David Cottam GDPC Executive Member Specialist in Oral Surgery

Transcription

1 David Cottam GDPC Executive Member Specialist in Oral Surgery

2 Membership of the Working Group Tim Baker Colette Balmer Julie Bradshaw Colette Bridgman Pete Brotherton Melanie Catleugh Geoff Chiu Andy Cole Dave Cottam Paul Coulthard Gary Cousin Michael Davidson Tariq Drabu Michael Escudier Helen Falcon Emma Fernandez Ruth Gasser Rob Haley Andrew Harris Elaine Hawthorne Richard Haywood Ann Heaton Rebecca Hierons Dionne Hilton Peter Howitt Illanko Illankovan Clare Jones Serbjit Kaur Jasveen Matharu Kim Piper Tara Renton Nouha Seoudi Ian Sharp Ben Squires Andrew Smith Madeleine Wang Association of Dental Hospitals Secondary Care Oral Surgeon Commissioner Public Health England SAS Grade Oral Surgeon Public Health England Fellow in training OMFS NHS Business Services Authority British Dental Association Chair Faculty of Dental Surgery, Royal College of Surgeons of England Chairman British Association of Oral and Maxillofacial Surgeons Dental Local Professional Network British Society for Oral Medicine Health Education England Royal College of Surgeons NHS Business Services Authority Primary Care Commissioning Area Team Commissioner Dental Local Professional Network Faculty of General Dental Practice Patient Public representative Primary Care Oral Surgeon NHS England President British Association of Oral and Maxillofacial Surgeons Primary Care Commissioning NHS England Dental Core Trainee British Society for Oral and Maxillofacial Pathology British Association of Oral Surgeons Oral Microbiology Associate Postgraduate Dental Dean Area Team Commissioning Oral Microbiology Patient Public representative

3 2 Guides Oral Surgery and Oral Medicine Related Specialties including Dental and Maxillofacial Radiology Oral and Maxillofacial Pathology Oral Microbiology

4 Dental and Maxillofacial Radiology 25 (0.58%) Dental Public Health 119 (2.74%) Endodontics 260 (5.99%) Oral and Maxillofacial Pathology 32 (0.74%) Oral Medicine 76 (1.75%) Oral Microbiology 7 (0.16%) Oral Surgery 765 (17.63%) Orthodontics 1,383 (31.87%) Paediatric Dentistry 247 (5.69%) Periodontics 343 (7.91%) Prosthodontics 440 (10.14%) Restorative Dentistry 317 (7.31%) Special Care Dentistry 325 (7.49%) Total 4,339

5 Clinicians should be competent to provide a specific oral surgery procedure and manage any complications that may arise before proceeding. Any procedure should be planned as part of a comprehensive treatment plan and consideration should be given to a multi-disciplinary approach where appropriate. The level of complexity may change depending upon one or more of the following factors: Medical History Social Factors Patient anxiety Other patient-associated modifiers

6 Oral surgery procedures/conditions to be performed or managed by a commensurate with a level of competence as defined by the Curriculum for Dental Foundation Training or its equivalent.

7 Oral surgery procedures/conditions to be performed or managed by a clinician recognised as a at the GDC defined criteria and on a specialist list or by a above those commensurate with a level of competence as defined by the Curriculum for Dental Foundation Training or its equivalent

8 Level 3a Oral surgery procedures/conditions to be performed or managed by a clinician recognised as a at the GDC defined criteria and on a specialist list. Level 3b Oral surgery procedures/conditions to be performed or managed by a clinician recognised as a and at the GDC defined criteria and on a specialist list.

9 Extraction of erupted tooth/teeth including erupted uncomplicated third molars Effective management, including extraction where appropriate, of buried roots (whether fractured during extraction or retained root fragments), unerupted, impacted, ectopic and supernumerary teeth Understanding and assistance in the investigation, diagnosis and effective management of oral mucosal disease, including the early referral of patients with possible pre-malignant or malignant lesions Management of dental trauma including re-implantation of avulsed tooth/teeth Management of haemorrhage following tooth/teeth extraction Diagnosis and treatment of localised odontogenic infections and postoperative surgical complications with the appropriate therapeutic agents, and diagnose and refer patients with major odontogenic infections with the appropriate degree of urgency. Recognition of disorders in patients with craniofacial pain including initial management of temporomandibular disorders and identification of those patients that require specialised management (with appropriate referral)

10 Surgical removal of uncomplicated third molars involving bone removal Surgical removal of buried roots and fractured or residual root fragments Management and surgical removal of uncomplicated ectopic teeth (including supernumerary teeth) Management and surgical exposure of teeth to include bonding of orthodontic bracket or chain Surgical endodontics Minor soft tissue surgery to remove apparent nonsuspicious lesions Placement of uncomplicated dental implants in accordance with NHS protocols

11 (include any procedures consistent with the competencies defined within the GDC Oral Surgery Curriculum and FDS Career Development Framework) Procedures involving soft/hard tissues where there is an increased risk of complications (such as nerve damage displacement of fragments into the maxillary antrum and fracture of the mandible) Management and treatment of salivary gland disease Surgical removal of tooth/teeth/root(s) that may involve access into the maxillary antrum Management of temporomandibular disorders and craniofacial pain that have not responded to initial therapy Treatment of cysts Management of suspicious/non-suspicious oral lesions The placement of dental implants requiring complicated additional procedures such as bone grafting, sinus lifts etc Treatment of complex dento-alveolar injuries Management of spreading infections and incision of abscesses (or abscess) requiring an extra-oral approach to drain

12 Registered as a dentist with the GDC. No additional qualifications necessary. No specific training in Oral Surgery Undergraduate teaching in Oral Surgery. May have attended relevant postgraduate Oral Surgery courses. Providers must provide Level 1 care.

13 Clinical experience limited for patients with oral surgery needs. May undertake shared care with specialist or DES. Ability to recognise when the help and advice of a specialist or DES is required. May attend relevant oral surgery courses as part of CPD cycle (GDC requirement.

14 Primary care setting. Compliance with CQC, DDA and HTM Appropriate oral surgery equipment to meet current quality and patient safety standards. Works with dental team and may not have any training in Oral Surgery

15 GDC registered primary care dentist with additional experience and/or competencies. Or Dentist with Extended Skills (DES)

16 Evidence of attendance at relevant postgraduate oral surgery courses. Primary Care setting Supervision of training in Oral Surgery. Providers will accept Level 2 care referrals as defined by the terms of the Oral Surgery care pathway. It is not expected that Level 1 care will be provided.

17 Ability to carry out a range of clinical activity for patients with moderate needs. Ability to recognise when help and advice of a specialist is required. Membership of Managed Clinical Network (MCN) Participation in CPD of relevance to Oral Surgery.

18 Must be on Oral Surgery Specialist List with GDC. Supervision of higher training in Oral Surgery and provision of mentorship for DES in Oral Surgery. Involvement in undergraduate &/or postgraduate training desirable. Providers will accept Level 2 referrals as defined by the terms of the Oral Surgery care pathway

19 Acceptance of a wide range of clinical cases for patients with complex needs. Taking a lead role for developing a local infrastructure for the delivery of Oral Surgery. Participation in Managed Clinical Network. Co-ordination, provision and participation in CPD in Oral Surgery. Primary or Secondary Care setting

20 The Guide will inform LDN s and AT s National care pathway for OS delivery Consultant led triaging with a managed clinical network of primary and secondary care providers Greater consistency in delivery OS services Focus on PREMS and PROMS

21 A significant proportion of the procedures currently carried out in many secondary care services can and should be delivered by specialists and dentists in a primary care setting. Approximately 80% of referrals to an OMFS unit are for oral surgery and about 20% specifically require the services of a maxillofacial surgeon.

22 PCR Requirement of performer number National pricing of procedures Standard contract for each level of care? Workforce numbers? Workforce training requirements? Costs to be a DES? Medico legal implications? Effects on private provision?

23 Is it just about Doing the right procedure In the right place At the right time By the right person And at the right price?