North Yorkshire and Humber Area Team Newsletter-ISSUE 3
Introduction
I am delighted that so many of you are contacting me with queries and articles you would like to share with other dental professionals. Please keep sending your issues to me, Caroline Bolland, my email address being
I also welcome giving advice and support to practices outside of the newsletter if you wish for help in any circumstances.
When I started the newsletter it was simply a means of communication as we started down a little known path without PCT/CTP’s and I had concerns about getting messages out and communication in general. I now am hoping the newsletter will enable a merging and exchange of ideas, policies and information throughout our new Area and Area Team.
This newsletter again has some very pertinent topics
- End of Year issues and how contracts will be dealt with. A MUST READ.
- Healthwatch – what is it?
- Brush DJ -a new app for changing ways of delivering Oral Health.
- New advice on prescribing Diclofenac and Codeine (you may have seen this information sent by the Medicines and Healthcare Products Regulatory Agency recently).
- Interactions of Dabigatran (Information from Sally Eapen-Simon).
- Antibiotic use and C. Difficile (further information asked for by GDP).
- Information on Cross Infection audit and how to UPDATE. Also the latest link to Information Governance Toolkit.
- LDC meetings and an Article from Hull and East Riding LDC about LDC levy and the need for support. Useful contact numbers and news of website launch.
- Useful contact numbers.
Year End Process
- For 2012/13, the Area Team will adhere to the policies of the relevant former Primary Care Trusts.
- For 2013/14, the Area Team will follow the national policy as determined by NHS England as follows:
- Any provider exceeding 100% will be allowed a tolerance of up to 2 % a year (to a maximum of 102% delivery). This will not be paid as an additional payment of the contract value but will be carried forward to allow the activity to be provided in the following financial year.
- As per the contract, any provider performing between 96 – 100% will automatically be asked to re-provide the shortfall of activity in the following year.
- All providers performing under 96% will be subject to clawback and may receive a breach notice. The Area Team will meet with these providers to discuss the feasibility of contract reduction where appropriate.
- Any queries, please do not hesitate to contact Jane Ollerton (jane.ollerton@nhs.net) or David Iley (david.iley@nhs.net) .
HEALTHWATCH
A number of you have contacted me having received leaflets and a letter from this new body. It is not in general the body to send patient complaints to as some dentists thought who have contacted me, although potentially, a patient could choose to discuss an issue with Healthwatch. Healthwatch do however have rights of entry to dental practices. In North Yorkshire we know they have always given notice of a visit to a practice and mainly focused on talking to patients.
Nichola Adcock from the Area Team has put together the information for us set out below.
Healthwatch England, previously known as Links, is the national champion for consumers and users of health and social care services, their carers and the wider public. It was established in October 2012 and is currently made up of 152 community-focused local Healthwatch groups. These local groups engage with charities, community and voluntary organisations on the development/improvement of services and ensuring support is available to people who struggle to be heard. They also are part of the statutory Health and Wellbeing Boards. North Yorkshire & Humber has 3 local groups North Yorkshire, East Riding & York. The East Riding group has proceeded to distribute letters and posters to local health care providers outlining their services and how people can get partake in their work. Further details on all the local groups can be found on the main Healthwatch England website: http://www.healthwatch.co.uk.
Local Healthwatch Groups contact details.
|
Name |
Region |
Website |
|
Healthwatch East Riding of Yorkshire |
YORKSHIRE & HUMBERSIDE |
www.healthwatcheastridingofyorkshire.co.uk
|
|
Healthwatch North Lincolnshire |
EAST MIDLANDS
|
www.healthwatchnortheastlincolnshire.co.uk
|
|
Healthwatch North Yorkshire |
YORKSHIRE & HUMBERSIDE |
|
|
Healthwatch North East Lincolnshire |
EAST MIDLANDS
|
|
|
Healthwatch York |
YORKSHIRE & HUMBERSIDE |
Health & Wellbeing Boards
East Riding Health and Wellbeing Board Tel: 01482 393204
County Hall Contact: Jane Stewart
Beverley HU17 9BA Tel: 01482 615096
Anita Eckersley – Democratic Services Officer Tel 01482 615000
Contact: trish.dalby@hullcc.gov.uk – Director
Hull Health and Wellbeing Board Tel: 01482 300300
The Partnership Team Email: partnershipteam@hullcc.gov.uk
Room 41
The Guildhall
Alfred Gelder Street
Hull
HU1 2AA
North Lincolnshire Tel: 01724 296384
Civic Centre Contact: Julie.poole@northlincs.gov.uk
Ashby Road General Tel Number: 01724 296296
Scunthorpe
DN16 1AB
North East Lincolnshire Council Tel: 01472 324134
Municipal Offices Contact: Sue.webster@nelincs.gov.uk
Town Hall Square General Tel Number: 01472 313131
Grimsby
DN31 1HU
North Yorkshire Council Tel: 0845 8 72 73 74
County Hall Contact: Seamus Breen – Assistant Director
Northallerton seamus.breen@northyorks.gov.uk
DL7 8AD Email: nypartnerships@northyorks.gov.uk
York Health and Wellbeing Board Tel: 01904 551078
West Offices Contact: Judith.Betts@york.gov.uk
Station Rise General Tel Number: 01904 551550
York
YO1 6GA
BRUSH DJ
The first oral health app to be approved by the NHS!
York dentist Ben Underwood has developed a free app called Brush DJ, which motivates users to have an effective daily oral hygiene routine.
The main feature of the app is a timer, which plays 2 minutes of music taken at random from the user’s device. This makes the mundane task of brushing for the correct length of time more fun and therefore more likely to happen. The app also contains the evidence-based oral health advice given in the Department of Health document ‘Delivering Better Oral Health’. Reminders can be set to prompt twice a day brushing, when to change toothbrushes, visit the dentist and hygienist.
This short video gives an overview of all the apps features.
http://www.youtube.com/watch?v=plUxuzEvINg
Brush DJ has recently become the first oral health app to have been approved by the NHS in England. http://apps.nhs.uk/app/brush-dj/.
The second in a series of videos showing how to carry out basic oral health tasks has just been uploaded to YouTube.
http://www.youtube.com/watch?v=fkq_Mjdjz6U.
The next version of the app will have a link to this video and 5 others showing how to carry out basic oral hygiene tasks effectively. The video along with lots more information can be found on the website www.brushdj.com, Facebook, https://www.facebook.com/pages/Brush-DJ/245442625526057 and Twitter https://twitter.com/BrushDJ.
Brush DJ has already been downloaded in 157 countries and it is well worth spending time looking at this app and considering how it might help you in practice.
Feedback on the app is welcomed together with any suggestions on how it might be improved via;
New advice on prescribing Diclofenac and Codeine issued by Medicines and Healthcare Products Regulatory Agency -July 2013
Diclofenac- Summary
Available data indicates that the cardiovascular risk with diclofenac is similar to that of the selective COX-2 inhibitors. Consistent with COX-2 inhibitors, diclofenac is now contraindicated in those with: ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, or established congestive heart failure (New York Heart Association [NYHA] classification II–IV).
Advice for healthcare professionals:
New advice for Diclofenac.
Diclofenac is now contraindicated in patients with established:
– ischaemic heart disease
– peripheral arterial disease
– cerebrovascular disease
– congestive heart failure (New York Heart Association [NYHA] classification II–IV)
Patients with these conditions should be switched to an alternative treatment at their next routine appointment
Diclofenac treatment should only be initiated after careful consideration for patients with significant risk factors for cardiovascular events (e g, hypertension, hyperlipidaemia, diabetes mellitus, smoking).
Naproxen and low-dose ibuprofen are considered to have the most favourable thrombotic cardiovascular safety profiles of all non-selective NSAIDs
The lowest effective dose should be used for the shortest duration necessary to control symptoms. A patient’s need for symptomatic relief and response to treatment should be re-evaluated periodically
Email: info@mhra.gsi.gov.uk for further information
Codeine Summary
Codeine should only be used to relieve acute moderate pain in children older than 12 years and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen alone.
Furthermore, a significant risk of serious and life-threatening adverse reactions has been identified in children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy (or both). Codeine is now contraindicated in all children younger than 18 years who undergo these procedures for obstructive sleep apnoea
Advice for healthcare professionals:
Codeine should only be used to relieve acute moderate pain in children older than 12 years and only if it cannot be relieved by other painkillers such as paracetamol or ibuprofen.
Codeine is contraindicated in all children (i.e. younger than 18 years) who undergo tonsillectomy or adenoidectomy (or both) for obstructive sleep apnoea.
Codeine is not recommended for use in children whose breathing might be compromised, including those with: neuromuscular disorders; severe cardiac or respiratory conditions; upper respiratory or lung infections; multiple trauma; or extensive surgical procedures. The symptoms of morphine toxicity may be increased in these settings.
In children age 12–18 years, the maximum daily dose should not exceed 240 mg. This may be taken in divided doses, up to four times a day at intervals of no less than 6 hours. It should be used at the lowest effective dose for the shortest period. Duration of treatment should be limited to 3 days and if no effective pain relief is achieved, treatment should be reviewed by a physician. Information should be given to parents and caregivers on how to recognise the signs of morphine toxicity, and advice should be given to stop giving the child codeine and to seek medical attention immediately if their child is showing these signs or symptoms
Symptoms of codeine toxicity include: reduced levels of consciousness; somnolence; respiratory depression; ‘pin-point’ pupils; lack of appetite; constipation; or nausea and vomiting
Codeine is contraindicated in all patients of any age known to be CYP2D6 ultra-rapid metabolisers
Codeine should not be used by breastfeeding mothers because it can pass to the baby through breast milk and potentially cause harm
For further Information Email: info@mhra.gsi.gov.uk
Dabagatran drug interaction
Dabigatran has some notable drug interactions which all dentists should be aware of when prescribing drugs. These include ketoconazole, clarithromycin and NSAIDs.
It remains the dentist’s responsibility to check the patient’s drug history and they should refer to the BNF for further guidance before prescribing medication for patients currently taking any of the new oral anti-coagulant drugs or other drugs that they are unfamiliar with. In circumstances where the patient’s drug history is unclear it would be best practice to contact the patient’s GMP for advice.
Antibiotic use and C Difficile (Further information asked for by a GDP)
I am sorry to say I have not had much feedback as to best practice for the prescribing of antibiotics to C. Difficile card carrying patients but I am still pursuing this. Sandra Whiston, Specialist Registrar in Dental Public Health has replied as set out below but is getting back to me further.
“ In terms of responding to your specific query – I’m not sure if there are particular antibiotics to avoid – it’s about being aware of safe antibiotic prescribing and that all patients should be asked if they carry a warning card (known risk), and being aware of those patient groups who are at greater risk. ”
Information on Cross Infection audit and how to UPDATE and the latest link to Information Governance Toolkit
You should all have received the CD ROM about 2 years ago to start the process of regular audits for Cross infection control from the DOH.
For your information if you are looking for the CD ROM it has the following title:-
IPS/DOH ‘Local self-assessment audit for assessing implementation of HTM 01-05: decontamination in primary care dental practices and related infection prevention and control issues.
As you all should be aware we are now to carry out audits on a six monthly basis. The link below will install the update of the April 13 changes. Please note the CD ROM must be installed to update with this link.
http://www.ips.uk.net/template1.aspx?PageID=95&cid=19&category=Dental-Audit-Tool
If you are struggling I can send you by attachment a paper version of the updated audit tool, please contact me if you require this.
I also enclose the latest Information Governance link.
LDC • LDC meetings and an article from Hull and East Riding LDC about LDC levy and the need for support. Useful contact numbers and news of website launch.
First of all I am delighted to report that the South Bank LDC representing North and North East Lincolnshire dentists looks to be re-forming, as yet I have no information on elected officials but the next date for your diary for meeting is Monday the 7th October 2013 at Arties Mill, Brigg at 6.30 pm
North Yorkshire and York LDC
Next meeting 6.30 pm Wednesday the 11th September 2013 at the Golden Fleece, Thirsk.
Chair: Ian Gordon
Email Iangordon1@nhs.net
Secretary Mark Green
Email markpgreen@aol.com
I am sure they would welcome new voices but please contact them directly to attend.
Hull and East Riding LDC
The next meeting is on Tuesday the 22nd October at 7.30 pm at Brantingham Sports Park (Ionians), Elloughton.
I would also be grateful if providers/dentists could read the article below:
Article by Hull ad East Riding Treasurer about the LDC and Levy
LDC (= Local Dental Committee) is a group of elected volunteers to represent local dentists.
What do we do?
Representing, negotiating, fact-finding, supporting, alerting, informing you
In the near future, this is going to be increasingly vital to facilitate our future activity within the NHS.
(We also fund contributions to the BDA Benevolent Fund, the charity supporting sick dentists in need of help.)
To ensure you are kept in the loop, please send your email to the LDC Secretary, Mr Chris Groombridge, who is exceptionally good at keeping everyone up to date with all the current information available. (chris@543dentalcentre.co.uk)
How are we funded?
Every dentist (performer) working on a NHS GDS contract has to pay a statutory levy of £10 per month. This is compulsory and ideally is collected directly from the monthly schedule. Each practice should remember to deduct this levy from the dentist.
At present, since the restructuring of the NHS, it depends on the Area Team to arrange these levies with the payments department at NHS England Dental Services. It has come to my attention that numerous errors are being made, both in overpayment and non-payments. Ultimately, when better systems are in place, it will be appropriate to claim clawback of non-payments of the LDC levy. I realise that this is far from ideal for managing practice affairs and dentist payments, and obviously it is preferable to correct the levies as soon as possible.
How can you help?
Please could all practice managers check that “NHS England Fixed Levy” appears on ‘page 2’ for every performer schedule (i.e. ‘Monthly Superannuation Notification’), and identify any errors. Please contact me so that I may assist you to correct these errors to avoid / reduce potential clawbacks of non-payments.
You can contact me, Chris Ayer (LDC Treasurer) on (01482) 506004 or chris@wgrange.karoo.co.uk
Chris Ayer
East Riding LDC Treasurer
Please also note the launch of Hull and East Riding website
contact committee members:- info@eryldc.co.uk
Useful contact numbers
Finally
Dental Advisers contacts
alisterweightman@nhs.net Alister
bhdp@btinternet.com Roger
c.bolland@nhs.net Caroline (myself)
Area Team contact
Nichola Adcock tel 011382 51910 or leave email at england.primarycare@nhs.net and leave a message.
Finally good wishes to all.