Meeting 9th December 2020
ONLINE MEETING VIA WEBEX
WEDNESDAY 9th DECEMBER 2020
Patrik Zachrisson - LDC Chairman & Treasurer
Amiras Chokshi - Secretary
Mariana De Villiers - LDC Administrator
Marlise De Vos
- Chairman’s Report: Patrik Zachrisson:
Patrik Zachrisson hosted the LDC online meeting on Wednesday evening, 13th May 2020 at 7.00 pm via Cisco Webex.
Minutes of Meeting held on 19th August 2020 was confirmed.
Since the outbreak of COVID-19, the impact the pandemic has had on dentistry has been particularly acute. However, most practices now operate as normal, offering access to both routine and emergency dental services although at reduced capacity.
Discussions with NHS England are ongoing over the contractual arrangements for quarter three and four. In the meantime, practices should continue to work according to the SOP and to maximum NHS capacity, with a minimum of 20 per cent of previous activity levels. NHS England was seeking to move the minimum activity threshold upwards, but this has not been actioned yet.
NHS England was looking at how it could reimburse providers for PPE costs, but it had not yet been confirmed how this would occur. It is also unclear what PPE would be included.
- Treasurer’s Report – Patrik Zachrisson
The Cambridgeshire and Peterborough LDC continues to be financially stable and secure.
The LDC has provided Financial Contribution to 13 Dental Practices to help with compliance to new COVID-19 secure measures.
The possibility of having a Cambridgeshire & Peterborough LDC Facebook presence with limited access to dentists only was discussed.
- Secretary’s Report – Amiras Chokshi:
The LDC Secretaries Meeting was held on 19th November 2020 and the GDPC Meeting on 6th November 202.
Nick Stolls will retire as Secretary of the Norfolk LDC at end of March 2021. The group welcomed Jason Stokes as the secretary elect for Norfolk.
Future contractual arrangements: Possible mechanisms for activity metrics for the rest of this financial year with a very real possibility of the return to UDAs as the activity measure was discussed. However, talks with David Barter suggested that a system of Flexible Commissioning would be preferred. Exactly what this entails, how it would be measured and what type of activity would be expected is unclear. It was suggested that a small part of the contract would include Flexible Commissioning and that Dental Nurses might be able to perform extra duties under the flexible commissioning framework.
NHS England was seeking to move the minimum activity threshold of 20% upwards. The British Dental Association (BDA)’s position remained unchanged in that it was opposed to UDAs being used at all and did not think that there was a case that increasing the minimum threshold was appropriate at a time when there is a wider effort to reduce social contact. Remote triage is still a significant resource commitment for practices and should continue to be counted as activity. It would also be very unfair to retrospectively impose any changes on quarter three. Practices need to be given proper notice in advance of any changes to the contractual framework to which they are required to work.
Patient charges appear to be a problem. Lots of patient charges were lost.
NHS dental charges will increase from 14 December 2020.
Band 1: Current charge £22.70 will increase to £23.80
Band 2: Current charge £62.10 will increase to £65.20
Band 3: Current charge £269.30 will increase to £ 282.80
Fallow time was discussed and the possibility of capital funding to address financial support for ventilation equipment to Dental Practices to reduce this. In particular, practices require capital investment support from NHS England to meet the installation costs. There was also a need to understand the current air changes per hour in the surgery through an audit. Practices needed the reassurance that if they make an investment in ventilation then they will not be told in few months that it was not needed. The likelihood of funding is very slim.
UDCs. Many of the centres were still receiving referrals but these are now mainly from 111 and direct referral rather than via FDS. It was reported that nationally there was a question as to the need for UDCs now most practices have returned to face to face care but it was pointed out that several practices were impacted by staff self-isolating and may need to use the UDC services over the next few months. Some UDCs have linked to GP services but very few cases are being referred by this route. All practices should now have enough PPE and capacity.
Clustering and Bubble formation: It was suggested that patients from Peterborough, Cambridge, Ely and Huntingdon form a cluster. A cluster is being seen as a bubble that brings together all local services involved in health and care across a geographical area, typically serving an area between 25 000 and 100 000 in order to co-ordinate and promote the wellbeing of individuals and communities. The idea is to have Accident and Emergency Doctors, General Practitioners and Pharmacies involved in order for patients to move a lot quicker between different departments. However, there is no guidance, leadership or direction or audit trail. This would create lots of additional work when there are clear pathways in place.
Orthodontics. A paper has been agreed over the method for treating and remunerating for patients who relapsed during the lockdown after they experienced a retainer fracture. It was noted that the current PDS contracts could be extended until September 2023 should it be needed. David Barter also hinted to introduce a Flexible Commissioning Process. The Commissioning Process would be slightly different. The £200 000 eligibility no longer a requirement. The uncertainty around being awarded an Orthodontic Contract or not is very unsettling.
The Commissioning Team is quite stretched. Appeals to Breech notices are not being looked at.
Associates. It was disappointing to report that associates were still experiencing contractual issues over fees payments and working arrangements although the group accepted that often there were two sides to the story. It was agreed that as secretaries it was wise to avoid trying to act as an arbitrator but rather to signpost to the BDA. Based on the previous year’s earnings it is difficult to calculate remuneration for new starters, associates returning from maternity leave, etc. Guidelines are unclear.
- Special Care Dentistry: Julia Hallam-Seagrave
The Dental Access Centre had to cancel around 1 000 patients due to the Covid-19 pandemic. Due to the backlog of patients Special Care Dentistry was stopped. There has been a huge increase in referrals over the last month. The list for General Aneasthetics has increased in Peterborough. Only 3 children per day are being seen vs 10 previously. Waiting times are quite significant. Patients are currently not being seen at Addenbrooks hospital but are mostly seen at Peterborough hospital and some at Bury St Edmonds. The best pathway for children now is triage and prioritise.
The backlog for providing Minor Oral surgery services has been reduced from 500 patients to 300. The Dental Access Centres became Urgent Dental Centres during the pandemic and still exists as such.There are still many patients without a dentist and centres are still inundated with patients requiring access.
- Other Business
Free masks are available through NHS England. Dental practitioners need to apply for this. Mask recycling was discussed. This is hugely dependent on the type of mask and practitioners need to be clear on whether this is appropriate or not. FFP2 and FFP3 masks are not re-useable and cannot be washed.
Options for further support of dental practices by the LDC was discussed. Funding of new projects will be available at a later stage.
- Next Meeting:
3rd March 2021.