Meeting 19th September 2018

LOCATION

THE HUNTINGDON MARRIOTT HOTEL

WESTMINSTER ROOM

WEDNESDAY 19^th September 2018

7pm Arrival for 7-30pm Start

MINUTES

1. Attendees:

Jaco Craig - LDC Chairman

Bharpur Sanghera - LDC Secretary

Patrik Zachrisson - LDC Treasurer

Mariana De Villiers - LDC Administrator     

Marlise De Vos

Julia Hallam-Seagrave

Amiras Chokshi

Peter Mullins

Claire Jackman

2. Apologies:

Maria Ross-Russell

3. Guests:

Tom Norfolk - LPN Chairman

David Barter - Head of Commissioning NHS England – Midlands and East

4. Minutes of previous meeting held on 13^th June 2018 were agreed as true and correct record.

5. Jaco Craig – LDC Chairman:

Jaco Craig welcomed David Barter, Head of Commissioning NHS England – Midlands and East to the LDC Meeting.  David is keen to introduce a constructive line of communication with the LDC looking at “both sides of the coin” moving forward, in commissioning of dental contracts and services.

Commissioners of Dental Contracts need to make sure dental care is optimised by focusing on the health needs of the population ensuring care is delivered where it is needed and providing services from the right place (i.e. primary/community/ secondary).

There are currently 645 Primary Care Dental Contracts commissioned. The number of contracts seems to be increasing year on year.

Orthodontics:

Orthodontic PDS Contracts are coming to an end March 2019. The idea is not to have a roll-on contract but to put contracts out to tender. Orthodontic Activity (UOA’s) are geographically planned across the region. Orthodontic Planning Areas (OPA) are based on Local Authority area but have been modified where a Local Authority is small or large.  A Lot is the potential contract size and geographic area. When calculating lots current patient flows and hospital treatment provision were taken into account.  In establishing the proposed lot size a number of issues are taken into consideration: The lot size must be at least 1,050 UOAs per annum i.e. 50 cases as a minimum.  Aim to commission lots is based on a minimum size of 6,500 UOAs. Geographical access and patient feedback will also be taken into account.

Survey evidence suggests that 33% of 12 year olds would need orthodontic intervention. It is a pragmatic figure which is widely accepted. Not all children with ‘need’ will want orthodontic treatment.  Some children with ‘need’ will want private orthodontic treatment. Not all children with ‘need’ will maintain oral health suitable for orthodontic treatment

The Unit of Orthodontic Activity (UOA) requirement within each OPA is based on 1/3rd of 12 year olds resident in the OPA x 21 UOAs plus 5% for interceptive treatments and assessment not resulting in treatment.

The aspiration is to commission orthodontic contracts over 10 years – 7 + 3 (break clause after year 7). This model would provide long term planning an activity as well as stability within practices.

Currently, there are 45 PDS Orthodontic contracts commissioned and the aim is to reduce these to 37 going forward, geographically placed in order for a patient not to travel more than 30 minutes to a practice.

Current providers of Orthodontics might be asked to roll out contracts for a few months in the transition period. All providers need to re-apply for contracts. Applications is via the portal and involve a number of stages: Registration, ITT Stages and Invitation to tender.   Stage 1- Request to Participate: Assessment of an eligibility questionnaire to assess an organisations core competency. Stage 2 - Call for Competition: To receive proposals to deliver specific lots and will test in more detail an organisation’s ability to meet the Commissioners requirements. When the call for competition is advertised it will available at the Intend website. Once the relevant project has been chosen, expression of Interest is made by ‘opting in’, in order to access the documentation. Bidding for contracts is via the dynamic purchasing system where a number of questions will need to be answered. In order to submit tenders for contracts commencing in April 2019 accreditation for this need to be gained before the invitation to tender is published.

 A decision panel will assess the tenders and would consist of clinicians, procurement experts, commissioning experts and representatives from Local Dental Committees (LDCs).

Quality would be assessed on numerous questions in order to understand times, accessibility, etc.  The procurement needs to be forward looking and bidders need to also articulate services that is going to be offered with the contract. Contracts would only be awarded to Specialist Orthodontists.

The stages in the process will include: evaluation, decisions of Decisioning Panel and notification of outcome. A 10-day standstill period will follow to allow for further questions and clarification, whereupon a start date would be agreed.

Set UOA Value and underbidding:

The aspiration is to assess 80% on quality and 20 % on financial outcome.  This implies that the cheapest bid would not necessarily be the preferred option. The UOA value currently varies from £44.00 to £78.00. The aim is to have this figure vary between £56.00 to £63.00. A baseline guide is £56.00.

UOA contracts under 1000 units would not be commissioned.  A contract of 6 500 units would be more favourable.

Head of procurement for orthodontics is Andy Harvey. 

Currently, in the event where a contractor chooses not to continue OR the contract comes to an end and is not awarded a new contract and agrees to complete active courses of treatment or supervised retention, the contractor will receive a one off close down payment of £662 per patient or £25 for patients under retention. This figure was negotiated by Department of Health and BOS).  Where a new contractor is not taking over an existing case load a stepped payment may be introduced. The transition costs will impact the procurement process and budget. NHS England is responsible to find care for these patients.

Dental Year End and Clawback:

Under-delivery clawback monies go into healthcare and is not re-invested into dentistry.

Across our region (Midlands and East [East]) for 2017/18 there is an underperformance of ~£7M, of which ~£1.5M relates to Essex and has already been reallocated away from dentistry. Similar underperformance is anticipated for 2018/19. Discussions will be held with providers who are behind on the ‘30% by mid-year’ and those who consistently under-deliver (going back 5 years). It will no longer be possible for these providers to refuse to give up the undelivered UDAs, as a subcommittee is to be formed to identify where additional dental activity is required and to look at dental cases and to address difficulties.  The first meeting is on 3^rd October 2018.

This will be reported to the Direct Commissioning Oversight Group (DCOG) to consider business plans (growth, needs assessments, etc.) for recurrent commissioning of this clawback funding. Applications will be invited in the first 4/5 months of the next financial year so as to be proactive in protecting the ever-reducing dental budget and UDA increases will be pro-rata in the first year as necessary and at the practice UDA rate or median for that area (whichever is the higher, with the long-term aim being uplift of the lowest rates rather than decreasing the upper levels). This will be matched to known growth and patient demographics over the entire DCO and will include Sustainability projects, Starting Well, Care Homes dental provision, oral surgery teaching, diabetes project, DCby1, etc.

Underperformance is currently at £1,5 million in the South and between £5 - £6 million in the North. NHS England want to work with providers, MCN and LDC in order to understand and evaluate these tendencies. Clawback in this area is exponentially increasing in Norfolk, Suffolk and Cambridgeshire, but decreasing in Essex.  Attracting dentists to practice in these “rural” areas is quite difficult compared to big cities. The aim is to also look into ways to attract dentist back to these areas.

Urgent Treatment:

Dental access Centres are under the spotlight due to the high demand for urgent dental treatment of patients. Reasons for this include the shortage of dentists in some areas, practices who cannot accommodate more patients and are up to capacity, the high number of patients wanting treatment and NHS contracts that were given back by dental corporate practices. Once a patient was seen at the Dental Access Centre for urgent care there is no pathway for further treatment for patients.

6. Bharpur Sanghera – LDC Secretary:

Bharpur to report on LDC Secretaries’ meeting to be held in October.

7. Patrik Zachrisson – LDC Treasurer:

The Cambridgeshire and Peterborough LDC continues to be in a healthy financial state.  The LDC is hosting a 3 hour verifiable CPD Event on 17^th October 2018 – Dentists and NHSE – how do they work together in this region?

1. Date of Next Meeting:

Wednesday, 14^th November 2018