Dr Rosie Benneyworth’s blog

Monthly column for providers and professionals working in primary medical and dental services from Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care

This month I want to talk about two great pieces of work across CQC, our new publication Smiling matters, looking at oral health in care homes, and also improvements to our registration processes that are already starting to bear fruit.

Smiling matters: oral health care in care homes

Oral health has a big impact on our quality of life. We express ourselves by talking or smiling. We can take immense enjoyment from what we eat or drink and pride in the state of our teeth and gums.

On Monday we published the findings of an in-depth review on the state of oral health care in care homes across England. Our dental inspectors attended 100 routine planned inspections of care homes alongside inspectors from our adult social care team. We spoke with managers and senior members of staff, as well as people who use services and their relatives to find out about their experiences of care.

The report reveals that three years on from the publication of NICE guidance on oral health in care homes, steps are often not being taken to ensure that people get the oral health care they need to ensure that they are pain-free and that their dignity is respected.

Key findings include:

• The majority (52%) of care homes visited had no policy to promote and protect people’s oral health
• Nearly half (47%) of care homes were not providing any staff training to support people’s daily oral healthcare
• 73% of residents’ care plans we reviewed only partly covered or did not cover oral health at all — homes looking after people with dementia being the most likely to have no plan in place.
• 17% of care homes said they did not assess people’s oral health on admission

While two-thirds (67%) of the care homes that CQC visited said people who used their services could always, or nearly always, access NHS dental care, the report did reveal a lack of dentists who were able or willing to visit care homes. Other challenges people faced involved local dentists not accepting new patients and the length of time it took to get an appointment with an NHS dentist — even for a procedure such as getting dentures fitted.

A small percentage reported they had no way of accessing emergency dental treatment for people and many managers stated that they had to call GPs, NHS 111, or even take the person requiring emergency care to A&E.

This report should not just be of interest to care homes and to dentists, there are lessons for all working in primary care. We highlight the need for a cross-sector approach to tackle the concerns raised by this report. The review includes case studies of productive, joined-up relationships between care homes and local dental practices, including dentists providing routine check-ups, ongoing treatment and emergency care, both in and outside the care home.

The recommendations include a call for mandatory staff training in oral care, oral health check-ups for all residents upon admission, better signposting to local dental services and the convening of a multi-agency group tasked with raising awareness among people living in care homes, their families and carers of the importance of day-to-day dental hygiene and the need for routine check-ups.

I want to thank the team involved on this review and support at publication, both internally, and also the members of our external advisory group, I know it will play a role in improving outcomes for those using services.

Improvements to our registration processes

As part of our strategic objective to improve our efficiency and effectiveness we have been looking to improve a number of our registration processes. Providers often talk to me about the need to improve these as part of the customer experience we offer.

Following work to review our add / remove partner processes, we have streamlined a number of areas, and are training our staff to work in a different way. All of this means that we are now processing all applications to add / remove partners within an average of 12 days, down from the 10-week service-level agreement that we originally had in place. I hope that you are feeling the difference on the ground. We will continue to improve our forms and guidance over the coming months.

We are also currently trialling changing the way we deal with errors on application forms. This means we now contact providers directly and make the changes with them, rather than just rejecting the forms. As primary care providers, you may have already started to see this, but this will become more common over the coming months. Early signs in our pilot are really encouraging.

We have a programme in place to review a number of our registration processes. The changes take some time to implement as there is a need for us to alter our training, processes and culture as part of this. However, by looking at these problems through a Quality Improvement lens we have already seen a number of positive developments for providers. I hope we can continue to improve your experience when interacting with us, right across our operating model.

Have a great month everyone.

Rosie