Re-shaping NHS orthodontic provision - the North Wales experience.

The orthodontic service provision within North Wales, in common with many areas of the United Kingdom, was experiencing increasing waiting times for assessment and treatment. Reasons for this included an increasing population, patient demand and fixed NHS contracted orthodontic provision. In addition to these universal challenges, the geography of North Wales contributed to difficulties in accessing care. It was felt that with a reshaping of the orthodontic services there was potential to enhance the quality of orthodontic care available to patients and deliver prudent NHS orthodontic services. Three distinct, but inter-related steps, were identified to progress the reshaping of the service with the intended outcome of achieving an improved co-ordinated service. Initially, this involved the re-commissioning of the primary care specialist service through a formal retendering process. Following this, a standardised orthodontic referral form was developed, to be used for all orthodontic referrals regardless of whether their destination was a primary or secondary care provider. Finally, a formal accreditation process for all non-specialist dentists who were undertaking NHS orthodontic treatment was developed and implemented. The successful outcome of this process was only possible because of the close working partnership between the North Wales Orthodontic Managed Clinical Network (OMCN) and Betsi Cadwaladr University Health Board.