HAMPSHIRE AND ISLE OF WIGHT LOCAL DENTAL
COMMITTEE
Secretary’s Report and Correspondence: 9th September
2015
1. KEY INFORMATION FOR PRIMARY CARE DENTAL TEAMS was released
in early August but not sent to the LDC Secretary until the 26th August.
This omission has been flagged up with NHS England so that in future the
LDC receives these important updates. Once received these bulletins are
routinely placed on the LDC website www.hants-iow-ldc.info
2. OCCUPATIONAL HEALTH PROVISION FOR DENTISTS has attracted
some marketing interest from Solent NHS Trust who are looking to offer a
full or customised OH service to all types of dental practice in
Southampton and Portsmouth. GDPs are still awaiting details of the new
OH services for dentists and their teams but currently the existing
arrangements continue to operate. The LDC is always looking for avenues
of support for our constituents and it is likely that a reasonably costed
service may be of interest. Currently Solent cannot provide an OH service
because there are no agreements in place but practices may choose to do
so in the future.
3. ADDITIONAL NON-RECURRING UOAs have been offered to existing
providers of NHS Orthodontic Services at a rate of £52 per UOA. The
closing date is the 9th September 2015. The strategic intention is to
reduce the highest waiting times. There are certain limitations/conditions
that need to be satisfied to be able to take advantage of this offer.
4. TRANSFORMING GENERAL DENTAL SERVICES IN WESSEX is based on
the NHS Five Year Forward View to reduce variation when patients
receive dental care. Existing providers of non-restricted GDS/PDS
Contract/Agreements are invited to apply for these recurring UDAs.
Priority will be given to areas where access to NHS dental care is difficult
and where there are no existing Equitable Access Centres in place. There
is a comprehensive list of minimum criteria, service specification and
there is a need to consult with the local population to assess demand.
There is no need to carry out a needs assessment. There is no appeal
process and applications must be lodged with NHS England.
5. THE GDPC/LDC REGIONAL LIAISON GROUP (RLG) met in June 2015
and it was decided that a working group would look at developing a
specification for a central LDC website. The group decided that there is a
need for a more robust approach to information gathering and sharing to
support LDCs. The RLG noted that the Single Operating Model (SOM) and
policy for 24 hour retirement is still awaited and the implementation date
for the revised NHS sickness and maternity/paternity payments is also
overdue. There are some concerns around Foundation Dentists paying the
Statutory Levy (SL) and this is a topic of conversation with the BSA. It was
noted that co-commissioning and local devolution with seven day opening
is high on the agenda. Dentistry has not been formally mentioned in the
plans for integration of health and social care but this could be an
important future responsibility for the Local Dental Network (LDN). LDCs
have been identified as having an important role in creating good
relations with CCGs and Local Authorities and thereby highlighting the
importance of good oral health. Greater integration could raise concerns
where dental service money is released from clawback/decommissioning.
There was another discussion on the necessity to formally review NICE
guidance on recall timelines. Apparently LDNs vary significantly across
the regions with many relying too heavily on the goodwill of those
participating in the process and generally engagement with Health and
Wellbeing Boards is poor. Concerns were raised about the legality of
contract extensions and in particular orthodontic agreements and legal
advice was being sought with the resultant decisions going through
GATEWAY. Dental Contract Reform highlighted various problems that
have been discussed in previous reports but specifically there are issues
around PDS+ agreements and their transition to GDS contracts where the
contract value might drop by 49% and specific guidance from NHS
England was necessary. NHS England have agreed that training for voting
and non-voting members of PAG/PLDP should be available and the issue
of DBS checks with the current lack of support was highlighted and this
especially applies to new graduates who need to get on the National
Performers List (NPL).
6. THE GDPC EXECUTIVE GROUP IN COMBINATION WITH THE
LDC/GDPC RLG has considered the problem of holiday cover 2015 and
no doubt with Christmas in mind has (as a result of the RLG discussions
with Carol Reece) had some correspondence on this matter with NHS
England. NHS England will be contacting their local offices after the 7th
September 2015 to achieve a more consistent and pragmatic approach to
this perennial problem. NHS England will contact providers to ascertain
the provider’s plans for the Christmas and New Year period with an
assurance that suitable alternative arrangements are in place for patients.
There will be a minimum standard which will include buddying
arrangements and there is no mention of formal contract variation.
7. THE SCIENTIFIC ADVISORY COMMITTEE ON NUTRITION (SCN)
released a report on the links between carbohydrates, including sugar, on
the nation’s oral health and other health issues and made new dietary
recommendations. Consumption of sugar is now over double (12%) the
recommended adult’s daily calorie intake (5%) of sugar with teenagers
consuming around three times the recommended amount. GDPs can
continue to give helpful advice:
http://www.nhs.uk/change4life/Pages/low-sugar-healthy-snacks.aspx
More information can be found on:
https://www.gov.uk/government/uploads/system/uploads/attachment_
data/file/445503/SACN_Carbohydrates_and_Health.pdf There have been
calls from BDA/GDPC to introduce a Sugar Tax and Jamie Oliver has
launched a Sugar Tax petition.
8. THE BDA HAS WARNED THE HEALTH COMMITTEE ENQUIRY INTO
PRIMARY CARE that policymakers are failing in their duty to
appropriately consider the role of oral health in the wider health system.
Tooth decay is responsible for the majority of hospital admissions of
young children but dentists are besieged by red tape, declining incomes,
mounting costs and a regulator that is not fit for purpose. The Chair of the
BDA’s PEC has highlighted that dentists are saddled by a government that
talks prevention but provides opaque structures and payment systems.
The main points are that dentistry needs to be brought into the
mainstream NHS with its attendant messages of wellbeing advice. It
should be recognized that Government only provides a reducing pot of
money badged for dentistry and that it is only sufficient to meet the
demands of 56% of the population. Greater clarity for patients about what
they can expect to receive from NHS dentistry needs to be addressed and
the process of contract reform needs to have a finite deadline with a
preventive approach not more discredited units of activity. National
commissioning of dentistry has always fared better than local
commissioning and oral health needs/funding should be protected during
any moves to local commissioning. Practice income has declined so
significantly that any further reduction or increase in cost pressures will
inevitably threaten the quality of patient care.
9. THE RECENT WESTMINSTER FORUM EVENT ON PRIORITIES IN
DENTISTRY: PROTOTYPE PRACTICES, REGULATION AND CONTRACT
REFORM was addressed by the BDA Chair of PEC who highlighted that
current issues with the GDC does not create confident and positive
professionals. He called for greater investment in dentistry and to treat
dentists as a valued part of whole person care. Mick Armstrong
highlighted that patient satisfaction was very high (96%) with 75%
recommending their own dentist. It was concerning to note that over 25%
of practice owning dentists have very low life satisfaction compared to
6% of the general population. Mick spoke of the tragedy and waste of the
cadre of high quality healthcare professionals that are being prematurely
lost as providers of dental care. There was a presentation on the third
edition of Delivering Better Oral Health outlining its benefits that have
been channeled into improving patient care. Professor Rebecca Harris
CDPH talked about increasing access and improving oral health through
dental contract reform. She identified a new additional treadmill of
quality measures to add to UDAs and how the measure of patient
numbers will be an important marker for success. There will be a
dilemma of which patients are included and those that will be excluded
under the terms of contract reform. Some people will be resource friendly
and others will be the opposite or in-between. There was talk about
‘conditional’ dentistry whereby patients can only secure their desired
dental care treatments if they satisfy certain criteria – is this ethical? The
other layer of complication is patient payment and its relationship to
socioeconomic backgrounds. High compliance is required but red patients
are more likely to be from a poor socioeconomic background and may
have additional preventative appointments and these come at a financial
cost. Finally she concluded that there are concerns with access to dental
care within the reformed contract - access for who? The other question
must be – what sort of patients will both the practitioner and the patient
be most incentivized to receive care and is this a good or bad thing for
inequalities in the nation’s oral health of the future. Other speakers were
keen to abandon UDAs completely, expressed concerns about the blends
and especially the artificial need to increase Band 3 activity to 25% in
Blend B, the desirability of individual practice commissioning, the
perverse influences of different payment models and especially for
performers. Evlynne Gilvarry the Chief Executive and Registrar of the GDC
talked about a regulatory eco system working closely with other
regulators to achieve fairness for patients, the public and the regulated
sector. In the described eco system she included important partners such
as the defence organisations and NHS England. The concept of future
regulation was one of continually raising standards and she believed that
this was responsible for the increased caseload over the past three years
which was now showing signs of a slight reduction in activity. There was
a need for legislative reform to enable a move from the current costly,
cumbersome and complex regulatory machinery. The speaker cited the
current poor complaints pathways that were not responsive to patients’
needs and were burdensome to professionals. As an interim measure the
GDC is using case examiners but to truly prioritise reform the necessary
Bill will need to go before Parliament next year. Helen Falcon gave a
presentation on training and securing the future dental workforce and
opened with a reference to the lack of a clear strategy. There will be a
Workforce Strategy Group established within HEE and it is essential that
the quality of the education and training for dentists post FT is
scrutinized and uprated where necessary. Helen felt that there was a need
for strategic dental workforce plans, formal assessment of satisfactory
completion of foundation training, a curriculum for dental core training
and quality assurance standards for dental CPD.
10. INTEGRATED WELLBEING SERVICE IN PORTSMOUTH CITY is being
developed as a holistic service to tackle the problems of smoking, obesity,
alcohol dependence within the communities of Portsmouth.
11. BARRIE THOMAS EVANS FRCS FDS FFD passed away on the 3rd July
2015. Barrie was a very much respected and eminent local Consultant
Oral and Maxillofacial Surgeon who dedicated his professional life to the
treatment of his patients that were in need of his many and accomplished
surgical skills. Barrie was also a past President of the British Association
of Oral and Maxillofacial Surgeons.
12. SPONSORSHIP FOR THE WEBSITE has been explored with Henry Schein
and the Secretary is awaiting a reply. Dental Directory is our historical
sponsor but they have failed to honour their commitment to the LDC. The
Dental Directory banner advertisement will be removed in the very near
future.
13. LDC BUYING GROUPS have been considered by the Secretary: LDCs
Buying Group (Practice Support Services Ltd (PSS)) and Dental
Professionals Ltd (DPLtd) are the two Ltd companies being considered.
 The LDCs Buying Group has a list of 13 suppliers, some of which
are well know names in dentistry and these have been vetted by
this group. Practices can only participate if they pay the Statutory
Levy and it is free to join. The agreement is between PSS as the

advisor and supporter with the LDC as the operative Buying Group
provider. There are some drawbacks for the LDC as they have to
obtain all the necessary consents to process any Personal Data and
this must be evidenced to PSS. The LDC agrees to indemnify and
keep indemnified and defend at its own expense PSS against
ALL costs, claims, damages or expenses incurred by PSS or for
which PSS may become liable due to any failure by the LDC or
its employees or agents. Any inappropriate Personal Data
processing as a result of LDC misdirection to PSS will be the
liability of the LDC. The liability of PSS is virtually zero and
legal advice should be sought by the LDC before signing this
agreement. www.ldcsbuyinggroup.co.uk
Dental Professional Ltd is a buying consortium with an extended
focus on further helping its members through accredited training,
education, support and networking. The negotiated deals are with
companies such as: Dentsply, Coltene, Initial Waste and Beaumont
Insurance. There is also a 2% loyalty rebate with Dental Directory
and access to 690 net price products. There is an annual cash back
from DPLtd based on the individual spend level. There is no joining
fee but membership is monitored. http://www.dplgroup.org.uk
14. TRAINING OPPORTUNITY TITLED DEVELOPING DENTAL LEADERSHIP:
making prevention work in practice. This one-day course trains dentists
to train dental nurses in the provision of appropriate preventive advice,
the application of topical fluoride varnish and with the emphasis on
patient self-care. The courses will be held on the 24th September in
Manchester and the 25th November in London. Contact
developingdentalleadership@pcc.nhs.uk
K Percival
Hon Secretary