Meeting 28th March 2018

THE HUNTINGDON MARRIOTT HOTEL

WESTMINSTER ROOM

WEDNESDAY 28^th MARCH  2018

7pm Arrival for 7-30pm Start

MINUTES

1. Attendees:

JacoCraig - LDC Chairman

PatrikZachrisson - LDC Treasurer

Bharpur Sanghera - LDC Secretary

Mariana De Villiers - LDC Administrator

Peter Mullins

Julia Hallam-Seagrave

AmirasChokshi

Gawain King

David Smith

2. Apologies:

Claire Jackman

Marlise De Vos

Maria Ross-Russell

Guests:

Tom Norfolk - LPN Chairman

Judith Roberts - GDPC Representative

Christopher Sprinz

3. Minutes of previous meeting held on 15^th November 2017 were agreed as true and correct record.
   
   
4. Jaco Craig – Chairman’s Report:

The LDC is currently in contact with Maria Ross-Russell (Head of Deanery) looking at funding some of the Continued Professional Development (CPD) Courses offered by the Deanery.  It is suggested that access to funding would be via our LDC Website either though individual or block booking. Courses sponsored by the LDC would be posted on the website well in advance of the course date. As an example, a course on Record Keeping would be a popular choice.

In order to raise awareness on the role and the benefits of the LDC it was suggested to investigate the possibility of creating a closed Facebook Page for the LDC.

Care Quality Commission (CQC):

Following public consultation between 26^th October 2017 and 18th January 2018 on proposals for fees that will be charged to providers of health and adult social care in England from 1^st April 2018, CQC has announced the new Fee Structure. However, there will be no change for Dentists.

As an Independent Regulator of Health and Social Care in England, the purpose of CQC is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and encourages care services to improve. The role has changed from conviction rather to support.

Membership:

The Cambridgeshire and Peterborough LDC to recruit more members.

5. Patrik Zachrisson - Treasurer’s Report:

The Cambridgeshire and Peterborough LDC continues to be in a healthy financial state.  The LDC supports PASS and are also looking into areas to support and benefit General Dental Practitioners in other areas such as funding of courses.

6. Bharpur Sanghera – Secretary’s Report:

LDC Secretary’s Meeting was recently held on 15^th February 2018.

1. Role of LDCs.

 A discussion took place to establish the roles that each LDC undertook. It was clear that each LDC undertook multiple but varying roles. Northants had been asked by the LT to take

part in many initiatives which had severely depleted their financial reserves. Because,

their levy collection rate was governed across 4 LDCs they were unable to raise further funds due to the other 3 LDCs having sufficient or excess funds to cover their honorarium and sessional payments. As a result Northants had curtailed their Continued Professional Development (CPD) courses however it was agreed that the method of levy collection across a number of LDCs was anachronistic and should be challenged to enable each LDC to function adequately in an independent manner. It was agreed for to send a list of functions that Essex LDC perform and each other LDC would populate this list to indicate if LDCs had 'blind spots' in what they undertook.

2. LDC Insurance.

As LDCs offer advice on a regular basis it was agreed that it would be sensible to take out insurance to protect against potential litigation. Lloyd and Whyte provide this cover through the offices of the BDA. Cambridgeshire and Peterborough LDC to arrange this.

3. Primary Care Support Services /Capita - who manages the National Performers list (PCSE).

The problem of under delivery due to the PCSE/Capita mismanagement of the National Performers list is continuing to emerge. Issues are still surfacing over practices that underperformed in 16/17. Some were unaware that they were entitled to support and could roll over the UDAs to 17/18 whilst others simply accepted a clawback of under delivered UDAs for 16/17. Those practices who accepted their under delivered UDAs were to be rolled on are now finding that they won't have completed those plus their existing annual contact by the end of the 17/18 year (end of March). As such they may be subject to clawback and a breach notice. However other practices are finding similar problems in 17/18 due to Capita's ineptitude and are facing just the same problems as those practices from the previous year. The BDA are having regular meetings with NHSE to resolve these issues.

Most LDCs represented gave examples of practice's that had struggled to get performer numbers for new dentists to practices in a reasonable period of time. Many had experienced clawback despite being exempted of this following NHS England (NHSE)'s announcement. Those that had been allowed to roll over their under delivered UDAs to this year were now struggling to complete them plus their target for this year. None had received any goodwill payments to this point. HSMs LT had not issued any breach notices and had been relaxed with those underperforming providers. East had taken a more aggressive approach with no temp contract variations being agreed but instead forcing the providers to underperform to allow them to issue a breach notice. Two breach notices and they have the opportunity to unilaterally vary the contract. Concern was raised that those UDAs released through this method may often not be redistributed within the LT but be lost on a recurrent basis to the region.

4. Recruitment.

 There are a number of workforce challenges. In 2016, nearly half of practices that had tried to recruit associates experienced difficulties in doing so and in 2017 this had increased to two-thirds. As the UK leaves the EU, it is worth bearing in mind that 17 per cent of registrants are from the EU and 20 per cent of NHS work is done by EU dentists. Research had shown that EU dentists were likely to be registered for a shorter period of time. Yet there remains uncertainty as to how Brexit will impact on the supply of dentists.

It was agreed that with the reducing associate incomes and the threat of Brexit looming that the already difficult recruitment issues were becoming even more difficult. There appeared to be no simple solution with all counties reporting similar problems. There was a brief discussion about sharing of clinicians between practice's although this was considered to be utopian, the reality being that Associates might well be poached by neighbouring practices.

5. Performer List Validation by Experience (PVLE).

This is the process non EU/EEA dentists have to go through to obtain their performer number much like Foundation Dentist training. Concerns were raised about examples of exploitation of colleagues from overseas who had to undertake PVLE prior to receiving a performer number. It was considered cumbersome and disorganised and efforts should be made to rationalise it so that the scheme was more aligned to Foundation Training.

6. Hep B vaccines.

Concerns were raised about obtaining Hep B vaccines for new dental nurses to allow them to start working. Hertfordshire described the lack of an Occupational Health service for dentists and their staff despite the introduction of a new scheme across the country last year. At present nurses have to try and obtain Hep B vaccines privately but doctors are reluctant to write up for serology following the course because of the extra work involved. Concerns were raised about the employer’s liability if following the guidance from PHE released in Oct 2017.

The latest news from the BDA is 

In a nutshell, the manufacturing issue has been resolved, but here is a backlog and the situation is "anticipated to improve during 2018."

As it says, "PHE priority groups 1 -3 will continue to have access to vaccine" and it appears, from feedback, to be open to local interpretation as to whether dental nurses are in 4 or stray into 3 (see table); provision appears to vary massive locally and queries from dentists have dropped to one or two per week...

From GlaxoSmithKlein website 28/2/18

GSK's Hepatitis B supply constraints have been resolved and supply of these vaccines is anticipated to return to historical volumes during 2018.

However, due to back log demand from 2017 and supply constraints by other manufacturers the Hepatitis B vaccine market is likely to continue to experience constraints in 2018.

While PHE priority groups 1 -3 will continue to have access to vaccine, Engerix B adult vaccines is anticipated to be reintroduced to the market in a phased approach prioritising healthcare workers via occupational health, patients with chronic liver disease and household contacts of chronic hepatitis B cases.

7. Prototypes.

There was little to report over the current prototypes however concerns were raised over the future financial viability of those practices should they bid for Wave 4 status.

The British Dental Association (BDA) has responded to news that the Department of Health and Social Care and NHS England have opened calls for interest in the fourth wave of NHS contract reform prototypes in England.

The BDA has restated its commitment to the reform process, but expressed frustration over the pace of change, and the failure to offer changes in the prototype model for this latest wave. Despite widespread support for the approach to clinical pathways, dentist leaders have expressed concern that many practices have struggled to deliver under the prototype business model. The BDA remains committed to a model that maximises capitation.

8. Practitioner Advice and Support Service (PASS).

Most of the LDCs represented indicated that they had PASS scheme established. Some were quite mature and covered just their county (Northants) while others covered a region (Essex and East) however some were still in development (Herts). East were regularly taking referrals from the Patient Advisory Group (PAG) and Dental Practice Advisor (DPA) visits. Some PASS had several of their members who were trained mentors while in the East most were of a supervisory/support and signposting role with two trained mentors available should further referral be appropriate. A discussion took place over the status of LRC observers at the PAG - East allowed an observer for all cases while Central Midlands region demanded an opt-in following agreement from each colleague whose case was heard. Clarification was requested from RLG.

9. Officers Honorarium. One LDC raised the question of paying their chair an Honorarium. None of the LDCs represented paid their chairs however it was agreed that if that LDC could demonstrate to their levy payers that this was justified by the additional work undertaken that couldn't be claimed by travel or sessional payments then this would be reasonable. If however, it was simply because of long service then this would be harder to justify. In Northants each officer has to sign at the end of each financial year to certificate their hours worked on LDC business. Most other LDCs didn't have this arrangement.

10. General Data Protection Regulations (GDPR).

The General Date Protection Regulations come into operation on May 25th 2018.

It was agreed that the greatest impact that the new regulations would have upon LDCs would be in the area of email lists held. It was agreed that LDCs don't use these lists to 'market' their constituents however there was uncertainty within the meeting over whether this would demand the 'cleansing' of all lists. It was agreed that the LDCs might help their constituents to understand the GDPR and the impact this might have at practice level by facilitating an evening course, jointly or separately. It was agreed to take the issue of GDPR and email lists back to Regional Liaison Group (RLG) Tthis is the meeting in London for all the LDC secretaries representing regions across England and Wales.

11. Email lists.

Essex have been in dialogue with Alexis Brown at Primary Care Support Services (PCSE)/Capita – managers of the National Performers list, who are attempting to arrange for new performers to tick an opt-in for their email addresses to be shared with the LDC of their proposed area of work. This has still not been concluded.

12. Non-dentists on LDC.

Norfolk reported on progress of this issue. At the LDC conference motion approval was given to those practice owners who are GDC registered but not dentists now being entitled to be nominated to the LDC. As such, the hygienist whose application had triggered this chain of events had been officially approved to be included in the LDC as an ex officio member until such time as the BDA revised their model constitution to allow for these circumstances.

13. Dental check up by 1 (Dcby1).

A certain amount of confusion was expressed by LDCs over the progress of this initiative by Office of the Chief Dental Officer (OCDO). At a recent meeting of the Eastern Region LDC Secretaries some felt that it was already in place and that 1 year olds could benefit.  However, others were aware that the scheme had not been officially adopted yet. It was felt sensible to wait until it had been officially approved by the LTs and appropriate funding put in place. There was concern over the degree of confusion that the introduction had caused amongst LDCs present. At the moment the scheme has stalled until legal issues have been dealt with.

14. Tier 2.

Concerns were raised over the work being undertaken by NHSE over the 4 new

workstreams to establish the criteria for tier 2 working. The principal concern was regarding the funding for these when no network was currently in place, particularly with paedodontics and periodontics. Bedfordshire & Milton Keynes still has a restorative referral pathway for the time being but no other county has anything in place. Discussion took place around the medico legal elements of the tiering structure.

15. Amalgam.

Phasing down of amalgam from July 2018 is likely to place dentists in a vulnerable position when one member of the family is considered not to be allowed to have an amalgam in a tooth (under 15 year olds) while the adult members of the family are entitled to have a filling (unless pregnant or nursing). It was agreed there might be difficult conversations to be had in the surgery and the importance of having a clear understanding of the new guidelines together with a thought through argument to support the clinical actions expected of clinicians.

16. New approach to dental training.

Due to the change in oral health needs and the aim to increase the quality of care within the budget, Health Education England (HEE) are in the process of discussing a new way of training those considering on embarking on a career in some form of dentistry. They are proposing that all considering a career in any form of dentistry will take a 3 year degree in Oral Health and then will be selected, or not, to complete a further 2 years to be able to qualify as a dentist or undertake shortened modules to allow them to qualify as a therapist or hygienist. This is set to encouraging skill mix.  Although it was seen as perhaps assisting HEE and Department of Health (DH) with the fluctuations in dentist demand, it was seen as doing nothing to give confidence to those that had considered a career as a dentist. For many there would be uncertainty when they started the degree over whether they would be able to complete the 5 years when they embarked on the course.

17. As described in the GDPC report, the specification document for orthodontic practices in the southern part of England has been released and this suggests a significant reduction in the terms and conditions for orthodontic practices in that region. Most noticeably that successful bidders will expect between 10 - 15% reduction in their contract value. Worryingly the Midlands and East region will shortly start the process for all their PDS orthodontists and NHSE are very likely to use the same specification document for potential bidders to tender against - so similar figures and again a vast reduction in the contract value.

7. Date of Next Meeting:

Wednesday, 13^th June 2018