Download Minute 27 August 2014

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MINUTE of MEETING of the
HIGHLAND AREA DENTAL COMMITTEE
Board Room, Assynt House,
Inverness
27 August 2014 – 6.30 pm
Present:
Mr Colin Crawford, (Chair)
Mr Neal Drummond, GDP
Mrs Catherine Lush, Clinical Dental Director
Mr Gregor Muir, GDP
Mr Duncan Railton, Associate Specialist, Raigmore Hospital
In Attendance:
Mrs Alex Fraser, Dental Services Manager
Mr Malcolm Jones, Dental Practice Advisor
Mr Tom McWilliam, Assistant Clinical Dental Director
Brian Mitchell, Board Committee Administrator
Dr Ken Proctor, Associate Medical Director (Primary Care)
Mr Stuart Robb, Dental Practice Advisor
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APOLOGIES & WELCOME
An Apology for absence was received from Gordon McGovern and Elizabeth Reilly.
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MINUTE OF MEETING HELD ON 28 MAY 2014
The Minute of the meeting held on 28 May 2014 was Approved subject to the following
amendments:
Page 3, Item 6, Line 15 – Amend to read “...to create capacity for inequality groups all ...”
Page 3, Item 6, Line 21 – Amend to read “…,an informal dental Designated Patients
Scheme…”
The Committee agreed to consider the following Items at this point in the meeting.
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ORAL SURGERY REFERRAL PACK
Mr McWilliam spoke to the circulated NHSH Public Dental Services Referral Pack, issued
in June 2014, incorporating reference to referral services and flowcharts, Patient
Information Leaflets, referral forms and associated Guidance. It was noted key changes
had been made in response to considerations of those both in and outwith the service in
relation to avoiding treatment delay, providing a consistent point of referral, and enabling
appropriate service monitoring and audit against appropriate Key Standards. Those key
changes had included those in relation to the Referral Pathway for Primary Care oral
referrals, and notification of the change in relation to the location of bariatric treatment
service provision. It was noted the first service Annual Report, for 2012/13, had been
published and considered by the Senior Management Team.
During discussion, Mr McWilliam advised the 2013/14 Annual Report was in preparation
and this would indicate an increase in referrals, including from GDPs. GMP referral levels
were improving and there were a steady number of referrals from hospital services. On
the issue of access for those otherwise unable to access GDP services, this was being
considered as part of the Primary Care Strategy Review. There was reference to version
control in relation to the various referral forms and documents, and Mr McWilliam agreed
to consider annotating these for ease of reference as well as establishing if these were R4
compatible for use by GDPs.
After discussion, the Committee:
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Noted the circulated Oral Surgery Referral Pack.
Agreed consideration would be given to annotation of referral documentation in
relation to appropriate version control.
Noted clarification would be sought as to R4 compatibility of documentation.
RECRUITMENT OF PATIENTS FOR THE TEACHING WING
Members had noted that the previously considered Oral Surgery Referral Pack had
included an NHSH Student Referral Form and Inverness Dental Centre (IDC) Student
Wing Patient Leaflet. It was reported that Undergraduate Trainees provided a range of
Perio-Dental and Restorative treatments, and would welcome referrals from General
Dental Practice especially in relation to children as well as restorative treatment. Any
referrals should include as much detail as necessary to enable consideration for treatment
and in this regard issues relating to future use of the SCi Gateway were being considered.
There followed discussion as to how best to increase the level of referral to the IDC
Student Wing for treatment and a number of suggestions were made including inclusion of
an article in the next NHS Highland Newsletter and DPA Bytes publications, flyers for
students attending University of the Highlands and Islands (UHI), and consideration of an
article within “Scottish Dentists” and “Dentist Scotland” publications.
The Committee otherwise Agreed that active recruitment of patients for the Teaching
Wing be undertaken, including as per the suggestions made during discussion.
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MATTERS ARISING
5.1
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.
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5.2
OMFS – CBCT Services
At the meeting held on 28 May 2014 the Committee had agreed to write to the Chair of the
Clinical Advisory Group (CAG) seeking clarification of the decision relating to stopping
referrals of patients to Dundee requiring CBCT and emphasising the need for this form of
imaging in appropriate cases. There had been circulated response from the Director of
Public Health and Health Policy.
Mr Railton advised that although specific patient groups could still be referred for CBCT
imaging (mandibular third molars requiring extraction that are in intimate association with
the inferior dental nerve and molar furcational defects) there remained many other clinical
situations where CBCT was indicated where CAG would not support onward referral. The
Scottish Health Technologies Group (SHTG) document cited by CAG was described as
narrow in its remit only dealing with hard tissue pathology and so excludes cases such as
dental implant assessment. He believed CBCT should be an imaging modality that is
available to more patient groups than was now the case. He raised concerns that there
had been inevitable delays in imaging being sanctioned and that this constituted poor
patient care.
There followed discussion, during which it was emphasised that the Clinical Advisory
Group could only take decisions based on available evidence, not associated costs, and
on this point the validity of the Scottish Health Technologies Group (SHTG) evidence, as
opposed to that of SedentexCT was questioned. It was noted the Dental Clinical
Governance and Risk Management Group (DCGRM) had also discussed this matter and
had agreed the views of the Scottish Dental Clinical Effectiveness Programme (SDCEP)
be sought. DCGRM had also raised the issue of governance in relation to image
interpretation and it was suggested that Section Criteria for Radiography guidance may be
of interest in this area.
The Committee:
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Noted the circulated response from the Clinical Advisory Group Chair.
Agreed to express concern that the expressed CAG decision would limit treatment
assessment options for patients.
Agreed further discussion be held with the Public Health Scientist regarding
appropriate evidence for CBCT services.
Mr T McWilliam was asked to leave the meeting for the following Item.
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COMMITTEE MEMBERSHIP
Members had been previously advised that there were two vacancies in relation to
Committee membership, one each for a Salaried and Independent GDP Practitioner and
had been asked to consider submitting nominations. It was noted that one nomination
had been received from the GDP Sub Committee in relation to Ms L Garwood. The Public
Dental Service would be requested to make a similar nomination in relation to the vacancy
for a Salaried Practitioner.
The Committee:


Agreed to co-opt Ms L Garwood into the vacant GDP position.
Agreed to invite nomination from the Public Dental Service in relation to the vacant
Salaried Practitioner position.
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Mr T McWilliam rejoined the meeting at this point.
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PRIMARY CARE DENTAL STRATEGY UPDATE
Mrs Lush spoke to the circulated SBAR briefing paper in relation to a Framework for rebalancing Primary Dental Care Service Providers and sought the views of members. This
re-balancing was to reflect the Scottish Government Policy that, wherever possible, the
independent contractor dentist is the preferred vehicle for the delivery of primary care
dental services. The aim was to build on the strengths of each provider model to ensure
accessible and sustainable services are in place for all; including priority groups and
deprived and remote and rural communities through the PDS. The circulated document
set out the assessment of issues relating to a re-balancing of providers and it was stated it
had been estimated that a PDS presence would be required in all localities to meet the
potential needs of approximately 20% of the population. Any shortfall in relevant funding
would become a further cost pressure for the NHS Board. The exact number of patients
impacted by re-balancing was unknown and would vary from location to location. In terms
of planning for equitable, sustainable, affordable and accessible primary care dental
services, there was a need to agree a set of parameters and proposals for these were
outlined in detail in the circulated document. Mrs Lush further advised no decision had yet
been made in relation to movement of patients. Matters relating to appropriate
engagement were being discussed with the Head of Public Relations and Engagement.
During discussion, it was confirmed that the proposed approach would differ between the
North Highland and Argyll and Bute areas, with the proposed integrated Body Corporate
in the latter area being subject to an appropriate Outcome Agreement with NHS Highland
in relation to implementation of any agreed model of care. Mr G Muir referred to support
for PDS dentists wishing to become GDP practitioners and was advised PDS practitioners
could request relevant support from the NHS Board to enable a lease of premises etc
however it was emphasised that as a rule the NHS Board did not support single-handed
practice. All relevant options around such issues had yet to be fully scoped. It was noted
that one of the agreed proposed parameters for the planning of services was that all
patients should have a choice of GDP provider wherever possible, and it was emphasised
that again market forces would be allowed to prevail wherever possible.
Mrs Lush advised that the circulated document was for discussion and comment at this
stage and that once relevant parameters had been agreed there would be consultation
with relevant Independent Contractors, public/patient representatives, stakeholders etc.
The paper was not for wider discussion at this stage.
After discussion, the Committee
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
Noted the circulated proposed Framework for re-balancing Primary Dental Care
Service Providers.
Noted relevant comments should be relayed to Mrs C Lush or Mr N Drummond.
Mr T McWilliam left the meeting at this point.
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DECONTAMINATION
There were no formal matters discussed in relation to this Item.
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OUT OF HOURS SERVICE
There had been circulated Third Annual Report for the Out of Hours Service 2011/13
which had been previously ratified by the Dental Clinical Governance and Risk
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Management Group. The Report incorporated a service review and summary of
developments as well as challenges encountered. It was noted that the cost of OOH
services was at the lowest since commencement in 2008. The Report also outlined a
summary of results and associated recommendations arising from a series of audits
during 2011-2013 in relation to relevant Key Performance Indicators (KPIs). Issues
relating to the pilot of an OOH pro-forma and provision of feedback to a patient’s
registered dentist were also outlined. Cross-boundary working with NHS Grampian
remained in place and continued to benefit relevant patients. The Report further went on
to outline the position in relation to basic life support, development of a detailed action
plan following an NHS QIS review, a review of the interface between NHS24/SEDS and
NHSH, inclusion of Maxillofacial Consultant support into the OOH service, Complaints and
Serious Adverse Events, patient feedback, and dentist feedback. The Report also
included a series of priority, ongoing and routine activity recommendations as focus for
the period of the next report. There was included an Argyll and Bute CHP Statement for
2011-13 incorporating elements relating to sustainability, frequency of commitment,
difficulties encountered, KPIs, the interface between NHS24/SEDS and NHSH and a
conclusion that a recent antimicrobial prescribing audit had suggested that closer attention
be given to clinical governance issues.
During discussion, it was noted that the standard of record keeping required to be
improved and in this regard Mr Robb advised that adequacy of relevant clinician notes
could also be improved. Mrs Lush emphasised the importance of a clear documentary
audit trail for clinical treatment, advising that appropriate documentation had been tested
on a number of occasions. Mr Muir stated that provision of an electronic pro-forma
document would aid consistency of information provision by virtue of automatic data
population reducing the time required for completion of each document. Mrs Fraser
advised that a number of issues were being considered, including e-documentation and
the potential for document completion by Dental Nurses.
After discussion, the Committee otherwise Noted the Third Annual Report for the Out
of Hours Service.
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HOSPITAL SERVICES
9.1
OMFS
Members were advised that advertisement for a second OMFS Consultant had been
unsuccessful and no decision had been taken on whether to re-advertise at this time.
Management of more complex surgery for Oncology patients continues to be delivered
from Aberdeen.
The Committee Noted the position.
9.2
Orthodontic
Members were advised there was no waiting list for treatment at this time and that
additional capacity continued to be provided within Raigmore from NHS Grampian. The
Tain Dental Practice now employed a Dentist with Special Interest and this in turn was a
boost to capacity within Highland.
The Committee Noted the position.
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9.3
Restorative
Members were advised that issues relating to decontamination of surgical equipment
continued to be raised. Mrs Lush advised the Board Nurse Director had written seeking
clarification on a particular issue around this area and relevant issues were also to be
escalated to Health Protection Scotland (HPS). The matter of CBCT referral had been
discussed earlier on the Agenda.
The Committee so Noted.
9.4
18 Week RTT
Members were advised there continued to be breaches of the relevant target, with the
local position in relation to Anaesthetic services being a contributory factor.
The Committee so Noted.
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PROVISION OF PAEDIATRIC DENTISTRY
There had been circulated paper, discussed at a recent meeting of the North of Scotland
Planning Group, in relation to a proposed service model based on a North of Scotland
Network/Managed Clinical Network approach.
This model had emerged after
engagement with Paediatric Dentistry colleagues across the six northern NHS Boards.
The model sought to ensure contribution to multi-disciplinary Paediatric dentistry care,
contribution to education and training, provision of support and advice to primary care
dental services, enable working with other professionals, ensure clinical leadership,
ensure accessibility of service, and ensure contribution to service development. If agreed,
an appropriate business case would be developed for consideration. The views of
members were sought.
Mrs Lush advised there currently were issues relating to issues such as training pathways
and associated case mix. Whilst Childsmile had been a positive development there was
recognition that patients/cases requiring General Anaesthetic would be more complex in
nature, making treatment planning more difficult. There can also be issues relating to
trauma. Current Paediatric Consultant support to NHSH was provided from NHS Tayside.
She stated that the pathway for medically compromised patients was working well
however there were issues when patients returned to NHSH.
The Committee otherwise Noted the circulated proposed network service model
discussion document.
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DENTAL CLINICAL GOVERNANCE AND RISK MANAGEMENT GROUP
11.1
Minute of Meeting held on 11 June 2014
Members were advised that the draft Combined Practice Inspections Report would be
submitted to the next meeting.
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The Committee:
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
Noted the circulated minute.
Noted draft Combined Practice Inspections Report would be submitted to next
meeting.
11.2
Draft Guidance on Dental Management of Patients Taking Anticoagulant
Drugs Outside a General Hospital Setting
Mr Railton spoke to the draft guidance document, which had been circulated for comment,
advising this had been based on a similar Policy operated in NHS Tayside. He advised
issues to be considered included guidance in relation to patients on dual/multiple
therapies and also the matter of point of care testing. Mr Crawford stated there was a
need to ensure that any final document reflect the position in Argyll and Bute CHP and
was consistent with advice from NHS Greater Glasgow and Clyde. It was noted this
matter had also been discussed by the NHSH GP Sub Committee.
The Committee:
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
Noted the draft Guidance document.
Noted relevant comments should be relayed to Mr Railton in early course.
11.3
Draft Protocol for Assessment of Paracetamol Overdose
There had been circulated draft Protocol for Assessment of Paracetamol Overdose
document, which had been ratified by the Policies, Procedures and Guidelines Sub Group
of the Area Drugs and Therapeutics Committee. It was reported that further changes
would be required to this draft document and that the final iteration would be referred back
for formal approval in September 2014 prior to eventual publication.
The Committee otherwise Noted the circulated draft protocol document.
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FOR INFORMATION
12.1
Area Clinical Forum – Draft Minute and Action Plan from Meeting held on 29
May 2014
There had been circulated relevant Minute and Action Plan from the Area Clinical Forum
meeting held on 29 May 2014. Mr Crawford confirmed he had given an update to the
NHSH Annual Review in relation to the formation of the Public Dental Service.
The Committee Noted the circulated draft Minute and Action Plan.
12.2
Committee Meeting Schedule 2015
The Committee Agreed the following dates for meetings in 2015:
25 February
27 May
26 August
25 November
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13
ANY OTHER BUSINESS
13.1
Consultant in Dental Public Health
Mrs Lush confirmed that an appointment had been made to the relevant Consultant
position, based in NHS Grampian. Provision of advice to NHS Highland would be subject
to an appropriate Service Level Agreement.
The Committee Agreed to invite the newly appointed Consultant in Dental Public Health
to address the meeting in February 2015.
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DATE OF NEXT MEETING
The next meeting of the Area Dental Committee will be held on 26 November 2014, in the
Board Room, Assynt House, Inverness.
The meeting closed at 8.50pm
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