National Dental Advisory Committee

National Dental Advisory Committee Dental Practice Advisers in Scotland July 2001 Working together for a healthy, caring Scotland

NATIONAL DENTAL ADVISORY COMMITTEE DENTAL PRACTICE ADVISERS IN SCOTLAND JULY 2001

REPORT OF THE WORKING GROUP ON DENTAL PRACTICE ADVISERS IN SCOTLAND TERMS OF REFERENCE The Chief Dental Officer asked the National Dental Advisory Committee (NDAC) to review the role of Dental Practice Advisers in Scotland with the following terms of reference: 1. To review the present functions and job descriptions of Dental Practice Advisers (DPAs) in Scotland and to identify their core responsibilities. 2. Make recommendations on the future responsibilities and functions of a DPA within a Primary Care Trust. Should some of the support and advice functions be offered to the Community Dental Service (CDS)? 3. Develop a core job description for DPAs which should be disseminated to the Primary Care Trusts after agreement with the Scottish Executive, Health Department. 4. Review the communication between DPAs, Health Boards, Primary Care Trusts, Scottish Dental Practice Board, Scottish Council for Post Graduate Medical and Dental Education (SCPMDE) and the Scottish Executive and make recommendations for clear relationships with these bodies. 5. Review the training and continuing education of DPAs and make recommendations on future arrangements. Details of the membership of the Working Group are shown in Appendix I. ii

CONTENTS 1 INTRODUCTION 2 THE CURRENT DPA ROLE 3 FUTURE DEVELOPMENTS 4 COMMUNICATION 5 TRAINING AND CONTINUING EDUCATION FOR DPAs 6 EMPLOYMENT OF DPAs 7 RECOMMENDATIONS APPENDICES I MEMBERSHIP OF THE WORKING GROUP II DPA SURVEY - 1998 III IV V DPA QUESTIONNAIRE RESULTS JOB SPECIFICATION PERSON SPECIFICATION iii

1 INTRODUCTION 1.1 Dental Practice Adviser (DPA) posts were first piloted in Scotland in May 1990 for an initial 3-year period. This followed a report of a joint working party on Dental Practice Advisers, which was published in 1987. 1.2 It was envisaged that DPAs would have a number of possible functions including: Dentist references - requests by General Dental Practitioners (GDPs) for advice on treatment planning. Estimate references - requests by the Scottish Dental Practice Board for advice on a proposed treatment plan by a local GDP. Inspection of new dental practices. Inspection of established dental practices. Counselling of GDPs (requests from a Health Board, Scottish Dental Practice Division (SDPD) or by the individual GDP). Pastoral visits to general dental practitioners. 1.3 Pilots in Scotland were centrally funded and were run in 4 Health Board areas. Funding was on the basis of each DPA working for 2 sessions a week. 1.4 An evaluation of the 4 pilot sites was carried out by the Department of Dental Health at Dundee University and was published by the Management Executive in May 1994. 1.5 The evaluation sought to address 2 central questions: Did those involved find the DPA scheme efficient, effective, appropriate and acceptable? Did the DPA scheme increase the quality of care offered to patients? 1.6 The evaluation of the pilot scheme suggested that DPAs played a valuable role. It was further recommended that DPAs should continue to be available to all the parties involved and that their job descriptions should be made flexible to allow them to respond to local needs and evolving changes in NHS dentistry. 1.7 Since 1994, a number of DPAs have been appointed in Scotland although not in all areas. Evidence suggests significant differences in the role of the DPA across Scotland. Furthermore, changes in the National Health Service in Scotland following the publication of the White Paper Designed to Care and the emergence of Primary Care Trusts and Local Health Care Co-operatives from April 1999 have provided the opportunity to review the role and function 1

of DPAs in the NHSScotland. This work was also supported in the Action Plan for Dental Services in Scotland. 2

2 THE CURRENT DPA ROLE Availability 2.1 The Deputy Chief Dental Officer conducted a brief survey of DPA posts in September 1998, the results of which are contained in Appendix II. These details will have changed as a result of the establishment of Primary Care Trusts in April 1999. 2.2 By 31 March 1999, 11 DPAs had been appointed in 9 Health Board areas. In Greater Glasgow and Lothian two DPAs each provide one session a week. 2.3 All DPAs had job descriptions. Many of the duties outlined in the job descriptions were based on the DPA pilot scheme (1994 PCA(D)6) and included practice inspections; pastoral/counselling responsibilities; D reference patient examinations and the provision of advice to practitioners on a range of issues including Health & Safety. At 31 March 1999 most DPAs were managerially accountable to Directors of Primary Care or their equivalents. 2.4 Several DPAs, however, had a broader role including the provision of advice to Health Boards on dental and oral health issues. On the basis of the job descriptions and the remit for the working group a detailed questionnaire was developed and sent to all DPAs. Replies were received from 10 DPAs and an analysis is presented in Appendix III. 2.5 The review group strongly recommends that at least one DPA should be appointed on a sessional basis in each Primary Care Trust and hence in each Health Board area in Scotland. The island Health Boards should also have access to the services of a DPA possibly by arrangement with an adjoining mainland Primary Care Trust. Age and Experience 2.6 Of the 10 replies, no DPA in Scotland has been qualified for less than 10 years and all report that they are currently in clinical dental practice. Most DPAs work for 7 or more sessions per week in practice - and none work less than 3 sessions. It is considered important that DPAs continue to be drawn from the ranks of practitioners who are senior and experienced and who continue to spend the majority of their working week in GDS practice. This should ensure that DPAs are not only fully aware of current GDS regulations and contractual issues but are also seen as credible to fellow GDPs. 2.7 All DPAs have been in post for more than a year - 5 having been in post for more than 3 years. Seven DPAs were appointed for a 2 or 3 year period although one appointment was reported as indefinite. The issue of length of tenure of the DPA post is important. There may be benefits in a regular change of DPA as was foreseen after the original pilot phase but this has to be balanced by the fact that knowledge, skills and networks developed by the DPA will be lost on completion of the appointment. 3

2.8 One solution could be to appoint 2 DPAs and stagger their appointments in order to maintain access to an experienced DPA who can offer training and support. An example of such an approach can be seen in Greater Glasgow and Lothian Health Boards. 2.9 However, the principle of having 2 DPAs is only likely to be relevant in the larger Health Board areas. It is suggested that the tenure of the appointment could be extended beyond three years (subject to satisfactory annual review), with a maximum of 2 terms of office (6 years). It should be incumbent upon employers to ensure adequate induction and structured training for incoming DPAs in order to maximise their effectiveness. This training could be coordinated on a national basis through the auspices of the existing DPA network and would include the identification of learning needs and the formulation of learning plans for DPAs. Reviewing Performance 2.10 Five DPAs reported that they do not have annual performance reviews and rely on more informal mechanisms to gain feedback on performance and to set priorities. Five DPAs currently produce an annual report. 2.11 All DPAs should have an annual performance review. The production of an annual report is an important part of this process and should be required of all DPAs. It is recommended that the DPA annual report should be circulated to Primary Care Trust Boards, Area Dental Committees and Health Boards and should be seen as part of the clinical governance mechanism in primary dental care. Liaison 2.12 DPAs network widely with a variety of people. Regular contact with the Consultants in Dental Public Health is essential as DPAs are now part of Primary Care Trusts. Regular liaison, with the Scottish Dental Practice Division is important and may also often involve the Consultant in Dental Public Health. 2.13 Few DPAs report that they currently liaise regularly with the Scottish Council for Postgraduate and Medical and Dental Education. It is recommended that DPAs should have an increased role in encouraging GDPs to identify training needs and to develop a more structured approach to continuing professional development. DPAs should therefore liaise with Section 63 tutors and others in order to ensure that GDP training needs feed into postgraduate programmes. 4

Practice Inspections 2.14 The majority of DPAs report that they are involved in practice inspections. This ranges from the inspection of new practices alone to the inspection of all practices. In some cases DPAs work alongside practitioners in an advisory and support role prior to a formal inspection by local GDPs, who have been nominated to undertake this activity by the Area Dental Committee on the advice of GDP representatives. 2.15 Considerable variation is also reported in the frequency of practice inspections - from occasional to annual inspections. Several DPAs commented that an enhanced DPA practice inspection function would be counterproductive - conflicting with their role in supporting and advising practitioners. It would also take up a great deal of time and thus detract from other important elements of their work. 2.16 The review group supports this view and recommends that, in future, formal practice inspections should no longer be a core part of the DPA role. It is proposed that the Area Dental Committees nominate GDP representatives who can be trained and calibrated to carry out practice inspections according to an agreed, standardised, check list. 2.17 To ensure that standards are consistent the DPA should have an organisational and quality assurance role in inspections. Training and calibration should be co-ordinated at a national level; although nominated GDPs should normally only work within their own Health Board area. It is probably wasteful to insist on annual practice inspections and the review group recommends the adoption of the following principles: All new practices to be inspected before opening. Existing practices to be inspected at least once every 3 years. Practices where problems have been identified should be inspected more frequently. Arrangements should be in place for ad hoc requests for practice inspections made by the Primary Care Trust. 2.18 Practice inspection reports should be available to Primary Care Trusts. The practice standards checklist should be agreed nationally. All dental practices should be encouraged to work towards the standard already agreed for Vocational Training (VT) practices in Scotland and should in future link to the Clinical Standards Board for Scotland. 2.19 A peer-led system of local GDP inspectors already exists in several areas but it is not consistent across the country nor is it supported by training and calibration. Discussions should be held with the profession in order to progress the recommendations on practice inspections at an early stage. This 5

will have significant implications for Primary Care Trusts in their role of assuring clinical quality. 2.20 The role of DPA should thus incorporate the provision of informal advice, support information and have an overview of standards - perhaps at a preinspection visit - and this should enable the emphasis of the DPA role to focus on practice development rather than on inspection and regulation. 2.21 However, this development role should not undermine the attainment of high standards in dental practice, indeed, it should be directed towards continuous quality improvement. There should be clear lines of accountability established, including regular contact between the DPA and the Medical or Dental Director, to enable the Primary Care Trust to fully discharge its clinical governance function. If there is evidence of poor standards of practice, which are not amenable to informal DPA advice, this could result in a referral to a practice inspection team or a Dental Reference Officer. Complaints and Discipline 2.22 With one exception, all DPAs report that they have an informal role in providing technical and clinical advice to primary care staff who deal with complaints and disciplinary matters. Several DPAs also noted that they provide advice to practitioners and to the general public mainly connected with the process for complaints or discipline. 2.23 The group believe that it is important that Primary Care Trusts should have access to dental advice on matters of fact and accuracy and that the DPA should be available to provide this. It is, however, inconsistent with the DPA s role if they are asked to make decisions on the management of discipline or complaint cases or to play an active role in pursuing a prosecution. Consultants in Dental Public Health should also be involved and informed at all stages. The review group is aware of changes to the disciplinary process in Scotland that might significantly alter the need for local technical advice to be available. There should continue to be local advice available to the public on the complaints procedures. Main Areas of Work and Core Functions 2.24 DPAs were asked to identify their main areas of work and to indicate the proportion of time currently spent on each activity. The majority of time was spent on practice visits (pre-inspection and inspection visits); giving general advice (mainly to GDPs but also to Primary Care Departments and to the general public) and representing the GDP view at meetings. One DPA indicated that he helped to organise training courses. 2.25 Considerably less time was spent on D references and pastoral advice. D references are requests from dental practitioners to a DPA for an opinion on a planned course of treatment. An agreed joint treatment plan is then submitted to the Scottish Dental Practice Division for approval. 6

2.26 Many, but not all, DPAs attend the Area Dental Committee and their Committees in their capacity as DPAs. The Group recommends that the constitution of local professional committees should always include the DPA. 7

3 FUTURE DEVELOPMENTS 3.1 As part of the review, DPAs were invited to comment on the importance of their current role and how it may develop in the future. 3.2 The 2 key activities identified were that of bridge builder between Primary Care Trust management and the general dental service (GDS) and the role of the DPA in supporting and encouraging GDPs - including the provision of advice, counselling and clinical support. 3.3 There was also a view that DPAs had an important role in improving standards in general dental practice and that they should have an involvement in guideline implementation and links with clinical audit facilitators and should contribute to the identification of training and development needs. It is therefore recommended that all Primary Care Trusts should appoint DPAs with the following core responsibilities and functions: Advice to Primary Care Trusts. Advice to Health Boards. Support for Practitioners. Improving Standards/Practice Development. Liaison with the Community Dental Service. Advice to Primary Care Trusts 3.4 DPAs should be available to provide advice within the Primary Care Trust and ought therefore to be managerially accountable to the Trust. The DPA role should include advising on GDS systems and structures; providing factual clinical advice on complaints and disciplinary matters and acting as a conduit between the Trust and professional advisory committees on matters relating to the GDS. There would also be an expectation that the DPA will build bridges with other branches of the service including the Community Dental Service. 3.5 In many cases - particularly those relating to proposed projects to improve oral health, monitoring and profiling service delivery and identifying treatment trends - the DPA should work closely with the Consultant in Dental Public Health and others. The Consultant in Dental Public Health should, however, remain the chief professional adviser on matters relating to dentistry in each Health Board area. 3.6 Clear lines of accountability need to be established to ensure that the Trust can discharge its responsibility for clinical governance. 8

Advice to Health Boards 3.7 Health Boards still require advice on matters relating to the general dental service. The DPA, through the Consultant in Dental Public Health and the Area Dental Committee, should be available to provide this information as required. Support for Practitioners 3.8 Informal support and advice to GDPs is critical to the success of the DPA in improving standards in general dental practice. It is recommended that DPAs should carry out pre-inspection visits to practices in order to help identify shortfalls, to enable practitioners to develop appropriate risk management strategies and to act as an information source eg, on aspects of health and safety legislation. 3.9 DPAs should be encouraged to get to know their patch. Anecdotal evidence suggests that this informal and supportive way of working alongside practitioners is a powerful lever in improving standards, whilst ensuring access to other support networks such as The Sick Dentist Scheme. 3.10 The Scottish Dental Practice Division should be able to make a direct referral to a DPA if there are concerns about the clinical quality of a particular practitioner s work - provided that the practitioner s prior agreement is given. Such a referral should emphasise the role of the DPA in supporting and helping to improve practice rather than be seen as a threat. 3.11 The clinical role of DPAs in D references (see section 2.25) is important and the use of D references should be actively promoted and encouraged - both by Scottish Dental Practice Division and in other ways within the profession. 3.12 DPAs should seek to maximise the amount of time they spend visiting dental practices and making direct contact with practitioners, including D references. Primary Care Trusts should recognise the crucial role of DPAs in this aspect of clinical governance. DPAs, for their part, will need to juxtapose confidentiality in their dealings with practitioners with the requirement for clinical accountability within the Trust. Improving Standards/Practice Development 3.13 DPAs are also important players in the process of improving quality in general dental practice. They should have a pivotal role in (though not necessarily be the deliverers of) the implementation of guidelines; clinical audit; contributing to the training needs assessment and the promotion of continuing professional development for GDPs, professionals complementary to dentistry (PCDs) and practice staff. The expectation is that that this work will be of assistance to the Clinical Standards Board for Scotland when it begins to look at clinical standards in dentistry. 9

3.14 Primary Care Trusts should therefore review their structures and policies to ensure that the DPA is well informed; able to exert appropriate influence and strategically placed to have maximum effect in helping to improve standards of care in dental practice. 3.15 Links with local postgraduate networks, Section 63 tutors and internal Trust training and development departments need to be nurtured and the way in which DPAs interface with existing postgraduate structures should be reviewed in order to ensure maximum effectiveness. DPAs should also build links with the defence societies who themselves have contributions to make to education and training. 3.16 Section 63 tutors may wish to meet with DPAs in their region before meeting with SCPMDE to plan prospective postgraduate programmes. 3.17 Practice development and infrastructure should encompass more than the physical equipment. In particular, it should incorporate the whole practice structure to take account of cross infection standards, education and training and support for the implementation of policy procedures. Liaison with the Community Dental Service 3.18 Given the broader role envisaged for DPAs, it would be appropriate for Primary Care Trusts to consider how DPAs could relate to other parts of the service, particularly the Community Dental Service. 3.19 Whilst the Consultants in Dental Public Health provide advice on the establishment and development of salaried GDP posts or joint CDS/GDS posts, DPAs should be available to advise on aspects of legislation (eg, health and safety, radiological protection) and detailed GDS issues. 3.20 The DPA role in promoting the development of best practice, audit and training and development in the GDS overlaps with community dental practice. DPAs and Community Dental Services Managers should therefore seek to maximise the potential for joint working on areas of common interest. 3.21 In the light of these recommendations a core job specification and person specification are detailed in Appendices IV and V. Trusts are encouraged to use these as an outline, but should note that the core duties are not exhaustive. 10

4 COMMUNICATION 4.1 DPAs in Scotland already have an informal network, which meets on a regular basis. Several joint meetings have been held with practitioners from the Dental Reference Officer Service and Dental Advisers from the Scottish Dental Practice Division. These meetings have included some aspects of education with an emphasis on updating clinical awareness. 4.2 In other parts of the United Kingdom, DPAs also meet regularly with Consultants in Dental Public Health in order to share information and to discuss common areas of work. 4.3 There is a need to develop consistent and structured pathways for communication in Scotland not only between DPAs but also with other stakeholders. The following action points are considered to be of key importance: DPAs in Scotland should continue to develop a structured DPA network with regular meetings. Communications between DPAs and existing postgraduate structures should be strengthened. Meetings should regularly include Dental Reference Officers and Dental Advisers and should involve a formal element of continuing professional development. DPAs, Consultants in Dental Public Health and the Chief Dental Officer should meet to discuss matters of mutual importance. Lines of communication should be established between the Scottish Dental Practice Division and DPAs to ensure that practitioners are directed to a DPA for advice and support in cases where the Scottish Dental Practice Division might have concerns over aspects of clinical quality. The DPA network should develop links with the association of Trust Medical Directors. 11

5 TRAINING AND CONTINUING EDUCATION FOR DENTAL PRACTICE ADVISERS 5.1 At present the training of DPAs is ad hoc and varies across Scotland. It is likely that many DPAs partly because of their independent contractor status receive little or no formal training for their DPA role. 5.2 The Scottish DPA network should develop national standards for DPA training and development and should also be the locus for audit. Primary Care Trusts as employers of DPAs should be reminded of their responsibility to support training and development for this group of staff. 5.3 DPAs should have the opportunity to develop skills in facilitation and counselling in recognition of their support and advice role to GDPs. 12

6 EMPLOYMENT OF DPAs 6.1 Most DPAs are currently employed on a similar basis to the specimen terms and conditions of service developed for the DPA pilot. Most are employed as independent contractors on a sessional basis and are paid on a rate similar, or identical, to the Dental Guild rate. 6.2 DPAs are all practising GDS dentists and most if not all, are likely to be principals with practice overheads. It is therefore recommended that Primary Care Trusts should employ DPAs on a DPA sessional rate (based on the Dental Guild rate). In the case where a DPA is appointed who is a salaried practitioner or a dentist who has no practice overheads, local flexibility will apply and it is recommended that a negotiated sessional rate would be appropriate. 6.3 DPA appointment committees should normally be chaired by a Non-Executive Board member and consist of the Medical or Dental Director, the Consultant in Dental Public Health, a GDP representative nominated through the Area Dental Committee and an external DPA (nominated by the DPA network). 13

7 RECOMMENDATIONS 7.1 At least one DPA should be appointed on a sessional basis in each Primary Care Trust and therefore in each mainland Health Board area in Scotland. The Island Health Boards should also have access to the services of a DPA. 7.2 DPAs should be senior and experienced GDPs who continue to spend the majority of their working week in GDS practice. 7.3 Consideration should be given to appointing 2 DPAs with staggered appointment periods so that there is always a more experienced DPA to offer training and support. 7.4 Alternatively, the tenure of the DPA appointment could be extended to make the most efficient use of the DPA resource with a maximum of 2 terms of office (6 years). 7.5 Employing Trusts should ensure that adequate induction and structured training arrangements are in place for DPAs in order to maximise their effectiveness. 7.6 DPAs should produce an annual report which should be circulated to Area Dental Committees, Health Boards and Primary Care Trust Boards. 7.7 DPAs should have an increased role in providing support to GDPs to enable continuous improvement of the quality of clinical practice. This should encompass guideline implementation, dissemination of best practice, audit, contributing to the identification of training needs and liaison with postgraduate networks. Practice development should also include the education and training of professions complementary to dentistry and practice staff and would address issues of practice infrastructure. 7.8 DPAs should liaise with SCPMDE to assist in the planning of postgraduate programmes. 7.9 DPAs should not be actively involved in the management of discipline cases, but should be available to give dental advice on matters of fact and accuracy to Trusts, practitioners and the general public. All such advice must be recorded for future reference and audit. 7.10 Area Dental Committees and GDP Sub Committees should always include the DPA. 7.11 The clinical role of DPAs in D references is important and the use of D references should be actively promoted and encouraged. 7.12 Primary Care Trusts should review their structures and policies to ensure that the DPA is well informed, able to exert appropriate influence and strategically placed to have maximum effect in improving standards of care in dental practice. 14

7.13 DPAs in Scotland should continue to develop a structured DPA network with regular meetings, some of which should include Dental Reference Officers, Dental Advisers and may involve a formal Continuing Professional Development component. 7.14 The DPA network should also be involved in co-ordinating DPA training, nominating DPAs to serve on appointment committees and auditing the work of DPAs nationally. 7.15 DPAs, Consultants in Dental Public Health and the Chief Dental Officer should meet to discuss issues of mutual importance. 7.16 Communications should be established between Scottish Dental Practice Division and DPAs to ensure practitioners can be directed to a DPA for advice and support in cases where Scottish Dental Practice Division might have concerns over aspects of clinical quality. 7.17 DPAs should develop links with the Association of Trust Medical Directors. 7.18 DPAs should continue to be employed as independent contractors on a sessional basis and paid at an appropriate rate. 7.19 DPA appointment committees should be appropriately constituted. Practice Inspections The Group highlighted that the role of the DPA is closely associated with practice inspections. A number of recommendations on practice inspections have been made although it is acknowledged that the Scottish Executive is in the process of reviewing this activity. 7.20 Practice inspections should normally be carried out by trained and calibrated local GDPs. Training and calibration for practice inspections should be coordinated on a national basis and should use standardised checklists. 7.21 Practice inspection reports must be available to Primary Care Trusts. 7.22 Whilst the role of the DPA should be developmental rather than regulatory this should not undermine the responsibility of Primary Care Trusts in clinical governance and mechanisms should be in place to ensure that the advice of DPAs is acted upon. 7.23 Dental practices in Scotland should work towards achieving the standard already agreed for vocational training practices and should in future link to the Clinical Standards Board for Scotland. 15

APPENDIX I MEMBERSHIP OF THE NDAC WORKING GROUP ON DENTAL PRACTICE ADVISERS IN SCOTLAND Chairman: Mr G Ball Consultant in Dental Public Health, Borders, Fife and Lothian Health Boards Members: Mr D Arthur Mr R Broadfoot Dr F Elliot Mr J Herrick Dr J Rennie Mr T Timmons Mr F Toner Dental Adviser Dental Practice Division General Dental Practitioner Glasgow Medical Director Fife Primary Care NHS Trust Community Dental Services Manager Lomond and Argyll Primary Care NHS Trust Dental Director Scottish Council for Postgraduate Medical and Dental Education General Dental Practitioner Musselburgh General Dental Practitioner Cupar Secretariat: Ms M Miller Mrs K Scott Health Planning & Quality Scottish Executive Fife Health Board 16

Grampian Yes Two Yes Joyce Will Tayside Yes Yes Dr H Leadbetter Lanarkshire No R Shorter Greater Glasgow Yes Two Yes N Mcgregor Edwards Lothian Yes Two Yes Duncan Miller Argyll & Clyde Yes One Yes Duncan Galbraith Highland No Alex Fraser Borders Yes On session a fortnight Yes Jenny Gill APPENDIX II DPA SURVEY 1998 HEALTH BOARD AREA DENTAL PRACTICE ADVISER YES/NO NUMBER OF SESSIONS JOB DESCRIPTION YES/NO Forth Valley Discussions taking place To be finalised Duncan Harris CONTACT NAME Fife Yes One/Two (depending on service needs) Shetland No Yes Joyce Kelly Orkney No Ayrshire & Arran Yes Yes Western Isles No 17

APPENDIX III DPA QUESTIONNAIRE RESULTS 1999 1. Time qualified 5-10 years 10-20 years 20 years + 4 6 2. Currently in practice Yes No 10 3. Approximate number of GDP sessions None 1-3 3-6 7+ 2 8 4. Time since appointment < 1 year 1-3 years > 3 years 5 5 5. Job description reviewed regularly? Yes No 7 3 6. Length of DPA appointment 1-2 years 2-3 years > 3 years Indefinite 2 7 1 7. Possible to reapply Yes No Don t know 6 4 18

8. Annual performance reviews Yes No 4 6 9. Annual report Yes No 5 4 10. Other arrangements to review performance Informal discussion of annual report Ongoing assessment by key directorates Regular meetings where DPA function is discussed 11. Liaison with others Regular Occasional Never SDPD 4 5 1 CDPH 10 SCPMDE 5 5 12. Conduct practice inspections Yes No 7 3 The 3 DPAs who did not carry out practice inspections indicated that this was done by local GDPs appointed by the Local Dental Committee. 13. Frequency of practice inspections Annual 1 18 months 1 3 years 2 Rolling 2 programme Occasional 1 19

14. Role in complaints and/or disciplinary process With the exception of one DPA, DPAs all had an informal role in providing technical and clinical advice to primary care staff who were dealing with complaints and disciplinary matters. Three DPAs highlighted their role in providing advice to practitioners regarding procedures in complaints and disciplinary matters. One DPA had a role in liasing with the Procurator Fiscal s office on fraud investigation. One DPA had no role in complaints/discipline matters. 15. Activity - breakdown of main areas of work and time spent on each Main area of work Proportion of time spent D references 2% (1), <5% (1), 5% (2), 10% (3) General advice - to GDPs, public or Health Board Meetings - including audit, R&D, EDS 5% (1), 20% (1), 25% (1), 40% (2), 45% (1), 65% (1) 10% (1), 15% (1), 20% (3), 25% (1), 40% (1) Practice visits 15% (2), 20% (2), 30% (1), 50% (2), 60% (1) Pastoral advice 10% (1), 15th (2), 20% (1), 25% (1) Organising training courses 5% (1) 16. Attend ADC in capacity as DPA Yes No 6 4 17. Attend GDP Sub-Committee in capacity as DPA Yes No 7 3 20

18. Areas of work considered to be of most importance Acting as a bridge building/go-between GDPs and Health Board (9). Supporting and encouraging GDPs - including advice, counselling, clinical support (7). Providing accurate, impartial advice to Health Boards (4). Other emphasis: Helping vital role of GDP to be recognised; Bringing GDS/CDS/HDS together to maximise resource utilisation; Helping patients and providing advice to patients; Providing confidential pastoral care; Improving standards - eg, through audit, guideline implementation, training, personal learning plans, practice development plans; DPAs must be seen as independent of Health Boards/ Primary Care Trusts; Encouraging research and development in practice. 19. How should the DPA role develop in the future? Support and develop the GDS; More input to local health strategy/ funding decisions; More patient contact - D references; Improving GDP/Health Board/Primary Care Trust communication; Raising the profile of GDS within Health Boards; Advice to Health Boards on care trends eg, GA/Sedation; Support PDS initiatives; Decreasing practice inspection role - more time advising Health Board; Increasing role as arbiter in disputes between patients/health Boards/Dental Practice Division; Developing postgraduate education; Doing more practice visits. 21

20. Any other comments Informal practice visits very rewarding; Current additional roles in managing GA service, salaried dentists and input to primary care resource centre; DPA has been very successful in building bridges e.g. Health Boards/Dental Practice Division/GDPs; Vital role in helping strengthen the GDS to counter the drift to independent practice; Practice inspections an ideal opportunity to discuss contractual obligations, career change, personal difficulties, emergency rotas etc; D references have not developed; More in-service DPA training needed; Different role in Scotland to England and Wales; DPA role in clinical governance is relevant for the future; Provision of training for dentists and the dental team will become more important; DPA role should expand but DPAs must still be firmly based in practice; DPAs should have no disciplinary role - practitioners need someone to help without fear of discipline; DPAs have no role in clinical governance other than to assist GDPs at request of PCT; Primary role of DPA must be to represent GDP and ensure good communication with PCT. 22

APPENDIX IV DENTAL PRACTICE ADVISER DRAFT JOB SPECIFICATION JOB TITLE Dental Practice Adviser JOB SUMMARY To contribute to and promote the improvement of overall quality of care in general dental practice; To act in a support and advisory capacity (including clinical advice) to general dental practitioners; To advise the Primary Care Trust on all matters relating to the general dental service and to work in close liaison with other professional staff. ORGANISATIONAL RELATIONSHIPS Normally accountable to the Medical or Dental Director. PRINCIPAL DUTIES Provide support and advice to GDPs and others by a variety of informal contacts including pre-inspection visits to assist in helping practitioners to meet required standards; Provide advice to the Primary Care Trust on matters relating to the GDS including GDS systems and structures; Provide technical and clinical advice in complaints and disciplinary matters; Act as a link between the Primary Care Trust, Health Board, professional advisory committees and GDPs on matters relating to the GDS; Build bridges with other branches of the service within the Primary Care Trust particularly the Community Dental Service; Work closely with the Consultant in Dental Public Health on a variety of projects including GDS aspects of the implementation of the oral health strategy; monitoring local GDS activity and identifying treatment trends; 23

As far as possible, gain a detailed local knowledge of General Dental Practice in the area in order to support and facilitate continuous practice quality development; Respond to requests from Scottish Dental Practice Division or the Trust for counselling and/or professional advice for GDPs where there are concerns over clinical or service quality issues; Carry out D reference examinations at the request of the GDP; Link with existing audit, guideline implementation and training structures within the Trust in order to promote and facilitate high clinical standards in practice; Link with local postgraduate networks and Section 63 tutors; Provide appropriate advice to the Community Dental Service and other branches of the profession on matters relating to the GDS and the interface between them; Participate in the Scottish DPA network in conjunction with other key professional groups including Dental Reference Officers, Dental Advisers, Consultants in Dental Public Health and others; Provide advice to Health Boards on matters relating to the GDS and in conjunction with Consultant in Dental Public Health. 24

APPENDIX V DENTAL PRACTICE ADVISER PERSON SPECIFICATION FACTOR ESSENTIAL DESIRABLE EXPERIENCE Extensive experience of General Dental Practice Maintains active participation in clinical dentistry Undertakes to spend the majority of clinical time in GDS after appointment QUALIFICATION TRAINING BDS or equivalent Active in post graduate education KNOWLEDGE OR SKILLS Innovative approach Good communication skills Good organisation skills Working in NHS/GDS practice for at least 65% of the time Registered for 10 years or more DGDP/MGDS Computer literate DISPOSITION e.g. Personal (transferable) skills Friendly Approachable Ability to work in a team A positive and enthusiastic approach to general practice High professional values OTHER Positive approach to work and the challenges of new opportunities No conflicts of professional interest No adverse disciplinary record No evidence of poor clinical quality from DRO examinations Minimum complaints against the practice 25

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