCT
08-09
08-09
Comparative
Current
Quarter
Vital Signs
% Contract
SHA Target
Contract Yr
Contract Yr
End Position
End Position
Contract
Contractor Vs
Contractor Vs
achieved YTD
5.6% 17.9% 22.8% 41.7% 42.0% 85.3% 76.5% 0.0% Annual data Annual data 69.0% 100.75%





-2.8% 9.0% 8.6% 54.4% 38.3% 100.0% 100.0% 0.8% Annual data Annual data 69.0% 101.62%













Target: 2.00% 6.00% 4.40% 14.4% 26.60% 36.6% 90.00% 90.00% 3.93% 50% to 74% 100.00%
At end of Qtr 3:
Red =< -0.9% =<2.9% =>14.4% =>36.6% Below 69% Below 69% => 2.1% Below 69% Below 69% Below 43% or =< 95.9% or > 101.1%
above 82%
At end of Qtr 3:
Between 70% and Between 70% and Between 70% & Between 70% & 96% and 99.9% or 100.1%
Amber -1% to 1.9% 3% to 5.9% 4.5% - 14.3% 26.7% - 36.5% 0.1% to 2% 43% to 49% or
89% 89% 89% 89% to 101%
75% to 81%
At end of Qtr 3:
Green => 2% => 6% =<4.4% =< 26.6% Above 90% Above 90% =< 0% Above 90% Above 90% 100%
50% to 74%
This target is The comparisons above are recall rates within 3 mths and between Delivery of between 96 -
from the 3 to 9 months. NICE guidelines allow for recall to be up to 24 mths. It is expected that 100% of activity results in
SHA's This is part of Pledge 4 to reduce recall rates by 10% and therefore a contract will of the residual carried over to
Pledge 4 in the target is set at 10% below the average perform achieved at least the following year.
This demonstrates This survey is commissioned by DPD
the Data at PCT level 50% by end of
delivery of the Vital and the purpose of the questionnaires is This information demonstrates the
Commissioni only is available at Q3. Over
Signs target of 2% to seek confirmation of use of interventions used in
Notes and ng Strategy monthly intervals so performance may
increase of new patients the information submitted on the FP17 preventative procedures in the fight If delivery is below 96% the
explanations: 2010 - 2011; performance can indicate early
being seen by an NHS but also asks for patients opinion of to imrove the oral health of children monetry equivalent is
this is set at Each contract is monitored annually against the previous year's only be compared delivery of
dentist in the previous service received. This is reported and is available annually. clawed back by the PCT.
6% increase data. It would not be unusual to see an increase here if there has locally contract. Under
24 months. quarterly. Over 100% is Amber as it
of new been an increase in Access, but this would then be expected to performance may
patients indicate claw shows ineffective
improve as oral health improves.
attending a back at year end. management by the
dentist. contract holder.
13

Standards Setting in Primary Care Balanced Scorecard Dental Services Paper

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STANDARDS SETTING IN PRIMARY CARE –

IMPLEMENTATION OF CONTRACT MANAGEMENT THROUGH A PERFORMANCE

3. CONTRACT VAULES – SPEND

4. TWO-PRONGED APPROACH - IMPLEMENTATION

4.1. Contract Management

4.2. Performance Management Framework – Standards for Better Dental Practice

Implementing collaborative contract management, focused on quality as well as productivity, will

• Promote good quality and support improvement in efficiency and effectiveness

The Professional Executive Committee and Commissioning Sub-Committee have supported

5. WHAT DO WE AIM TO ACHIEVE?

For Patients and the PCT:

The introduction of contract management, through a performance management framework and

CQC have developed two types of guidance:

1B Manage risk through effective procedures about involvement

1C Promote rights and choices

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