Managing Dispersed Outreach: Is it worth it?

Michael Smith

Spectrum of Outreach

Clinical activity

outsourced (piggybacked)

Hospital Annexe with

the same procedures

High Green

Fairlawns

Taptonville House

Rotherham

The Mount, Hemsworth 25km

Chesterfield

Dearne Valley DAC

Southey Green, Firth

Park & Wheata Place

Genesis Lynton House

Salaried ServicesDental Practices

Sheffield

Content

• Brief Description

• Development

• Operation

Sheffield’s Outreach Aims

• Professional Responsibility

• Public Health Dentistry

• Practice Environment

• Clinical Skills

The Outreach Year

Year 2 H&T

Introduction to Primary Care

TeamTraining

Outreach Project

Audit Project

Teamwork Project

Work 4+ days a week for 20+ weeks

Content

• Brief Description

• Development

• Operation

Development

2005 Decision to adopt outreach

2006 Funding HEFCE £0.8M, SHA £1,5MIncreased undergraduate intake3 years to develop a 6 month prog.

2009 38 chairs across 12 locations 64 supervisors + dental nurses

Selection of Practices

~250 dental practices notified▼

~24 expressions of interest▼

15 costed outline bids▼

6 bids selected▼

6 delivered

Management Structure

Executive Committee

Teaching Committee

Outreach Programme Steering Group

Outreach Working Party

Dental Service Managers Group

Independent Outreach Locations

Quality Management

• Shared understanding

• Contract

• Monitoring of outcomes• Activity

• Perception

• Training days

Enhancements

• Outreach Project link two case studies to local health data

• Audit Project design, conduct and report an audit

• Teamwork Project help develop dental therapy students, assess progress

• Visits other healthcare services, sedation, GPs, domiciliary

Content

• Brief Description

• Development

• Operation

Preparation

• Handbook• Lecture Programme

Introduction / Epidemiology Methods / Project work / Quality of Dental Care / Structure of NHS Dentistry / Health Promotion + Managing expectations

• Allocations• Meet Hosts

Boundary Crossing…

• Students initially nervous

• Soon settle

• Needlestick injuries

Cope et al. J Adv Nursing 2000; 31:850-856Wilcox et al. J Hosp Dent Pract 1977; 11:13-17

2008 after 2 blocks

n=62

Prediction from Three Block Model

Restorations- simple plastic

118(10)

188(24 in children)

Dentures 6 14

Endodontics 7 15

Extractions - simple

44(4)

66(4 in children)

Fissure sealants

18 20

Pt appointments

280 410

Sheffield Outreach

Recently published *

requirements

Restorations- simple plastic

195(29 in children)

~70

Dentures 14 ~2 to ~8

Endodontics 13 ~ 6 or ~8

Extractions - simple

67(7 in children)

Fissure sealants

26

Pt appointments

461

Clinical Activity * Lynch & Allen 2007 Br Dent J, Youngson et al. 2007 Br Dent J

Communication

• Formal channels

• Informal

• Time consuming…

… but vital

Holloway & Dixon, BDJ 1977; 143: 146-150.

Integration

• Some staff both Outreach and hospital

• Academics present at development days

• Students carry (mis)information

• Visits by the Dean and L&T Advocate

• Annual Review visits

Managing students

• Want the practical skills and ‘real’ world

• Increase competence

• ‘Stand out’ among applicants

Managing - hosts

• Altruistic innovators seeking a challenge

• Initially uncertain - reassurance

• Wide variation between students

• Encouraging assessments objective

Managing Recurrent Costs• For: supervision, close

dental nursing support, additional materials / wear, time for induction, feedback, coaching, local admin and staff training

• £1m pa – paid monthly • BDS travel allowances• H&T Bursary awards• Training events• Office salaries

Placements Travel allowances

Administration Meetings

Summary

Is it worth it?

Small and dispersed• Variation / scattered• Admin complex• Service ethos• ‘Real’ and broad• Boundaries to be

crossed – Integration more complex

• Feel ready for VT and practice

Single large• Standardised• Admin eased• School’s ethos• School-like• Smother transitions

within course – Easier integration

• Less familiar with typical practice

Wider benefits• Partnerships developed• Partners’ reputations’ enhanced inc. outreach

staff CVs • Outreach staff want ‘teacher’ training• Students better informed re employment

(but then make comparisons) • University logo seen in new communities• Learning kept up-to-date – feedback on currency

Unintended outcomes

• Partners flexible and innovative

• School increasingly reliant on outreach

• Some School staff resistant

Dispersed Outreach:

Is it worth it? No!Yes!