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Study in deprived area reveals negative attitudes to dentists
14th Sep 2009
A new campaign to tackle poor oral health and boost numbers visiting dentists has been undertaken in a deprived area of London.
NHS Kensington & Chelsea, based in the west London borough, is looking to increase the number of residents regularly visiting an NHS dentist in the borough.
Its innovative campaign relies on quality-based commissioning closely linked to behaviour change programmes and is thanks to a £3 million investment.
Research investigated why local residents fail to visit an NHS dentist for preventive treatment and what would need to change to make them do so more frequently.
The campaign addresses poor dental attendance rates, which are the lowest in the country, combined with extremely poor oral health.
When local residents do visit the NHS dentist they do so for severe or major treatments rather than for routine regular check-ups.
The study also found that children in the borough are more likely to receive fillings as their first treatment and the number of children visiting the dentist in the most deprived wards in the borough is 25% lower than the average for London.
The numbers of residents visiting the dentist has declined significantly since 2006.
Central to the plan is the introduction of a dental Quality Outcomes Framework (QOF) from August of this year.
The dental QOF has been designed to incentivise practices to achieve a number of quality targets over the course of a year.
Practices reaching targets will be rewarded with an enhanced payment for each unit of dental activity they provide. In addition, funding and support will be available for all members of the dental team in each participating practice.
Quality targets include:
• the number of patients seen
• the type and quality of services provided
• patient satisfaction
• recalls
• training for non-clinical staff
• adoption of the BDA best practice scheme and achievement of child-friendly criteria.
In addition to the introduction of the QOF, the plan from NHS Kensington & Chelsea has a number of elements aimed at changing attitudes to dental treatment amongst residents and improving access:
• A dedicated child oral health campaign to help instil good habits from birth and the introduction of new ‘Child Friendly' NHS dental services
• Improved patient experience and cultural sensitivity, including the provision of same sex dentists, enhanced translation services, relaxation techniques and guidance on dental treatment during Ramadan (based on Islamic texts and expert advice, showing that in most cases dental treatment is not considered a break in the fast)
• Creation of a special toolkit, to enable NHS dentists to engage better with existing patients and attract new ones
• A registration campaign to help patients find a new NHS dentist
Buddy
Plans are also afoot to introduce a 'buddy' system for residents who are anxious or nervous about visiting a dentist, to provide reassurance and company on attending an appointment.
However, what makes the plan from NHS Kensington & Chelsea different is that it is based on detailed research into the reasons why residents don't go to the dentist for preventive treatment.
These insights into the behaviour of residents have been the prime driver behind the changes in the way NHS dental services in the borough will be provided in future.
Director of public health for NHS Kensington & Chelsea, Dr Melanie Smith, explains: ‘Our research showed that many people in the borough place a very low value on preventative treatment and take the view that a lack of pain or trauma equates to good oral health.
‘Thus they only go to the dentist when they are suffering pain or discomfort. At that stage, treatment may be unpleasant or costly, creating a vicious circle where people are less likely to return for regular check-ups.
'They are also put off by a lack of clarity about how much they will have to pay for NHS dental treatment. Also, in the past it was hard to find an NHS dentist and although that is no longer true, that perception still exists.'
She added: “Our campaign has two parts – we want to improve the quality and availability of NHS dentistry in the borough and we also want to change the way in which people view dentistry, encouraging them to value preventative treatment much more highly and to access it much more regularly. We hope that by instilling good habits from birth that we can make long term improvements to oral health in the borough.'
Local NHS dentist Parish Vaid said: ‘We have been working very closely with NHS Kensington & Chelsea to make major improvements to the services in the borough. The insights to emerge from their research into residents' behaviour, have been absolutely invaluable in helping us to rethink the way in which we provide our service.'
The commissioning process for new practices in the borough has already started as has the incentives for quality improvements in existing practices.
A pilot exercise on the child oral health campaign will start shortly, with children under 8 receiving a free ‘Brighter Smiles in K & C' pack when they attend their appointment. Each pack contains a free brush, paste and a range of materials to encourage children to brush their teeth regularly.
Once the pilot has been evaluated, it is planned to roll out to all practices in the autumn.
A major campaign to encourage residents to register with an NHS dentist will be launched in January 2010.
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