Essex Local Dental Committee

Essex Local Dental Committee Newsletters

This is a report on the recent LDC Officials Day by Clint Foreman.

Essex Local Dental Committee

Hon. Secretary : Tony Clough, Roxwell House, Roxwell, Essex, CM1 4NL

Tel :01245 248553,  e-mail : clogdent@btinternet.com

Assist. Secretary : Clinton Foreman,

Tel : 07718 900909,  e-mail : clintforeman@lismail.co.uk

Notes of LDC Officials'Day meeting held at  Hotel Russell on 7.12.07.

Unfortunately, due to train cancellations, which meant nearly 8 hours travel, I missed most of the first presentation by Lester Ellman, and can only enclose his lecture notes. However, it appears that he continues to press the DoH under the FOI Act, and presents damning evidence of the failure of the new contract to deliver to patients or dentists. He highlights the need to remove UDAs as sole currency and the PCTs' PCR liability, as well as securing funding for planning (including 'high needs' patients).

Statistics show 40% subject to claw-back; 35% asked to make up the shortfall; 25% not penalised. His view is that there is inconsistency and unfairness generally, although some pragmatism prevails occasionally. He is worried that the contract is causing 'dumbing down' in the profession, thereby denying patients the skills available (especially 'high needs' patients).

Susie Sanderson (Chair BDA Exec) reminded us that April 2009 will bring the end of 'ring-fencing', and PCTs will be able to impose individual contract changes (e.g. UDA values). It is important to engage with PCTs now (commissioning plans are due in early 2008, and the DoH is very keen on 'practice-based commissioning'), and to influence the LDP, which should have 'Oral Health Stategies'. The BDA is tendering workshops, and experiences can be shared, such as the '10p UDA'/added value to contract needing added time to deliver,etc., by accessing LDCtaskforce@bda.org.

Eddie Crouch (Chair LDC Conf.) spoke about his legal challenge to his PCT under section 11(now 242) of H & SC Bill, and emphasised the failure of 'local commissioning' to take account of atypical assessment years/needs assessments/public consultation/dental trends/population changes/limited PCT workforce and understanding, etc.

Henric Overgaard-Nielsen requested donations to this legal challenge.

Janine Brooks of the National Clinical Assessment Service reported on the referral of dentists (not other staff at present) re sickness, addiction and poor performance.

Ros Hamburger (Cons in DPH, Birmingham) suggested a structure of accreditation for better practice, with some additional financial reward (dependent upon PCT resources), and made the point that PCTs should be looking for better rather than more services. This proposal was greeted with considerable approval, but no little scepticism. She offended the delegates by asserting that the previous 'item of service' structure had resulted in 'three times' the number of fillings being provided than were required, proving that a little knowledge of the statistics can be dangerous in the wrong hands.

Barry Cockcroft (who did not attend) had sent a letter to Eddie Crouch offering to meet him, and any other representatives who were showing 'significant commitment' to the NHS, to discuss LDC concerns. Delegates were horrified that the CDO was attempting to dictate which LDC representatives would be acceptable to him, and it was pointed out that the 'gift of NHS dentistry' no longer resided with GDPs, but with PCTs, and that many dentists had far less NHS funding than they requested/required. I suggested that the CDO let us know the level of commitment that he thought 'significant', and that future government figures of 'NHS dentists' did not include those dentists that fell below this level.

It was agreed that EC and any other interested representatives (please contact him at ECrouch9@aol.com ) would meet the CDO, although much caution was advised in the light of previous meetings with him and ministers such as Rosie Winterton.

Duncan Rudkin (CE of GDC) said that DCP registrations were to protect the public from the incompetent and the bad, and to enable professionals to keep things moving forward. More than 13,000 d.nurses are registered (recent rush to avoid increased fees in 2008), but only 1,200 d.technicians (some of whom believe, mistakenly, that they can opt out). We should encourage registration, apparently, because the GDC is 'not a club for dentists'. He was taken to task for the 'high fees amid financial incompetence', and could offer no advice re illegal 'denturists', nor 'tanning parlours' providing tooth whitening. He felt that the lack of training courses for d.nurses would be addressed by registration 'driving the need' ('chicken and egg'?), and that it was not his place to comment on the likely increase in d.nurse remuneration as a result of qualification, in a fixed NHS budget.

Notable points in the 'Q & A' session :

  •  The need for a Cons. in DPH was stressed (one up to us).  
  •  Brian Levy wanted new owners, often with overseas dentists working cheaply, and who often accepted any UDA price, to be included in LDC discussions.
  •  It was suggested that a 'floor value' UDA should be negotiated (?£22, depending upon area), but it was also felt that this would inevitably be too low, and the only level then accepted by the PCTs.
  •  Apparently, IDH refuse to contract below £22, because it wants to deliver good treatment, and many contracts have been lost when the UDA value was £17.
  •  EC hoped that IDH encouraged their dentists to join the LDC.
  •  Ian Gordon ('Challenge') said that we are negotiating UDA values for a 'flawed contract'. Nothing new here, I think, and we need to accept a 'fait a complit' when we see one, and get on with improving it by engaging with the PCTs.
  •  Jason Stokes requested increased use of the LDC website to 'flag-up' successes.
  •  The danger to 'single-handed' practices in local commissioning was highlighted.
  •  The new NHS forms (April 2008) will require some additional information, e.g. notification of fluoride applications, etc.

The 'Workshop' put together the 'East of England' (Norfolk, Suffolk, Beds., Camb./Peterborough, Herts., and Essex), and wanted to know if/how far 'local comm.' was progressing, and what successes the LDCs had in influencing PCT LDPs.

Not much, was the consensus, although all PCTs were engaged with LDCs, and it was felt that 'best practice' should be shared among LDCs, with advice coming from the BDA, where relevant. Improving personal relationships with PCTs appeared to be the key.

There was condemnation, however, of attempts by such regions to deal with SHAs, as previous experience had resulted in the unanimous response of, 'you must ask your local PCT'.

Nick Stolls (LDC Sec Norfolk) gave a presentation on the breakdown of the relationship with his PCT, and Tony and I have long been aware that a change in personnel at the PCT can have catastrophic effects. I urge you to read his notes.

John Cantwell (LDC Sec Avon) reported that his PCT has agreed an allowance of 20 UDAs per session for dentists attending meetings for the PCT, which suggests more positive cooperation.

Martin Whiteman (Partner, Howell Jones RHW Solicitors) spoke about their take on the legal aspects of the new contract, e.g., goodwill, and the ability of PCTs to terminate contracts. He outlined how to sell a practice without the PCT being able to insist on a change of contract, by taking in a prospective buyer as a partner, and then allowing the vendor to 'fade away'. He also mentioned selling to a corporate.  

One interesting point was that he felt that treatment would have to be provided for an adult insisting on NHS treatment at a 'child only' contract practice.

All in all, a useful day, with interesting and lively debate. Overall, there is considerable disquiet within the profession, with wide variance of PCT response, with the majority struggling with implementation. It is now time to attack phase two.

Clint Foreman

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