On 30 June the LDC Confederation Chair, Mike Clarke, hosted a webinar to hear from Ali Sparke, Director for Dentistry NHS England, and Nick Barker, Deputy Chief Dental Officer, about the new care pathways.
The regulations putting the new pathways into effect from 23 June were passed on 19 June, with updated contractual guidance on the implementation of the pathways also published.
The new pathways are intended to sit alongside the current banded courses of treatment and provide an alternative and improved care structure for patients with higher needs. The pathways carry a band 2 patient charge, unless treatment becomes a band 3, in which case the patient pays the difference.
The pathway presentation is available to download here, and a summary is available below.
Clinical Care Pathway Philosophy
The intention behind the care pathways is to prioritise preventive oral health measures and minimally invasive strategies over traditional surgical interventions, utilising disease risk staging to manage dental conditions.
Financial and Operational Frameworks
It was clarified that practices can optionally adopt these pathways, receiving ongoing monthly remuneration rather than lump sum payments. This was intended to assist business planning. It was also intended that there would be no additional administrative burden, as these should be reduced through automated software integrations and streamlined declaration processes.
Implementation and Patient Logistics
The pathways should encourage the use of more skill mix. Pro-rata payments based on the care provided will be made to assist in cases where patients disengage from care.
Care Pathway 1 Details: This is a 6-month program for patients with five or more carious lesions . The process requires an initial assessment to record risk factors, followed by steps for behaviour change, prevention, a 3-month interim review, and a final assessment at 6 months. Separate claims can still be submitted for unpredictable incidents that occur during the pathway.
Care Pathway 2 and 3 Details: This is a 12-month program for patients with unstable periodontitis, involving four steps of therapy, including detailed pocket charting and ongoing risk factor management. Pathway 3 follows similar principles. For patients with complex periodontal needs, referral to level 2 or level 3 services is appropriate when available.
Following the presentations there was a short question and answer session. Some of the key questions delegates asked included;
Are the pathways mandatory? It was confirmed that the pathways are optional but that practices should present the pathway as an option to patients in line with good clinical practice.
What happens if a patient disengages from treatment part way through the pathway? Payments will be made on a pro-rata basis. If the same patient then re-attends they may re-enter the pathway if they meet the entry criteria, though if the patient has received some treatment they may not meet the criteria.
Where is the clinical guidance? It will be published shortly.
Can Foundation Dentists use the pathway? Foundation Dentists’ activity does not count towards a practice’s UDA target as they are paid separately, but should be encouraged to mirror the pathway approach.
The Restorative Dentistry Index of Treatment Need Complexity Assessment guidance which can be used to aid decision making for the appropriateness of the pathways is available to download here.
Further guidance and the CDO’s webinar from 15 June is available via NHS Futures (requires log in).