Getting It Right First Time (GIRFT)
GIRFT’s national report on oral and maxillofacial surgery was published in November 2018, with 15 recommendations aimed at making improvements in the specialty.
The GIRFT Report on Hospital Dental Services led by the GIRFT clinical lead for Hospital dentistry, Liz Jones, was published in September. This sits alongside the GIRFT report on OMFS published in November 2018 and all the other speciality specific GIRFT Reports. Part of the report deals with Oral Surgery and there is a good deal of overlap in this area with the OMFS report.
There are 20 recommendations 2 of which relate specifically to oral surgery practice but many relate to general issues such as speciality coding and better OPCS procedures coding both of which we fully support. There are also general recommendations about effective triage, which would be an essential part of the OMFS recommendation that some dentoalveolar surgery should move to a primary care setting, about the importance of MCNs, and of the need to introduce anaesthetic coding, again in the OMFS report.
In relation to other dental subspecialties there are recommendations to be applauded about restorative consultants to support oncology and other MDTs for complex conditions and about the maximum waiting times for orthognatic surgery which sadly indicates this report was written before the pandemic.
The report itself can be accessed on the FutureNHS platform
GIRFT update September 2021 from Maire Morton
As the GIRFT clinical lead I have been involved in issues around the elective recovery and I thought an update might be timely as ‘Oral Surgery’ is about to join the HVLC programme.
There is a lot of concern about Oral Surgery waiting lists. These waiting lists are all the procedures in Treatment Function Code 140 Oral Surgery, 144 Maxillofacial Surgery and 145 Oral and Maxillofacial Surgery so just about everything OMFS do except head and neck cancer and non elective work.
At the end of May there were 216978 patients waiting of whom 25078 were waiting over 52 weeks.
Many of you will be aware of the High Volume Low Complexity (HVLC) programme this was originally rolled out in London and involved 6 specialities with the highest waiting lists, T&O, Ophthalmology, General Surgery, Urology, ENT and Gynaecology. Oral Surgery is now going to be added to this programme. Hopefully we will be able to follow the other specialities and appoint a clinical lead in each region to help support the programme.
We have already done some preparatory work and some of you will have been involved in various webinars about trying to get the waiting lists down. There are already some pathways that have been agreed with BAOMS and in the case of dentoalveolar surgery with BAOS these are on the BAOMS and GIRFT websites. We have also established some gateway metrics that will soon be on the Model Hospital site. You should all get access to Model hospital and look at your own data. I am working to try and get rid of some of the very ‘dental’ metrics that are on that site but we need to remember that the bulk of the patients on our waiting lists are waiting for dentoalveolar procedures and are under the care of OMF Surgeons. However there are a lot of patients waiting for orthognathic surgery as well and I hope to get a pathway agreed for that shortly.
We need to engage with dental commissioning to support them in developing more and better Tier 2 provision. We need to engage with local MCNs in Oral surgery so that standardised guidance about what is appropriate for hospital care is agreed.
I would love to hear from any of you engaged with these problems especially individuals who might be chairing MCNs.
Maire Morton
GIRFT clinical lead for oral & maxillofacial surgery
September 2021
Most OMFS units in England have now had a deep dive meeting with the GIRFT team, reviewing their data, looking at the context of any unwarranted variations, discussing challenges and sharing best practice. After the deep dive visit, trusts receive a report on the findings and then develop their own action plans to address areas in need of improvement.
GIRFT’s implementation teams offer support in developing and driving forward those actions. Implementation managers are in regular contact with clinicians in all trusts and across all specialties. There are seven GIRFT regional hubs – if you are not sure who your GIRFT implementation manager is, visit GIRFT for contact details.
There are also a number of clinical ambassadors in each regional hub. These are senior clinicians who can support you and your hospital team to deliver on both deep dive recommendations and the recommendations from the OMFS national report.
My report highlighted a distinct lack of clinical outcome measures in our specialty. BAOMS has already taken action on this through the development of the QOMS project, led by Jeremy McMahon and project manager Fabien Puglia. The team is also working with the National Clinical Improvement Programme (NCIP) to produce measurable outcomes for OMFS.
A last word on the GIRFT Surgical Site Infection survey, now being run for the second time. Only a few OMFS units submitted data for the first survey - this time it is being organised in a different way and I hope the contribution from OMFS units will improve. Information about the survey has gone out to chief executives across the country so you should be able to access it in your trust. If you have not yet heard about it, ask your audit department for more details or visit GIRFT
Maire Morton, author of the GIRFT national report on oral and maxillofacial surgery and consultant oral and maxillofacial surgeon at East Lancashire Hospitals NHS Trust
The Getting It Right First Time (GIRFT) programme is delivered in partnership with the Royal National Orthopaedic Hospital NHS Trust and NHS Improvement.
Below are the pathways that have been developed by the GIRFT team and the BAOMS SSIG leads and for dentoalveolar surgery by BAOS as well. They were written to support the elective recovery.
Please also see:
GIRFT HVLC Guide Published May 2021
National Day Surgery Delivery Pack Sept 2020
OMFS: GIRFT Programme National Specialty Report Feb 2019
Learning from Litigation Claims The GIRFT and NHS Resolution best practice guide for clinicians and managers