Download General Dental Practitioner Committee Report 27th January 2017

General Dental Practitioner Committee Report
27th January 2017
Summary:
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Henrik Overgaard-Nielson, Dave Cottom and Richard Emms were all voted back into
the chair and vice-chair positions, unopposed.
Amalgam update – Still awaiting ratification of the Minimata treaty in March 2017
and potential for change of plan. Currently suggesting a phase out of amalgam,
possibly by 2030 but a ban on amalgam for the under 15 year olds and pregnant/
breastfeeding women, with provision about clinical necessity, as well as
requirements on amalgam separators and precapsulated amalgam
GDC – a consultation is currently open and BDA (Peter Ward and Mick Armstrong)
are attending.
Diversifying practice income – Dave Cottam will continue to develop advice with
BDA on increasing non-NHS income as a means of supplementing NHS income.
Patient charge revenue legal challenge – BDA have 50 responses and are looking into
12 cases to use.
Capita are looking to extend the time for foundation dental practitioner performer
registration until Mid February 2017.
CQC consultation – CQC are looking to update their regulation for a more targeted,
responsive and collaborative approach (cross sector and NHS trusts)
NHS England Primary care dynamic purchasing systems projects – DPS is an
electronic framework which allows for provider pre-registration for future
procurement opportunities.
NHS BSA 28 day recall – This monitoring will continue
Contract reform – The care pathways and RAG grading working well but business
suitability and 10% potential clawback is working less well.
Parental, maternity leave and sickness pay – new plans for implementation of the
capping may get pushed back by 9 months.
LDC conference motions – Motion 2 – supported but further research advised to see
if a system was feasible. Motion 26 – not supported because funding is not available.
The winter main meeting took place at the BDA headquarters in London. Henrik,
Dave and Richard were all reallocated into the chair and vice chair positions,
unopposed from any other party. The absences and minutes from the October meeting
were all noted, along with Henrik’s summary of the meetings he has attended over the
last quarter.
Dave Cottam gave a summary of the advice sheets that he is creating along with the
BDA to assist practices branch out from solely NHS income, including clarification of
private/NHS mixing, use of insurance plans (practice plan/Denplan etc) and
encouraging solely private patients. It was agreed that Dave should continue this
development and publish the advice sheets through BDA when ready.
The request for providers, who have experienced the collection of patient charge
revenue even when they have over-performed their UDA contracts and are not
receiving credit for their work, has gone well with 50 responses. The BDA are
looking carefully at 12 cases to use in their legal challenge and these cases are
currently with their legal team.
The Minimata treaty is awaiting further ratification due in March 2017, so details are
still likely to change. However it currently appears that there may be a complete ban
on amalgam use for the under 15s, pregnant and breastfeeding women. However the
reasons for the under 15s is unsubstantiated. There may be caveats where there is
required clinical necessity. The time line for the phase down may be as slack as 2030.
It remains to be seen if the vote in the European Parliament plenary session will be as
straightforward as the ENVI vote. Further working group meetings will develop a
strategy for providing input into the commission’s risk assessment.
The CQC consultation is the first of 2 consultations building updon the CQCs strategy
“shaping the future 2016-17” which was published in 2016. The consultation will be
followed by another in the spring 2017 for adult social care and primary medical
services. The consultation will look into regulating new models of care and complex
providers and the assurance framework. The draft response ill be collated with
colleagues in the compliance and education policy teams before a full draft is
circulated to relevant committees. The closing date for this consultation is 14th
February 2017. The five standards of care remain: Safe, Effective, Caring, Responsive
and Well led.
The BDA are writing a response to the multispecialty community provider contract
consultation. The Five year forward view introduced the concept of a multispecialist
community provider (MCP) within the emerging care model and contract framework,
published in July 2016. The MCP is one types of whole population provider. However
currently dentistry is not included in this. Central commissioning of dental services is
likely to remain for the meantime. This includes DevoManc.
Capita will roll back the deadline for foundation dental practitioners to register for
performer numbers until mid-Feb 2017. There are still cases of performers being
delayed between 9 months and a year, Henrik will be pursuing cases for
compensation, where there is obvious loss of earnings due to the delays.
Henrik has written to the CDO requesting that additional commissioning of in hours
unscheduled dental care is undertaken to relieve pressure on A&E/ doctors.
Commissioning would need to be on a sessional basis and paid irrespective of whether
patients attend the appointments or not.
NHS England is piloting a Primary Care Dynamic Purchasing System Projects. This
is an electronic framework which allows for provider pre-registration for future
procurement opportunities. This highlights how NHS England is seeing future dental
and medical commissioning, all based on tenders for time limited contracts. All under
the guise of improving quality but is accepted to be financially efficient (to the benefit
of NHS England) too.
The NHS BSA has had good success with the 28 day recall over the past 2 years and
is looking to continue this monitoring on a rolling basis. They will be looking at
outliers and contacting those thought to be seeing patient’s too often. GDPC are
highlighting that under claiming is the net result of these systematic reviews.
Contract reform is undergoing department of health review of initial data gained from
the prototypes. There has been a request from the DoH as to whether GDPC feel that
the prototypes should be dropped in preference to returning/ accepting the UDA
contract. However, GDPC want to continue to support contract reform and help
develop a model which is both clinically successful (pathways and RAG monitoring)
and viable financially (capitation numbers as well as activity can be achievable).
Parental/maternity leave and sickness pay caps are to be imposed but the timescale of
these reforms is likely to be pushed back by 9 months, rather than the 1st April
implementation.
A presentation by Nicholas Taylor, Chair of COPDEND was given. He is looking into
how to make DFT more cost efficient for the DoH. He also looks to change
undergraduate training to develop pathways for dental courses to graduate therapists
and hygienists, who can go further to graduate as full dentists, prior to training further
to specialist standard. It is assumed that future NHS tiers will be workable by
therapists to a level 1, dentist to a level 2 and then specialists to a level 3. There are
also concerns that dental nurse courses are not suitable at graduating DCPs able to
undertaken some level 1 requirements, thus development of suitable training pathways
are being looked at.
Conference motions have been responded to by the GDPC Executive and forwarded
to the DoH. Our motions 2 and 26 (no win no fee and free training) that were put
forward by Agi at the 2016 conference have been approved with further research and
found not financially sustainable (respectively). The full list of motions and responses
are available upon request from me.
Scotland, Northern Ireland and Wales gave summaries of their developments and
ways of working. Reports available upon request.
The next meeting is scheduled for 5th May 2017
Once the actual minutes of this meeting are published I will make them available to
anyone who wants them.
Toby Hancock
Sussex and Surrey representative
Regional Group of LDC East & West Sussex, East & West Kent and Surrey
Monday 16th January 2017
Attendees:
Barry Westwood (Surrey)
Toby Hancock (West Sussex)
Tim Hogan (Kent)
Annie Godden (NHS England)
Emmanuel Lazanakis (West Sussex)
Snehal Dattani (Surrey)
Julian Unter (Kent)
Jackie Sowerbutts(PHE)
Agi Tarnowski (LPN)
Nish Suchak (East Sussex),
Connie Sheridan (Kent orthodontist)
Richard Wilcynski (GDPC)
Robert Seath (East Sussex)
Apologies:
Nil
Minutes of Previous Meeting: Agreed as accurate representation of meeting
East Sussex
 Nish and his team are running a core training day; details of which are to follow
 With the local oral health promotion for children, the local dentists are not engaging
with assisting staff training or getting staff out into the community
 Nish, no behalf of the LDC, has refused to authorise a “stopping of prescribing” for
duraphat from GPs
Surrey
 Barry and Snehal feel that the Rego installation has had simplified training to go with
the implementation of it in Surrey. They have been advised that Google Chrome is
the preferred system although Rego will work with other systems such as Safari.
 Annie stated that additional training would be available in a one to one form from
Vantage upon request. Also there will be some Vantage focus groups with the
clinicians who wrote the referral pathways.
West Sussex
 Toby is still awaiting attendance of Stephen or Lawrence from Health Education KSS
to a meeting to discuss their plans to spend the funds that we hold for them
 Toby has been developing ties with the LMC of West Sussex. He has attended a
LMC meeting in Billingshurst, giving them an update on our status and 3 GP are
attending our February meeting in West Chiltington.
 Toby and Mark have attended a one to one meeting with David Ezra to discuss the
progress and development of Rego. There are plans to expand the system into
electronic prescribing and laboratory referrals. Also there is the possibility of
developing private referral bases, outside of their NHS contract.
 Agi’s core training day was felt to be another success. East Sussex and Surrey are
looking to undertake a similar format in coming weeks/months.
Kent
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Christmas breach notices were zero this year, mainly due to the hard work of the
dental team ringing practices.
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Orthodontic Rego referral difficulties were noted, mainly through a lack of
understanding and practice of using it.
Barry requested if there could be a lack of penalty for failing to achieve targets for
UOAs since the introduction of Rego. Annie responded that it would need to go to
DCQAP for a case by case negotiation.
Some Whistleblowing cases as grudge/blackmailing of previous owners have been
experienced. Often directly to the GDC. There is a suggestion for dentists to lodge a
“vested interested” status between themselves and the whistlebower. There is a
request to raise the awareness of this within the LDCs.
Tim highlighted the poor health of Shab and the whole committee wished him a
speedy recovery.
Tim is giving a talk to foundation dentists in London to raise the awareness of LDCs
and their work.
Current contract matters and LPN
 Community and Unscheduled dental care contracts have been extended to April
2019.
 Agi has written a special care MCN questionnaire which she will forward to Channel
members to get a feel for feedback of the service.
Orthodontic needs assessment and contract tendering parameters
Jackie was previously sent these questions (responses in red):
1.
Five-year time limited contracts are an impossible business model for anybody who
is not already a PDS or GDS provider or does not have considerable financial backing. No
lender or landlord would countenance an agreement over this period. This may be seen at
appeal as a restriction of patient choice and an unfair advantage to existing Providers and
Corporate Groups. What is your response to this perceived restriction of opportunity and
choice? Can’t answer specifically but would look to have longer than 5 years, awaiting
“central” response with the hope for substantially longer contract times
2.
You speak of a pan-area UOA value of £56.50. In your report you say that the
average UOA value across the area is £63 although a median value would be more accurate.
A median value of £60.76 was disclosed under FOI for Hampshire in 2011, so given rises
since then £63 seems to be about the median for the South and South East of England but
you have arrived at a value of £56.50. Do you have any business model to support this or is it
a figure plucked out of the air? If you have chosen this figure after engagement with
Orthodontic Providers based in the South East with attendant high employment and high
expenses, could you explain how they have helped you to arrive at this figure? Again, this is
perceived to be beneficial to Providers able to withstand initial financial loss to eliminate
Patient choice. Please explain how this is not so and who has helped with the model. UOA
value came from the transitional document, suggestion that value could have been as low as
£48.39. Orthodontists are encouraged to undertake their own business model assessment
and bid what their business requires rather than aim for an “ideal procurement target”
3.
The approximately 50% reduction in non-productive assessments/reviews shown in
your report translates to about £31 per treatment in Surrey and £40 in Kent/Medway. This is
a sharp reduction in profits already and means an Orthodontist is already providing many
more treatments per contract than at the assessment period prior to 2006. How have you
factored this possible extra strain on performance into the figure of £56.50 which in effect
becomes far less as the average of £63 is prior to the assessment reduction? How would you
be able to demonstrate in this scenario that price is not the consideration to the detriment of
the quality of provision and choice and that the tariff is consistent with national net averages,
transparent and in the best interests of patients? Is this tender process only happening in the
South East of England - what about the rest of the country? What consideration has been
given to the varying costs on delivering treatment and sustaining service provision in each
location? The LAT had pointed out very plainly to Orthodontic providers that it was in their
best interests to achieve parity between referrals and treatments and therefore the reduction
figures are not a true picture as Providers felt pressurised into the legally grey area of
providing free private assessments – this is the BDA position on which they have taken
advice. The DERS system appears to be working well, but have the Commissioners
considered the possibility of legal challenges by patients in the future against the on-line
system?
4.
Transfer cases. As you are reducing the number of contracts it makes little sense to
say that it would be a matter of swings and roundabouts to pay nothing for these cases. There
would be more swings to drop patients off than roundabouts to pick them up. This would
mean that Orthodontists will have a fair amount of unpaid work imposed on them along with
the proposed UOA value reduction and this unpaid work may even lead to contract
underperformance and breach notices. How can this not be to the detriment of provision?
The question of dealing with transfer cases from unsuccessful providers needs to be
quantified accurately. What is the proposed model?
British orthodontic society and British
dental association have been in discussions with NHS England. Earlier proposals for a
complex differentiated payment has been replaced with an offer of £662 as a one off payment
per patient to complete the treatment. There is a general sense that BDA would accept this as
long as BOS were supportive
5.
Distances between practices and increased working hours. Travelling times across
the LAT vary enormously. It may take less time to travel 20 miles in one area than it does 4 in
another but this doesn’t seem to have been considered. Can you demonstrate if and how
these variations have been recognised? Most children take a session (i.e. morning or
afternoon) off school for Orthodontic appointments, usually for only 10-12 visits, so extended
hours are an unnecessary burden on potential Providers. There are many infrastructure
issues such as staff looking after their own children, retention of staff, hours of cleaners etc.
so that any anticipated service enhancement needs to be proven. The hours of 7.30 to 9.30
am and 4.30 to 6.30 pm are the times that our roads are most congested as you will know.
Government statistics show that Surrey has the slowest roads in the country at these times
and I am sure it’s not much better over the whole area. Could you therefore explain how this
disruption to working lives would benefit anyone?
6.
Standardised waiting lists. It is impossible to standardise waiting lists as GDS
Providers will always prefer to refer to those practices which they perceive to provide the best
outcomes for their patients. I remember having this conversation with you at East Surrey
PCT about 15 years ago, so has someone found a way to standardise waiting times whilst
protecting patient choice? The new DERS system is surely able to record the waiting lists
and times of initial visit to treatment. Is this so?
7.
The model you show of two-centre contracts with one Provider is heavily-biased in
favour of Corporate bodies given the short period of time available for other Providers to get
together and align their working practises, IT systems, staffing arrangements etc. and to
produce potentially successful tender documents for their services. Could you explain how
this isn’t the case? Also if the same Provider is in two adjacent areas that is a massive
restriction on patient choice since if a patient is unhappy with one branch they could only
transfer to the other and could possibly see the same clinician. You couldn’t reasonably
expect them to transfer to another Orthodontist who would receive zero payment and if the
patient was dissatisfied with the pairing they would actually have much further to travel than
they do at present. Has this been considered? The non-colour format of your document
makes it impossible for us to make sense of the demographic figures provided, but there are
areas such as Maidstone and Eastbourne with only one contract each and potential increases
of 7% in 12 year olds where there is possible reduction in provision and definite intended
reduction in patient choice. How is this justifiable? It is felt that management of sub 1000
UOA contracts is too onerous but it is not the only reason for encouraging larger contract
sizes. However 15,000 is not set in stone and practices should consider what contract size
would fit their business plan.
8.
Your UOA figure is generally seen as unworkable except to the detriment of quality,
and this by owner-Providers with personal input to fee income. Corporate bodies have no
management input to income but a management tier to pay for and investors who require
dividends and positive returns on capital. The inherent questions are obvious, so could you
please explain how this is a level playing field for all potential bidders?
Jackie will be summarising our points along with other stakeholder groups feedback.
AOB
 LDN: Julian discussed the Kent position for a generalised Option 1 style however the
core was not to be the decision maker, only the idea generator, decisions would be
taken to the wide LDN for agreement and implementation. However a vote was taken
for the Channel wide response to Gemma/Brett. Tim and Julian abstained from the
Vote and 8 voted for an option 2.
Barry responded to Gemma via email on Wednesday 18th January: “We had a wide
and lengthy discussion regarding the LDN options at Monday's meeting and after a
vote the majority decision was reached to follow option two - one large LDN across
KSS with representation from each area.
We're very aware of the possible problems associated with large groups and the
logistical difficulties but it was felt that option two would encourage transparency and
cooperation. Given that it is untried and that there is no clear perfect solution we
would like to trial this arrangement for a year and then see how it is working.
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We suggest that decision-making be left to the LDN and not small core groups
although some local issue projects may need to be addressed by sub groups.
I hope this is agreeable to all and thank you for your forbearance in allowing us extra
time.”
Treasurers report: £1800 is in the account and Julian will be requesting contributions
at the next meeting with the possible suggestion of £700 per LDC.
Toby raised the interest of linking our websites. Emmanuel is looking to overhaul the
West Sussex one. As a means to co-operation and cost sharing he will discuss
potential developments with John Noakes ( [email protected] (01634
828190)) who was the creator of the Kent and Surrey Website.
Date of the next meetings
24th April 2017 at 6pm Reigate manor hotel, Reigate