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Draft MINUTE of MEETING of the
HIGHLAND AREA DENTAL COMMITTEE
Centre for Health Sciences, Raigmore
Hospital, Inverness
25 April 2012 – 6.30 pm
Present:
Mr Adrian Hart, Chair
Ms Kay Ballantyne, Salaried GDP
Mr Neville Bo, GDP
Mr Colin Crawford, Senior Salaried GDP
Mr Neal Drummond, GDP
Mr Hamish Isaac, GDP
Mrs Catherine Lush, Clinical Dental Director
Mr Gregor Muir, GDP
In Attendance:
Mr Tom McWilliam, Deputy Clinical Dental Manager (from 6.45pm)
Mr Brian Mitchell, Board Committee Administrator
Dr Ken Proctor, Associate Medical Director (Primary Care)
Mr Stuart Robb, Dental Practice Advisor
Mr Duncan Railton, Associate Specialist
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APOLOGIES & WELCOME
Mr A Hart welcomed attendees to the meeting and advised an earlier separate meeting
with GDP nominees had taken place. There had been agreement to establish a GDP Sub
Committee, Chaired by Mr H Isaac, with four representative members attending meetings
of the Area Dental Committee.
Apologies for absence were received from Alex Fraser, Linda Garwood, Gordon
McGovern, Iain McIntyre, and Elizabeth Reilly.
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MINUTE OF MEETING HELD ON 31 AUGUST 2012
The Minutes were Approved subject to the following amendments:
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
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Page 4, Item 5.3, Line 4 – Amend to read “… in partnership with NHS Grampian.”
Page 5, Item 7, Line 3 – Amend to read “…leading work programme activity on this…”
Page 5, Item 7, Line 4 – Amend to read “…stem root caries…”
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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
Dental Committee Annual General Meeting
Mr A Hart advised that an Annual General Meeting (AGM) of the Committee had been
held on 4 November 2011 following which the current Committee election process had
been undertaken.
The Committee so Noted.
3.3
GDP Sub Committee Update
Mr A Hart advised that at their earlier meeting those GDPs present had agreed to
establish a GDP Sub Committee of the Area Dental Committee. This would be chaired by
Mr H Isaac and the Vice Chair role would be undertaken by Mr G Muir. An appropriate
Constitution document would be developed, based on the NHS Grampian model. Four
members from this Sub Committee, including the Chair and Vice Chair, would be
members of the Area Dental Committee.
The Committee Noted the position.
3.4
Appointment of Committee Office Bearers and Representatives to Area
Clinical Forum and Dental Clinical Governance and Risk Management Group
Mr A Hart advised he was to stand down from the Committee after this meeting and that
Mr D Railton had been nominated to fill the position for a Hospital Dental Officer. Mr
Railton would attend the next meeting of the Area Clinical Forum. Dr Proctor took the
opportunity, on behalf of the Committee and NHS Board, to thank Mr Hart for his
Chairmanship of the Committee over a number of years.
Mr G Muir, seconded by Mrs C Lush, moved that Mr C Crawford be appointed Area
Dental Committee Chair. There being no counter proposal the Motion was carried.
In relation to the remaining positions, after discussion, there was agreement that decision
in relation to these be held in abeyance pending agreement of GDP representation.
The Committee:
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
3.5
Agreed to appoint Mr C Crawford to the role of Area Dental Committee Chair.
Agreed to delay appointment to the remaining positions until the next meeting.
Reimbursement of Local Authority Business Rates
There had been circulated report outlining the detail of conditions of entitlement, amount
of reimbursement, and claims for reimbursement in relation to non domestic rates
allowance; and additional information relating to valuations for Rent Allowance. It was
noted any relevant queries may be directed to Mrs A Fraser, Dental Service Development
Manager. Mr G Muir raised the issue of reclamation of relevant VAT and was advised this
could be reclaimed in relation to rent, up to the stated agreed rateable value only.
The Committee Noted the position.
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DECONTAMINATION
Mr S Robb advised there had been two meetings of the Decontamination Group since the
last Area Dental Committee meeting in August 2011. There had been discussion in
relation to meeting the relevant compliance deadline of end December 2012. The Chief
Executive had requested an update on the current position given that NHS Highland was
the contracting organisation for NHS Dental Services. It was stated that Mrs A Cosh was
to visit all relevant dental practices to monitor respective arrangements and report back to
the Decontamination Group as appropriate. Practices should have completed relevant
Level 2 training prior to inspection. Mrs Cosh would provide a professional view on
whether existing risks are considered acceptable. On the point raised with regard to
relevant required Standards, it was stated that there was a prevailing view among a
number of practitioners that these were being applied more rigorously in Highland than in
other NHS Boards in Scotland. Standards were interpreted initially by the Chief Dental
Officer, then by individual NHS Boards and as such can result in variances being agreed
at a local level. The Chief Dental Officer had been requested to advise as to the
implications of non-compliance and Mr C Crawford stated that the initial indicative
Ministerial view was that additional advice and training would be provided as necessary.
Mrs C Lush advised this issue had been raised at a Quality in Dentistry meeting and it
was her understanding decontamination compliance would be undertaken as part of the
proposed combined inspection programme. A small group of DPAs was to be established
to consider relevant inspection regimes as it was important that these be consistent prior
to any associated sanctions relating to compliance being considered. Mr G Muir
suggested that NES, who provided training and support, be involved in the inspection
regime and it was stated that Ken Scoular and his team link into the work of Mrs A Cosh
as required. Relevant training would be aligned accordingly. Mr S Robb emphasised the
new practice inspection document would be the main driver.
Mr C Crawford stated the main issues appeared to be in relation to interpretation of
requirements and associated advice given to practitioners in Highland. Dr K Proctor
stated that evidence would be required if it were to be argued that NHS Highland was
interpreting guidelines in a more restrictive manner than other NHS Boards in Scotland. It
was stated Highland was in a strong position with regard to overall level of compliance
and Mrs A Cosh should be recognised for her work in helping achieve the current position.
The Committee:
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
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Noted the position.
Agreed that Mrs A Cosh, Mr K Scoular and Dr E Watson be invited to attend a future
meeting to discuss the relevant issues involved.
HOSPITAL SERVICES
5.1 Maxillofacial
Mr A Hart advised a second maxillofacial surgeon had now been appointed and was in
post, working two days per week in Elgin and three days in Highland. The appointment of
a second surgeon had assisted greatly with relevant ‘On Call’ arrangements.
The Committee Noted the position.
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5.2 Orthodontic – GDP Treatment letter and Referral Form
Mr Hart spoke to the circulated letter and associated referral form relating to hospital
orthodontic services in Highland. The letter gave an update to GDPs on the position in
Highland, referenced a Chief Dental Officer letter relating to the Index of Orthodontic
Treatment Need (IOTN), and gave guidance in relation to criteria for referral of orthodontic
patients. In terms of hospital services, Mr Hart advised that two Orthodontic Therapists
were currently in training and that a number of evening clinics were being operated under
the Waiting List Initiative. It was advised that the waiting list for specialist treatment was
impacting on overall capacity levels, the result of which was that cases designated as
straightforward are referred to Mr C Buchanan. On this point, the view was expressed
that a degree of triage would help GDPs decide on referral and that better communication
with referring GDPs would be of benefit. Mr Hart further advised that interest had been
expressed in relation to establishing new provision in the Highland area although no firm
commitment had yet been made, that access grants were available, and that Mr
Buchanan was seeking to recruit more staff. There was reference to the potential for
encouraging Specialist Practitioner recruitment under the Scottish Dental Access Initiative
and this may allow the release of capacity within the Hospital Dental service for the
Caithness area. It was stated there was need to initially establish where the existing
service pressure points were.
After discussion, the Committee:
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
Noted the position.
Agreed an assessment of current geographical dental service issues be brought to
the next meeting.
5.3 Restorative
Mrs C Lush advised that following the preparation and consideration of an appropriate
clinical risk document agreement had been given to the development of a business case
for the establishment of a Consultant Restorative Dentist position in partnership with NHS
Grampian. This matter was to be the subject of further discussion with the North of
Scotland Planning Group. It was emphasised that any proposal would require to be
formulated within existing budgetary constraints.
The Committee Noted the position.
5.4 18 Week RTT
Mr A Hart advised that the Maxillofacial service was operating within target and that
Orthodontic services were now 80% compliant. Both services were reported to be
compliant within Argyll and Bute CHP. On the point raised, with regard to advice to GDPs
in relation to referrals, Mr Railton stated this was given on a case by case basis and that
Mr K Sanders was assisting in a review of current advice.
The Committee Noted the position.
The Committee agreed to consider the following Item at this point in the meeting.
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SDS REFERRALS – SINGLE RESOURCE PACK/DENTAL REFERRAL HUB/
MAXIMISING ACCESS
Mr T McWilliam spoke to the circulated NHS Highland Salaried Primary Care Dental
Services Referral Pack of referral guidelines and protocols, which had been produced to
provide a clinical framework to support practitioners when making referrals. The pack
included general information and guidelines to support health and social care practitioners
in making quality referrals within the North Highland area. It was stated all referrals
should be addressed and directed to the Dental Helpline where they are to be triaged and
forwarded to the appropriate care site.
The referrer would receive an early
acknowledgement of receipt of the referral. In order to support the referral process an
appropriate form had been produced, including for anxious child referrals for consideration
by General Anaesthetics. There was an intention to develop an electronic system for
accepting referrals however at this time these should be submitted by mail or fax. On the
point raised, Mr McWilliam agreed that relevant clinicians could be named in the
documents should that be requested. He added that inclusion of a printed medical history
would be beneficial when assessing referrals and that electronic signature is acceptable.
During discussion, it was confirmed that there was appropriate communication where a
patient was referred back to the original referring clinician, and that establishment of an
electronic referral template would be investigated. Mr C Crawford advised there had been
recent consideration of salaried service referrals in Argyll and Bute CHP and requested
the circulated document be utilised for application in that area, subject to minor
amendment. This was agreed. On the point raised it was advised that triage would be
conducted at clinic level and in line with existing mapped Clinical Pathways. Mr A Hart
referred to Section 3.3 relating to Surgical Dentistry, where there was reference to
patients being potentially referred on to secondary care services, and requested this be
more explicit. It was stated this particular point was to be followed up accordingly. Mr N
Bo requested that contact details for NHS Grampian also be included in this document
and this was agreed. Mr McWilliam added that he would forward the relevant NHS
Grampian referral pack, and confirmed that secondary referrals from Highland can also be
provided, if required.
After discussion, the Committee Noted the circulated documentation.
Mr T McWilliam left the meeting at 8.25pm.
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DENTAL OUT OF HOURS SERVICE ANNUAL REPORT SEPTEMBER 2009 –
MARCH 2011
Mrs 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 Annual Report
had been considered by the Dental Out of Hours (OOH) Project Steering Group and
relevant progress on these was outlined. It was advised that the service capacity in
Inverness had been reduced as indicated 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, the development of a service for HMP Prison Porterfield, continuation of crossboundary arrangements, and contingency for non-sustainable rotas. Mrs Lush added that
work was ongoing with regard to the Clinical Effectiveness Programme, and also on
antimicrobial prescribing matters. With regard to the interface between NHS24/SEDS and
NHS Boards, it was advised that patients under the age of sixteen, with trauma, would
now be considered under the relevant emergency care pathway. An appropriate briefing
paper would be issued. The Dental Clinical Governance and Risk Management Group
were to discuss issues relating to potential service pressures. The Annual Report had
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concluded that the integrated Dental OOH service was a sustainable service delivering
guaranteed access to patients based on clinical need. Mr C Crawford requested that
there be greater consistency as to the information provided by North Highland, and Argyll
and Bute CHP, within their respective Annual Reports so as to allow appropriate
comparison and it was advised this point was being discussed with the Argyll and Bute
CHP General Manager.
After discussion, the Committee Noted the Dental Out of Hours Annual Report
2009/2011.
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COMPLAINTS MANAGEMENT
There was no discussion under this Item.
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CHILDSMILE FLOURIDE VARNISH SURVEY
Mr G Muir stated that the national survey had raised a number of issues, this point being
echoed by Mr C Crawford.
The Committee Agreed the Chief Dental Officer be advised as to the relevant issues.
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CLINICAL ADVISORY GROUP – OUT OF AREA REFERRALS
The Committee was advised the NHSH Clinical Advisory Group (CAG) had been
established to provide clinical advice to the Senior Management Team (SMT) on the
introduction of non-pharmacological health technologies, and advice on the
appropriateness of requests to refer patients to healthcare facilities outwith NHSH for
assessment, investigation and/or treatment (Out of Area requests). Mr A Hart advised
that all referrals for Out of Area Care were now considered by CAG, including for
dentistry.
The Committee Noted the position.
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SCDEP COMBINED PRACTICE INSPECTION PILOT
Mr S Robb advised that the Chief Dental Officer had been anxious to roll out the
combined inspection pilot. This was to be conducted in association with NES. The matter
was included on the dental risk register. He advised the inspections were still subject to a
pilot exercise at this time and had raised issues, including in relation to Vocational
Training. Ms C Lush stated feedback on the pilot to date had highlighted training needs
for both practitioners and inspectors, for instance in relation to IRMER requirements.
The Committee Noted the position.
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DENTAL CLINICAL GOVERNANCE AND RISK MANAGEMENT GROUP
12.1
Minutes of Meetings held on 4 August and 3 November 2011, and 16
February 2012
The Committee Noted the circulated Minutes.
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FOR INFORMATION
13.1
LDU Advice Service
13.2
CEL01(2012) Health promoting Health Service: Action in Hospital Settings
13.3
SDNAP Report into Restorative Dental Services
13.4
Report on Chlorhexidine Anaphylaxis
The Committee Noted the circulated documents
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ANY OTHER BUSINESS
There were no matters raised under this Item.
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DATE OF NEXT MEETING
The next meeting of the Area Dental Committee will be held on 13 June 2012, a venue for
which will be confirmed by the Committee Administrator.
The meeting closed at 8.40 pm
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