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MINUTE of MEETING of the
HIGHLAND AREA DENTAL COMMITTEE
Centre for Health Sciences, Raigmore Hospital, Inverness /
31 August 2011 – 6.30 pm
Present: Mr Adrian Hart, Chair
Mr Neal Drummond, GDP
Mr Hamish Isaac, GDP
Mrs Catherine Lush, Clinical Dental Director
Mr Gordon McGovern, GDP
Mr Iain McIntyre, GDP
Mr Gregor Muir, GDP
In Attendance: Mr Brian Mitchell, Board Committee Administrator
Dr Ken Proctor, Associate Medical Director (Primary Care)
Mr Stuart Robb, Dental Practice Advisor
1 APOLOGIES & WELCOME
Apologies for absence were received from Alex Fraser, Elaine Goldsmith, and Elizabeth Reilly.
2 MINUTE OF MEETING HELD ON 25 MAY 2011
The Minutes were Approved.
3 MATTERS ARISING
3.1 Changes to Dental List
There had been circulated letters advising of changes to the NHS Highland Dental List, along with an up to date version of the List.
The Committee Noted the changes to the Dental List.
3.2 Process for Raising Concerns
Mr A Hart advised that the process for raising concerns would be aligned to existing complaints management processes.
The Committee so Noted.
3.3 Annual General Meeting
Mr A Hart advised that provisional arrangements were being made to hold an Annual General Meeting (AGM) of the Committee on 4 November 2011, further detail in relation to which would be issued in early course.
The Committee so Noted.
3.4 Establishment of GDP Sub Committee
Mr A Hart advised that as part of the arrangements for an AGM, correspondence would be issued to GDPs in relation to nominations for both the Area Dental Committee and a GDP Sub Committee from which the level of interest would be gauged.
The Committee Noted the position.
3.5 Referral Issues
The Committee was advised there had been no progress to date in relation to introducing new referral documentation for access to maxillofacial services within NHS Highland.
The Committee so Noted.
3.6 Reimbursement of Local Authority Business Rates
Mr N Drummond raised the issue of reimbursement of Local Authority Business Rates, and in particular the practice of employment of independent assessors of rateable value by NHS Boards, which can lead to valuation discrepancies and associated financial implications. It was agreed there was a need for clarification of the relevant procedures for reimbursement in order that these may be considered appropriately.
After discussion, the Committee Agreed a further report be submitted to the next meeting.
3.7 Central Fees for Private Contract Patients
Mr I McIntyre referred to the position whereby if a patient opts to receive private treatment, the practitioner holding the original registration can continue to receive payment as a result of arrangements for lifelong registration. The view was expressed this issue could be addressed through amendment of existing registration documentation. Mrs C Lush advised national consideration was being given to ‘participation’ reporting, including indication of frequency of contact which may help in highlighting the point raised. She stated that this matter raised matters relating to Clinical Governance and as such should be raised as an issue with both Lead Officers and Dental Practice Advisors (DPAs).
The Committee Agreed the matter be raised at Lead Officer and DPA meetings.
4 DECONTAMINATION
Mr S Robb advised that the majority of Practices were operating Local Decontamination Units (LDUs). There was one practice in Highland that had opted not to engage. Mrs C Lush advised a formal update had been given to the Clinical Governance Committee and stated that the timeline for compliance was end December 2012. The NHS Highland Decontamination Group was chaired by Dr E Watson and met on a quarterly basis. An inaugural meeting had been held and the Group was keen to have GDP representation. Mr S Robb had agreed to sit as a member of the NHS Highland Decontamination Group and on the point raised it was agreed that Mr G Muir would act as deputy from the Area Dental Committee if required.
Mrs C Lush stated there would be a need for consideration of inspection arrangements for confirming appropriate compliance with the process and her understanding was the CDO’s office and Scottish Government were aware of this. Mr S Robb advised a meeting was to be held on 21 October 2011 to discuss issues around possible joint NHSH/NES inspections and suggested the Committee consider sending a representative. The view was expressed that there was a need for strict inspection criteria and effective action to be taken where non-compliance was evidenced. Mrs C Lush confirmed that inspectors would have to receive appropriate training as confirming compliance was a significant responsibility and that inclusion of lay representatives on inspection teams was being considered.
The Committee:
· Noted the position.
· Agreed the Clinical Governance Committee update be circulated to members.
· Agreed Mr G Muir act as Deputy for Mr S Robb in relation to attendance at Decontamination Group meetings.
5 HOSPITAL SERVICES
5.1 Maxillofacial
Mr A Hart advised the post of second maxillofacial surgeon was subject to advertisement, that a number of job packs had been issued, and that no formal applications had yet been received. Provision of service by a specialty doctor, two days per week, meant that the current on-call rota was now compliant.
The Committee Noted the position.
5.2 Orthodontic
Mr Hart advised that current locum service provision was to end within the coming two weeks and that there were no proposals to advertise for a replacement. Mr K Clarke, Senior Dental Practitioner had been appointed to the post of Specialty Doctor (Orthodontics) for three sessions per week. A member of the existing nursing staff was in the process of undertaking Orthodontic Therapist training and it was hoped a further member of staff would also undertake this training in due course. Mr C Buchanan continued to provide orthodontic services and a member of his nursing staff was also undertaking Therapist training. Mr Hart was required to be present when trainees were practicing on patients.
There was reference made to the impact on Highland services of patients from the Moray area and it was stated that the issue related to recruitment as appropriate resource was available from NHS Grampian to fund the relevant establishment need.
The Committee Noted the position.
5.3 Restorative
Mrs C Lush advised that the issue of Restorative Dental services had been discussed by the NHS Board, including aspects relating to current service provision and associated clinical risk. One proposal under consideration was the establishment of a Consultant Restorative Dentist position in partnership with NHS Grampian although there were training and skill enhancement implications associated with this approach. The Board Medical Director had considered a relevant draft Briefing Note, his comments on which were to be fully assessed in detail prior to further action being taken forward. Dr K Proctor advised that there was a need for further development of the Public Health element of any associated business case prior to moving forward.
The Committee:
· Noted the position.
· Agreed to write to the Board Medical Director supporting the draft proposal for partnership arrangements with NHS Grampian.
5.4 18 Week RTT
Mr A Hart advised that the deadline for compliance with 18 Week RTT was December 2011, with approximately 177 patients on the waiting list at this time. On the point raised, with regard to referring patients for treatment outwith Raigmore, there were a number of issues involved although this would remain an option. It was anticipated that the relevant proposed HEAT target would require 90% compliance. It was confirmed that referral guidelines had been issued to GDPs.
The Committee:
· Noted the position.
· Agreed referral guidelines should be re-issued to GDPs.
6 OUT OF HOURS SERVICE ANNUAL REPORT 2010/2011
Ms C Lush spoke to the circulated Dental Out of Hours Annual Report, which incorporated a service review and summary of developments in year as well as recommendations for future development. Recommendations from the previous Annual Report had been considered by the Dental Out of Hours (OOH) Project Steering Group and relevant progress on these was outlined. A number of service provision changes had been made in year and it was advised that the service capacity in Inverness was to be reduced to reflect actual demand. The changes proposed for Inverness also reflected the potential increase in demand that may arise from a range of issues including possible integration with the Armed Forces Dental Service and the development of a service for HMP Prison Porterfield. Further consideration was to be given to existing service gaps between NHS24/SEDS and NHS Highland on weekdays between the hours of 5pm and 6pm. The Annual Report had concluded that the integrated Dental OOH service was a sustainable service delivering guaranteed access to patients based on clinical need. The main focus for work during 2011-2014 will be the re-profiling of the service in Inverness to ensure it reflects the demand for service, and ensuring public funds are allocated appropriately with a view to optimising the opportunities for partnership working to improve efficiencies.
The Committee Noted the Dental Out of Hours Annual Report 2010/2011.
7 SCOTTISH DENTAL NEEDS ASSESSMENT PROGRAMME DOMICILIARY DENTAL CARE NEEDS ASSESSMENT REPORT (October 2010)
There had been circulated report by NHS Scotland on the Scottish Dental Needs Assessment Programme (SDNAP). Mrs C Lush advised that Mr Malcolm Hamilton was leading work programme activity on this area in NHS Highland. Key issues highlighted had included aspects relating to equipment, fluoride use to stem root caries, denture making to prevent tooth loss, continuing GDP engagement, SDR payments, training exposure for VTs, and emergency oxygen and drugs. It was anticipated that such activity was likely to increase given current demographic changes and discussion relating to patient contact had been held with the Highland Community Care Forum. The issue of self-referral was raised and it was advised that an appropriate care pathway had yet to be confirmed. Issues to be addressed would include introduction of electronic referrals, and clarification of referral routes for community/district nurses and community carers.
The Committee:
· Noted the key issues highlighted in the report.
· Agreed the need for greater consistency
8 LABORATORY COSTS FOR DENTURE REPAIRS AND DENTURE REPAIR FEES IN THE STATEMENT OF DENTAL REMUNERATION
Mr G Muir stated that an issue existed with regard to the fee received by Practitioners for denture repairs whereby this was less than the actual cost to undertake the repair itself.
After discussion, the Committee Agreed to write to the Dental Practice Board highlighting this issue.
9 COMPLAINTS MANAGEMENT
The Committee Agreed to Defer consideration of this Item to the next meeting.
10 CHILDSMILE FLOURIDE VARNISH SURVEY
Members were advised that the University of Glasgow Dental School was undertaking a national survey of practitioners in Scotland to establish current views and practices in relation to the application of fluoride varnish to children’s teeth. The survey would inform ongoing training and support for dental practice teams as this component of Childsmile delivery is incorporated into the Statement of Dental Remuneration.
The Committee so Noted.
11 ORAL HEALTH ASSESSMENT RECORD DOCUMENTATION
There had been circulated a series of draft documents for recording the oral health of patients. The view was expressed that these documents were overly extensive and Mr A Hart advised that pilot exercises had indicated these would take on average 20 minutes to complete for each patient. However, other Committee members expressed different views. The Scottish Council of the British Dental Association had given the initial view that such activity should be targeted, easy to complete, and subject to appropriate remuneration. Mrs C Lush stated her view that the documentation illustrated a move toward a comprehensive oral health assessment as opposed to an assessment of condition of teeth. She stated that the inclusion of a section relating to patient experience had been informative and well received by colleagues involved in the pilot and acknowledged that there were issues relating to remuneration, training, IT, and time constraints. Overall there was consensus that the circulated documentation represented a ‘gold standard’ approach however this needed to be practical for use in surgeries and an appropriate resource framework established.
The Committee otherwise Noted the circulated draft documentation.
12 DENTAL CLINICAL GOVERNANCE AND RISK MANAGEMENT GROUP
12.1 Minute of Meeting held on 12 May 2011
The Committee Noted the circulated Minute.
12.2 Nomination of Representative from Area Dental Committee
The Committee Agreed to Defer consideration of this Item to the next meeting.
13 FOR INFORMATION
13.1 Changes to the Scottish Dental Access Grants
13.2 Analysis of the Dental Workforce in Scotland Report
The Committee Noted the circulated documents
14 ANY OTHER BUSINESS
There were no matters raised under this Item.
15 DATE OF NEXT MEETING
The next meeting of the Area Dental Committee will be held on 7 December 2011, a venue for which was to be confirmed by the Committee Administrator.
The meeting closed at 8.45 pm
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