Earlier this year Anna Hunt, a Consultant in Dental Public Health for Public Health England, wrote to BDJ Team about a campaign in the West Midlands she was involved with for NHS England and Starting Well. It was called 'A Little Trip To The Dentist'. Anna and colleagues* at Public Health England and NHS England/NHS Improvement spoke to Kate Quinlan about the campaign.

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What is 'A Little Trip To The Dentist'?

It is all about trying to encourage more parents to take their children to the dentist, even before their first teeth come through. We firmly believe that good oral health starts even before a baby is born, which is why our campaign offers useful advice around different themes ranging from tooth brushing through to sugar and even oral health during pregnancy.

What was the starting point for devising this campaign?

The Local Dental Network (LDN) in the West Midlands first started focusing on the number of children and young people accessing a dentist back in 2016, and it soon became apparent that there were some very low numbers in the 0-2 age group with wide inequalities seen both between local authority areas and between wards within areas. It's fair to say that no area had really high access rates for the very young, and so the LDN decided to start some work to try and increase access to NHS dentistry in that age group. Around the same time national work began led by the Office of the Chief Dental Officer and also the Dental Check by One (DCby1) campaign was gaining momentum. So this all came together locally under the Starting Well Core badge and a local West Midlands campaign was devised.

Who was involved with devising the campaign?

The project team works across both NHS England/NHS Improvement and Public Health England. Members include commissioners, public health consultants, communications professionals and project managers.

We firmly believe that good oral health starts even before a baby is born, which is why our campaign offers useful advice around different themes ranging from tooth brushing through to sugar and even oral health during pregnancy.

What does the campaign hope to achieve?

The ultimate aim is to see an increase in the number of under 2s, and especially under 1s, accessing an NHS dentist. Numbers across the country are relatively low, so our hope is that by raising awareness of the importance of early visits we might start to see more taking place right across the region.

Our secondary aim has been to try and engage the wider health community in oral health. It can be difficult to get oral health on other people's agendas, so this has been a real opportunity to provide a common cause for a wide range of health professionals to get behind.

What had to happen in order to launch the campaign, and how was the plan developed?

We were lucky enough to have a member of the dental public health team focused on the campaign. Their role was to keep each member of the team on track and ensure actions were completed in good time. The first step once 'A Little Trip To The Dentist' had been decided on was to identify who could be a key vehicle for helping to spread the message to the right audiences. These 'influencers' were approached early on to ensure buy-in from the beginning. We then had to factor in how we might appeal to the wider health community in the region and which organisations it was relevant to. We worked with colleagues from a multitude of areas and organisations to develop our plans, including local authorities and local dental committee chairs. Once we had a better idea of the direction we wanted to go in, our communications colleagues took it and badged it up as a comprehensive communications plan.

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How were practices/dentists recruited to the campaign?

We tried to engage with both on social media, by responding to and interacting with any tweets they put out themselves. We also put call outs directly to practices to ask for support and for any good case studies to be sent our way. The campaign was also on the agenda at regional meetings to try and raise awareness face-to-face too.

How was the campaign promoted and implemented?

We employed a few different tactics, but mostly focused it around social media and empowering health professionals to talk directly to their patients about the importance of a little trip to the dentist. We provided posters, email signatures, stickers, quizzes, top tip sheets, graphics for screens in waiting areas and much more.

We utilised social media by providing cut and paste content for all health professionals to use on their organisational or personal profiles. This content covered all of our key messages and could also be used as a starting point to create organic messaging too.

Content included polls, straightforward text content, infographics, picture stories, case studies, links to resources and more.

We've encouraged practices to utilise existing capacity to see babies - eg encouraging pregnant mums to bring their babies once born. We are hoping to be able to put additional capacity into practices that are doing really well and are likely to exceed their annual activity target - we now have a commissioning mechanism to do so, which is great. We're currently reviewing the achievement of our practices as we're half way through the commissioning year.

What resources were required and how were they distributed/shared with relevant parties?

Printed A3 posters were produced and distributed to primary care professionals. We asked for them to be displayed in practices, clinics or surgeries in an accompanying letter from NHS England explaining the campaign in more detail alongside the latest communications toolkit and campaign newsletter. We also produced stickers for the front of 'red books' which were distributed to health visitors by colleagues in local authority areas who were already working closely with these groups. The idea behind this was that a health professional could have a conversation about visiting a dentist and deliver oral health messages to a parent or carer and then stick the sticker on the red book to remind the parent of the interaction. Also soft intelligence gleaned by the project team was that stickers work very well to motivate the group of health professionals we were targeting for this work (health visitors).

There are lots of ways to measure success, some of which we can't do until the right data is available, but we've seen a definite increase in general awareness amongst healthcare professionals of the importance of dental check-ups in the very young.

Have you encountered any problems communicating with practices?

There have been some distribution issues. We send out toolkits/resources to practices via email and the email addresses we have are not always up to date. Alongside this, the posted packs are addressed to the practice which means occasionally they were opened and not always passed on, as there wasn't a named individual on the envelope. There are a lot of other professionals based in other locations we needed to distribute items to as well, and all partners involved worked hard to make sure they reached the right people.

Which partners supported the campaign and how?

Almost all of the CCGs, trusts and councils in the West Midlands supported the campaign on social media. We also received some really great pictures from events which oral health practitioners or student health visitors were running, where they'd used our resources. GP practices and dental practices also got behind it with social media content.

How will the success of the campaign be measured?

NHS England are keen to measure the impact using the access rates regularly collected and reported for the 0-2 age group. The project team are also looking at the coverage the campaign is obtaining to try and evaluate the most successful methods of engaging with different groups, including health professionals and the public. This learning can then be shared to improve similar campaigns in future.

What has worked well with this campaign?

Our engagement with the wider health community was a real positive, as it meant no matter where a patient is treated or which local authority they fell under, they had a good chance of seeing the messaging. The links with communications teams in each of our partner organisations were really helpful, with lots of people keen to support something new.

What proved more challenging?

Our most challenging element was engaging with the dental community, ironically. NHS England use email addresses for contract holders, and we sent newsletters and toolkits electronically via this method. The posters were sent hard copy by post. Some practice staff reported not receiving the emails or the posters. We spoke to the Local Dental Committee Chairs and asked them to share details of the campaign with their members and we sent out information in the Local Dental Network newsletter. We held engagement events which also provided training in how to approach a check-up for a very young child, led by our consultants in paediatric dentistry which were widely publicised and well attended. Still some practice staff had not heard of the campaign when asked. The lesson we have taken away is that there is more that can be done to effectively liaise with the dental profession and NHS England are thinking about how they can further develop engagement. We are open to any suggestions!

We feel that this campaign has really shown what good partnership working can do. None of our teams or professions individually would've been able to pull off a large scale and ever changing campaign like this.

We also struggled to secure more traditional coverage due to a disappointing lack of case studies. Much of the feedback we'd had was that we'd need to find 'worst case scenario' stories to help illustrate why the campaign is necessary, but often families either weren't forthcoming with their stories, dental practices felt uncomfortable approaching them or there just weren't the right kinds of stories we needed.

What unforeseen obstacles had to be overcome?

Once the campaign had launched, we had some changes within the project team which presented some challenges. We'd also begun the process of sourcing case studies relatively early on but found that it was really difficult to get any confirmed. Often by the time a family had agreed to take part, their child had passed the age we needed or their teeth had started coming through. This meant much of the campaign went out without any personal stories, which while not a deal breaker was certainly not what we'd planned.

Do you think 'A Little Trip To The Dentist' has been a success story?

Yes, absolutely. There are lots of ways to measure success, some of which we can't do until the right data is available, but we've seen a definite increase in general awareness amongst healthcare professionals of the importance of dental check ups in the very young. Without seeing the final data to review whether there is an actual increase in the number of zero two year olds accessing an NHS dentist, we're taking this as a good indication that even if the numbers aren't what we'd like, conversations are being had outside of a dental practice too which is one of the most important things.

What can other commissioners/dental practices learn from this campaign?

We feel that this campaign has really shown what good partnership working can do. None of our teams or professions individually would've been able to pull off a large scale and ever changing campaign like this, despite having wanted to in the past. If anyone is looking to do something similar, the best advice we can give is to prepare for hard work, plan well but most of all, defer to the experts and accept that you and your team alone can't do everything.

What resources/advice can you share with the readers of BDJ Team?

All resources are available via the NHS England website: https://www.england.nhs.uk/midlands/2019/06/20/campaign-a-little-trip-to-the-dentist/.

Everything is free to use and adapt. We see dental care professionals (DCPs) as key to developing this campaign in their local area. They can champion the issue, develop relationships with neighbouring health professionals and explain how to access services at the dental practice they work in. They can use the resources as part of future health promotion campaigns they may wish to run.

What would you like to improve upon for the next communications campaign?

Now that we know there is an appetite for messaging like this, we'd like to use social media in a much more innovative way. The majority of this campaign was centred around Twitter, but we know there are health professionals and organisational presence on other channels too such as Facebook and Instagram. While we did provide content for other channels, it wasn't something we particularly utilised ourselves so who knows what doors that might open in the future. Some other channels could have provided a more direct line to patients and families too, but we wanted to make sure we could walk before we tried to run!

Other than that, we're hopeful that we might have better routes to market within dental practices themselves moving forwards. This campaign has shown that often we aren't reaching the people in practices who can or are willing to make the most of opportunities like this. If we can get better links to practice managers or dentists, then we might see more activity in the areas that can make the most difference in future.

Finally, some of the key learning we've taken away is the importance of a personal story to really illustrate the campaign and its messaging in action. Next time, we'd like to spend more time securing these stories earlier on to ensure we have a broad and diverse bank of case studies to help us secure wider coverage and interest.

We're really proud of the campaign we've developed and we'd really encourage more people to utilise our resources as they see fit. While A Little Trip To The Dentist was developed in the West Midlands, the materials can be used in any setting in any location, so if anyone is interested or would like to talk further, then we'd love to hear from them.

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