Quality and Clinical Governance

1
Quality and Clinical Governance

• Ruth Gasser
• Head of Quality and Standards
• (Dentistry)

2
Overview

• Responsibilities with regard to quality and
  clinical governance
• Managing quality and clinical governance in
  primary dental services contracts
• Supporting resources available
• Understanding clinical variation
• Links to other parts of the contract monitoring
  process

3
Duty of quality

• 45. Quality in healthcare
• It is the duty of each NHS body to put and keep
  in place arrangements for the purpose of
  monitoring and improving the quality of health
  care provided by and for that body
• In this part health care means
• Services provided to individuals for or in
  connection with the prevention, diagnosis or
  treatment of illness and
• The promotion and protection of public health
• Health and Social Care (Community Health and
  Standards) Act 2003

4
Defining quality

• The totality of features and characteristics of
  a product or service that bear on its ability to
  satisfy stated or implied needs
• BS4778

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Quality in primary dental services contracts

• All aspects of the service, including
• Clinical effectiveness
• Cost effectiveness
• Patient needs and wishes
• Other clinical quality issues
• All members of the dental team

6
Managing quality in primary dental services
contracts

• PCT clinical governance arrangements
• Other contractual requirements

7
NHS (GDS Contracts) Regulations

• Clinical governance arrangements
• 79.
• The contractor shall comply with such clinical
  governance arrangements as the Primary Care Trust
  may establish in respect of contractors providing
  services under a contract.
• (3) In this paragraph, clinical governance
  arrangements means arrangements through which
  the contractor endeavours to continuously improve
  the quality of its services and safeguard high
  standards of care by creating an environment in
  which clinical excellence can flourish.

8
Standards for Better Health

• 46 Standards set by Secretary of State
• The SoS may prepare and publish statements of
  standards in relation to the provision of
  healthcare by and for English NHS bodies and
  cross-border SHAs.
• The SoS must keep the standards under review and
  may publish amended statements whenever he
  considers it appropriate
• (4) The standards set out in statements under
  this section are to be taken into account by
  every English NHS body and cross-border SHA in
  discharging its duty under section 45
• Health and Social Care (Community Health and
  Standards) Act 2003

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Standards for Better Health

• Published in 2004
• Describe common set of quality requirements which
  all health care organisations are expected to
  achieve
• Provide framework for continuous improvement
• Aim to reduce burden of unnecessary inspection
• Aim to underpin delivery of high quality services
  that are fair, personal and responsive to
  patients needs and wishes provided equitably
  and delivering improvements in the health and
  well being of the population
• For health care providers, managers,
  commissioners, public and Healthcare commission

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Standards for Better Health

• 7 domains Safety, Clinical and cost
  effectiveness, Governance, Patient focus,
  Accessible and responsive care, Care environment
  and amenities, Public health
• 24 Core standards
• 13 Developmental standards

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Clinical Governance

• Positive way to work with practices to build in
  quality
• Collaborative working
• Link to quality and clinical governance in other
  areas health care
• Identify training needs

12
PCC Clinical Governance Toolkit

• Mapped to the standards
• 12 themes
• Key actions, policies, information sources and
  evidence identified for each

13
Other clinical governance materials

• BDA Good Practice Scheme
• Smile-On Clinical Governance Programme - produced
  in conjunction with Kent Surrey and Sussex
  Deanery
• Faculty of Dental Practice Key Skills in
  Primary Dental Care
• BDA Clinical Governance Toolkit
• Others

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Support for clinical governance in primary dental
services

• Clinical governance leads
• Dental Practice Advisors
• Postgraduate advisors and postgraduate dental
  deans
• Infection Control Advisors
• Dental Reference Service
• Complaints data
• PALS data

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Other contractual requirement

• Some other quality and governance issues in
  contract
• Quality assurance
• Patient information (charges poster, practice
  leaflet, treatment plans, referral notices, etc)
• Patient right to express preference of performer
• Complaints
• Clinical records

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NHS (GDS Contracts) Regulations

• Quality assurance system
• 80.- (1) the contractor shall establish and
  operate a practice based quality assurance system
  which is applicable to all persons specified in
  sub-paragraph (2)
• (4) In this paragraph, a practice based quality
  assurance system means one which comprises a
  system to ensure that
• Effective measure of infection control are used
• All legal requirements relating to health and
  safety in the workplace are satisfied
• All legal requirements relating to radiological
  protection are satisfied and
• Any requirements of the General Dental Council in
  respect of continuing professional development of
  dental practitioners are satisfied.

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Understanding clinical variation

• Misunderstanding regulations
• Manipulation of regulations
• Quality and clinical governance issues

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Understanding clinical variation

• Charge exempt courses of treatment for
  prescriptions
• Free repair or replacement of restorations
• NICE guidance on recall intervals
• Continuation of treatment
• Multiple courses of treatment

19
Understanding clinical variation

• Understanding data
• Collaborative working to investigate further
  where appropriate
• Work with practices to address quality and
  clinical governance issues.

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Links with other aspects of contract monitoring

• Quality and clinical governance integral contract
  monitoring.
• Quality issues may overlap with other areas of
  contract monitoring
• Identify local training needs / support
• Integral to development of quality primary dental
  services

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Summary

• PCTs have a duty of quality
• Monitor and improve quality by clinical
  governance arrangements and other contractual
  requirements
• Variety of materials and resources to help
• Integral part of contract monitoring process
• Overlaps other aspects contract monitoring
• Positive way to work with practices and develop
  quality primary dental services