Download SH and H/ER Orthodontic MCN Meeting Notes Castle Hill Hospital

SH and H/ER Orthodontic MCN Meeting Notes
Castle Hill Hospital 230414
Present: Constance Pillar; Jane Ollerton; Sally Eapon Simon
Simon Hearnshaw
Joe Neal
Cherie Davis; Jon O’Dwyer; Anne-Marie Isaac; Ross Paton
Apologies: Mike Heanue; Phil Sims; Ken Dobbs
Minutes of last meeting were agreed
AT has, I believe, issues with: Long waiting lists; inappropriate referrals; quality
control.
JN is still unhappy re the Hub-and-Spoke referral system: who is responsible for
treatment? Is it the practitioner carrying it out or the specialist providing the treatment
plan? RP thought it was the practitioner CP stated that BOS felt responsibility lay
with the prescriber.
AT are, in co-operation with Cherie Davis, developing a patient information leaflet,
explaining why there is a long waiting list for orthodontic treatment ( Ms Davis has a
5 year waiting list) referring to funding constraints. Letters will be sent to patients
inviting them to attend more geographically appropriate practices for their orthodontic
treatment.
RP commented that some Grimsby patients found it financially difficult to travel the 8
miles to Immingham.
CP observed that demand will meet capacity.
SES wishes to support CDs waiting list using DwSI. However, funding, not delivery is
a problem. It was agreed to write to the DwSIs to identify if they had spare capacity.
JO’D observed that given these contracts were relatively small, little spare funding
could be generated.
JN is dropping a session per week. His case starts will drop from 600 to 350 per
annum
SES suggested a working group, as part of the LDN, to look at the following:
Publishing Validated Waiting Lists to allow patient choice to travel where appropriate
Training esp DwSI and therapists
Inappropriate Referrals Audit
Communication
Validated waiting lists would be complied and published quarterly, with data
collection by the ortho practitioners. LDC websites could be used to inform GDPs of
practices with shorter waiting lists.
A standard protocol for urgent cases, for example where growth could be a factor in
successful orthodontic treatment might need to be formulated. ? how are the other
LANs doing this? CD asked who would monitor this triage.
Inappropriate referrals were discussed, with perhaps inviting practitioners to a
learning event. RP suggested using BSA data capture retrospectively to identify this
extent . SH wants additionally a prospective audit by practitioners to identify WHY
referrals as inappropriate. CP stated that Brian Kelly, the BSAs Ortho DRO, quoted
10% of cases as “assess and refuse treatment”.
The AT now receives dipping reports from the BSA. Only one practitioner had been
red flagged and Alistair Weightman, the DPA, has reviewed this case. RP felt it
would be useful to know the BSAs “marking scheme” to avoid potential
administrative difficulties. Brian Kelly has delivered a talk on such matters as part of
CPD in the past and JO will approach him to consider his giving another lecture.
RP: “Does the AT have any issues with quality?”
CP: “No”.
CP is looking at the transitional framework to extend the length of contracts, without
having to re-tender. This was an interesting discussion, involving legal challenges
potentially. CP stated that a PDS contract could only be rolled over once without
retendering. EU law was quoted. CP observed that PMS contracts were being
extended to 10 years and that dentistry often followed where medicine leads.....
The AT has certainly learned from past experience in contract discussions. For
example, they will certainly consider wind-down clauses in the contracts now. SH
could not see any benefit in putting contracts out to tender if AT had no issues with
them.
CP informed us that she sits on the GDS Contract Reform Committee and that things
on this front were “quiet”.
The next meeting of this committee was arranged for 10th September, with CP
hoping that work could be done virtually in the meantime and SES calling for a LDN
subgroup to analyse waiting lists, inappropriate referrals, training, and an urgent
treatment protocol established if it is found to be necessary.
Patients referred to practices with high waiting lists should be referred elsewhere
where appropriate, with AT becoming more relaxed re boundaries.
A restorative dentist may be required to restore post ortho: JO’D highlighted the
potential difficulty if, for example, there is no one prepared to place an adhesive
bridge after space has been created orthodontically.
The orthognathic surgery protocol is being re-drafted.