Sustainability and Transformation Partnerships (STPs) and Accountable Care Organisations (ACOs) are the future of the NHS. Here’s why dentistry and dentists need to be involved…
STPs are health and social care organisational partnerships, based on defined geographical ‘footprints’, which aim to improve the patient experience of care and health services and create efficiencies in their delivery that save public resources. The Five Year Forward View, and its successor, “Next Steps” for the Five Year Forward View (released earlier this year), have outlined the challenges faced by the NHS, which are largely based on four major themes:
- need for system focus on prevention
- need for a ‘joined up’ health and social care system
Although the original intentions of the Five Year Forward View were clear, the STPs now have the challenge of actually delivering a meaningful response to these challenges, whilst ensuring public and frontline staff are involved in the development and implementation of changes.
I have reviewed the STPs’ plans (all freely available online) to understand how dentistry is included. Dentistry was mentioned in some, within sections on the workforce or primary care engagement groups and urgent care. But the majority did not make any reference to dentistry. NHS England’s Local Dental Networks (LDNs) were involved in some areas, but this was not consistent across the country. Having spoken to a range of colleagues in the dental workforce, it is clear to me that the majority of dentists are unaware of the role of STPs and how they might integrate dentistry and NHS dental services into their planning.
There is a lot of evidence that supports the integration of dental services to the wider healthcare landscape. The common risk factors for poor oral and general health are well known to those in the dental profession – diabetes, cardiovascular disease, aspiration pneumonia and quality of life, to name just a few – but we continue to see the profound impact that poor or irregular access to a dentist can have on patient behaviour (e.g. the repeated general anaesthesia of children, dental pain causing significant attendance at Accident & Emergency departments, and inappropriate attendance at GP clinics).
Both working within an STP, and from speaking to dental professionals, I have identified some common reasons why dentists might not getting involved:
- Perceptions that STPs will not work and will not deliver any change
- Clinicians would like remuneration for time spent engaging with STPs
- Expectation that STPs will (or should) approach the dental workforce
- Dentists do not have the time or resources to dedicate to working with STPs
- Dentists would like to get involved but do not know how (they want more knowledge and training)
STP plans talk about prevention in primary care, hubs within the community, single electronic health records and holistic care. ACOs look set to lead to a shared responsibility for the commissioning and the delivery of healthcare.
Dentistry is an integral part of the primary healthcare system but is often omitted from NHS plans. With a ready and willing workforce made up of highly skilled professionals working in primary care, dentists are well placed to deliver interventions as part of a holistic care system but dentistry and dentists need to be included in the discussion to help to inform and develop this change.