LDC Officials Day and LDC Special Conference – Friday 5
th
December 2014
LDC Officials Day
Mick Armstrong described difficult times for dentistry. The BDA are preparing for the
Judicidal Review against the GDC
Mick has written to the Secretary of State to remind him of the impending JR.
Rt Hon Paul Beresford MP is going to let parliament know the situation with the
GDC.
2. Update from John Milne
John Milne spoke of Simon Stevens, the Chief Executive of the NHS, who has
published a document called ‘A five year forward view’. This document
describes a vision for the future of the NHS and tackles financial problems in the
NHS. Although this document does not specifically mention NHS dentistry, the
document encompasses all sectors of healthcare . The vision includes the
integration of primary and secondary healthcare. This vision may inspire
corporate healthcare provision. We must be ready to adapt to this concept in
Dentistry as this vision is greater than simply the expansion of corporate
dentistry, it is much greater than that. It may inspire companies that can provide
healthcare in the future.
Alternative Contract Reform (ACR) was mentioned by John Milne. The GPDC are
going to work with ACR in the future and GPDC exec are going to consider the
ACR at their meeting in December.
John is going to meet with David Geddes, NHS Enlgand, soon, to talk about
clawback, reinvestment of clawback, difference between area teams, pay rises.
LDC Levy is still a problem. The Levy collection is working in some areas but not
in others.
GPDC are engaging with the software companies regarding the software for
contract reform.
3. Contract Reform Update – John Milne
Is this being viewed as low priority/oral health is seen to be improving/few
complaints/ access is OK???
It does matter! The difference between being rich and poor: at aged 65+ poorer
people have 8 fewer teeth than richer of the same age.
Principles of new contract are to align incentives and enable good practice. The
practice should not be penalized because they do the right thing.
Prototypes:
st
blended prototype
52% activity (band 2 and 3 type items)
10% quality and outcomes (clinical outcomes/patient experience/DQOF etc)
38% capitation (band 1 type items)
The second blended prototype (more based on Steele)
68% capitation (band 1 and 2 items)
22% activity (band
3,
modified UDAs)
10% quality and outcomes (clinical outcomes, patient experience, DQOF etc)
Capitation Section
This would include items such as urgent care? Acrylic dents? Routine endo,
perio, fills, prevention, assessment and diagnosis, radiographs.
Activity section
This would include molar endo, metal dens, crown bridge veneers.
The prototypes are due to start in 2015-16, then run for 2 years before
implementation, which seems a long way off.
The government does not necessarily have any ambition to change access/levels
of care/increase funding.
4. Peter Howitt Deputy Director of the Department of Health gave us an update
on contract reform along with Barry Cockroft.
Barry Cockroft informed us about a very important document called ‘The Five
year Forward View” (mentioned by John Milne) Commissioning guidance work
is based upon the recommendations in this document. This document is focused
on prevention in the wider NHS as a whole. The future of dentistry is described
in this document (even though dentistry is not specifically mentioned in the
document).
Timeline for protoptypes:
January 2015 – calls for expressions of interest in the prototypes
Spring 2015 – prototypes selected
Summer 2015 – prepare for protypes, training, and software update.
Autumn 2015 – prototypes go live.
Engagement exercise
Early findings of this have already been published.
There will be more detailed findings from this published by DoH in January.
Of the engagement papers:
Paper 1: clinical philosophy
Results are that the preventive pathway approach is the correct approach. The
pathway does not work for patients who want urgent and casual care, and the
pathway needs to be modified to accommodate this.
Paper 2: quality and outcomes
Clinical effectiveness, patient experience, and safety – all three aspects are
correct for the DQOF.
Paper 3: remuneration approaches
Spectrum varies from full UDA system to full capitation. The engagement
exercise concluded that a blended remuneration approach was going to work
best.
Next steps
Publication in January 2015
Final proposals for prototypes
Calls for expressions of interest
Indicative timetables for national change
Detailed findings from engagement exercise.
5. LDC Special Conference
Dental Protection (Speaker Brian Westbury) gave their view of the GDC
problems, PDL’s view is that they would prefer a reformed GDC rather then risk
introduction of a new unknown regulator.
Motion for special conference
‘This conference believes the GDC has failed in it’s role as the regulator for
Dentistry in its current model, and demands a reformation of the GDC that
will protect patients and re-establish the support of the dental profession.”
A vote took place at the conference and the motion was carries unanimously.
6. Presentation from the British Dental Guild
Guild donations are down by 75% compared to last year.
Suggested guild donations are £25/ per dentist in your area / year
7. Dentist Health Support Trust
Donations can come out of the statutory levy and can be donated to the trust.
8. Benevolent Fund
They are also reminding us to donate from our LDCs.
9. Dentists with Enhanced Skills DBS
Level 1= GDP post foundation training, for 1 – 2 years after FT
Level 2= dentists with additional or enhanced skills
Level 3a = dentists on specialist lists
Level 3b= consultants
What is the problem that needs solving?
There are increased referrals to Oral surgery and for children
There is a funding imbalance between primary and secondary care (hospital
takes 20% of the budget but delivers 5% of the activity)
Skill level of FD trainers
Pros and Cons of DBS
Pros
Career pathway
Additional fudning for practices
Greater effeiciency for NHS
More convenient for patients
Cons
Additional time and cost of training
Divisive NHS /PVT
Undermines generalists
Undermines secondary care training
Medicolegal risk
Commissioning guides for DES in all the following specialities are under
construction:
1. restorative
2. oral surgery and related specialities
3. special care dentistry
4. orthodontics
10. Richard Birkin, National Director BDA Wales gave a presentation about
current issues in NHS contracting
Dentists are getting letters from BSA re red flags
These letters are asking the dentist t reply with comments. DO no reply without
getting advice from the BDA.
2 month rules – completed claims need to be submitted to BSA within 2 months.
GDPs can refer pts to hospital for OPG as part of’advanced mandatory services’
Xmas opening hours can be subcontracted but you need to write to LAT with
your formal arrangements.
Occupational Health arrangements
More work is needed on this
Urgent continuations as per recent advice published from BSA – the BDA are
seeking a legal opinion on this, so watch this space.
DO NOT reopen the previous course of treatment if the patient returns within 2
months with a problem