Download Minute 26 February 2014

Assynt House
Beechwood Park
Inverness, IV2 3BW
Telephone: 01463 717123
Fax: 01463 235189
Textphone users can contact us via
Typetalk: Tel 0800 959598
www.nhshighland.scot.nhs.uk
MINUTE of MEETING of the
HIGHLAND AREA DENTAL COMMITTEE
Board Room, Assynt House,
Inverness
26 February 2014 – 6.30 pm
Present:
Mr Colin Crawford, (Chair)
Mr Neal Drummond, GDP
Mr Malcolm Jones, Dental Practice Advisor
Mrs Catherine Lush, Clinical Dental Director
Mr Gordon McGovern, GDP
Mr Gregor Muir, GDP
Mr Duncan Railton, Associate Specialist
Mr Stuart Robb, Dental Practice Advisor
In Attendance:
Mr David Babb, Senior Dental Officer
Dr Manar Elkhazindar, Consultant in Restorative Dentistry
Mrs Alex Fraser, Dental Services Manager
Mr Brian Mitchell, Board Committee Administrator
Dr Ken Proctor, Associate Medical Director (Primary Care)
1
APOLOGIES & WELCOME
An Apology for absence was received from Elizabeth Reilly.
2
MINUTE OF MEETING HELD ON 27 NOVEMBER 2013
The Minute of the meeting held on 27 November 2013 was Approved subject to the
following amendments:
Page 3, Item 4.2 – Amend to read “Duncan Railton advised that Kevin Sanders had left
the service to return to an orthagnathic post in Manchester and discussions are ongoing
within the North of Scotland Planning Group as to how to redesign the service with
particular reference to On Call, and Oncology services and the transfer of cases to
Grampian for formal treatment when appropriate. The need for collaborative working
patterns between OMFS and ENT to help manage head and neck Oncology cases was
being discussed. It was advised that all referrals should continue as normal with GP
referrals being received electronically and GDP referrals remaining paper based. “
Page 3, Item 4.3 – Amend to read “There was brief discussion relating to the Treatment
Time Guarantee, in addition to the 18 Week Referral To Treatment pathway. It was
advised additional locum staff had been employed, with Mr Sanders having left, to help
prevent patients breaching.”
3
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.
3.3
Letter to Chief Dental Officer on Mouthguard provision
Mr Mitchell advised a response had been received from the Chief Dental Officer, the detail
of which would be considered by the Committee Chair.
The Committee so Noted.
4
PRIMARY CARE DENTAL STRATEGY GROUP
Mr Babb advised that the first meeting of the Primary Care Dental Strategy Group had
taken place on 20 January 2014. There had been circulated a copy of the relevant Group
Role and Remit along with a copy of the letter dated 23 December 2013, from the Chief
Dental Officer and Director Finance, eHealth and Pharmaceuticals, outlining the main
requirements of the integrated service and financial plans on the Public Dental Service
that NHS Boards were required to submit to the Scottish Government.
Mr Babb went on to give a presentation to members relating to Oral Health in Highland - A
Preliminary Assessment of Care Needs, this having been carried out following publication
of the Annual Report of the Chief Dental Officer 2012 “A Picture of Scotland’s Oral Health”
which stated that a key priority was to reduce oral health inequalities while promoting oral
health improvement for all. The presentation went on to provide relevant statistical data
relating to changes in the estimated percentage of population registered with a GDP
between 2009 and 2012, and a breakdown of that between various age groups. There
was also data provided in relation to evidence of dental decay in children of Primary 1
age, those adults with no teeth in both the least and most deprived areas as detailed by
the Scottish Health Survey (2008), and issues relating to people who were designated
homeless. That survey had indicated that issues evidenced in Care Homes related to
appropriate access to advice, access to emergency dental care, and training for staff.
Survey results were also outlined for the prison and housebound populations. It was
indicated that treatment of special needs groups was often more complex and time
consuming than routine treatment and as patient expectation rises there is a growing need
for appropriately equipped and accessible dedicated dental care facilities. In addition
those who have difficulty in accessing care, for whatever reason, should have the same
opportunities as others to enjoy good oral health. Concern had been expressed that
mainstreaming people with a disability could result in neglect and that optimal benefits
arise from a mix of both mainstream and dedicated services, with access to specialist care
when required. In this regard relevant priority groups relating to children and young
people, socially excluded and special care were listed. Mr Babb went on to give a number
of examples of where a successful multi-disciplinary care approach had been taken and
how this can provide real benefit to patients.
There followed discussion, during which there was agreement that reliance on statistical
data was not always advisable, as this can mask or omit a number of variables. It was
also suggested that adoption of a frailty index would be more appropriate than
consideration of age when looking at a number of aspects relating to care access needs.
2
All agreed the needs of special care patients can vary enormously and a multi-disciplinary
approach was very beneficial. It was stated clinical skills training for relevant staff was
one of many elements that should be considered in relation to this client group and a
range of other ‘soft skills’ such as communication had to be involved. A patient–centred
care approach was important and this was reflected in the Highland Quality Approach now
being adopted within NHS Highland. The Primary Care Dental Strategy Group would
need to consider all these matters, in partnership, and in a proportionate manner.
After discussion, the Committee Noted the position in relation to the Primary Care
Dental Strategy Group.
Mr Babb left the meeting at 7.50pm
5
NEW PUBLIC DENTAL SERVICE
5.1
Short Life Working Group on Anti Coagulants
Mrs Lush advised that the outcomes from the Working group would be discussed at the
meeting of the Dental Clinical Governance and Risk Management Group in June 2014.
The Committee so Noted.
6
AREA CLINICAL FORUM – RESPONSE TO THE FRANCIS REPORT
Members had noted that at the meeting of the Area Clinical Forum held on 28 November
2013 it had been agreed that a response to the Francis Report be requested from all
Professional Advisory Committees for collation and presentation to the NHS Board as a
considered document. There had been previously circulated response template for
consideration members, along with a copy of the response which had been received from
the Area Optometric Committee. There had also been circulated, for information, relevant
BDA Brief relating to the Francis Report.
During discussion, there was recognition that dentistry comprised a series of differing
service groups, each with their own particular processes and concerns. It was
emphasised that consideration of the Francis Report and the issues it raised were
common in that it was about ensuring that all staff, at all levels, have the ability and
confidence to raise issues in relation to which they have genuine concern and are
supported to do so. The needs of the patient must be paramount and in some cases the
patient themselves would not know if there was an issue or concern.
After discussion, the Committee:


7
Agreed the Committee Administrator share examples of consideration of this matter at
other NHSH Professional Advisory Committees.
Agreed members consider relevant issues and provide comment to the Chair for
collation into a formal response to the Area Clinical Forum.
AREA CLINICAL FORUM DEVELOPMENT PLAN 2013/2014
There had been previously circulated a Development Plan, as agreed by the Area Clinical
Forum, in relation to which Professional Advisory Committees had been asked to consider
3
and take forward. Members, having considered the Development Plan, agreed that the
Committee in the first instance should receive Area Clinical Forum Minutes and Action
Plans from relevant meetings. In terms of actions for Advisory Committees it was noted
that matters of clinical and strategic concern should be escalated to the Area Clinical
Forum. In addition, all Area Clinical Forum members, including those representing
Advisory Committees, should proactively contribute agenda items to future meetings.
The Committee:


Noted the Development Plan and contribution required by Area Clinical Forum
members representing Professional Advisory Committees.
Agreed that the Committee receive the Minutes and Action Plans from meetings of the
Area Clinical Forum.
8
ANNUAL REPORT OF THE CHIEF DENTAL OFFICER 2012
There had been circulated relevant Annual Report ‘A Picture of Scotland’s Oral Health’,
for information, and members noted this acknowledged the work undertaken at NHS
Board and community level in improving the overall oral health position in Scotland.
The Committee Agreed that members share the report with their respective teams.
9
DECONTAMINATION
There were no matters discussed in relation to this Item.
10
OUT OF HOURS SERVICE
Mrs Lush advised production had begun in relation to the Third Annual Report for the Out
of Hours service, the proforma for which was being piloted. She advised routine feedback
on patient treatment, and formal record keeping in relation to the same, would be a
recommendation in the report. Mr Crawford stated issues existed in relation to Out of
Hours payments under the new contract arrangements, and employment of Independent
Practice Nurses. Mrs Lush advised matters should be raised with CHP management.
The Committee:


Noted the position in relation production of the Third Annual Report for the Out of
Hours service.
Noted the Final Report would be submitted to the next meeting.
11
HOSPITAL SERVICES
11.1
Orthodontic
The Committee were advised the proposal to establish an Orthodontic Practice in Elgin
would no longer be proceeding, with an associated impact on planning arrangements
within the Highland area. Mr Chris Buchanan was considering the option for employing a
4
further Orthodontic Practitioner. As previously advised two recently trained Orthodontic
Therapists continued to work well.
The Committee so Noted.
11.2
Maxillofacial
Duncan Railton advised that with only one Consultant Maxillofacial surgeon in Raigmore
at this time there were significant service pressures, with particular issues around
provision of Oncology services. NHS Grampian continued to provide services to Highland
patients when appropriate, but their own service was also under pressure at this time. It
was advised that Siobhan Reilly had been engaged as a full-time Oral Surgeon.
Mr Railton referred to discussions about transfer of more straightforward oral surgery case
from the acute sector into the primary care setting in accordance with current practice
elsewhere in the UK. This will hopefully allow these cases to be managed more quickly
and relieve waiting list pressures in the acute setting freeing up clinical time for more
appropriate cases. There was a need to reduce the number of inappropriate referrals
being received. Mr Muir advised that in the Primary Care setting this service was
provided by Practitioners with Special Interest. Mrs Lush stated that any new process
should be appropriately agreed, and also considered by the Dental Clinical Governance
and Risk Management Group. It was emphasised the aim was to ensure that appropriate
care was delivered in the most appropriate place and it was confirmed that Mr C Hope
was leading on relevant service development activity.
The Committee:


Noted the position.
Agreed any service development proposals be appropriately considered and agreed.
11.3
Restorative
There had been circulated, for comment, Referral Guidelines and Forms (2014) for the
North of Scotland Restorative Dentistry Network NHS Highland Service. It was noted that
the role of the Restorative Dentistry Department is to provide a diagnostic, treatment
planning and advice service to referring practitioners and to carry out specialist level
treatment where appropriate. On the point raised, Dr Elkhazindar advised she did not
anticipate service expansion in the near future and that it was hoped the circulated
Guidelines would encourage greater activity in the Primary Care setting. Current issues
within the Restorative service included aspects relating to staffing levels, instrument
sterilisation and laboratory support arrangements.
The Committee Noted the 2014 Referral Guidelines and Forms.
12
DENTAL CLINICAL GOVERNANCE AND RISK MANAGEMENT GROUP
12.1
Minute of Meeting held on 4 December 2013
The Committee Noted the circulated minute.
5
13
FOR INFORMATION
There were no matters considered in relation to this Item.
14
ANY OTHER BUSINESS
14.1
Repeat Prescription for Fluoride Tablets
Mr Drummond advised that an issue existed whereby the Formulary included repeat
prescriptions for fluoride tablets, although these were not currently available.
The Committee Agreed this point be investigated further.
15
DATE OF NEXT MEETING
The next meeting of the Area Dental Committee will be held on 28 May 2014, in the Board
Room, Assynt House, Inverness.
The meeting closed at 8.50pm
6