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Meeting 11th September 2019

LOCATION

THE HUNTINGDON MARRIOTT HOTEL

PEMBROKE ROOM

WEDNESDAY 11th SEPTEMBER 2019

7pm Arrival for 7-30pm Start

 

MINUTES

  1. Attendees:

Jaco Craig - LDC Chairman

Mariana De Villiers - LDC Administrator

Patrik Zachrisson - LDC Treasurer

Amiras Chokshi

Marlise De Vos

Gawain King

Peter Mullins

Francis Scriven

  1. Apologies:

Maria Ross-Russell

Julia Hallam-Seagrave

Claire Jackman

Deepak Kumar

Meeraj Patel

Bharpur Sanghera

  1. Guests:

Tom Norfolk - LDN Chairman

  1. Orthodontic Update: Francis Scriven

The Orthodontic tendering process is now well underway with Stage 1 of the bidding process now closed. Cambridgeshire moved down from being first to position 7 of lots being awarded.

The aim is to commission lots based on a minimum size of 6,500 UOAs which equates to about 250 to 350 starts on a 7 + 3 year contract: 7 years in the first instance with the option available to both parties to extend for up to a further 3 years by mutual agreement.

It appears that big practices will be awarded big lots and smaller practices smaller lots. However, no clarification on how the process work is being offered. The Cambridgeshire area is split into 4 lots of 6500 UOA’s with no defined border for each of the lot areas.

Clarification on Q and A portal:

 Some confusion emerged on the basis of the following scenario:

“Eg. Lot 1 – 3 companies submitted a bid:

                  Provider A scores 98%, Provider B scores 89% and Provider C scores 80%.

       Lot 2 – 2 companies submitted a bid:

                   Provider D scores 95%, Provider E scores 92%

       Lot 3 – 1 company submitted a bid:

                   Provider F scores 60%

       Lot 4 – NO Providers bid:              

Thus Lot 1 is awarded to Provider A, Lot 2 is awarded to Provider D and Lot 3 is awarded to Provider F and Lot 4 is not awarded to any Provider.

If this is the case then depending on the Lot you choose to bid under will become a lottery if you win or not, ass for example the Provider who wins Lot 3 is the  lowest scoring bid, and Provider E, the second highest across all lots will not be awarded a contract.”

Responses included:

  • The evaluation of bids and selection of a preferred bidder for each Lot will be as described in Document 1, in particular refer to sections 27,28 and 29. Bids will be assessed within this criteria for each lot bid for. Contracts cannot be awarded outside this criteria. It is up to each bidding orginisation to decide as to how many Lots they wish to bid for and which Lots.
  • East Region are not asking Bidders for their “preferred” Lot(s) and will not do this at any stage in the Procurement Process. Bidders should only bid for the number of Lots they are capable of mobilising and delivering.
  • Bidders can only bid for one lot at a time. Each lot is a separate entity and if a Bidder wants to bid for more than one lot they will be required to complete and submit bids for each lot applied for including FTMs and mobilisation plans, this implies two lots would require two FTM and two mobilisation plans.

It is unknown who bid for which Lots.  The decision has been deferred to end of October with mobilisation October/November 2020.

It is quite alarming that in some instances Bids were awarded to Practitioners without Premises or Staff.

In the event that an Orthodontic Practitioner has not been awarded a contract:

  • Wind down is set at 70% payment in first year and 30% payment in 2nd However, the 30% payment is not a profitable option.
  • The age of the patient at time of initial referral should be honoured.

In the event of a 17year old patient this might result in a secondary referral which would result in a new date for eligibility for treatment. This implies that with No contract being awarded it would result in a new referral with a new referral date in which case the patient may not be eligible for treatment.

  • GDPR also presents a problem – with NHS records stored a new referral would result in obtaining consent from parents to action a new referral.
  1. Chairman’s report 11-09-2019

LDC Conference

The LDC Conference was held on 6th to 7th of June 2019 at The Birmingham Conference and Event Centre.  

The British Dental Association (BDA) have amended the constitution for LDC’s. It is recommended that LDCs accept and/or adapt existing constitution.

Update from the GDPC provided by the Vice Chairs Shawn Charlwood and Dave Cottam on contract reform:

Green light is yet to be given for Prototypes to go ahead. Department of Health (DoH) is still committed to this, however, likely to be delayed until 2021.

Agreed points between BDA and DoH:

  • Weighted capitation based on national rates
  • Non-capitation activity rate
  • Split between the 2 will be based on individual practice profiles, i.e. the split would be based on historic values for that practice. National average to be used for activity portion

Points under debate:

  • Roll out of Bland A (Activity) and Bland B (capitation)
  • If there is a choice, the BDA want the practice to have the choice. DoH wants the commissioners to have the choice of whether a practice is blend A or B. The BDA favours blend B with as much capitation as possible. Pushing for 100% but it is likely will only get about 85%.
  • Nature of the roll-out process and transition. The BDA wants a gradual roll-out (likely to happen) over a number of years
  • Timing of the roll-out
  • Future of activity payments
  • Financial sustainability of the new contract
  • BDA wants item-of-service for activity rather than UDA. DoH very much in favour of UDA’s and will not guarantee that UDA’s will be stopped with introduction of the new contract.

Prototype practices found it almost impossible to get capitation numbers back once they started dropping. In the new contract this is likely to lead to guaranteed clawback for the AT’s and future contract reductions for practices. At present, 25% of Wave 3 Prototype practices face Clawback. The financial model is simply not viable.

In North East England, of the 50 practices earmarked for joining the prototypes, 50+% have opted out or left the prototype scheme.

Recruitment and retention

The BDA has carried out a survey:

  • 75% report difficulty in recruiting
  • 66% of Practice owners with large NHS commitments want to scale down their NHS commitment
  • 59% of Practice Owners and Associates want to scale down or leave the NHS
  • Serious lack of willingness on the part of NHSE to accept that there is a problem. The number of dentists are declining including the number of graduates as well as the number of immigrants.

Environmental sustainability

The average practice produces 6100kg of waste per year, 81% being clinical. HTM 105 responsible for a large increase in waste produced by dental practices.

New initiatives

Brexit

  • Anticipating a more open migration policy but likely to be only for employed posts with a salary above £30k
  • Issues with recognition of qualification
  • No “Force Majure” if there is a no-deal Brexit according to NHS England (NHSE) e. we are strongly advised not to hoard/store items such as Local Anaesthetic (LA) and dental materials by NHSE to avoid panic buying or running out of stock. However, if a no-deal Brexit and practices are unable to attain LA/dental materials to carry out their daily practice, NHSE would not see this a “force majure” and the practice would be in breach of contract for not providing treatment to its patients, performance subject to claw-back. 

Amalgam phase down

Newcastle University are conducting a study on behalf of the BDA on costs involved to accomplish this. Found cost of doing this to be £9500/year for average NHS practice. DoH disputes the figures. The BDA is trying to get re-imbursement for practices to set a president, but unlikely to occur.

Collection of LDC levies on an individual basis: Capita’s contract with the BSA runs out end of 2019. They are not prepared to spend any time/work on this.

PCR: BDA are challenging NHSE for collection of PCR when a claim is rejected by the BSA

Presentation by Stephen Tidman on practice profitability since the introduction on the 2006 contract (Figures attached)

Key points:

  • Net profit Practice Owners (PO’s) reduced by 2%
  • Net Profit Associates (A’s) reduced by 9%
  • Expense ratio for PO’s increased by 7.7%
  • Expense ratio for A’s by 9.3%
  • Number of PO’s reduced by 27.9%
  • Number of GDS practices reduced from 9000 to 7000
  • PCR increased from £400m to £800m
  • LDC motions

Full report on the LDC Conference is available on LDC Conference Website: https://www.ldcuk.org

The next LDC Conference is to be held in Brighton, 4th - 5th June 2020 at the Grand Hotel. 

EAST OF ENGLAND (EoE) secretaries meeting 5th September 2019

Friends & Family tests are due to change in some way, not sure of the exact details yet.

The BDA wants evidence of claims rejected under the 2-month rule. The BDA is looking for practices who would like to participate.

Ortho: Run off contracts being offered to unsuccessful bidders – 70% value 1st year and 30% value 2nd year. However, it is unlikely to be successful in 2nd year as not possible to run a practice on 30% of contract value. Exemption status of referred patients is being honoured at age of patient at the time of referral. Proving to be a problem where patients cannot be treated and have to be referred to another provider, exemption status is then taken at the time of 2nd referral.

Major issues with ortho contracts in the South of England. A number of contacts were awarded to practices with no premises or staff. These contracts were taken back and re-commissioned.

Introduction of PCN’s:

Due to become very important part of how the NHS operates. Funding comes from the Clinical Commissioning Groups (CCG’s) for the GP’s to set up PCN’s. Dental money comes from the Area Team (AT) however and it is unlikely at this stage that dentistry will benefit. Following a meeting at Fulbourn House on the benefit of PCN’s it was reflected that Dentistry, Pharmacy and Ophthalmic are very much an afterthought !

Sustainability in dental practice/Environmental impact

A study carried out on a dental practice in Fife, found that 30% of carbon footprint is based on staff travel, 30% based on patient travel.

General:

Health and Social Care Committee launch inquiry into Dental Services – Response from LDC will be send before deadline for submission on 13th of September 2019

  1. Treasurer’s Report – Patrik Zachrisson

The Cambridgeshire and Peterborough LDC continues to be in a healthy financial state.  The LDC made a financial contribution to the Benevolent Fund.

  1. Date of Next Meeting

20th November 2019