YBJOM-4559; No. of Pages 4

ARTICLE IN PRESS Available online at www.sciencedirect.com

British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx

Editorial

How would you persuade reluctant commissioners to purchase maxillofacial services from your Trust? The 2010 White Paper Equity and Excellence: Liberating the NHS led to the creation of national Clinical Commissioning Groups (CCG), which came out of shadow in April 2013. In England, they have taken over the commissioning roles originally performed by primary care trusts (PCT), and they now control around 60% of the NHS budget and have a legal duty to support quality improvement in general practice.1 Commissioning is about purchasing. CCGs “buy” local healthcare services for their designated patient population, which include community-based and hospital services. A CCG is led by general practitioners (GP) and clinicians, as they are said to have the best overall understanding of the social and healthcare needs of their patients and already play a key role in coordinating this care. CCGs will determine and plan which services will be provided, by whom, and in what volume. In doing so, they are supposed to use resources to obtain the best and most costeffective outcomes for patients, ensuring that the services are affordable and reflect the needs and wants of patients throughout the NHS. To help in this process, healthcare commissioners have developed a decision-making tool, the Ethical Framework, to facilitate fairness and transparency in the priority-setting process.2 Principles in the framework will be taken into account in the development of each commissioning policy recommendation. Having knowledge of this basic framework will allow us to engage commissioners within terms that they themselves have set, and to work around them. The Ancient Greeks believed that for any persuasion to be effective, it had to be built on the three pillars of ethos, pathos, and logos. Herein, we lay out seven strategies of persuasion that will encompass all three pillars of Aristotle’s Rhetoric.

Cost-utility analysis of maxillofacial procedures The NHS Commissioning Board stated that it is not possible, without defining clear pathways, to robustly separate the delivery of oral surgery and the many elements of oral

and maxillofacial (OMFS) surgery. Hence, we will be focusing on surgical procedures that are undisputed maxillofacial procedures. Over 2700 orthognathic surgical procedures were undertaken in England in 2011/12.3 The benefits of orthognathic intervention have been well documented, and the Orthognathic Quality of Life Questionnaire (OQLQ) was developed to measure surgical–orthodontic patients’ quality of life.4 It has four dimensions consisting of 22 statements. The dimensions are social aspects of dentofacial deformity, facial aesthetics, oral function, and awareness of dentofacial aesthetics. The score can range from 0 to 88. A lower score indicates better quality of life (QoL) and higher score poorer QoL. Generic health-related QoL is assessed using the 36-item Short Form Health Survey (SF-36), and generic oral healthrelated QoL is assessed by the 14-item Short Form Oral Health Impact Profile (OHIP-14). In the study by Lee et al at 6 months after orthognathic surgery, SF-36 summary scores returned to baseline levels, and significant reductions (improvements) in OHIP-14 (p

How would you persuade reluctant commissioners to purchase maxillofacial services from your Trust?

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