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  • Bernard Alston

Midsummer Madness Blog – July 2019

Hello Lancashire and South Cumbria,

In all my years in NHS dentistry I have never seen as much change going on within the NHS as there is at this present time. It is difficult keeping up with all the changes and making sure that dentistry is not forgotten about, as often happens. In our neck of the woods we have always ensured that within the local situation we keep the flag flying and we have been very successful in making sure all is well.

Our Local Area Team and the LDC Exec work very closely together to engage with the direction of travel, whilst ensuring our local practices are looked after. What we can’t influence is the national direction of travel and I have to say as someone who is integrated with the processes, the centre do not appreciate the difficulties experienced at the dental coalface. We are fortunate to be in close contact with the BDA through our GDPC reps John Edwards, Bruce Porteous and Andy Harvey and also with the Central NHS Team through Eric Rooney, so can get the messages communicated up to the NHS hierarchy.

As is usual there are developments afoot which are medically based and properly funded. Behind this then comes the other professions who have no funding attached to make changes – business as usual for the NHS!

Irrespective of this situation we must keep plugging away for recognition for the profession to avoid being either forgotten about altogether, or just getting bolted onto the side of the new structures at a later date. Such an example is the emerging Primary Care Networks which are taking centre stage at present.

Primary Care Networks (PCNs)

For information: Primary Care Networks consist of a group of GP Practices who come together to encourage joint working. There is funding attached to it in the form of what is termed a Directed Enhanced Service (DES). GP practices are not obliged to join in but those not engaging will miss out on the DES payment. As part of the DES spec. the GPs are obliged to engage with the other healthcare professions which include dentists.

Across the country there is very limited (if any) dental input to the emerging PCNs.

PCNs cover a population size of between 30K and 50K and there will be in the region of 43 of these PCNs across Lancashire and South Cumbria (LASC). The PCNs are grouped together in five areas across the patch called Integrated Care Partnerships (ICPs) – for us it is Bay Health & Care Partners, Fylde Coast, Penine Lancashire, Central Lancashire and West Lancashire. The five areas above are combined then to form the Integrated Care System (ICS) which is basically LASC.

The area in the country where there is the most established PCN, with also the most established dental input, is Fleetwood over on the Fylde Coast. The Fleetwood model has been in place for a couple of years now and I am currently representing dentistry with my NHSE Clinical Advisor hat on. I can therefore give grass roots opinions on how it works and how we best engage with the process. At NHSE we are working on a supporting structure to ensure representation of dentistry at all the ICS/ICP/PCN levels.

So what is my view from the coalface and what is in it for dentistry?

What is it like being part of a PCN? - what a refreshing change it is to work together across the professions and be able to exchange ideas, discuss issues and to learn from each other

How well received is dentistry within the PCN? - I have attended the Fleetwood meetings now for two years and have been accompanied on different occasions by Nick Barkworth, Eric Rooney and the local Fleetwood GDP practices. We could not have been made more welcome and have managed to get Oral Health as a priority agenda item.

Should we engage with the process? - well as usual we are in a position whereby if we do then we have a chance of contributing to the joint working ethos and ensure dentistry is included in the best possible way and if we don’t we will either be forgotten about altogether or accommodated at a later date in a disadvantaged manner.

What is the view of the BDA? - I have been party to a number of conversations with the BDA on the subject and do respond to requests for information. As always the key issue is that dentists must not be disadvantaged by engaging in this process and be allowed to secure the longevity of their practices into the future.

What contractual changes will be needed? - firstly the existing contract will not allow GDP practices to become part of the new innovation. Contractual changes and flexible commissioning are the only way this can be achieved. This is an essential component of success for the future of NHS dentistry.

More to come over the next few months and there will be an NHSE engagement event hopefully by the Autumn to enable everyone to be fully brought up to speed with the developments.

LASC LDC Executive Events Calendar

We are currently working on the Events Calendar for the next 12 months with Health Education England and we have also had requests from practices for topics to be covered. As always the LASC LDC Exec Events will be free of charge and open to all members of the Dental Team. Below is the draft programme which will be finalised over the next month or so. We will continue to ensure advance notice is given through the e-group and LASC LDC Website and full details also listed on Maxcourse. All places will need to be booked on Maxcourse in the normal way. Please note all timings are estimates and are likely to vary.

Periodontal Treatment Guidance late September - advice on both clinical aspects and how to claim appropriately

Performance Event early November - “How to stay out of trouble” This event will include NHSE/CQC/DPASS

NHS Pensions - “How much are you worth?” early New Year - this was such a hit in October 2018 we will be running the event again with Phil McEvoy from the BDA

NHS Regulations and Indemnity - New Year date and format to be decided

Workforce Planning and Recruitment – New Year date and format to be decided

Emergency Dental Care Clinical Advice/Sepsis – New Year date and format to be decided

Workforce Planning and Recruitment

This is one of the crucial issues for the profession at present and a subject within which the LDC Exec are very much involved. Currently we are working with NHSE and HEE around a number of aspects and over the past few months we have had successful events at Blackburn and Kendal. The BDA are keen to know what is going on up in “the sticks” and I gave some input to the recent meeting between the Junior Minister for Health and the BDA. Coincidentally the Junior Minister for Health is also the MP for South Ribble, so the BDA were keen to know how things were on her patch!

Below is the summary of what I sent over to Eddie Crouch and Dave Cottam for their meeting with the Minister.

  • Our LDC website has a Recruitment Section and we host recruitment vacancies free of charge. We also developed an advice section encouraging practices to think outside the box in how they advertise job vacancies. If we get an uninteresting advert we will advise them to reconsider their wording to make it more attractive. This has helped in a few cases and at least it encourages people to think differently.

  • In conjunction with NHSE we have developed an FD questionnaire to get some feedback from the younger end of the profession as to what they would be looking for in a job.

  • In conjunction with HEE and NHSE we hosted Recruitment Events earlier in the year with LASC practices to have a two-way communication around issues with recruitment, new ways of working, skill mix, Tier 2 stuff etc... We had a range of speakers both National and Local plus some good feedback from our practices to feed into the Workforce Development Plan.

  • Portfolio Careers seem to be the opportunities many of the younger end are looking for and we have some possibilities developing in this respect in line with our involvement with our Primary Care Networks and secondary care providers.

  • Coming back from our practices are complaints around the long-winded processes (ORE and PLVE) involved in bringing overseas graduates into this country and getting them onto the Performers List - this is a major issue.

In order to enable us to move forward there are two main issues that need to be addressed ;

1. We desperately need Flexible Commissioning opportunities in place. Our Local Area Team are working hard to be as flexible as possible within the contractual regulations, but we do need a substantial change from the centre to enable us to develop any of our recruitment initiatives. New graduates do not want to get onto the UDA treadmill but that is so much the basis of our current contract.

2. Career Portfolios and PCN opportunities are a potential way forward but again we need the flexibility to develop these options. The ORE and PLVE processes need to be slicker, less costly and less complicated.

The message for the Minister from our area is that we are doing everything we can to support our practices but we will only be successful if we have help from the centre!


We already have two representatives from LASC on the General Dental Practice Committee in John Edwards and Bruce Porteous. John is also on the BDA PEC. We are now fortunate to have a third representative on the GDPC in Andy Harvey Joint Chair of East Lancs LDC and a member of the LASC LDC Executive. Andy was elected recently and will be a great asset.

Dave Cottam has been elected Chair of the GDPC. For those who do not know Dave, although based in Birmingham he is a local Lytham lad. I have known him for some 50 years or so, we were both from Lytham and Dave and yours truly went to the same school!

Just one more thing…

What better way to round off the Blog than some “Tales from the Tip” Just a quick couple of stories around visits to the local tip and waste disposal experiences.

I do drop into our local tip every couple of weeks or so when I take my mother in law’s shopping up to her. I always take the shopping in a large black cloth carrier bag and put it on the front seat of the car. Now our “Tip Guys” are extremely helpful and always pitch in to help me unload my rubbish. As I arrive there one particular morning I first of all congratulated myself on timing my arrival, so I missed the skip changeover process which always brings the whole operation to a stand-still whilst they change it over. I parked the car and started emptying the rubbish. As they always do the chaps came over to help out (you can see what is coming now!) I was returning to the car having located the “small electricals” skip and dumped the old kettle only to see one of the loyal team marching over to the non-recyclable skip with mum’s shopping! Fortunately, I managed to stop him in time or I would be going back to Morrisons!

My second experience was of what you would call the councils “Domiciliary Refuse Collection Service” Now this is a completely different kettle of fish! These guys are surly, non-communicative and down-right rude as they go about their business cursing and swearing as they go. On this particular occasion they were (supposed to be) emptying the grey bins of non-recyclable rubbish. I returned from work later in the afternoon to find they had only half emptied it! I rang the council the following day and firstly had a long conversation with the helpline person who steadfastly refused to budge on the stance of “well it happens so they won’t come back” After some perseverance she agreed to pass me through to the “Waste Collection Manager” which I said was simply splendid of her. Our man at the helm then again took the stance of “well it happens and we can’t do anything about it.” He then got into all sorts of technical stuff about the process which was very boring… The crunch to the argument was that he kept saying they had emptied the bin but the machine had simply not shaken it out and this was “not their fault.” After some considerable time going round the houses I narrowed the discussion down to the fact that he agreed their job was to “empty the bin” and my position being had they actually done that I would not be ringing him! After he agreed that by definition they had not emptied the bin he agreed to send the jolly chaps back to complete the job as defined - this was duly completed with the usual cursing and swearing - happy days but why could they not have done this first time round?

That’s all for now folks. Have a good summer and don’t forget – factor 30 at least!! Onwards and Upwards,


Bernard Alston


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