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Development of the Service Specification

There are several possible provider organisations; for example, it may be an oral health promotion team hosted by a Trust or social enterprise or it may be a dental practice. This raises a number of commissioning implications particularly if the supervised toothbrushing programme is going to be delivered as part of a pre-existing dental or oral health improvement contract.

The service specification will typically include detail such as: 

  • Size of the supervised toothbrushing programme

    • Will a specific number of settings be specified?  

    • Or, will it specify nurseries/schools within a specific neighbourhood or level of deprivation, e.g. 20% most deprived areas.  

    • If a large supervised toothbrushing programme is being considered, it may be worth starting with a smaller pilot scheme before launching a large-scale programme to ensure smooth implementation. 

  • Funding

    • This will depend on the size of the programme and its duration. Typically, the benefit of a supervised toothbrushing programme comes when children are involved for two years although time needs to be allowed for mobilisation beforehand. Funding for supplies needs to be considered as the costs during the mobilisation stage including supplies such as racks and resources such as staff time for training and travel are greater initially than during the delivery phase so a payment schedule for the provider should consider both how the funding will be paid and how frequently. 

  • Identification of eligible settings.

    • Who will be responsible for this? Will it be the commissioners during the procurement stage or providers during the mobilisation stage?

    • How will eligible settings be identified? Will specific criteria be used? It is important to be aware of any other locally commissioned supervised toothbrushing schemes and other oral health promotion activities targeted at the same or similar populations in the area. See the section on targeting. 

  • Training.

    • Establish who will be responsible for delivering the training and how it will be delivered, for example, face-to-face, virtually or a combination of both. Consider what qualifications and expertise are needed for people who will be delivering training and providing ongoing support. 

    • Establish who will be responsible for monitoring the training of settings staff (the provider or setting)? 

  • Consent and safeguarding responsibilities should be considered and agreed upon between the provider and settings.

    • In most areas, parents ‘opt-in’ their child to a toothbrushing club in their setting. 

    • Consider the timing for optimum parental consent. During the mobilisation phase, providers found that schools would have preferred to hear about the supervised toothbrushing programme before children were allocated their places at schools in April. This would enable them to send information and consent forms to parents along with other information about starting school, thus encouraging parental consent whilst minimising administration. Commissioning timetables should therefore be planned with this in mind. 

  • Supplies (e.g. toothpaste, brushes and racks)

    • Who will have responsibility for the purchase of supplies initially and recurrently? The provider, funder or other organisation? 

  • Monitoring.

    • A plan, usually completed annually, for monitoring the providers performance needs to be devised to include: 

      • Key Performance Indicators (KPIs) for example the number of settings participating, the proportion of children consented per site, stakeholder satisfaction etc.  

      • Establish who will be responsible for monitoring the training of setting staff (the provider or setting)


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