Channel Meeting of LDCs
15th June 2015
East Surrey Hospital
Attendees
Barry Westwood (Surrey) Robert Seath (East Sussex)
Toby Hancock (West Sussex) Snehal Dattani (Surrey)
Tim Hogan (Kent) Julian Unter (Kent)
Annie Godden (NHS England) Nish Suchak (East Sussex)
Agi Tarnowski (LPN)
Apologies
Richard Wilcynski (GDPC)
Emmanuel Lazanakis (West Sussex)
Minutes of the last meeting
These were previously agreed.
Kent
· Tim discussed some personal work that he has been undertaking with nursing homes and oral health. Consideration was given to new oral anticoagulants (NAOC's), eg clopidogrel, being difficult to manage due to it not responding to INR, however short half-life was felt to limit this problem.
· The Oral Health issues will be linked to CQC inspections within nursing homes.
· Local councils are undertaking health improvement activities which are including oral health or children. Kent LDC has been invited to be involved.
Surrey
· There is no sedation locally. Cases are being referred to providers within West Sussex. A sedation needs assessment is due to be undertaken by Brett which will allow for local procurement.
· Barry raised that the orthodontic tendering was generating grief. The MCNs of Surrey and Sussex did not wish to join, but it was considered that a pooling of chairs could occur to satisfy the need for a single MCN to report to the LPN. The MCN would usually be consultant lead but does not have to be.
West Sussex
· Toby checked that the IMOS contracts held in county were superannuable. Annie confirmed that ours were but the ability to be superannuable was based on the type of contract held and there was no blanket Yes or No to these contracts having superannuable status.
· Toby raised his disappointment on the Ortho referral pack singling out West Sussex for continuing to use the RMS for secondary care referrals where the rest of KSS can use direct referrals. This was a point initially raised by Jo Clark (ortho consultant in West Sussex). Annie confirmed that once the Ortho commissioning guides are acted upon the whole of KSS will be using an RMS for its secondary care referrals.
East Sussex
· Nish discussed the offer to the orthodontic providers for funding to attend procurement training, on the condition that these providers paid the LDC levy. No requests for the funding have been received and neither has any offer to pay the levy.
· Nish will report back with regards to the ortho referral pack to both Cherie Young and Annie Godden one week after their next meeting which is on Thursday 2nd July 2015.
· Request for endodontic and restorative services was requested of Annie. Who confirmed that an endo contract was held with Guy’s hospital. If a practice wishes to refer a patient, they can contact the dental team and request a referral, which if it satisfies the criteria will then be forwarded to Guys hospital. The restorative service is awaiting the commissioning guides prior to being put in place.
· Nish is still keen to give feedback on the dental advisor practice visits and Snehal requested that two forms were sent out after a visit (one to the practitioner to be returned to the area team and one to be returned to the LDC), Annie was happy to assist with this.
Current contract matters
· There will be 2 prototypes in our area (2 of the previous pilots are returning to standard GDS contracts).
· Half year repayments within Surrey and Sussex for underperformance will remain for only this year. After this it will revert to the Kent model in which deductions will be made from the following schedules.
Treasurer’s report
· No treasurer report
Information Governance/CQC/NHS England South (South East)
· Annie informed us that the first newsletter is coming out with details of the organisation realignment that has occurred which effectively means that Kent, Surrey and Sussex are merged and now called NHS England South (South East). This newsletter will also include details of the PCSS changes.
· Each LDC has been invited to attend the Dental Contract and quality assurance panel meetings, as observers. This is the spirit of transparency for what occurs with contracts and for the benefit of information sharing. The part 2 of the meetings will be from 12.30 till 4.30pm in Lewis or Tonbridge.
· The new PCSS dental staff are now in post and based in Tonbridge, they are undertaking POL services.
· Information governance toolkit is now on toolkit 10.
· The HE(KSS) Challenges conference on 7th October at the Holiday Inn, Gatwick will include a session on the future of the out of hours service within Kent, Surrey and Sussex. The West Sussex out of hours service contracts come to an end in 2017.
· The orthodontic needs assessment is almost complete. Procurement is to commence throughout 2015 but updates of timescales will be forthcoming.
LPN
(report quoted from Agi’s chairmen email – AG = Annie Godden, BD = Brett Duane, AR = Amit Rai)
Review of last meeting’s minutes and actions:
The minutes from the previous meeting were reviewed and agreed, problems with IT administrative support within NHS England locally prevent uploading onto website it is hoped this will improve with recruitment.
Jeremy Collier Consultant in MFU appointed as representative from 2ndry care Jeremy works out of Redhill and Queen Victoria hospitals. Within his field he specializes further in orthognathic surgery and trauma and also leads on the surgical training program for HEKSS.
Prescribing of High F toothpaste by GMP’s BD has been in contact with pharmacy leads with regard to a shared care document which may help provide a solution.
The minutes of Kent LPN and Surrey Sussex LPN will be shared.
Managed Clinical Network – update
These MCN are part of the vision of the evolution of the dental contract and are needed for the new commissioning guides/ strategic framework/ care pathways to work (all relate to the same thing)
NHS England would like to see 1 of each MCN still per LPN to allow attendance of a limited and reduced amount of staff available.
Current there is no funding for these, AG reiterated that the vision is for MCN’s to involve all providers to varying degrees, be responsible for agreeing levels for referral as well as quality measures. AG highlighted a difference between clinical networks which could be in a several area and a managed clinical network which has management input.
ORTHO MCN: AR wrote to Sussex and Surrey MCN both replied with a reluctance to join at this time but with an understanding they would work together. There were some issues around the reply from Surrey MCN which was retracted and a new version sent due to comments from the chair which the group felt were not representative of the MCN. It perhaps highlighted tensions between orthodontic 1ry and 2ndry providers in Surrey.
NHS England would like to see a consistent referral Performa across KSS with criteria applied to address inappropriate referrals due to low need and too young age.
The needs assessment is almost complete but the consultation element had to be paused due to purdah and as a result current orthodontic contracts are proposed to be rolled forward to 2017, which has yet to be confirmed.
RESTORATIVE MCN: KSS will have a joint MCN for this discipline, Andrew Elder of East Kent University NHS Foundation Trust is leading on this. A questionnaire was sent to all consultants regarding what the issues were, BR commented on this positively as a good way of starting a needs assessment for relevant background and insight which could be used in the future.
SPECIAL CARE MCN: Mark Johnston Managing Director of Dental Services of Kent Community NHS Foundations Trust is contacting leads in SCD across the patch to start work on a SCD MCN pre-empting the publication of care pathways.
(PEADS MCN): Currently included in SCD/ Community
ORAL SURGERY MCN: AR and AG were identifying Oral surgery consultants in Surrey and Sussex, JC agreed to review the list and draft letters and discuss at the next Local Clinical Governance meeting.
Healthwatch Update: AR and Pharmacy LPN chair attended local Health watch conference to request patient representation at LPN. A Healthwatch representative is desirable as it is recognised and evidence based organisation. The blocking point is that local healthwatches are based on local authorities and it has been hard to find a regional representative to attend. In lieu or until a representative can come the chair will attend Healthwatch for input.
Old Age Project
SLH did not attend today. SC and BD had drafted a letter raising concerns which was seen by SLH informally for input. The concerns were around the implementation of preventions strategies, outcome measures and inclusion. BR met with HEKSS and felt that this was a better way of moving forward. BR is now on the steering group for the project and feels this will be a better way to influence HEKSS.
Plan on a page
AR discussed the Plan on a Page for 2015/2016.
• Complete LPN membership.
DCP – to be advertised, letter to go out as stated in previous
Pt representative
• CQC Information on Dental Inspections
Raise local concerns with the national CQC dental lead to discuss dental service inspections – align with Kent and Medway
• Managed Clinical Networks
Work to establish an Orthodontic, Oral Surgery, Restorative, Special Care Dentistry and Oral Health Promotion Managed Clinical Network and to develop a ‘task and finish’ plan for the year
• National Care Pathways
Review commissioning directions when the national care pathways are published and work with HE KSS (SLH) to include training and intelligent referrals
• Local Authorities
Support the development of Oral Health Promotion Strategies for Local Authorities,
• LPN website
Update the Dental LPN website, enabling meeting minutes and related documents to be uploaded and shared – this is in place
• Improving the Oral Health in Older Person’s Initiative
Support HE KSS with this project –
• Challenges conference
Work with HE KSS to provide a ‘Challenges’ conference for stakeholders in KSS –7 October 2015
• Orthodontic Needs Assessment
To support the development/implementation of a Surrey/Sussex Orthodontic Needs Assessment
• Sedation Needs Assessment
To support the development of a Surrey/Sussex wide Sedation Needs Assessment –
• Project on improving the Oral Health in the Homeless Groups/Fluoride varnish in children
Any other business
Urgent/ Emergency Dental Services contracts, some expire in 2016 while others expire in 2017.
Sedation: needs assessment commenced already contract rolled forward to 2017, new RCS guidelines recommend sedation for over 12 only.
IMOS: variation in services across the patch seem contract expire 2016.
New contract: rather worryingly AG stated that there no signs of a new dental contract, but rather there will just be changes to the current. Which leads me to question what the prototype practices are for and how the care pathways and MCN will fit.
Dental Electronic Referral: used in Kent instead of referral management does this create a cost saving?
Date of next meeting:
July 2 - Lewes
Sept 15 – Horley - tbc
Nov 15 – Lewes – tbc
Part 2
· The new information that has come to light in regards the LPN chair was discussed and Kent brought up to speed on what has been disclosed. A letter has been given to Annie and Richard Woolterton giving Surrey and Sussex’s concerns.
· The PLDP and PAG were discussed. Snehal asked for feedback as to whether we needed to send observers to the PLDP as well as the trained dentists and it was concluded that we didn’t. Snehal will email Jane Godden and confirm this. Nish, Snehal and Tim will support the PLDP, while Julian, Robert and Toby would support the PAG. Top up funding will be from individual LDCs.
· Neither Snehal, nor Toby had any luck acquiring secretarial support for minute taking. Barry and Agi will try their various sources. The offer is £80 for attendance to each meeting and the production of a set of minutes.
· Attendance to Annie’s invitation to observe the DCQAP meetings was discussed. It was felt that each LDC should send a representative, at least initially to get a feel for the value of attending, Barry and Toby expressed their interest in attending.
Date of the next meetings
12th October 2015 @ East Surrey Hospital
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