Modelling a Consultant Workforce for the United Kingdom: needs-based planning for Dental Public Health.

OBJECTIVE: To develop a needs-based workforce planning model to explore specialist workforce capacity and capability for the effective, efficient, and safe provision of services in the United Kingdom (UK); and test the model using Dental Public Health (DPH). BASIC RESEARCH DESIGN: Data from a national workforce survey, national audit, and specialty workshops in 2020 and 2021 set the parameters for a safe effective DPH workforce. A working group drawing on external expertise, developed a conceptual workforce model which informed the mathematical modelling, taking a Markovian approach. The latter enabled the consideration of possible scenarios relating to workforce development. It involved exploration of capacity within each career stage in DPH across a time horizon of 15 years. Workforce capacity requirements were calculated, informed by past principles. RESULTS: Currently an estimated 100 whole time equivalent (WTE) specialists are required to provide a realistic basic capacity nationally for DPH across the UK given the range of organisations, population growth, complexity and diversity of specialty roles. In February 2022 the specialty had 53.55 WTE academic/service consultants, thus a significant gap. The modelling evidence suggests a reduction in DPH specialist capacity towards a steady state in line with the current rate of training, recruitment and retention. The scenario involving increasing training numbers and drawing on other sources of public health trained dentists whilst retaining expertise within DPH has the potential to build workforce capacity. CONCLUSIONS: Current capacity is below basic requirements and approaching 'steady state'. Retention and innovative capacity building are required to secure and safeguard the provision of specialist DPH services to meet the needs of the UK health and care systems.

A National Equity Initiative to Address Noncommunicable Diseases and Injuries: Findings and Recommendation from the Nepal NCDI Poverty Commission.

We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission's conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally.

Admitting Deserving Medical Students from Rural and Disadvantaged: Patan Academy of Health Sciences' Approach.

BACKGROUND: Patan Academy of Health Sciences (PAHS) aims to produce physicians who would be able and willing to serve in the rural areas. Recognizing the critical importance of student selection strategy, among others, in achieving the program goals, it has adopted an innovative scheme for selecting medical students. This paper describes PAHS medical student selection scheme that favors enrollment of deserving applicants from rural and disadvantaged groups so as to help improve distribution of physicians in rural Nepal. METHODS: A student admission committee comprising a group of medical educators finalized a three-step student selection scheme linked with scholarships after reviewing relevant literatures and consultative meetings with experts within and outside Nepal. The committee did local validation of Personal Quality Assessment (PQA) that tested cognitive ability and personality traits, Admission OSPE (Objective Structured Performance Examination) that assessed non-cognitive attributes of applicants. It also provided preferential credits to applicants' socio-economic characteristics to favor the enrollment of deserving applicants from rural and disadvantaged groups through Social Inclusion Matrix (SIM). Three different categories of scholarship schemes namely Partial, Collaborative and Full were devised with Partial providing 50% and other two categories each providing 100% coverage of tuition fee. RESULTS: PAHS student selection scheme succeeded in enrolling more than half of its students from rural areas of Nepal, including about 10% of the students from that of the most backward region of the country. About one third of students were female and about the same were from public and community school. Sixty percent of students receive different categories of scholarships. CONCLUSIONS: Limited findings indicate the success of the selection scheme in enrolling high proportion of applicants from rural and disadvantageous groups and enable them to pursue study by providing scholarships.

Development of Community Based Learning and Education system within Undergraduate Medical Curriculum of Patan Academy of Health Sciences.

BACKGROUND: In response to continuing health disparities between rural and urban population, Patan Academy of Health Sciences (PAHS) was established in 2008. It aimed to produce physicians who would be able and willing to serve in the rural areas. In order to empower them with understanding and tools to address health issues of rural population, an innovative curriculum was developed. This paper aims to describe the community based learning and education (CBLE) system within the overall framework of PAHS undergraduate medical curriculum. METHODS: A Medical School Steering Committee (MSSC) comprising of a group of committed medical educators led the curriculum development process. The committee reviewed different medical curricula, relevant literatures, and held a series of consultative meetings with the stakeholders and experts within and outside Nepal. This process resulted in defining the desirable attributes, terminal competencies of the graduates, and then the actual development of the entire curriculum including CBLE. RESULTS: Given the critical importance of population health, 25% of the curricular weightage was allocated to the Community Health Sciences (CHS). CBLE system was developed as the primary means of delivering CHS curriculum. The details of CBLE system was finalized for implementation with the first cohort of medical students commencing their studies from June 2010. CONCLUSIONS: The CBLE, a key educational strategy of PAHS curriculum, is envisaged to improve retention and performance of PAHS graduates and, thereby, health status of rural population. However, whether or not that goal will be achieved needs to be verified after the graduates join the health system.

Complexities associated with orthodontic services in the National Health Service.

AIM: To detail orthodontic provision in Wales. BACKGROUND: In 2006 the new orthodontic contract was introduced in the NHS in England and Wales. Since the introduction of the new contract there have been recent reports of inefficiencies in orthodontic provision in Wales in terms of: orthodontic provision reaching those who need it, type of orthodontic activities undertaken, who is providing orthodontic care, the relative cost-efficiency of the orthodontic services, contracting and performance management of the services and robustness of the orthodontic database. MATERIALS AND METHODS: 2008/09 orthodontic data on contracted services were analysed. Data from the salaried services was collected through a questionnaire. Normative orthodontic treatment need was estimated from mid-year population estimates. RESULTS: In 2008/09, there were considerable inefficiencies in the orthodontic services in Wales with varied level of access by children living in 22 former local health boards, co-terminus with local authorities in Wales. Total spend on orthodontics in Wales was around £12,718,370. It was estimated that 11,539 (30%) of 12-17-year-olds required orthodontic treatment. In 2008/09, 11,031 children received orthodontic treatment in all NHS services in Wales indicating a potential shortfall of 508 treatments. Out of 135 GDS/PDS orthodontic contracts, 27 provided no active treatment (only assessments) and 62 provided less than 50 treatments annually. Cost per units of orthodontic activity (UOA) ranged from £58 to £74. With improved contracts and efficiency, the orthodontic budget seems sufficient to meet the orthodontic need of the population. CONCLUSIONS: As with any type of NHS provision, it is important that orthodontic services are competitive, highly efficient and provided on the basis of need. Performance management of orthodontic services should focus on the number of successful orthodontic treatments delivered annually. The personal dental services (PDS) orthodontic contract will need to be modified accordingly.