Oral and Maxillofacial Surgery

Improve attribution to main specialty to ensure coded in accordance with the NHS Data Dictionary. 1a: Ensure that all work under the responsibility of consultant oral and maxillofacial surgeons is consistently attributed to their main oral and maxillofacial specialty in accordance with the NHS Data Dictionary. 1b: Where a consultant oral surgeon carries out oral surgery in an oral and maxillofacial unit, ensure that their work is attributed to their main oral surgery specialty in accordance with the NHS Data Dictionary. 1c: GIRFT to investigate options to measure or estimate the amount of activity performed by non-consultant career grade staff under consultant supervision in all surgical specialties.

Improve clinical coding, particularly for difficult-to-code areas, such as head and neck cancer. 2a: Liaise with key stakeholders to develop a short guide to clinical coding for clinicians and coders that would support best practice. 2b: Offer specialty-specific coder training. 2c: Ensure that surgeons have easy access to their own data and are able to understand and interpret it. 2d: Ensure that surgeons, trust information teams and coders meet regularly to review activity attributed to the surgeons.

Produce a clear definition of an out-patient procedure for data collection purposes. 3a: Agree the out-patient definition. 3b: Establish which oral and maxillofacial out-patient procedures meet the definition.

Improve the recording of workforce and HR data to support workforce planning. 4a: Review and take actions to improve recording attribution of area of work in ESR. 4b: Investigate how national locum expenditure can be recorded by specialty.

Deliver an efficient and patient-focused outcomes audit programme for oral and maxillofacial surgery. 5a: Establish how to use real-time data, reduce the duplication of data collection supported by trusts and support continuous improvement. 5b: Develop and evaluate the Quality Outcomes in OMFS (QOMS) pilot. 5c: Review the National Head and Neck Cancer Audit (HANA) with the other relevant specialties.

Take steps to ensure that dentoalveolar surgery takes place in the appropriate setting. 6a: Ensure correct coding of: the type of anaesthetic used; the presence of an anaesthetist; the presence of any co-morbidities. 6b: Use the coding and comorbidities data to assess what proportion of dentoalveolar surgery could be carried out in the different settings. 6c: Explore the potential impact of moving a proportion of dentoalveolar work out of secondary care and the functionality of the different settings available locally to support an integrated care pathway across both the elective and non-elective elements. This is to include planning and contractual requirements. 6d: Based on the findings from 6b, 6c and examples of good practice, produce a plan to enable the development, implementation and continuous improvement of an integrated pathway for dentoalveolar surgery.

Deliver oral and maxillofacial surgery through local networks, such as hub and spoke models, to optimise quality and efficiency. 7a: Develop guidance based on existing best practice examples to support the development of a service specification for local network reconfiguration. The guidance should cover the full oral and maxillofacial workload. We expect the specification would be a minimum volume of approximately 300 non-elective admissions per year (representing around one admission per day). It should also support contract, operational and geographical considerations. 7b: Support NHS England on the development and implementation of the revised head and neck cancer service specification.

Ensure equal access to orthognathic treatment across England. 8a: Review local access to orthognathic surgery. 8b: Review the outcomes of NHS England's orthognathic commissioning guide and approval process pilot. 8c: Develop plan based on 8a and 8b.

Review how best to deliver maxillofacial laboratory services and technical services, taking changing needs, technologies, and practices into account. 9a: Undertake a separate dedicated review of maxillofacial laboratories and technological support. The report should include recommendations and actions.

Explore how the number and types of non-surgical out-patient appointments can be reviewed. 10a: Understand if there are diagnostic codes that can be used to help record non-surgical out-patient appointments, and what the implications of introducing these may be. 10b: Introduce codes (depending on finding of 10a).

Improve understanding of follow-up rates and take action accordingly to reduce unwarranted variation. 11a: Audit causes of current local follow-up rates. 11b: Ensure robust follow-up protocols are in place in all clinical areas to address unwarranted variation in local follow-up rates. 11c: Establish ongoing local audits to check that the new protocol is followed and action taken accordingly.

Improve theatre utilisation and use of day case for emergency care in order to reduce length of stay for non-elective patients. 12a: Add national reporting of time to theatre for non-elective oral and maxillofacial patients once they are fit for surgery to the theatre dashboard. 12b: Review variation in time to theatre and set a best practice target. 12c: Align with the development of the local networks (recommendation 7). Develop: specialty-specific emergency lists in larger units; dedicated time in the general emergency theatre in smaller units. 12d: Explore the feasibility of including oral and maxillofacial trauma procedures in the British Association of Day Surgery data directory.

Improve understanding of readmission rates and take action accordingly to reduce unwarranted variation. 13a: Audit causes of current local readmission rates. 13b: Develop an action plan and ensure a robust standard protocol is in place. 13c: Establish ongoing local audits to check that the new protocol is followed and take action accordingly.

Implement GIRFT 5 point plan for reducing litigation costs. 14a: Assess benchmarked position for estimated litigation cost per unit of activity compared to the national average. 14b: Review claims submitted to NHS Resolution to confirm correct coding. Inform NHS Resolution of any claims that are not coded correctly at CNST.Helpline@resolution.nhs.uk 14c: Review claims in detail, including expert witness statements, panel firm reports, counsel advice and medical records, to determine where patient care or documentation could be improved. 14d: Triangulate claims with learning themes from complaints, inquests and serious untoward incidents (SUI). If a claim has not already been reviewed as an SUI, we recommend that this is done to ensure no opportunity for learning is missed. 14e: Where trusts are outside the top quartile of trusts for litigation costs per activity, GIRFT national clinical leads and regional hub directors will support them in learning from claims, including sharing examples of good practice.

Enable improved procurement of devices and consumables through cost and pricing transparency, aggregation and consolidation, and by sharing best practice. 15a: Use sources of procurement data, such as Purchase Price Index and Benchmarking tool (PPIB) and relevant clinical data, to identify optimum value for money procurement choices, considering both outcomes and cost/price. 15b: Identify opportunities for improved value for money, including the development of benchmarks and specifications. Locate sources of best practice and procurement excellence, identifying factors that lead to the most favourable procurement outcomes. 15c: Use Category Towers to benchmark and evaluate products and seek to rationalise and aggregate demand with other trusts to secure lower prices and supply chain costs.