Routine Care Network, Meeting with Area Team Director / Commissioner, Occupational Health, ARF Incre

Hello Lancashire

Hope you are all well and are over the rush caused by patients removing restorations with bonfire toffee! It is amazing how you can almost predict situations. I remember just after I started in practice “Pork Scratchings” were the pub delicacy of the seventies ( if you can call a load of fried hairy pig skin a delicacy!). Every other patient that came in had fractured a cusp with the damn things! Christmas was the same but due to people wishing to catch all sorts of untold diseases by putting coins in the Christmas puddings! Never mind it all makes the world go round.

Routine Care Network (RCN): the first meeting of the newly formed RCN will take place next Wednesday. This is the group that will drive forward the strategy for dentistry across the county and also link into procurement processes. The membership of the Network is below, and on the Website for future reference... more to follow in the next newsletter.

Bernard Alston (Interim Chair), Phil Gale (LDC Rep), John Edwards, Shaz Tahir, Noel Bowen, Denise Forshaw, Ian Wild, Richard Stanage, Zuber Bagassi, Martin Kenyon

Meeting with RJ/MC: representatives of the Lancs LDC Executive ie Steve Bass (Vice Chair Central Lancs LDC) and myself, accompanied by Nick Barkworth, met with Richard Jones (Director of the Lancashire Area Team) and Martin Clayton (Director of Direct Commissioning Lancashire Area Team). The aim of the meeting was to raise the profile of dentistry at the highest level and to ensure the hierarchy were aware of the importance of enabling our GDPs to run effective and financially sound dental practices in the present difficult times. We set out a brief agenda with eight objectives which had been developed and approved by the Lancs LDC Exec and the Local Dental Network (LDN). I have included the agenda for the meeting below with summarised outcomes

  • To ensure dentistry, dentists and the LDC Exec have the full support and recognition of the current (and emerging) organisation – Outcome: acknowledged

  • Co-commissioning issues – this is the potential future direction where dental services along with Pharmacy and Optometry services may be commissioned by the Clinical Commissioning Groups – Outcome: cannot happen without changes in legislation but not impossible. Thinking is it will happen in next five years. Essential that LDC and LDN remain strong and influential.

  • To discuss the position and authority of the LDN and underpinning networks – potentially also to look for the LDN to hold a budget – Outcome: authority acknowledged. Budget holding unlikely.

  • To ensure that Senior Management fully understand the scope of knowledge and experience that exists within the LDN and underpinning networks – Outcome: acknowledged

  • Innovation needs to be encouraged and not stifled by finance – Outcome: difficult at present because of the need for tight financial controls but intention is to develop innovative and watertight proposals to take forward.

  • We need to explain how a robust Dental Appraisal Scheme can make financial savings – Outcome: positive support and NB/BA asked to look at a remodelled scheme to fit the available funding

  • To ensure that senior management are fully aware of the LDC’s willingness and historical record on actively engaging with local commissioning teams over many years, helping to find solutions, giving support to local GDP’s and assisting Commissioners – Outcome: acknowledged

  • Occupational Health services for GDPs – Outcome: RJ/MC to take higher within NHS England

So, overall a positive meeting and an opportunity to fly the flag for dentistry. We will continue to do this as always, particularly as there is to be a high level merger between the Lancashire and the Greater Manchester area Teams. As the LDC Exec we will have to ensure we keep this on the radar!

Occy Health LMC: I met with a representative from the LMC with respect to access to Occupational Health Services. We are to take a joint approach to look to source funding for these services from the centre.

ARF increase: there is some media interest around this issue at present and it is important that we all “sing out of the same hymn book”. Mike Jolly (Chair Central Lancs LDC and member of the LDC Exec) has put this response together on behalf of Lancashire dentists and provides guidance to any of us who might receive enquiries from newspapers or radio. Mike has already dealt with one enquiry from the media but cautions us that the media are looking for scapegoats in this process and whatever we say we must not imply we are solely complaining about the increase in the ARF but rather concerns about the actions of the GDC as outlined below

The majority of dental practitioners, the BDA and the Dental defence organisations have all lost faith in GDC. It is considered to be failing in its duty to protect patients, is a heavy handed regulator and is seen as empire building and being wasteful with financial resources.

The GDC proposed that the retention fee for dental practitioners should go up by 64% from £576 to £945 (the fee has just been set and is actually £890) the highest fee charged by any comparable regulator.

The problem is not the actual increase but that it is symptomatic of an out of control organisation. The General Medical Council in contrast have frozen the annual retention fee at 2011 levels (£390). The BDA and most dentists feel that we are being asked to pay the price for the GDC's mismanagement.

The role of the GDC is to protect patients and to regulate the dental team. Patient safety is best served by an effective and efficient regulator. What we have at present is a heavy handed organisation. Excessive and slow complaints handling , and no accountability. That is bad for patients and bad for dentists.

The BDA has attempted to liaise with the GDC to resolve the current problems but the response has been dismissive.

Faced with this attitude the BDJ has called for a judicial review of the GDC and Dental practitioners through their local dental committees have voted for a special LDC conference to debate the conduct of the GDC. This is a unique event and is not about the fee increase. We did not call one when we were faced with a huge amount of work and a large fee (£800 - £1500) for CQC registration. It is about the inefficiency of the GDC.

The underlying problem is there is a huge workload at the GDC which is consuming vast quantities of money. Much of which seems to be generated by the GDC itself and is of no benefit to patients. The GDC has faced heavy criticism from the Professional Standards Authority about the way it deals with patient complaints.

The root problem is that rather than let minor problems be resolved at a local level quickly and easily, which is better for patients and dentists, the GDC will bypass this and accept any complaint. This can incur large legal costs and takes ages, often a year or more.

The second problem is that the GDC invent their own complaint. Minor errors or omissions in record keeping are viewed as potentially impairing a dentist's fitness to practice and the expensive process grinds on incurring large legal bills, putting practitioners under immense strain and fails to give the patient what they want – a speedy and efficient resolution of their complaint.

All practices must have a protocol for dealing with complaints. Beyond that the local NHS England team have a complaints procedure. These structures allow the majority of complaints to be resolved quickly. This is to the benefit of the patient who always prefers a speedy resolution of a problem and removes the enormous stress all practitioners feel at these times. This is also important for other patients as it has been shown clinicians are more likely to commit errors whilst under investigation. Suicides are not unknown amongst clinicians as highlighted in the report 'Suicides by clinicians involved in serious incidents in the NHS: a situational analysis.' Published June 2014 Rajan Madhok ( Public Health consultant) at clinical leaders network in Salford Royal and others. Included in the report is reference to a Yorkshire dentist who committed suicide. He had not provided substandard clinical treatment, it was just slack record keeping due to the pressure of caring for a large list of NHS patients.

Original Article by Lavery M NHS strain. Leeds dentist Yorkshire evening post 2013 21 May

We are now facing a potentially very serious problem for NHS dentistry. Morale is very low in the profession.

If the retention fee continues to rise for dentists and their indemnity cost (insurance against lawsuits, GDC investigation etc) escalate it may become uneconomic to see NHS patients.

Dentists will become more defensive. They may stop seeing new patients and irregular attenders especially on the NHS due to time pressures on note taking.

The GDC is currently run by administrators who do not understand dentistry. Qualified dentists are now minority participants at the GDC.

There is a consultation document produced by the department of health on legislative changes to streamline fitness to practice procedures. This would allow the GDC to introduce case examiners to replace the investigating committee reducing the time to process a case. This is however viewed as a sticking plaster on a deeply dysfunctional organisation. Doing the wrong thing faster doesn’t make it right.

Obviously the special LDC conference has not taken place yet so I cannot say what our proposal will be but it appears that a major reorganisation of the GDC is required probably with a change of senior personnel and a return to a majority of dentists on the council.

Just one more thing – “BDJ disaster”: I left my recent copy of the BDJ on a chair in our lounge whilst I was doing something outside. I was only out for about ten minutes however when i returned I discovered that our little Staffie had demolished the magazine including the CPD quiz I had just completed! I have now found out that the BDA are not recognised officially by the Staffordshire Bull Terrier Association and the BDJ is viewed as just something to chew – never mind!

Onwards and upwards (and that is not just the ARF!)


Sec Lancs LDC Exec

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