Procurement of new orthodontic services in the South West from April 2019

Orthodontic treatment – usually with braces – is most often used to improve the appearance and alignment of crooked, protruding or crowded teeth, and to correct problems with the bite.

It is usually only started after most of a child’s adult teeth have started to come through. This is tends to be when they’re about 12 years old, but depends on the number of adult teeth and the growth of the face and jaws. Treatment for adults can begin at any age, but the treatment options are more limited.

Orthodontics is commissioned by NHS England, alongside other forms of NHS dentistry. Referrals to the service nearly all come from general dental practitioners (high street dentists).

Practices are commissioned to provide a certain number of units of orthodontic activity (UOAs) each year. Initial assessment, for example, would take up one UOA, while a full course of treatment might take 20 UOAs.

Existing contracts for orthodontic treatment in Cornwall, Devon and Somerset, as in the rest of the South of England, are due to come to an end on 31 March 2019. A major procurement exercise has therefore been carried out to secure new providers from 1 April.

The new providers for all contracts have now been identified. Final contract negotiations are under way to mobilise the services and notify patients about any changes, ready for April.

NHS England commissioned public health specialists to carry out local health needs assessments to identify the level and pattern of need for orthodontics in Cornwall, Devon and Somerset.

NHS England also asked for feedback from patients. More than 2,000 people gave their views, which have been used to help inform the procurement and make improvements to orthodontic services.

One key issued raised was the ability of parents to get their children to appointments during the day in term-time. As a result, the incoming orthodontic practices will need to provide 30% of appointments outside school hours; this might include weekends and during the holidays, as well as after school hours.
Using this approach, new contracts were procured via ‘lots’ covering:

•Central and North Cornwall
•West Cornwall
•Plymouth South and West, with South East Cornwall
•Plymouth, North and East, with West Devon
•North Devon
•Exeter 1, including spokes in Mid and East Devon
•Exeter 2, including spoke to serve the West to Okehampton
•Teignbridge, Torbay and South Hams (two contracts)
•Taunton and West Somerset
•South Somerset

All bids underwent a rigorous evaluation process involving members of the NHS England local and regional teams, dental practice advisers, Public Health England consultants in dental public health and independent specialist orthodontic advisers from the NHS Business Services Authority.

Bids were assessed against a number of factors including:

•clinical and service delivery
•premises and equipment
•patient experience
•clinical and information governance
•the transfer of patients and how they would effectively mobilise the service to be ready from April 2019

All contracts for Cornwall, Devon and Somerset have now been awarded.

Most importantly, access should be improved for most patients, in terms of both travel-distance and opening hours. The most significant changes are that there will be services in:

•South East Cornwall; current patients have to go into Plymouth for treatment
•West Cornwall, saving on travel to central Cornwall
•Sedgemoor; current patients mostly go to Taunton or Wells
•South Hams, saving on travel into Torbay
•Mid, East and West Devon (Okehampton area), saving on travel into Exeter
•South West Devon (Tavistock area), saving travel into Plymouth

The exact location of procured services is still under discussion with the new providers, some of whom will need to secure premises.

Final contract negotiations are now under way with the incoming providers, to enable smooth transfer from 1 April 2019.

Patients affected by a change in provider will be written to about new arrangements



Copy from NHS England South West