Meeting 6th February 2019

LOCATION

THE HUNTINGDON MARRIOTT HOTEL

WESTMINSTER ROOM

WEDNESDAY 6^th February 2019

7pm Arrival for 7-30pm Start

MINUTES

1. Attendees:

Jaco Craig - LDC Chairman

Bharpur Sanghera - LDC Secretary

Mariana De Villiers - LDC Administrator     

Maria Ross-Russell

Marlise De Vos

Julia Hallam-Seagrave

Amiras Chokshi

Peter Mullins

Claire Jackman

2. Apologies:

Patrik Zachrisson - LDC Treasurer

Gawain King

3. Guests:

Tom Norfolk - LDN Chairman

4. Chairman’s Report – Jaco Craig

The Cambridgeshire and Peterborough LDC has sponsored part payment of the Professional Dentistry Midlands CPD Event on Saturday, 6^th April 2019 at The Kingsgate Conference Centre, Peterborough. Course fees are normally £39.95 but will be offered to our constituents at £19.95.

This Event is highly recommended offering a range of CPD topics and hours.  Courses cover all of the latest changes and developments in dental practice and are presented by leading speakers in their field.

The Cambridgeshire and Peterborough LDC continues to be in a healthy financial state. 

Dental Access Issues:

Dental Access Issues remain a concern. Part of the Local Dental Network core work is involved in looking at access.  Proposals are currently being evaluated whereupon formal notification will follow.

CPD Concerns:

Enhanced CPD scheme started on January 2018 for dentists and will be starting on 1 August 2018 for dental care professionals.

The main changes to the scheme are:

• ​The requirement for all dental professionals to have a personal development plan (PDP);
• An increase in the number of verifiable hours for most professional titles and the requirement to spread the hours more evenly across the five year cycle;
• Dental professionals no longer have to declare non-verifiable CPD to the GDC;
• The requirement to make an annual statement of CPD hours completed, even if zero hours have been completed for that year;
• The requirement to align CPD activity with specific development outcomes;
• The requirement for professionals to plan CPD activity according to their individual “field(s) of practice”.

Requirements:

The CPD record must contain:

• a description of each item of CPD completed and whether it is verifiable CPD; this should include the title, date and /or topic(s), venue and provider where applicable

• the number of CPD hours for each item; this should exclude breaks and travel time

• documentary evidence of each item of verifiable CPD.

Verifiable CPD:

Documentary evidence that the CPD has been undertaken and that the CPD has:

• concise educational aims and objectives;
• clear anticipated outcomes; and
• quality controls.

For More information on CPD as well as PDP visit please visit the GDC Website – Enhanced CPD

5. Secretary’s Report – Bharpur Sanghera

A Dental Strategy Group East Anglia was set up within the LDN to look at:

Clawback relating to Dental access issues – the golden triangle of need, improving access – eg through enhanced UDA’s, dentists to keep patients following emergency treatment, etc.

NHS England East – flexible commissioning, a list of what it is which could also be used by the Area Team (AT) to determine where to invest clawback

OPG (Orthopantomogram):

Dental Practitioners are being charged for OPG’s taken at the hospital. However, if the hospital has an active service level agreement in place the dental practitioner should not be charged.

Green Initiative:

This is part of a pilot programme in order to encourage dental practices to reduce the Carbon footprint to help the environment, whether it's improving recycling, using less water, promoting sustainable travel or reducing waste. Public Health England as well as NHS England are now involved and looking at recycling initiatives.

The LDC Secretary’s Meeting was held on 24^th January 2019.

Confirmation that clawback figures have increased dramatically by up to £4.4 million. However, clawback figures for East of England have not been released by the AT as yet. Flexible commissioning was discussed but little evidence of any incentives by the commissioners to engage in this new form of commissioning was reported. Flexible commissioning is seen as a way of allowing underperforming practices avoid claw back by undertaking other forms of contracted activity - Care home visits, in hours emergency slots, overperformance to 104%, and Starting Well equivalent schemes. This assumes there is the workforce to undertake this activity and many practices suffering from recruitment/retention issues may not be able to deliver. The AT should be encouraged to re-invest into dentistry rather than paying the money into NHS England where it would be used to cover shortfall in other areas.

Orthodontic procurement:

The whole region of East of England has had the timetable extended from 31^st March 2019 to April or July 2020 for the start of new PDS contracts. Concerns were raised by some counties over the inequity of the ‘lots’. Discussions were taking place between LDCs and commissioners directly as the Proactis portal was seen as cumbersome and a difficult platform to engage in dialogue. Reports from the south of England who are further ahead with their process indicate that serious problems in the process particularly the readiness of successful practices by April 1st - some have only just put in 'change of use' planning applications and staffing of the new contracts as many orthodontists took the opportunity to retire.

Notifications of bids should be available within the next 2 weeks. Commissioners will then take 6 to 8 weeks to look at the bids.

Interim referrals to orthodontic practices for starting new courses of orthodontic treatment, following the extension, is a problem.

BDA Day of Action:

This is a CPD event where every dentist partakes on the same day at the same time.

Many LDCs reported that their members were not completely keen to take part actively but were sympathetic to the cause.

LDC Officials Day:

The annual Local Dental Committees (LDCs) Officials Day took place on Friday 30 November in London, welcoming LDC reps from across the UK to discuss some of the big issues in dental politics today.

This was generally considered to be a well organised and productive day. Some LDCs are actively updating their constitution. Most LDCs are involved in a PASS which covers several LDCs. Training of mentors was seen as an issue and Oxford Deanery were reported as delivering a good quality course for £50 for 2/3 days with refresher courses available.

There was a debate in favour of funding a new system of levy collection on an individual LDC-by-LDC basis, LDCs would pay NHS Dental Services for this if necessary, but only as long as safeguards are in place to protect LDCs going forward.

The Annual LDC Conference 2019 is taking place in Birmingham in early June 2019, with the LDC Conference 2020 scheduled for Brighton.

NHS re-organization:

In 2016 the NHS and local councils came together in 44 areas covering all of England to develop proposals to improve health and care. They formed new partnerships – known as sustainability and transformation partnerships (STPs) – to run services in a more coordinated way, to agree system-wide priorities, and to plan collectively how to improve residents’ day-to-day health.

In some areas, STPs have evolved to become integrated care systems, a new form of even closer collaboration between the NHS and local councils. The NHS Long Term Plan set out the aim that every part of England will be covered by an integrated care system by 2021, replacing STPs but building on their good work to date.

This raised more questions than answers particularly over how the current Area Team distribution would fit with new STPs. Northants explained HSM was being split with them moving to Midlands whilst Herts, Beds & MK are to be grouped in East of England. How this will impact on performance panels and levy collection was not clear. There were other questions over how dentistry will fit into Integrated Care Partnerships and Primary Care Networks. Few answers were available.

Financial Governance:

Northants reported that £9k had been stolen from the online LDC account of the treasurer of their LDC. They banked with Yorkshire bank who it transpires only have one level of security. The bank is reluctant to refund the money. It was advised that if other LDCs bank with the Yorkshire Bank then they might consider moving their account to another more secure bank.

Dental Contracts handed back to AT with Practice closures:

Norfolk reported that two contracts held by Mydentist were handed back in November and the practices closed. No closures were reported by other LDCs represented. Concerns were raised over how keen the AT were to recommission the released budget. Access is a serious problem in some parts of the region and it was considered inconceivable for the commissioners to not re-procure in those areas.

Foundation Training:

Concerns were raised over the potential restructuring of Foundation Dentist (FD) schemes in the Midlands and East. The Dean for health Education England (HEE) (Midlands and East) is keen to reduce costs by restructuring and/or amalgamate schemes. This is likely to make some schemes less attractive to FDs and recruitment may become even more difficult, particularly in those areas which have historically been a problem to recruit to.

Occupational Health:

Northants reported that the LDC had been contacted urgently by a constituent who had received a needle stick from a known high risk patient. The dentist was passed from Occ Health to the ED and then to their GP who all declined to treat as they weren’t contracted to provide that service. They finally received the PEP via another source but not before they became extremely anxious. It transpired that the receptionist at the Occ Health department wasn’t aware of the Occ Health contractual agreement. Each LDC were advised to check that a service level agreement existed (Herts currently don’t have one) and that all parties are aware of their responsibilities and dentists are aware of the routes for contacting those service providers.

Providers and Performers in Cambridgeshire and Peterborough can go to Hinchinbrooke Hospital for this service.

The Telephone Number to contact Hinchinbrooke is: 01480 416416  Calls will be transferred to Occupational Health. Opening hours is Monday to Friday 8.00 am to 4.00 pm. After hours this service can be accessed via A&E.

Patient swallows object:

In the case of a patient swallowing or inhaling an object while in the dental chair, the patient should immediately be referred to their GP who in turn can refer the patient to Hospital for chest X-rays.

Dental recruitment.

It is believed that many Dental graduates will return to the area of the country where they were brought up and so it seemed sensible as LDCs to encourage 6th form students in those areas of difficult recruitment to consider a career in dentistry. London was seen as an example where a disproportionate number of 6th formers were accepted for dentistry and returned there after graduation. Whilst the demographics of the current undergraduates tends to be drawn from urban areas it was seen as a chance to encourage those from more rural areas of the region to apply. Careers days and perhaps a video, showcasing careers in dentistry might be a first step. Commissioners are funding golden hellos for trainee GPs in North West Norfolk. There is little chance that this will be extended to GDPs despite that area being one of the worst for dental recruitment.

Brexit implications:

The impact of a no deal Brexit may have some implications on availability of both clinical and non-clinical consumables, and workforce. However, this is unknown territory.

Peer review:

LDCs reported they do not have an NHS peer review scheme in their area. Funding was seen as a barrier together with lack of facilitators. Swindon was seen as a mature scheme and a specification document is highlighted as a potential model.

Sale of Practices/Retirement:

The Practice agents, Frank Taylor, have reported that the CQC are looking at “Partnerships of Convenience”.

Recent changes announced by the CQC could have an impact on practice owners transferring an NHS contract via a partnership, particularly if a practice is due to be sold. The question remains whether partnerships are still a viable pathway accepted by the Care Quality Commission (CQC) and the NHS today?

Until recently, the transfer of NHS contracts has always been a relatively straight-forward process that could be completed via the formation of a partnership. This has meant that when looking to sell practice owners have historically been able to take on a partner and then several months down the line retire, leaving the new owner solely responsible for the NHS contract held by the practice.

The notion that contracts belong to the NHS, not the dentists, and the transfer of a contract to another dentist has only been possible due to a contractual loophole.

Previously, vendors and buyers have successfully completed the transfer of NHS contracts via the partnership route.

The process became relatively more complicated back in 2013 when the NHS declared that in order to be a true partnership, both partners had to be registered with the Care Quality Commission (CQC), but in actual fact, the process has always worked relatively smoothly.

Going forward, dentists will no longer be able to ‘sell’ the contracts and the CQC has announced that they are going to stop agreeing to what they classify as a ‘bridging partnership’.

In other words, they are going to be much stricter about the partnerships they register in an attempt to block the NHS contract loophole.

Oral Surgery:

NHS England and the Office of the Chief Dental Officer have set out plans for the accreditation of Tier 2 services in primary care. NHS England are developing Tier 2 NHS services in various clinical disciplines. The intention is to accredit practitioners so that they can deliver NHS services that are not covered by GDS mandatory services via a referral service within a local managed clinical network (MCN). Level 2 accreditation specifications for oral surgery will be available first.

Stepping down:

After 2 years as secretary of the LDC Bharpur Sanghera has decided to step down. He noted that he has expanded his knowledge vastly through attending 4 Secretary’s Meetings per year, 4 LDN Meetings per year, the Annual LDC Conference and LDC Officials day. The LDC is thanked him for his excellent service and commitment.

6. Date of Next Meeting:

Wednesday, 22^nd May 2019