Hello Lancashire & South Cumbria Colleagues,
I hope you are all well and looking forward to a summer break. Let's face it, things have not been great over the last two years or so. I would not have believed it would go on for so long in March 2020 when Mrs A and myself had to return home early during a week away in the Lakes following Boris making the statement “You must all stay at home and adhere to the rules and regulations associated with managing the Pandemic”. “All'' of course did not include him and hence the “Partygate” saga started and look where that got him! What we need now is a new PM who looks to value those who give all to look after our population. As we progress with the Integration Agenda we start to be able to demonstrate that Dentistry is not just about drilling holes in teeth and putting some “stuff” into the hole. As a profession we offer comprehensive advice, treatment, and support with respect to Oral Health Maintenance and Improvement with the consequent impact on improving people's General Health and hence their lives. More on that later…
At the moment there is no other way to describe the position at the centre around the future of the Dental Profession than organised chaos. For most of the last two years we worked hard to deliver services under tremendous stress due to Covid and let's face it we delivered them very well. Now we find ourselves in “Peacetime” again the screw starts to tighten and the pressure grows from a different angle. Obviously, the dearth of information and definitive decision making from the Centre carries on and this results in a situation of total uncertainty for the profession. Our local commissioners are very supportive as we know, and this approach will continue. The snag comes though that overbearing control from the Centre snookers the much needed Flexible Commissioning.
The inevitable outcome, should the situation not improve, is that practices will vote with their feet and go Private.
This is as plain as the nose on your face to all of us and also when we explain the situation to non-dental people they also see it the same way. So why is nobody seeing this at the Centre?
Quite simply to manage to keep NHS provision at the appropriate level and to enable Dental Practices to embrace the Integration Agenda we need a properly funded Dental Contract with the scope for flexible commissioning.
So what are the issues?
Basically as I see it we have two different sides to the story. We have the Integration Agenda moving slowly but steadily forward awaiting a contract that will enable these concepts to be delivered and on the other hand we have the bean counters at the Treasury saying no to any sensible suggestion put forward by the BDA.
The other complicating factor is that as of April 2023 (at the moment!) the responsibility for commissioning NHS Dental Services will sit with the Integrated Care Board along with the contracts for the other clinical disciplines. This will be the same people we know, but working under a different structure. We do not yet know how this will pan out - we will need to wait and see.
The overall problem is caused primarily because the people controlling the Contract Reform at the centre do not know what they are doing, and do not have a clue about running a Dental Practice - hence the chaos!
What confidence can the profession possibly have under the cloud of uncertainty, lack of appreciation, and a scant disregard for the fact that we do have to manage complex services. These services need to deliver quality care whilst hopefully maintaining a healthy financial position, thus enabling us to pay our staff a reasonable wage, and ensuring favourable working conditions. Under the present circumstances it is a big ask!
AND THEN!
No sooner had the ink dried on the final contractual commentary than lo and behold we had some incoming from the Centre. There we have it - some minor tweaks to the broken contract, but not enough to trigger the flexible commissioning capability needed to see the Integration Agenda through from the Dental Perspective. The BDA have taken a neutral stance, because it does not go far enough to reassure the Profession and build much needed confidence and morale. And whilst the next steps sit centrally with the BDA, we are doing all we can to push the agenda for dentistry through our local MPs, as you’ll read below. It is concerning that the current contract which was acknowledged as unworkable just a couple of years after it came into being, hence triggering the Steele Review some 15 years ago, is still going. Tim Farron, Lib Dem MP from North of the patch, who we do have regular correspondence with, recently raised the question in Parliament about scrapping UDAs and was told it was all sorted now!
Political Scene
The BDA are lobbying Parliament to ram the message home, but in an attempt to get this message across locally we have formed a Political Liaison Group from within the Exec. led by our Political Lead Noel Bowen, who is also East Lancs LDC Treasurer. The group met with some of our local MPs (see the LDC Website for details of who turned up!) and were able to get a message across. Where this will go we do not know, but a good number of their constituents have been making a considerable amount of noise which is good for our cause - Noel will be producing regular updates via the website, but what would be great is if you would all urge your patients to lobby their MPs - the more the merrier! For those of you within South Cumbria we have had an invitation through our Comms Team to meet with Tim Farron MP, to go through the changes you want to see - he understands the problems, but wants to now challenge the government more effectively with proposals from the dental community itself. If you would be happy to join a group meeting with Tim please email the Comms team admin@lasc-ldc.co.uk we do need to get heard whenever there is an offer of a listening ear! At the recent LDC conference one of the motions passed was from North Yorkshire LDC:
'This conference calls for immediate changes to be implemented to the NHS dental contract. To enable changes to occur we need to increase pressure on those that can make these changes. We need to engage with our staff and most importantly our patients via an online petition.' They have now set up the petition and are encouraging LDCs throughout England to share the details You can access the petition through the QR code below;
Integration Agenda
The Integration Agenda is the main element of NHS Reform at present and is moving forward gradually, but as usual for NHSE it is slow because the process and structure keep being changed as it develops.
As we know the basic idea is that the four Healthcare Services - Dental, Medical, Pharmacy and Optom work together to deliver quality services taking advantage of the benefits of joint working.We are in contact with the LMC and the LPC and will take a collaborative approach to the developments.. Key to this for us is to ensure we get listened to and are able to demonstrate to our colleagues that there are huge benefits to be gained from ensuring that all patients have good Oral Health. As we all know there are numerous relationships between Oral Health and General Health. Having been involved in some of this over the last few years I can endorse the benefits of the Multidisciplinary Team approach to delivering patient care. We do have examples of this happening at present, the most advanced being the Dental input into Fleetwood Primary Care Network where we have a local Dental Practice Rep on the PCN and have managed to get Oral Health as a priority agenda item for the meetings.
At the end of the day though none of this can work for Dental Practices unless we have the properly funded Flexible Commissioning Contract approach which will need implementing ASAP!
Retention & Recruitment
Retention and Recruitment is a major issue at present, because they are simply a knock on effect from the position Dental Practices find themselves in. This encompasses all aspects of the Dental Team without exception, and the potential crisis situation that could emerge is that Practices may find themselves in a situation where they do not have any staff to support service delivery,
This issue is present across all four Professions Dental/Medicine/Pharmacy/Optom and the Integrated Care Board has commissioned a company called Redmoor Health to support the development of solutions to the problem. We have formed a group to address these issues and we have had an initial meeting with Redmoor Health. There is more to come and we have to say there is no magic wand but with all the Retention and Recruitment issues on the table at present we must all keep flying the flag for dentistry.
Practitioner Support
For a number of years now, we have been developing our Practitioner Support service. This ranges from straightforward conversations between Practitioners with problems of any kind and a member of the LASC LDC Executive, to full DPASS support should the Practitioner have been under the scrutiny of one of the Regulatory Bodies, or has Self Referred. In line with the NHSE move to manage all Professional Standards processes across the North West, which includes Greater Manchester and Cheshire & Merseyside as well as Lancashire & South Cumbria, we have been in regular contact with our colleagues in GM/CM. Following much discussion the three areas each run their own schemes across the patch using the LASC documentation and process. We are now getting more complicated cases which we are managing to support and achieve a positive outcome.
PLEASE REMEMBER THAT YOU ARE NOT ALONE AND NO MATTER IF YOU HAVE A MINOR OR A MAJOR PROBLEM YOUR LDC EXECUTIVE IS THERE TO HELP YOU. WE HAVE AVAILABILITY DURING DAYTIME HOURS 7 DAYS A WEEK 365 DAYS OF THE YEAR. JUST EMAIL US ON
BWell Boxes offer
The NHS working with Redmoor health are currently offering a limited number of Bwell boxes to those working in NHS Primary Care including Dentistry. They include an offer of devices and subscriptions to improve your physical and mental wellbeing. Check out the information on the LASC LDC Website for more details.
Just one more thing…
so to the fate of old Bozza - what a mess. He managed to deliver on Covid and should now be on a high with a spectacular term in office ahead of him. What a Plonker he is ruining his chances by being reckless. Why did he think he could do what he did whilst being so prominently in the Public eye? The opposition party and the media all needless to say picked it up, and questions were asked. When it came to answering the questions Bozza subsequently lied about it all - brilliant! So we went round in the circle again, and he was subjected to the same criticism and accusations which is no surprise. So where to now for Bozza? - well in Blackpool it was reported that Bozza's waxwork dummy from Madame Tussauds had been relocated outside the job centre! Let’s hope his successor fares better…
Just another thing… I did mention the ridiculous situation where I was accused of parking in London in a restricted zone and then driving off when approached by a traffic warden who wished to give me a parking ticket. When I contacted them and explained that it was not me as I was in the Lakes at the time and the car was a different model and a different colour. I did refrain from saying that the Traffic Warden needed to go to Specsavers in my response. I subsequently received a decision on my fate which said in this instance they would waive the parking fine, but they would not do this next time. Are we serious - no apology, no appreciation of the additional hassle they caused me. It occurred to me that it was like carrying out an extraction, removing the wrong tooth and then saying “watch out next time!” And yet just one more thing!
Just as we go to press with the Blog yet more incoming arrives from the media informing us of the BBC report on the state of NHS Dentistry. The BDA have worked with the BBC on this report so common sense should prevail - but you can’t always trust the media! The fundamental problem with this current contract is that it has always been a swings and roundabouts contract whereby there are high needs patients having a massive course of treatment for just 12 UDAs (The Swings) and those who need a minimal course of treatment which might involve some minimal lab work for the same 12 UDAs (The Roundabouts). The balance of “Swings and Roundabouts” needs to be set up at least to give us some chance of managing the demands of the patients within the funding envelope. Especially with a treasury that is unwilling to review the current level of funding. One of the influencers in the melting pot of dentistry over the past couple of years has been Covid, whereby due to the reduction in the availability of routine dentistry and therefore the advancement of the disease process there is now a pronounced increase in the “Swings” with respect to the “Roundabouts” hence reducing the possibility for practices to balance the treatment need. This predicament patients have been left in, which is often through no fault of their own or our Dental Practices will take a long time to correct itself and should be yet a further nail in the coffin of the UDA. Let’s hope something comes out in the wash from the BBC, and the ensuing response, which is balanced and does reflect the dire situation NHS dentistry finds itself in. It has long been causing much concern and sleepless nights amongst the Dental Profession and now is ratcheting up the pressure pushing practices away from the NHS towards private dentistry. That's all for now everyone. Stay safe, let's make sure we stay together as a united force and lets make sure we get a good outcome for Dentistry going forward.
Bernard
Bernard Alston
Secretary LASC LDC Exec Practitioner Support Lead