PCTs Have your say: Wishing on a rising star

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PCTs Have your say: Wishing on a rising star

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PCTs Have your say: Wishing on a rising star


PCTs Have your say: Wishing on a rising star

I'm only too aware that for some, sitting down for a friendly talk with a PCT is a little like conspiring with the enemy. But Kelly Nizzer is a far cry from your usual PCT commissioner.

The senior commissioning manager for dental services in Hounslow comes from a dental background, for a start. She spent several years as the manager of a dental practice before joining the PCT, which she credits as giving her a headstart on both an understanding of dentistry and her relationship with the area's dentists.

She's used that headstart to its fullest; building on it to cultivate an extremely successful relationship with her dentists. Last year, the PCT received a letter from the head of the Local Dental Committee  (Henrik Overgaard-Nielsen) to thank her for her approach, underlining just how positive that relationship is.

Kelly agrees: ‘As far as the commissioning relationship between us and the providers is concerned, it's very successful.' She's being modest; it comes across as one of the best in the country.

‘We had an event in December last year about how many new patients we needed to bring through the doors,' she says. ‘Hounslow PCT as a whole had quite a large deficit at that point, and there was no more money we could throw at dentistry. But we needed our dentists to see new patients – even though that could mean seeing high-needs patients.

‘I asked them for help in bringing in new patients, even though I had no extra money to give them.

‘One of our dentists stood up and said: “I'll do this – not because of the targets, but because of the relationship we have with you and because you've always understood where we come from.'

‘It was a domino effect; everyone in the room stood up, and we had 1,700 new patients brought in within two months.' It's a response that speaks volumes.

Reasonable, consistent and fair
But of course, a dental background alone does not a commissioner make, so it's reassuring to hear her outline her approach in more detail. She explains: ‘There are loads of pieces that you need to put together, and if you've got them all right, it can work well.

‘I'm not their line manager, but it's like that to some extent; if I had a bad relationship with my manager, I couldn't work as efficiently as I'd like to, and I think that's the same for most people.

‘If you're reasonable to deal with, stay consistent, and your approach is seen to be fair, then it makes a big difference.'

“Regular contact is really important. I think that's something that a lot of PCTs have done; set the new contract up and let go”

Keeping in touch is a crucial part of the agenda too, and something that Kelly feels strongly about. She continues: ‘Regular events to find out how dentists are feeling are really important. I think that's something that a lot of PCTs have done; set the new contract up and let go, and not met with dentists again unless it's a review meeting.

‘We have a mid-year review as well as the end-of-year one, so the practices don't have a surprise at the end of it. If, by the mid-year meeting, it looks like they're not going to hit target, then we tell them they need to get on top of things or they're going to have X amount of money clawed back.

‘I know that some other PCTs only do the ones that are underperforming, but I try to meet everybody. Somebody might be hitting target but have something else going on, and they won't be able to tell us about it if we don't speak to them. If it means half an hour just to say everything's fine, that's OK – it's worth that two weeks out of the year to do that with them.'

Learning curve
Things are going well now, but Kelly admits that it wasn't always this way. She joined the PCT just as the new contract was coming in – which didn't make for an easy introduction.

She is candid about just how big a challenge it was: ‘Career-wise, it was the most difficult thing I've ever done in my life. I was on my own, and commissioned all the contracts on my own, so I was at work till about 3am for three weeks putting everything together.

‘That point was the most difficult part of it. There wasn't a lot of clear guidance on what we should have been doing.'

Understanding dentistry was one thing, but it didn't help with the other half of the job – the dreaded ‘c' word, commissioning.

She admits: ‘Even the word was new to me. I remember being asked in my interview what I understood by commissioning, and I had no idea what they meant! I was trying to understand the PCT side of it, rather than the dental side.'

Her efforts paid off though – on top of the solid foundation she built with her dentists, she was also recognised as the PCT's employee of the year.

And it helped her last April too. ‘The three-year review meetings have been much easier,' she says. ‘Because I was on the roadshows, I knew already that it was going to be a rolling contract, so that made it a little bit easier for me. Some dentists were worried by the middle of their second year on the new contract about what would happen, so I was able to reassure them.

‘I haven't got any practice that's consistently under-performed over the last three years, so it's nice that I didn't have to take off or renegotiate any contracts. I'm quite lucky in that respect, otherwise those would have been really difficult to do.'

Essential continuity
Kelly recognises that her continued presence has been a huge factor in smoothing the transition to one-year contracts that came in earlier this year.

‘April 2009 was so much easier than the introduction of the new. Of course, I can say this because I'm the same commissioner who's been there from day one. This is my baby. But you've got a lot of commissioners in dentistry who've changed, and they keep changing.'

Her dedication to the role is refreshing at a time where a lack of continuity is causing huge problems between PCTs and the dental community. Unusually for someone who definitely fits the description of a ‘rising star', Kelly stresses that she's never felt any pressure from her employers to move on. She jokes: ‘I think they love me in dentistry and want me to stay here – I worry they might never let me get promoted!'

That's not to say she hasn't had offers, but the prospect of leaving hasn't occurred to her. ‘I'm happy where I am – if there were a position as director of dentistry, I might go for it, but that's about it! As long as it's got dentistry in the title, anyway, otherwise I don't think I'll move.

‘It's about job satisfaction, and knowing that you're working well with the providers – it means a lot. It's nice that Hounslow PCT is an organisation that recognises that, too.

‘I think some dentists were worried I was going to go, having heard so many horror stories, but for me as well, it's nice to have a comfortable relationship where everyone knows what they need to do.'

Adding fluoride
It doesn't hurt that Kelly also has some big projects to keep her busy. The success of her headline-grabbing fluoride varnish scheme has seen her join some of the NHS roadshows to talk to other PCTs about what's been going on in Hounslow.

The idea came from the CDO and a local MP, but it was up to Kelly to fill in the fine detail. Children go to Asda supermarket with their parents, where they are approached by one of the team and offered the fluoride varnish. If the child already has an NHS dentist, they're simply given a card to take to the practice where they can exchange it for a ‘Brush for Life' kit.

If they don't have a dentist, then they're directly booked in to see one – the team has an appointment system set up. In each locality, one practice a week works on the project, so there is always someone ready to see the children, sign them up – and then, of course, give them their ‘Brush for Life' kit, too.

The project has grown since its inception. Kelly says: ‘It's been hugely successful – we're seeing between 35-40 children a day. We've had a lot of feedback from people asking whether we could do it full time, too.' The varnish teams work three days a week (Tuesdays, Thursdays and Sundays) from 11am to 7pm.

Funding for the scheme would normally have been hard to come by, but Kelly admits that it wasn't an issue for her. She says: ‘We were approached by the Department of Health at the same point when the growth money was being given out, so it was great timing. But I had to remind them that I wouldn't have any UDAs for that money, so told them not to expect loads more fillings.'

Hounslow was a good choice for the scheme, as Kelly clearly takes her communication with the public really seriously.

‘We're trying to raise our game in every way in which we deal with the public, not just in dentistry,' she says. Alongside the varnish scheme, she has done various things to increase the profile of NHS dentistry in the local community, from radio interviews to leaflet drops.

One of the most successful bids has been the ‘street team' campaign, which put PCT representatives on the high street to talk to people about access and even book them in directly with local practices. This has brought in around 70 new patients each day.

Added to the success of the other schemes, it's clear to see that the tide in Hounslow is turning.

Changing times
She is hopeful that the simple fact that it was suggested to her is a sign of changing attitudes on behalf of the Department of Health as well.

‘I think dentistry has really changed where it is in the PCT agenda. If we'd tried to do some of these things – like giving a toothbrush to every child in Hounslow – five years ago, I don't think anyone would have had time to listen to it. All of a sudden, everyone's interested!'

She agrees that part of the current problem is that this changing attitude doesn't always filter down to dentists, but is hopeful that the results of Professor Steele's review could change things for everyone.

‘I think the biggest worry over the Steele report was how different it was going to be – would it say that everything that Barry's done has been wrong?

‘Of course, while it does say that some things can be done differently, he also says that as a whole, the contract is not a mess – and I think that's what we all needed'.

The report highlights oral health promotion a lot more than we've seen before, so I think it will make it easier to negotiate with the DoH over things like this.

‘The biggest thing for PCTs is the funding; how it will be doled out, and what it's going to be based on.

‘I think that's our biggest issue – we're giving out all this growth money at the moment, but are we going to have enough to sustain it? The budget is my first concern because that's what's going to affect the dentists. We read and understood the report, so now we have to sit tight and wait to see what gets implemented. It's really just a question of watching this space.' 


Publicity fallout
Hounslow has 180 NHS dentists operating in 42 dental practices. Despite this, uptake of NHS dentistry is not great; Kelly estimates that they're around 19,000 patients off target. But the issue is not capacity, she says – it's awareness of NHS dental services.
‘There was a lot of bad publicity about dentistry around the introduction of the new contract,' she explains. ‘So the drop has happened since 2006, not before it. I think we're at about 60% of the residents having registered with an NHS dentist, and while that's not the worst, it's not great either.'
The PCT runs an event each year in Hounslow's major shopping centre to raise awareness of NHS dental services, which has produced some surprising results.
Kelly says: ‘At the first event, we had 1,600 people who were not with an NHS dentist and didn't even realise there was one in the area. At the same event last year, we picked up lots of people who were now saying things like “you can't have root canal treatment under the NHS, can you?” and “you can't have a bridge done, can you?”
‘People now think all you can have done on the NHS is a check up and clean, or small fillings. It's become about raising awareness of how much treatment they can have done.'

For more information on events in Hounslow, visit www.hounslowpct.nhs.uk.

We want to build up an accurate picture of how PCTs are performing – and we need your help to do it.  The profession is at yet another crossroads, on the brink of more changes that will affect the lives of thousands of people, dentists and patients alike.
How far the Department of Health will take Professor Steele's recommend-ations remains to be seen, but only with a clear picture of the way things are now can they move forward effectively. We need your thoughts to help paint this picture.

Simply click here to have your say in our online survey.

 Posted on : Wed 30th - Sep - 2009


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