Meeting 27th June 2023
THE HUNTINGDON MARRIOTT HOTEL
DIRECTOR’S BOARDROOM
TUESDAY 27th JUNE 2023
7.30 START
MINUTES
- Attendees:
Patrik Zachrisson - LDC Chairman & Treasurer
Mariana De Villiers - LDC Administrator
Amiras Chokshi - LDC Secretary
Julia Hallam-Seagrave
Francis Scriven
Deepak Kumar
Gawain King
Marlise De Vos
Elinor Japp
- Apologies:
Claire Jackman
Bharpur Sanghera
Avtar Pardesi
Meeraj Patel
Jaco Craig
Peter Mullins
- Orthodontic Update – Francis Scriven:
A recent meeting with the British Orthodontic Society highlighted the enormous stress the NHS system is experiencing with ever declining access to NHS Dentistry in the UK.
Contributing factors for unavailability to provide NHS Orthodontic Services are:
- lack of New NHS Orthodontic contract being finalised and agreed, which then results in lack of ability to forward planning and practice development,
- Difficulty in Recruitment of Orthodontists: it appears that new graduates have no intention to provide orthodontic services on the NHS
- No interest from Orthodontists abroad – ORE Exams problematic,
which all results in long waiting lists at current Orthodontic Practices providing NHS services. Waiting lists are currently averaging a 2.5 to 3 year waiting period.
Orthodontic assessment and treatment through referrals from General Dental Practitioners are becoming increasingly more difficult as patients no longer have access to an NHS dentist. Patient demographics are principally teenage children whose treatment has already been impacted by the COVID pandemic and now coupled with long waiting lists. This issue is affecting all patients, but there are concerns that the situation is disproportionately affecting those families that are unable to pay to access private care.
The access problem surfaces again once orthodontic treatment has started.
- Patients often require dental work or extraction of teeth before orthodontic treatment can begin and, increasingly, patients are struggling to access NHS dental care, having found themselves unable to access their original referring dentist. This adds an extra delay to the start of their treatment. Some patients are feeling pressured into paying privately for the necessary tooth removal to begin the orthodontic treatment.
- Many patients again have difficulties in receiving routine dental care during their treatment course, which commonly last 18-36 months.
Some possible solutions to address these current difficulties may include:
- Orthodontic friendly practices:
There is a national pilot of ‘Dental Friendly Practices’ which is currently being run. There has been a suggestion made by a dental commissioner that this could be modified to ‘Orthodontic Friendly Practices’ where part of a participating dental practice would have funded UDAs to treat patient undergoing orthodontic treatment. This would allow completion of operative work required such as extractions and restorations, which are required to enable the orthodontic treatment to start.
- School screening:
Consider funding oral health programmes in school for children aged 12. This has been suggested in the recent report published by the Welsh Senedd (Recommendation 13). This would enable significant time-sensitive clinical issues to be identified and referred, e.g., front teeth not growing, very prominent front teeth.
- Chairman’s/Treasurer’s Report: Patrik Zachrisson:
Treasurer’s report:
The Cambridgeshire and Peterborough LDC continues to be financially stable and secure.
The LDC has agreed to further funding towards Hepatits B vaccinations, Needlestick injuries and Disclosure & Barring Service (DBS) checks, following the incurred costs of such procedures, in order to support the Dental Team.
Funding will be available for the year 1st Jan 2023 to 31st December 2023 to all NHS dental practices in Cambridgeshire and Peterborough who are providing NHS dental services.
It was agreed that further donations will be made to the Benevolent Fund and towards sponsoring CPD events for local dentists in conjunction with the BDA (British Dental Association).
The LDC would also make enquiries about supporting local charities involved in supporting NHS dentistry.
Chairman’s Report:
- Area Team action on Orthodontic Contracts Handed back:
Some orthodontic contracts have been handed back as a result of difficulty in recruiting staff and retaining staff on the NHS. This process appears to be very slow - referral of existing patients to another practice for completion of treatment.
- UDA changes:
The UDA General Dental Course of treatment (COT) will receive are:
BAND 1 1UDA
BAND 2 3UDA
BAND 2a 3UDA
BAND 2B 5UDA
BAND 2c 7UDA
BAND 3 12 UDA
BAND 4 1.2UDA
REGULATION 11 12UDA
Band 2 treatment
From 25 November 2022, any Band 2 treatment with a date of acceptance on or after 25 November 2022 will be broken down into 3 categories.
Band 2a awards 3 UDA. This covers all Band 2 treatments other than Band 2b and Band 2c.
Band 2b awards 5 UDA. This covers a COT involving either non-molar endodontics to permanent teeth or a combined total of three or more teeth requiring permanent fillings or extractions.
Band 2c awards 7 UDA. This covers a COT involving molar endodontics on permanent teeth.
Although UDA changes have been implemented from 25th November 2022 practices have note seen any significant changes and it appears that it has not made much difference. Associates are not keen on taking on more NHS work. The NHS workload is too much and they are worried about burn-out.
- Lack of NHS Dentists:
This remains a huge problem. There is limited influx from abroad to fulfil shortages. Some of the dentist arriving from abroad only want part time positions.
- Chief Dental Officer:
Jason Wong has been appointed as the Interim Chief Dental Officer (CDO) for England. He will hold the role on a temporary basis whilst recruitment is under way to appoint a permanent replacement for Sarah Hurley who stepped down as CDO in June 2023.
- Williams Judgement: Mixing of Private and NHS Treatment
Dentists and dental lawyers have been watching the case of GDC v. Williams with interest, due to the implications for the long-held view that it is not permitted to mix NHS and private treatment by charging patients a private top-up fee in addition to the NHS charge for NHS treatment. The registrant provided three patients with a crown on the NHS, and offered a ceramic crown for an additional top-up fee (of between £35 and £65) to cover the difference in lab cost between a ceramic crown and the porcelain crown which was sufficient to maintain oral health and would therefore have been provided on the NHS. The Professional Conduct Committee held that the Regulations did not allow such mixing, that the registrant had acted contrary to a fundamental tenet of dentistry, and that she was dishonest in so doing. The registrant appealed to the High Court, and the GDC then appealed that decision to the Court of Appeal.
- On 5 May 2023, the Court of Appeal handed down judgment, finding in favour of the registrant. They held that the NHS Contracts Regulations (which they noted are “unclear”) do not prevent dentists from charging a top-up fee to provide a better- looking crown on the NHS, and rejected the GDC’s argument that the Regulations prevent mixing of NHS and private work on a single tooth. Of most importance to the registrant involved, who had initially been erased by the GDC’s PCC for dishonesty, the Court of Appeal held that regardless of the way in which the Regulations were interpreted, the finding of dishonesty should never have been made. Of importance to the profession, the Court of Appeal found that these top-up fees are allowed by the Regulations and indeed are much closer to the spirit of NHS dentistry than the GDC’s interpretation. The Court recognised that their decision would have implications for other GDC cases arising out of top-up fees. The GDC’s comments will be interesting awaiting clarification.
- Secretary’s Report: Amiras Chokshi:
BDA – REPORT OF GDPC Committee meeting 5th May 2023:
- Media and political:
There have been significant media coverage and political attention about the crisis facing NHS dentistry.
Lots of media interviews with dentists and publicity highlighting that access to NHS dentistry is a problem. 90% of dental practices in the UK are not taking on new NHS patients.
There have also been a number of parliamentary debates in recent weeks. An urgent and ambitious action to move away from the current UDA contract, a fair funding package, and changes to the system that make people want to work on the NHS is needed.
The Minister, CDO and NHS England also provided evidence to the Select Committee. Ahead of this, the Minister indicated his intention to bring forward a Dental Recovery Plan. Proposals that GDPC felt should be putting forward to make the NHS more attractive. Proposals were made around commitment payments, increased minimum UDA values, late career retention payments and improved parental leave arrangements among others.
- Contract Reform:
Despite the political pressure, talks with NHS England on contract reform have not made much progress.
Preliminary conversations about the areas that have been identified as priorities; urgent care, new patients, high needs patients, workforce and prevention are being held.
The only area where there have been more advanced conversations with NHS England is about how ‘high needs patients’ can be defined. This matter is being referred to a clinical reference group on which the GDPC will be represented.
The GDPC’s elected officers continue to press for NHS England to move much more rapidly in making changes to the current contract and to argue for a real contract reform process that moves away from the UDA.
There is particular concern from younger dentists that the persistent uncertainty about the future of the NHS and the contract was making it impossible to plan careers for the long-term.
Reports from Devolved Nations:
In Northern Ireland, the lack of an Executive had led to an imposed budget from the Secretary of State, which left the health service facing significant cuts. Ciara Gallagher, Chair of NIDPC, said that this would be potentially catastrophic for NHS dentistry in Northern Ireland. Many dentists in Northern Ireland were considering whether there was a future in the NHS. The contract is in need of reform, but little to no progress has been made since the process started in October. The item of service fees are very low and in many cases meant that treatments were being provided at a loss.
In Scotland, the Government was looking to revise the fee scale into a consolidated SDR, moving from around 400 items to 40. The BDA had not been invited in the process to generate a consolidated list of items. It would, however, be involved in discussions around setting new fees for each of the new items. The process for doing so had been delayed by the resignation of the First Minister and subsequent political instability.
In Wales, the volumetrics-based contract that had been imposed for the last financial year had resulted in delivery levels of around 70 per cent of pre-covid levels. There were some mitigation measures around year-end to ease the impact of the new system. The volumetrics had been adjusted for 2023, so that the new patient target had been revised from five new patients per dentist per week to two new patients and two urgent care patients. The Welsh Government had also initiated a process to negotiate a reformed contract, but despite an initially ambitious timetable for negotiations, the talks were yet to begin.
Clawback and reconciliation:
The GDPC’s elected officers meet regularly with NHS England and we reported back on the conversations that we have had, which have focused on the low level of UDA delivery throughout 2022-23, the likelihood of very high levels of clawback as a result and the steps that we believe NHS England should take through the year-end reconciliation process to support practices.
There are various reasons why practices haven’t been able to deliver their NHS activity, but at the heart of the problem is that they are unable to recruit dentists to deliver UDAs. There is also a suggestion from many that, as a result of delays reattending during the pandemic, patients are presenting with significantly higher treatment need and complexity. This means that even where practices have the same NHS capacity as pre-pandemic, they are not able to achieve the same UDA output.
The BDA have urged NHS England to think imaginatively about what they can do to help support practices, but it does not appear that there is going to be any further action in relation to the situation for 2022-23. We will continue to press the argument at all opportunities. The GDPC was extremely concerned about the practices that will be left in severe financial difficulty as a result of clawback. Many would be subject to clawback for the first time. It was clear that many practices would leave the NHS as a result. The BDA is able to advise Extra and Expert members about how to approach commissioners about managing clawback.
Talks of the ‘ringfencing’ the dental budget were discussed. It appeared that this would only apply from 2023-24, when Integrated Care Boards (ICBs) take control of dental commissioning, but even then it remains unclear as to how this will operate in reality.
- Pensions:
The Government had recently made changes in relation to pensions taxation that had abolished the lifetime allowance and increased the annual allowance. Labour had indicated it indented to reintroduce the lifetime allowance and the BDA would be working to influence the party to change this policy.
There had also been some changes to modernise the NHS Pension’s rules, such as getting rid of the requirement for 24-hour retirement in order to draw pension and continue working. Partial retirement will now be an option. Contribution rates had changes mid-year and so therefore the annual reconciliation will have a mechanism to apply these to earnings.
Phil McEvoy BDA’s Head of Pensions Phil McEvoy can update on recent developments and can be contacted at Philip.mcevoy@bda.org.
Other:
- Extra Funding:
Extra funding has been made available and 3 days were allowed to fill out application forms. No specifics were indicated for what or how much funding would be allocated. Instead, the dentist was invited to offer suggestions. Possible examples of funding would be: offering access slots eg 3 patients per day/per week, school visits, etc.
- Daniel Zeichner MP:
Daniel is the Labour MP for Cambridge. Various zoom meetings to discuss the dentistry situation were arranged but unfortunately did not take place. The next meeting is arranged for 18th August 2023 at 2.30pm.
- Other Business:
- CPD Event feedback:
A good attendance and positive feedback.
- Hepatits B vaccinations, Needlestick injuries and Disclosure & Barring Service (DBS) checks:
Practices can apply for reimbursements. Letters to be emailed to practices.
- Gawain King:
The LDC to set up and support Practice Managers Committee and meetings . Examples of topics to be discussed to include HR, complaint management, compliance, motivation, etc.
Informed Practice Managers will enhance practice performance delivering of Dental Services.
- Next LDC Meeting:
WEDNESDAY 13th SEPTEMBER 2023
