Using the In Practice Prevention programme to improve oral health

In Practice Prevention programme

Michael Watson explains how the In Practice Prevention programme can target resources more effectively

The creation of the In Practice Prevention programme is encouraging, Michael Watson says.

News from Ireland last week that 10,000 children under 15 are being hospitalised every year for dental extractions under general anaesthetic struck a chord.

Although the figures are reportedly five times higher than in the UK, we cannot be complacent at our own record and child oral health must remain a high priority for our Department of Health.

In Practice Prevention programme

Encouraging news reaches me however of a prevention initiative, developed by the North Yorkshire and Humber local dental network and currently being run over three sites in Yorkshire.

Called the ‘In Practice Prevention’ (IPP) programme, it uses trained dental care professionals (normally extended skills dental nurses) to deliver targeted, evidence based Delivering Better Oral Health referenced interventions.

Earlier this year the network ran deanery endorsed training courses for DCPs developing their knowledge base for the programme and fluoride varnish competency in preparation for the development of the programme, which were well attended.

The IPP programme is based on a prevention care pathway approach in which children are signposted for the programme following assessment.

Each child is examined and described as red, amber and green.

Children with amber and red status, based on the number of active carious lesions identified clinically and on social history questions on diet and brushing habits, are signposted to the IPP programme.

The pilot sites are paid £40 to deliver each care pathway over three 12-minute appointments.

A maximum of 5% of contract value is commissionable as IPP delivering a set number of pathways, which will not be linked to units of dental activity.

Participating practices will have targets reduced by 5% and an IPP delivery target of a set number of pathways.


Initial evaluation of the pilot, looking at patient experience, patient outcomes and clinical outcomes is encouraging.

The North Yorkshire and the Humber local dental network are proposing to commission IPP initially in areas of social deprivation where disease rates are highest and dental health inequalities greatest.

They have also produced a discussion document looking at ideas around developing outreach prevention by linking practices with schools in areas of high dental need.

This discussion document looks at the possibility of the flexible commissioning of practices to run DCP-led school-based brushing and fluoride varnish programmes.

This strategy would capture children not accessing primary care allowing simple, reliable signposting for IPP and care.

The ideas surrounding this extension of IPP are in their infancy but are gaining some high profile support.

IPP is a success story for the concept of local dental networks and confirms the philosophy that clinicians in the field working closely with dental public health and commissioners can develop coherent patient-centred programmes that target resources cost effectively where they are needed.

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