Agenda item

(To receive a report by Jane Green (NHS England) which provides an overview of the NHS dental services commissioned in Lincolnshire and an update on the new Special Care Dentistry Service arrangements from 1 December 2016.  Jane Green (NHS England) will be in attendance for this item)

A report by NHS England (Central Midlands) was considered which provided an overview of the NHS dental services commissioned in Lincolnshire and an update on the new Special Care Dentistry Service arrangements from 1 December 2016.

 

Jane Green (Assistant Contract Manager for Dental and Optometry – NHS England (Midlands and East (Central Midlands))) and Jason Wong (Local Dental Network Chair – NHS England) were in attendance for this item.

 

NHS England had been responsible for commissioning primary and secondary care dental services since April 2013 and a commitment made to oral health and dentistry.

 

NHS England's clinical aim for each dental practice was to deliver high quality NHS clinical services were defined as:-

 

          "patient-centred and value for money primary care dental services, delivered in a safe and effective manner, through a learning environment, which includes the continuing professional development of dentists and other dental professionals"

 

The Central Midlands Local Officer was responsible for commissioning NHS primary, community and secondary care dental services and had two locality teams who managed dental and optometry commissioning.  Within the Central Midlands region, Lincolnshire formed part of the North Locality which also covered Leicestershire and Rutland. 

 

Within Lincolnshire 69 practices delivered 76 contracts including:-

·       49 practices providing general dental services (10 restricts contracts);

·       1 pilot contract to provide general dental services;

·       15 practices providing general dental and orthodontic services;

·       5 contractors providing orthodontic services;

·       5 contractors providing minor oral surgery services; and

·       1 Special Care Dentistry Service contractor.

 

NHS dental contractors were transferred to the new NHS Dental contract in April 2006 which monitored units of dental activity (UDA) target for general dental practice and units of orthodontic activity (UOA) for orthodontic contracts.

 

Patient charges were changed with the introduction of the new contract which was simplified in to three treatment bands ranging from £19.70 to £233.70.

 

An Oral Health Needs Assessment (OHNA) for the North Locality was developed by Public Health England in conjunction with NHS England Central Midlands Local Office.  The document had been submitted for gateway approval and would be published once received.

 

The OHNA reviewed the demographics of the resident population, provision of services, access to NHS dental services and also made recommendations for consideration by commissioners.  The review identified that the access rate in the following Local Authority areas was similar to, or above, the NHS England and Leicestershire and Lincolnshire averages:-

·       West Lindsey (for children and adults);

·       North Kesteven (for children);

·       South Kesteven (for children and adults); and

·       East Lindsey (for children and adults).

 

The access rate in the following areas was below the NHS England and Leicestershire and Lincolnshire average:-

·       Boston (for children and adults);

·       Lincoln (for children and adults);

·       South Holland (for children and adults); and

·       North Kesteven (for adults).

 

The Local Office also reviewed the outcomes of the draft OHNA along with other intelligence in order to develop the dental commissioning intentions and it had been agreed to commission new dental contract to improve access in priority areas within the resource envelope available:-

·       Boston;

·       Lincoln;

·       Sleaford (North Kesteven); and

·       Spalding (South Holland).

 

All newly qualified dentists were required to complete one year dental foundation training following completion of their dental degree, a process managed by Health Education England (HEE).  Foundations dentists were assigned to accredited dental practices with an identified mentor who would provide support throughout this training process.  Funding was provided to cover the cost of the Foundation Dentist and to support the accredited mentor.  26 training places were available across Leicestershire and Lincolnshire, three of which were secured within Lincolnshire practices.

 

Dental Commissioning Guides provided a standardised framework for local commissioning of dental specialities and were available to Local Offices.

 

Local Offices were expected to work closely with the Managed Clinical Networks (MCN), Regional Dental Public Health Consultants and Dental Local Professional Networks (LPN).  Guides available were Special Care Dentistry (Adults); Orthodontics; and Oral Surgery and Oral Medicine.

 

The Local Dental Professional Network (LPN) for Leicestershire and Lincolnshire was established in 2013 and the Steering Group developed work priorities each financial year with progress monitored by NHS England Central Midlands.  Although engagement from the dental health community, HEE, Public Health and Local Authorities had been good, engagement with CCGs had been a challenge which continued to have little success.

 

Recognition had been given nationally to the Dental LPN for the work on older patients oral health in Lincolnshire and was linked to the Oral Health Promotion Strategy.

 

Non-recurrent funding had been secured to fund a pilot for improved access to interpretation services across Leicestershire and Lincolnshire from NS England.

 

Challenges identified by the LPN related to:-

·       Access to Restorative Services;

·       Formation of Gerodontology MCN to focus on Older peoples, people with Dementia and Mental health issues oral health;

·       Delivering prevention to families who have experienced extraction with General Anaesthetic for tooth decay;

·       Encourage the increase in foundation training practices in Lincolnshire;

·       Increasing the level of Oral health promotion activities in Lincolnshire in partnership with Lincolnshire County Council;

·       Implementation of Health Gums Do Matter toolkit and increase the knowledge of the General Dental practitioner of the relevance of oral health on general health and vice versa.

 

Dedicated support across Central Midlands had been secured by NHS England for performance management of dental secondary care contracts, to review secondary care dental pathways to improve access and commission new pathways.

 

Managed Clinical Networks for Special Care Dentistry, Orthodontics and Minor Oral Surgery had been established by the LPN also.

 

Lincolnshire County Council became responsible for improving health and reducing inequalities for its local population from 1 April 2013 which included commissioning of oral health promotion programmes and epidemiology surveys.  LCC had agreed that this would be commissioned by NHS England's Special Care Dentistry Service contract on their behalf.

 

NHS England had completed a procurement process to secure service provision of Specialist Care Dentistry Service from 1 December 2016 and the contract awarded to Community Dental Services (CDS-CIC) in June 2016 on a seven year contract term with the option to extend for a further three years.

 

Work between NHS England, Lincolnshire Community HealthCare NHS Trust and Community Dental Services had been ongoing since June 2016 to ensure a smooth transition between services and providers. 

 

All referrers across the health community would be advised of the revised referral process and all stakeholders would receive an updated brief and media release during November 2016 prior to the commencement of the contract on 1 December 2016.

 

The Committee was invited to ask questions, during which the following points were noted:-

·       Further explanation of the banding structure for pricing was explained.  If, for example, band two work was carried out and needed to be repeated within a couple of months, this would be covered under the first payment.  Should the work be band one or three then a further payment would need to be made;

·       Lincolnshire found it harder than other areas of the country to recruit, especially in the east of the county.  There was thought to be enough dentists providing NHS dental treatment in the country but that these were not necessarily based in the areas of need;

·       Practices were being encouraged to recruit and also offer positions to foundation dentists.  It would also help if those trained in Lincolnshire (or any other area) were contracted to stay within the county for a set period on completion of that training.  Unfortunately, the contract did not allow for that;

·       Anecdotal evidence had been received that some dentists had not been accepting children from a young age.  A 'refusal form' had now been implemented to ensure that if any dentist did refuse a child patient for being too young, they could be challenged;

·       The Health and Social Care Act 2012 had resulted in the promotion of oral health falling under the remit of Local Authority Public Health function and there had been campaigns to support oral health.  Lincolnshire Smiles Programme had 12 practices affiliated to it to promote oral hygiene in schools across the county but additional funding would help further promotion;

 

RESOLVED

 

          That the report and update be noted.