Geographical simulation modelling for the regional planning of oral and maxillofacial surgery across London

Abstract

Oral and maxillofacial surgery (OMFS) is a recognized surgical specialty, with its foundations in dentistry. The current configuration of OMFS services across London has evolved over time and reflects historical rather than contemporary patterns of care. The creation of a London Health Region in 1998 provided the opportunity for rational planning of hospital services to serve the resident population of London (7.2 million) and beyond, with recent change focusing on London's five sectors that are represented within this planning model. A detailed geographical simulation model has been developed and has enabled planners to consider a number of OMFS service configurations and evaluate their impact on providers, variations in caseload, travelling distances and times for patients, and thus inform consultation over change. The research confirms that any in-patient service rationalization which concentrates care in one designated hub (main centre) per sector, involves a significant increase in caseload for the designated hub. Average travelling distances and times for in-patient admissions also increase significantly. However, it does suggest that current commissioned provision of day surgery patterns may not be well aligned to the geographical distribution of need for services, resulting in many patients travelling further than necessary for day surgery treatment. These may be overcome by sending patients to their local centre, which may be out with their sector of residence.

Keywords:

• scenario planning
• oral and maxillofacial surgery
• health services research
• simulation

Acknowledgements

The support of the following is acknowledged by the authors: The Department of Health for access to HES Data for 1991/1992–1997/1998;³⁷ Professors S Gelbier, A Sheiham and JD Langdon for their guidance on issues relating to facial, oral and dental surgery in London; Dr Arjan Shahani for his initial ideas and work on geographical modelling; the anonymous referees and Professor Ruth Davies and Dr David Bensley (special issue editors) for their many helpful comments in improving the paper.