H&IOW LDC Secretary S Report

H&IOW LDC Secretary’s Report

17th January 2018

NHS England-South (Wessex): the two LDCs met with Wessex towards the end of December to discuss the agenda items formulated at the November, joint LDCs’ meeting. The list of agenda items (15) included:

• Recovered monies – nationally over £81.5 million (budget in England of around £3.4 billion) and locally £7.8 million. This national problem represents over 25% of practices suffering clawback. We were given assurances that a large proportion of these monies had been reinvested in dental services where contracts have been rebased and especially with one large corporate provider deciding not to phase in the rebased contract process. The uptake on non-recurring activity has not increased and it is difficult to measure the proportional loss of dental funding relative to the overall budget. There is £3.0 million transformation funding, part of which is being invested in 4 health promotion initiatives. Inevitably huge amounts of money from the dental budget are lost year on year throughout England.
• LDN/MCN funding for GDP representation – NHSE GDP recruitment exercises and the levels of response
• Occupational Health –requested provision for the whole of dental teams
• IFRs –criteria and details of tariff and activity within Wessex
• Oral surgery standard contracts – loss of superannuation
• Contracts and non-recurring activity – activity and risk to practices
• Practice’s financial records – appropriate detail justified for Force Majeure claims
• Christmas message
• DERS – this will be initiated as an interim measure
• Orthodontic procurement – update and the current status quo
• Regional restructure – impact of the division into the South East and South West regions
• OPGs – charges to dental practices for referrals needing an OPG
• Pension issues related to extra non-recurring activity - resolved
• Communications with NHS England (South)- Wessex – Dorset LDC felt that these were poor
• The oral health, care homes, diabetes and under-5s initiatives – support mechanisms

An action tracker is regularly updated at these meetings to record and update themeeting’soutcomes information for the two LDCs.

The leadership team arrangements in BOB, Frimley Health and Care and Hampshire and Isle of Wight STP areas have changed to reflect the change in geography. Olivia Falgayrac-Jones has been promoted to the position of Director of Commissioning (South East) and this covers NHS England’s responsibility for direct commissioning for primary care and public health. The LDC understands that for the foreseeable future there will be no change to the Wessex contract/performance team footprint and Olivia will still be based in Southampton. The two LDCs will meet again in April 2018.

Orthodontic Procurement: The second phase of this procurement has been further delayed as the BDA sponsored judicial review deadline (progress in addressing BDA questions and the lawful interpretation of the process) is the 16th February with the judicial review hearing date fixed for the 9th May. It is planned that the procurement will go live on the 19th February with a loss of 4 weeks to the mobilization process and the first evaluations will start on the 19th March. The LDC has raised concerns about the commissioning intentions (lot size) on the Isle of Wight. Bearing in mind that the only stakeholder input from dentists in Wessex during the consultation period emanated from the LDC it is disappointing that the LDC has not received any further communication from the procurement team. The Secretary attends the stakeholder meetings on a regular basis. It is likely that procurement within the CDS will be delayed to 2020.

LDC Officials’ Day: This took place on Friday the 1st December and the Secretary and Treasurer joined the 200 strong delegates to network and to hear the latest developments in dental politics. The agenda format was slightly different from previous years to include breakout sessions on compliance, the work of the GDC (FTP and enhanced CPD), GDPR and contact with the media. Inevitably, contract reform was discussed but the rather hurried and lack lustrepresentations from the deputy CDO Eric Rooney and Helen Miscampbell a DoH Dental and Eyecare Section Headdid not reveal any cause for optimism with the business model. We were presented with some almost flat-lined graphs and at no time was improvement in the working lives of dentists given any positive attention. We await publication of the latest prototype evaluation report in early 2018. Clearly, contract reform is a risky thing to participate in with some of the Wave 1 and 2 pilot practices suffering significant clawback and GDPC is requesting compensation for broken promises in this regard. Helen Miscampbell informed delegates that prototypes will run to 31st March 2020 and that there would be a gradual roll-out rather than a ‘big bang’. Manda Copage gave a good,audience interactive update presentation on performance (PAG/PLDP) and support structures within the confines of the NPL and as part of her presentation she mentioned emergent regional PLDPs. John Hodson Senior IG Specialist from NHS Digital introduced the new data scrutiny and protection toolkit that dentists need to use for patient data. We had excellent presentations from the Guild, DHST and Benevolent Fund and finally, we were updated by Andrew Taylor Head of the Dental Programme from the Chief Dental Officer’s Office on NHS England’s digital developments and their relevance to dental practitioners (SNOMED CT). It is hoped that the slides will become available for publication on the LDC website.

National Association of Dental Advisors Conference: This high-profile event was held in Birmingham and commenced with Sara Hurley CDO who talked about contract reform, dental check by one, storage of data, smile4life, over-performance, starting welland standardization of record keeping. The Secretary quizzed Sara on the plight of orthodontic providers going through the current procurement exercise in the South. Janet Williamson Deputy Chief Inspector CQC followed and talked about CQC dental practice inspections and closer working with NHSE. Henry Clover Director of Policy Simply Health Professionals discussed changes during the year at Denplan and Carol Spur senior advisor at Denplan outlined the quality assurance scheme for their dental advisors. Simply Health have launched a shared capital investment practice purchase scheme to help younger dentists to secure their own practice. Janet Clarke painted an almost euphoric picture of LDNs and their influence on commissioning and their relationships with numerous stakeholders. The Secretary addressed her on this gold standard LDN where the MCNs, LDCs and GDPs are involved in every decision. Jonathan Greene Director of Fitness to Practice advised the delegates on the reforms taking place in the GDC and intimated that the ARF might be reduced in 2018. The Dental Director of DPL gave a personal view of the current situation within the dental profession followed by the immediate past-Chair of LDC Conference who outlined the failures in the current dental system.Malcom Smith Postgraduate Dental Dean and Chair of the Dental Foundation Training Advisory Group outlined COPDEND’s vision of the future of dental education – this was not well received.The LDC website has posted the YouTube Advancing Dentistry article that picks up training needs and scope of practice ideas but regrettably the survey questionnaire is now out of time. Finally, Janine Brooks talked about the use of dental mentoring and so the Conference ended on a positive note.

Ionising Radiations Regulations 2017 (approved Code of Practice and guidance): On the 1st January 2018 IRR17 (series code L121 2nd edition) replaced IRR99. IRMER18 will replace IRMER 2000 and the amendments from 2006 and 2011. A free copy is downloadable and includes the final copy of the Regulations with a full list of updated Schedules. The new IRMER18 will come into force on the 6th February 2018.

Level 2 services: The CDO has launched accreditation of NHS performers and providers of level 2 services and NHS England dental commissioning staff may follow this accreditation process for Providers of services who are contracted to deliver Level 2 services in Oral Surgery and Endodontics. However, much remains unclear and how this process links with CQC. We are still awaiting the commissioning guide for restorative services.

PCSE: The delays (performers list applications) last year are still impacting on providers as they are likely to underperform in 2017/18 and unlike 2016/17 they are likely to be in receipt of breach notices due to a breach of their contracts. The LDC Secretary will be involved with some national/local work with PCSE to ensure that this parlous situation will not be repeated in the future but this current situation where under delivery is due to past performers list administrative delays, the LDC would urge contractors to approach NHS England-South(Wessex) to discuss their contract delivery.

NHS Mail: A new portal will be launched in 2018 to facilitate applications for NHS Mail accounts. However, the LDC would urge dentists to secure their NHS email account (nhs.net) and the application process requirements are on the LDC website. Please go to the registration site and select registering dentists and fill in the downloadable application form.

General Data Protection Regulation (GDPR): Dental practices should where relevant prepare for GDPR which will apply from 25th May 2018. Many of the GDPR’s main concepts and principles are much the same as those covered by the current Data Protection Act (DPA). Current compliance with DPA will be a good starting point. The ICO will be producing new guidance and other tools to assist businesses. The GDPR will include greater transparency and individuals’ rights provisions and there will be greater emphasis on documentation that supports accountability. BDA have been contacted to give guidance and notice of any planned training events once it is more fully understood the impact on LDCs and dental practices. The LDC’s contact database may have to be reviewed to ensure that all our contact information was availed through positive consent mechanisms and to record in detail/audit how this was achieved.

H&IOW LDC Report to the Portsmouth City HOSP (PCH): This eight page report was compiled by cooperation between the LDC Secretary and Denise Mattin the Clinical Director of Special Care Dental Services and presented to the PCH. This report is available upon application to the LDC secretary and is viewable on the LDC website

Triennial BDA Representatives Elections (GDPC): Both Nick Forster and Keith Percival were re-elected with Jonathan Mynors-Wallis newly elected as the third GDPC member for Wessex.

LDC Conference (Belfast): The 67th Annual Conference of LDCs will take place in the Europa Hotel on the 5th and 8th of June and our very own Treasurer, Claudia Peace will be presenting on Contract Reform based on her experiences within a pilot and latterly a prototype practice in Winchester as an associate and as a member of the NSG. We wish her well. This years’ Chairman is Joe Hendron and he has reminded dentists that LDCs represent the profession locally - LDCs discuss and support current and developing service configuration, commissioning, NHS management of providers, practice staffing, matters that concern performers, workforce planning, education, interpretation of regulation with published updates, PASS, mentoring support, PAG representation as invited members (non-voting)and many other workstreams that help to sustain and protect the working lives of all GDPs and CDS dentists within their constituent boundaries.

CQC: The new inspection team’s key lines of enquiry (KLOEs) and prompts come into force in April 2018. This latest version has been produced to merge previous publications (2015) that were service specific and some changes have been made to the content to strengthen specific areas together with changes to the wording to improve and simplify the language to aid understanding.

EDITORIAL

The Poor State of the Nation’s Oral Health with special reference to Children’s oral Health: This has very recently hit the national media with poor investment by successive Governments jeopardizing the oral health wellbeing of the populace and especially children. Around forty percent of children have not visited a dentist in the past year and the main reason for the hospital admission of children (ages 5 to 9yrs) is because of tooth decay and on average 160 children a day undergo a general anaesthetic for the removal of teeth costing the NHS around £33 million per year. We know that this figure does not recognize the many other teeth removed under local anaesthesia. We live in an affluent society and yet the state provision of oral healthcare in England is shamefully underfunded and seriously damaged by the current flawed contract that is not an effective way of delivering the care need by adults and children. As a GDP, to see children of all ages suffering acute pain, swelling and difficulty in eating is a heart-rending experience and especially as dental decay is totally preventable. Prevention and education is the way forward rather than a quota driven system that does not address inequalities for example a child in the North is nearly seven times more likely to experience dental decay than one in an affluent area such as Surrey.

Steve Brine MP and Health Minister responsible for dentistry has expressed his dedication to improving oral health outcomes and to contract reform in England. Scotland and Wales have had successful, dedicated and funded child oral health programmes for more than a decade. We need a coherent national oral health strategy NOW.

The H&IOW LDC will invite Steve Brine MP to outline his plans for future oral healthcare in England

K Percival

Hon Secretary

H&IOW LDC