Download Full Committee Minutes – 17th Jun 2015

West Sussex Local Dental Committee
Meeting held on:
Wednesday 17th June 2015 at 6.30 pm
at the Roundabout Hotel, West Chiltington
MINUTES
Item
Action
Apologies, attendees & welcome
TH
Attendees: A.Tarnowski, T.Hancock, M.Botha, J.Clarke, M.Green, A.Pitchforth, E.McFarlane,
P.Mellings, E.Lazanakis, D.Bryan, S Walsh
Apologies: M. Ellis, Am and Pr Patel, C.Hallworth, M O’Hara, J.Parry, R.Walker, A.Rai,
D.McPherson
Guests welcomed: Leslie Berry
Minutes of the previous meeting
The minutes of the previous meeting were approved.
Matters arising
1. Smokefree West Sussex
 Leslie Barry attended on behalf of this organization to discuss smoking cessation and
how GDP's may get involved.
• Rebecca Cooper is their Public Health Consultant but could not attend.
• They are a team of 18 working across West Sussex ,
• They are a part of a private health organization (solutions4health) commissioned by WSCC.
• There are two main parts to the services: (1) Specialist Outreach Service [which works with
target groups] and (2) Training and Support for referrers and providers.
• For GDPs, our responsibility is to ask patients if they smoke; if yes, then advise them to
smoke smoking. If the patient would like to stop, but needs help/ direction/ assistance then to
refer them to the service, via their hotline or website.
http://www.smokefreewestsussex.co.uk/
0300 100 1823
• The service works with specific target groups only (see below). If the patient does not fall into
these groups, then you may still refer the patient to the Smoke Free service and the patient
will then be signposted to the correct support service (e.g. GP).
• Target Groups - minority ethnic group; routine and manual workers; smoker with at least 5
unsuccessful quit attempts; residents of deprived areas; young people under 25; mental
health service users in the community; pregnant smokers and their partners.
• Clinics run across the county and there is a mobile unit to optimise accessibility.
• The service is available to all of those who LIVE or WORK in West Sussex.
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They do one-to-one consultations or group therapy.
They can host training events for dentists/ DCPs or they can come and visit surgeries to
provide training. They can issue CPD. Consideration for the LDC to organise an evening?
They do not use vaporuring or e-cigarettes as part of their program.
S Walsh (SW) enquired about the waiting times and success rates. LB advised that referrals
are responded to within 48 hours. Appointments are offered within 2 weeks. Patients are
advised to call 01903 442 014 or 0300 100 1823. Success rate is 55-60%. For those who are
pregnant, this is 40-45%.
A Tarnowski (AT) suggested LB might be able to contact HEKSS regarding hosting formal
training sessions for DCPs/ GDPs.
LB to give E. Lazanakis (EL) a link to go on LDC website;
TH
EL
www.smokefreewestsussex.co.uk
2. Conference Report
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Minutes are almost ready to go on the website.
In summary; John Randall chaired, the conference held this year in London
Our motion was well received on MCN funding. T. Hancock (TH) gave a summarized speech
and the motion was passed.
J Milne gave reassurance on practice inspections. The scoring system from nursing home
sites will not be introduced in dental practices.
AT reported that the CQC inspected the whole of the Sussex Community Trust a few months
ago. A good was received across the trust. However, the CQC did not specifically inspect the
dental area.
A presentation was given by the BSA about a planned Dental Activity Review. The BSA
received £1million (from the DOH) to inspect repeat claims within 28 days. Practices will
receive a letter, either stating they are either (1) Within the tolerance levels and to continue
their method of claiming; (2) Just outside the tolerance levels, in which case providers are
required to do a self-audit in order to change their claiming habits; or (3) Way outside the
tolerance levels in which case patient records cards will be requested, and if claims are
deemed inappropriate, then funds will be taken back (claw back).
It was noted that the BSA should come out with better guidelines on what can and cannot be
claimed.
2018 is the expected year for the possible role out of the blended system. The piloted
practices which did not become a prototype practice are struggling to get back into the UDA
system and there was grave concern as to how quickly they were being expected to return to
their pre-pilot status.
The DOfH attended but little more was gained from thier question and answer session.
EL reported that the intention of the contract reform is not necessarily to increase access but
more importantly for access NOT to decrease. There is no scope in the new contract for
additional services; the current budget is the budget for the next 15 yrs. However, there is no
willingness to decrease the budget, but it will be frozen.
Alistair McKendrick was appointed chairman. 2017 will be his conference.
The guild rate is £275.00. Next year, the conference will be a 2 day conference, thus equaling
a 4 guild rate session.
3. PCSS Update
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The PCSS is now at Tonbridge (not at Lancing anymore).
A newsletter is coming out which gives a breakdown of the new Primary Care Support
Service.
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For reimbursements of travel and subsistence (Section 63 course/ VT, etc) please send to
Tonbridge.
The BSA keep changing the scheduling date. This is all to do with the BSA wanting to do
ARR. One month can have 40 days of processing activity; another month can have 15 days.
This will continue until Capita has come into play - this is now back in line to take over.
4. Ortho Assessment Needs and Procurement Update
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As soon as we know more about orthodontic procurement then we will let people know.
Orthodontic Providers have called TH enquiring what figure to put down as UOA. TH advises
them to base this figure on their business model.
Corporatism can offer cost saving based on economies of scale but individual providers may
not have the ability to compete with this .
There are concerns that whatever happens to orthodontic contracts may occur in the future to
GDS
New Orthodontic Referral Form
• Details came through from Sandy Tibble (MCN Chair), as reported by J. Clarke (JC).
• The new proposed form was distributed around the committee members. It involves GDPs
assessing the IOTN in practice and making an appropriate referral on this basis. It is not a
national form, but one for GDP's in Kent, Surrey and Sussex to use in the future. This form will
be used to refer patients to a preferred provider (primary care). If the patient is referred to
secondary care, then this goes through the RMS (Referral Management Service) in West
Sussex but not elsewhere.
• NHS England South (south east) there is and IOTN on the form to help reduce inappropriate
referrals though it is also possible to enclose photographs instead.
• DB suggested funding should be made available for IOTN training. P Mellings (PM) stated
that GDPs should be competent in using IOTN .However some sort of support/training may be
possible when introducing the new form.
• TH will draft a letter to Sandy and Annie Godden for our response back. To include; we all
agree that standardization is a good thing; at first glance the form seems very detailed [we
would rather have a Kent style referral form which is a simpler form]; GDPs are unhappy to
accept the responsibility of declining patients based on IOTN unless training is available,
which needs to be funded;
• It was felt that this process my not reduce ‘Assess + Refuse’ scenarios as much as NHS
England hope.
• TH suggested the document ‘Managing the Developing Occlusion, published by the British
Orthodontic Society’. This is picture based and user friendly. It is downloadable from the BOS
website.
http://members.bos.org.uk/Portals/0/Public/docs/Making%20a%20Referral/Managing-theDeveloping-Occulusion-Updated-Apr10.pdf
5. Dental Contract and Quality Assurance Panel (DEQAP) Representation
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TH
Annie Godden wrote to the LDC inviting representation at the Area Team DEQAP meetings.
The purpose is to ensure fairness in dealing with NHS dental contracts and facilitate better
communication with the LDC's.
It is between 12-4.30pm at Tonbridge and Lewes on a monthly basis. It is normally a Tuesday
or a Wednesday.
This was taken to Channel and it was concluded that it is good to have representation at the
DEQAP meetings.
A member of each LDC, initially, will be invited as a observer.
Funding would be 2 guild rates and mileage. It could mean £6000/ year out of our budget to
fund if we attended every meeting . We would lose touch with the area team if no-one went.
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So a rolling shared program was suggested between the LDC's to reduce costs.
PM suggested that attending 3-4/year would be advantageous. MB suggested the 4 LDCs
(Kent, Surrey, East Sussex and West Sussex) attend on a rotational basis. Additionally, it
makes more sense that LDC exec members who are nearer to Lewes attend (i.e. AT/ EL). AT
volunteered for the initial period.
6. PAG Report ( performance advisory group)
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TH and PM attended.
LDC observers attend on a rotational basis with East Sussex and Kent.
The observer provides insight from a clinical dental perspective on matters arising.
It is beneficial for a GDP (from the LDC) to attend to ensure fair play.
NHS England South (South East) Update.
• Additional staff joined the area teams. Each contract manager has an assistant, to help with
workloads.
• There is restructuring at Horley, and improvements being made in the complaints team. All
dental complaints are dealt with at Horley. There has been a vast improvement in the last 6
months, and much less risk of a GDP being sent to the GDC without good reason.
• Andrew Folkes has now left.
Secretary’s and LPN Report
• Jeremy Collier,MFU Consultant from East Grinstead and East Surrey hospitals, was been
appointed the Secondary Care Representative. All very positive in attending his first LPN.
• The major issue currently is to set up the MCNs, which are moving forward but slowly.
• Oral Surgery MCN update - PM stated that the area team are trying to locate all oral surgeons
across the patch. SW received email from Amit Rai to sort out an MCN, but no further
progress has been made.
• There will be a MOS MCN for Surrey and Sussex, a Restorative MCN for Kent, Surrey and
Sussex and a Special Care MCN currently for KSS
• We are still waiting on strategic pathways on how patients move through the system.
Treasurer’s Report
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PM
MB
AT
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PM
The accounts are currently with the LDC accountant.
Due to the schedule date, the levy was not collected this month. Thus, levy has not been
collected in April, May or June schedules. Instead, there will be 9 equal payments, and the
first payments coming in on the 1st August.
We are still holding the money from Professor S. Lambert-Humble.
GDPC Report
• This meeting was held on the 11th June 2015. TH reported;
Henrick opened by discussing the variety of meetings he has been attending with the vice chairs
and executive committee. The general focus of topic has been around prototype remuneration,
Nice guidelines, contract uplift, commissioning guides, co-commissioning, contractor loss
exercise and antimicrobial resistance.
There was general disappointment over the way in which existing pilots, who have failed to be
selected to become prototypes, have been passed back into UDA based contracts. They have
been issued with “pilot exit documentation – advice for practices”, with neither the BDA nor the
national steering group even aware of its existence. This was accepted by the DoH as an
oversight. The practices can negotiate with commissioners over the withdrawal time to return to
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2006 contracts.
It is hoped that there will be about 100 prototypes with 63 pilots entering. Although there will be
two blends of prototypes, the BDA feel that blend B is the only realistic one (as blend A is too
near the existing uda 2006 contract), the suggestion of 100 capitation being trialled has been
ruled out at the moment (even though this is one being championed by the BDA). The prototype
start date is to be 1st October 2015 but with a staggered start. As of yet there is no clear criteria
for success and the DoH did not know what success looked like.
The Nice guidelines on recall were discussed and consideration was given for whether the
BDA’s Health and science committee should ask for a review. Currently the guidance is on the
static list, however consideration to transfer a clinical guidance back to the active surveillance list
can occur if new evidence is brought which may impact on the guidance. Although Nice recall is
currently a GDS contractual requirement, evidence suggests that it isn’t followed by GDPs and is
generally accepted to not be evidence based rather a political model for saving money through
decreased re-attendance. In fact the 24 month re-attendance recommendation felt to be
damaging for a patient’s health and wholly inappropriate.
The DDRB recommendation of 1.34% contractual uplift was discussed, especially the aspect
discussing the 1% to go to all dentists. This has been generally accepted to mean that all
performers should be entitled to this contract increase and GDPC will undertake a publication to
recommend that this uplift is passed on, with special consideration to corporate associates who
were unlikely to receive it without this. It was felt that although the last few years have resulted in
disappointing DDRB contract uplift and that although supposed to be an independent review
body (often thought to pander to the political desires of DoH too much), the BDA should continue
to participate in the DDRB process.
The clinical commissioning guides for orthodontics, special care dentistry and oral surgery have
been published in a final draft form and with the indication of being in a living format. However
the BDA feel that they are not fit for purpose and should not be adopted by commissioning
bodies. There were specific issues with training, of who will be in level 1 and 2, as well as the
dento-legal considerations of each tier.
Co-commissioning is starting with development of devolution of powers to greater Manchester,
this has been nicknamed DevoManc. Although details of how this will develop as sketchy, it is a
pilot of how health care provision may be handed to local commissioners, most likely Clinical
commissioning groups to handle dental provision in their wider area. This an indication of how
the 5 year forward plan may work and it is felt that LDCs should look to gain involvement with
local authorities and CCGs as well as LPNs. If DevoManc is successful there may be a shift in
power of who holds dental funding. This shift will need to be watched and LDCs positioned to
assist with commissioning from whoever is holding the purse strings.
The Business Services Authority is about to undertake a 1 million pound DoH funded contractor
loss exercise or dental activity review. The belief is that this funding will allow for a significant
clawback of funding from providers who have inappropriately claimed. If this is successful there
is all likelihood that it will be rolled out again on a different topic. This time the subject is return
visits within a 28 day period. 3 letters will be sent out, such that all providers will receive one
type. The first letter expresses what is being looked at, gives the providers score in relation to
the national average and that they are within a tolerance of this average. This will indicate that
they just need to continue to monitor what they are claiming. The second letter is for outliers who
are just beyond this tolerance and will ask them to self-audit with the view of changing their
claiming habits. The third letter will be for those beyond this, who will be advised that further
action will follow. This further action will be a request for targeted record cards to be sent to the
BSA. If these claims are felt to be inappropriate then funds will be taken back. This activity
review was strongly criticised by the committee.
The BDA have requested individual feedback to the antimicrobial resistance (AMR) push from
the DoH. It is felt that due to a lack of funding into research and development for new antibiotics
by the DOH, the only alternative to the concern over ever more resistant bacteria development,
is to dramatically reduce the use of existing antibiotics. Subsequently there is a push for the 7%
currently used through dentistry to be reduced by undertaking invasive dental tasks rather than
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prescribing. This is unlikely to be funded with extended treatment times to allow this. The GDPC
exec will be meeting with the chief medical officer to discuss this further.
The subcommittees gave their reports and these can be requested from myself, as they are
available for public distribution but are too many for inclusion in this report. Of note is that
Northern Ireland dental practice committee is exploring the desire of individually placed contracts
rather than provider place contracts (ie similar to pre-2006 contracts compared with post-2006).
This could give hope to associates in England if this gained momentum, however there is no
indication of any prototypes exploring this. In fact there is a sense that future contracts will be
focusing on fewer, much larger contracts for the benefit of simplifying commissioning and
potentially ending the small GDS contract.
Mrs Victoria Matel is a new BDA/LDC liaison officer.
Channel
• The Channel meeting was on Monday 15th June 2015.
• Minutes of the last meeting: These were previously agreed.
Kent
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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 halflife 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.
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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 2 nd July 2015.
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EL
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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.
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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.
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Part 2
A letter has been given to Annie and Richard Woolterton giving Surrey and Sussex’s concerns
regarding new information that had come to light regarding the LPN chair.
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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MB brought to the attention of the committee that MOS and Complex Restorative Contracts
are not superannuable, as the contract cannot exceed £0. However, PM stated that at the end
of the UDA year, there needs to be a manual adjustment and for providers to contact the
contracts managers Mark Ridgeway in Kent or Jill Graham to do this.
Any Other Business
• SW reported D. Mcpherson retires on the 30th June 2015. They have not recruited their body
of DFT 2’s/ SHOs yet.
• EL shared there is an LDC buying group which offers 20% discounts on subscriptions,
services to GDPs. The LDC should join the group and then all the fee paying members can
have access to the discount. EL to do more research into this and report at next meeting.
• Mary Green (MG) is to attend The BDA Southern Counties meeting where the draft
pathways will be discussed and will feed back any important information.
• TH reported that LDC elections are overdue. Officers will need re-electing. Applications
should be made on website rather than ballot papers. Will be discussed at the next main
executive meeting.
• Jill Graham has sent TH guidance for publication on the LDC website, because she has had a
number of queries from providers, relating to retention of records and the scanning of paper
records. In brief, practices can capture patient’s electronic signatures (via an iPad or
equivalent) as part of the patient declaration (PR) form but they must ensure their system
complies with the ‘Electronic Signature Anti-Fraud Standards’ document. If the signature is
captured electronically in this manner, then a paper copy version is not required. However, if
the patients signs the PR paper form, then this may be scanned onto your system and stored
electronically, but the original paper form must be stored. The retention period for patient
records remains the same. For more information, providers are directed to the link on the LDC
website.
Date and Venue of Next Meeting
The next full meeting is 16th September 2015 at the Roundabout Hotel, West Chiltington.
Date and venues of 2015 meetings
Exec 4.30 pm
LDC Main 6.30 pm
Wed 15th July 2015
Wed 14th October 2015
Wed 9th December 2015
Wed 16th September 2015
Wed 18th November (AGM)
Wed 24th February 2016
Agreed by the committee on 12th June 2015 and signed by the WSLDC Chair
at the meeting.
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