The Scottish Government

Scottish Dental News April 2006

Contents

Statement of Dental Remuneration - uprating
NHS Commitment
General Dental Practice Allowance
Dental Waste Project
Fissure Sealants
Free NHS Dental Examination
IT
Practice Improvement Funding
Emergency Dental Services
Premises Funding
Action Plan Anniversary

Normally the Statement of Dental Remuneration (SDR) is uprated from 1 April each year to take account of the increase in the gross fees and other allowances recommended by the Doctors' and Dentists' Review Body (DDRB) and other agreed increases. DDRB's recommendations which were accepted by the Executive on 30 March 2006 are for a 3% increase for independent general dental practitioners and 2.4% for salaried general dental practitioners. The uprating of the SDR will be backdated to 1 April, and a revised SDR will be issued as soon as possible.

There has been some media coverage on the measurement of NHS commitment which underpins the new measures of financial support outlined in the dental action plan. We believe that these new allowances have been widely welcomed by dentists who are fully committed to the NHS. The allowances will not be made available, however, to dentists who continue to deny access to NHS treatment for some categories of patients.

Whilst there is no formal appeals mechanism under the Statement of Dental Remuneration, we are considering representations from practices that consider they have justifiable reasons for not meeting the full NHS commitment criteria - a number of such cases have been positively resolved and we are considering whether the criteria can be amended to bring all such practices within the definition.

There will be no clawback in respect of the increased general dental practice allowance. The additional GDP allowance of 6% for NHS committed practices will be payable for each quarter that the practice meets the conditions of entitlement. The payment will cease for any quarter that the conditions are not met. If the practice meets the conditions of entitlement in a subsequent quarter then the additional allowance will be payable again.

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In January the third payment of the General Dental Practice Allowance was paid to independent general dental practitioners. This included the increase to 12% of gross earnings for practices classed as NHS committed. In this financial year we have now paid over £10m for this allowance alone and estimate that over £15m will have been paid in the financial year 2005 - 06.

A letter will be issued to NHS Boards in the near future advising them of revised arrangements for the management of clinical and special dental wastes. The programme will be introduced operationally in a phased programme under the NHS Boards Clinical Waste Consortia Contract framework from 1 April 2006. Boards will be expected to meet directly all related costs for clinical and special waste uplift for dentists who fulfil the requirements for NHS committed practices.

Practitioner Services Division of NHS National Services Scotland will provide NHS Boards with details of the dental practices in their area regarded as NHS committed. Dentists who are providing NHS general dental services, but who do not meet the definitions of an NHS committed practice should be offered the opportunity to participate in Board waste schemes and should be invoiced for services provided. Practices should be advised by their NHS Board of the proposed service start date to allow practices to conclude any arrangements they may already have in place.

Examples of Dental Clinical and Special Wastes to be included under these arrangements are:

• Low risk clinical wastes: dressings and swabs, disposables such as gloves, aprons, masks, contaminated wipes, broken glass, blood and contaminated liquids, unrecognisable tissue.

• High risk clinical wastes: recognisable body parts, e.g. teeth with or without amalgam/fillings etc, Pharmaceuticals and pharmacy chemicals, used or unused sharps, used or unused drug vials, contaminated metal parts/instruments, highly infectious waste, infected blood.

• Special wastes: mercury, amalgam, lead and other "Heavy" metal compounds (including X Ray and Dental photochemicals, fixers & batteries with Silver Cadmium, Lithium and Radioactive Waste.

It should be noted that amalgam separators are specifically excluded from these arrangements.

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From 1 April 2006 a new item of service fee was introduced for the application of fissure sealants, as a primary preventive measure, to pits and fissures in each permanent molar tooth. This new fee replaces the caries prevention scheme for 6 and 7 year olds, item 41(d). The new fee, item 44(f), for the provision of fissure sealants for children was added to Section X (treatment under capitation). Payments under 41(d) will cease with effect from 1 April 2006.

As of 1 April, the Executive are making the current dental examinations and assessments free of charge to NHS patients.

On 17 March 2006 2006 PCA(D)2 containing information about the introduction of free NHS dental examinations was issued to all NHS Boards who were asked to copy Memorandum to NHS 2006 PCA(D)2 to all dentists on their NHS Board list. If you have not received a copy of this you should contact the NHS Board for the area in which you practise.

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ORAL HEALTH ASSESSMENT

Following completion of the recent Oral Health Assessment Pilot, the Executive will be meeting with a range of key interests to develop a suitable educational programme to support any future introduction of an oral health assessment. The Programme is likely to focus on history taking and risk assessment, examination of the oral soft tissues and the provision of information to patients.

CONTINUING CARE AND CAPITATION ARRANGEMENTS

From 1 April 2006, the continuing care and capitation arrangement has been extended from 15 months to 36 months.

IT

Current Progress - GDS IM&T Pilot

Although there have been delays in achieving the N3 connections to practices, the pilot is progressing well. Half of the 40 practices are currently fully live with the remainder planned to be complete early in April. Practices will be providing continuous feedback throughout the pilot, with a report on lessons learned being produced by mid-May. Beyond this the pilot practices will continue to have access to the managed service environment until such times as a national environment is available for all practices.

Beyond the Pilot

Planning for the GDS IM&T Programme as a whole is underway at present, with a particular emphasis on the national rollout of N3, which will commence independent of the business case for the clinical system and supporting infrastructure. As part of the N3 rollout each practice will be provided with one PC and printer. Currently an investigation is underway into the possibility of using a wireless network within practices instead of cabling. This would result in less disruption and greater flexibility for practices. However, even if the investigation is successful, some practices will require to be cabled due to, for example, lead lined walls.

PRACTICE IMPROVEMENT FUNDING

Over the next two financial years (2006/07 and 2007/08) £5m (£2.5m per annum) Practice Improvement Funding targeted at decontamination has been made available. Details for the eligibility and conditions of claiming from the NHS Board for this allowance are contained in Determination X of the Statement of Dental Remuneration.

REIMBURSEMENT OF CERTAIN GDP COSTS

In January we made an interim payment amounting to £3.2m in respect of premises reimbursement to dental practices who are classed as "NHS committed" under the new definition of NHS commitment. Valuations, which were carried out by GVA Grimleys, are now complete and the Executive has just received their report. The next step will be a reconciliation exercise to allow final payments to be made in respect of financial year 2005 -06.

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REMOTE AREAS ALLOWANCE

As we go to print NHS Practitioner Services Division will be contacting additional practices that may be entitled to the remote areas allowance under the revised definition.

EMERGENCY DENTAL SERVICES

The Executive has commissioned NHS 24 to take forward Emergency Dental Services in partnership with NHS Boards and will provide project management resources to support the project.

A project board has been established to oversee the work and, following discussions in all board areas, a business plan is being prepared.

The national project is to provide access and triage services. The provision of robust dental end-points for emergency and urgent cases rests with boards and the dental professions. Nevertheless, the interdependencies are vitally important and the project is working closely with boards and the dental professions to develop services. Similarly there are many local triage and advice lines with a range of operating hours both in and out of hours. Understanding these and how they might be further developed to improve the service is an integral part of the project.

It is evident that there is broad support for the policy objectives and the work is able to build on a range of initiatives already in train across Scotland.

NHS Fife has considerable experience in providing telephone triage for a number of health board areas and the national project is able to draw upon this experience and expertise. NHS Fife has extended the service it provides and currently provides a service for Fife, Borders, Perth & Kinross (with plans to extend to the whole of Tayside) and West Lothian.

Similarly NHS Greater Glasgow has been undertaking a pilot in which NHS Greater Glasgow dental staff have been trained to use NHS 24's telephone and computer systems and to provide a dental triage service at peak times. The pilot has been evaluated and deemed to be successful, with all emergency and urgent referrals being assessed as being appropriate, with a quarter of calls being triaged as not requiring emergency or urgent treatment. NHS Greater Glasgow and NHS 24 have agreed to continue the service and to extend it to cover weekday evenings.

These findings match well with the expected triage outcomes suggested in the National Dental Advisory Committee draft clinical guidance 'Pathways of Care - Emergency Dental Care' which has been out to consultation since the beginning of this year. The conclusion of the consultation should enable us to agree national standards which the SEDS project will be able to use for its role.

Work to model the likely activity levels that the service will be required to respond to is being completed and the final business case is expected to be made to the Scottish Executive by the end of April.

Meanwhile, there has been a developing consensus that the most appropriate and effective way to provide emergency dental service access and triage would be to:

• Build on existing services.

• Establish a robust and comprehensive service prior to raising the profile of the service.

• Stage the development of the service.

• Develop:

· Access to dental triage through the NHS 24 number.

· Agree a standard triage protocol based on National Dental Advisory Committee triage guidelines.

· Deliver the service through a virtual network, managed and call handled by NHS 24 with triage provided by Dental Nurses employed by local NHS boards in 3-4 centres with locally agreed referral arrangements to robust dental end-points for emergency and urgent cases.

· Maintain where they exist or develop local in-hours advice lines for routine access.

· Base the network on a common ICT platform.

This direction of travel has been shared with Dental Action Plan leads and their endorsement has enabled the service to move forward with staged developments which will support the implementation of the national service.

NHS Lanarkshire went live with a pilot service in March this year. NHS Lanarkshire employs dental nurses who, building on the Glasgow pilot, have received training from NHS 24 and provide an evenings and weekends service, based in NHS Lanarkshire's NHS 24 centre at Hairmyres Hospital. This triage service is backed by new emergency dental services which have been implemented in NHS Lanarkshire.

NHS Ayrshire & Arran has similarly developed new emergency dental services and NHS Fife are preparing to provide triage support to them at the end of April pending the implementation of national services.

To conclude, the SEDS project is but part of the work required to provide appropriate access to emergency dental services across Scotland. It contributes a national perspective and the opportunity to share practice across Scotland. Specifically, it will develop access to dental nurse telephone triage and advice on pain relief which will provide a vital component of an improved care pathway for patients needing emergency or urgent care.

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CHANGES TO SCOTTISH DENTAL FORMULARY

Scottish Executive Circular 2006 PCA(D)1 outlined the amendments made to the Scottish Minister's list for dental prescribing. The changes, which came in to effect on 1 March 2006, mean that General Dental Practitioners can now prescribe Sodium Fluoride Mouthwash, BP and Sodium Fluoride Toothpaste, 0.619% for their patients.

Chief Dental Officer, Ray Watkins, commented: "This will allow dental practitioners in Scotland to extend preventative care into the home environment for those patients at high risk".

WEBSITE

Last month saw the introduction of dentistry pages on the Scottish Executive website. The dental pages contain information on the Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland, NHS Board contact details, Oral Health Targets and much more including back copies of the Scottish Dental News. The dental pages on the website can be found at:

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/dentistry/intro

REVISED ACCESS SCHEME

We had hoped in this issue to be able to provide information on the revised Scottish Dental Access Initiative (SDAI) scheme but this is still being worked on. SDAI's should continue to be submitted under the existing process until further instructions are issued in due course.

DEPRIVED AREA ALLOWANCE

We are currently finalising details of this allowance which will be backdated to 1 April 2006.

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DENTAL PREMISES - PRIMARY AND COMMUNITY CARE PREMISES MODERNISATION PROGRAMME 2006-08

On 20 January 2006, Deputy Minister for Health and Community Care, Lewis Macdonald announced the results of the bidding to the first tranche of the Primary and Community Care Premises `Modernisation Programme for 2006-08 which was aimed at supporting and modernising dental facilities to support service provision and training across the country. Details of the successful bids are:

NHS Argyll & Clyde
Dykebar Hospital £180,000
Russell Institute, Paisley £210,000

NHS Ayrshire & Arran
NW Kilmarnock £1,415,000
Kilbirnie £437,000

NHS Borders
Hawick £1,060,128
Borders General Hospital site, Melrose £1,070,000

NHS Dumfries and Galloway
Dumfries Dental Centre £2,372,000

NHS Fife
Emergency Dental Triage Centre £300,000
Cowdenbeath Dental Centre £900,000
Cupar £450,000
Dovecot Clinic, Glenrothes £150,000
Leslie £300,000
Dunfermline Eastern Expansion £1,500,000

NHS Forth Valley
Langlees Dental Centre, Falkirk £425,000

NHS Grampian
Bilbohall, Elgin £1.582m
Buckie & Keith Modular units £204,000/£204,000

In addition to this, £2m is available for the outreach dental centre at Aberdeen Dental Institute, Foresthill.

NHS Greater Glasgow
Completion of Glasgow Primary Care Treatment Centre £900,000
Plean St. Clinic Replacement, Yoker £1,740,000

NHS Highland
Inverness East £325,000
Portree £225,000
Grantown £475,000
Fort William £345,000

NHS Lanarkshire
Coatbridge Dental Centre £4,426,000
Extension to Greenhills Health Centre, East Kilbride £420,000
Extension to Biggar HC, £500,000

NHS Lothian
NHS Dental Access Centre, Bonnyrigg, Midlothian £932,687
New Clinical Facility in Edinburgh Dental Institute £1,548,000

NHS Tayside
Dundee Primary Care Dental Access Centre- £450,000
Integrated Dental Treatment and Training Centre, Perth £3,000,000

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ACTION PLAN ANNIVERSARY

17 March saw the first anniversary of The Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland. So what has happened in the past 12 months?

In the period to 30 September 2004 there were 2,639 dentists providing NHS dental services in Scotland. At September 2005 this number had risen to 2,695, an increase of 2.1%. Information contained on NHS ISD website at http://www.isdscotland.org/isd/info3.jsp?pContentID=3446&p_applic=CCC&p_service=Content.show&

In addition, we are currently in the process of recruiting 40 dentists from Poland, all of whom should be in place by the end of this year.

In 2005-06 we will have paid over £15m in practice allowances to general dental practitioners providing NHS dental services. In January we made an interim payment of £3.2m to dentists committed to the NHS in respect of rent re-imbursement. We have also paid £5m in respect of practice improvement funding and £2m for emergency dental services.

Premises

As outlined above, on 20 January Mr Macdonald announced the results of the Primary and Community Care Premises Modernisation Programme, a total of £30m additional funding for 29 dental centres throughout Scotland. £2m is also available for the outreach dental centre at Aberdeen Dental Institute, Foresthill.

Funding - 2005 - 06

Forecast of £225.2m on general dental services

£3.2m Rent re-imbursement interim payment

£5m Practice Improvement Funding

£2m Emergency Dental Services

£4m Oral Health

£5m Education & Training

£1.07m Scottish Dental Access Initiative

£0.51m Vocation training golden hellos

Golden Hellos

In 2005-06 we have paid £102,500 to dentists who have joined the list of a NHS Board in Scotland for the first time or on re-entry to a dental list in Scotland after a break of 5 years. payment to each dentist is £5,000 over two years or £10,000 over two years for designated areas.

We have also paid £675,000 to dentists who have joined a NHS Board dental list within 3 months of completing their training. This amount includes payments to dentists in their first and second year. 67 dentists have joined a NHS Board dental list within 3 months of completing their training this year compared to 61 last year. The The payment to each dentist is £10,000 over two years or £20,000 over two years for designated areas.

Scottish Dental Access Initiative

We have paid over £1.07m to NHS Boards under the Scottish Dental Access Initiative Scheme to general dental practitioners who are willing to make a sustained commitment to the NHS, and who wish to establish a new practice or extend existing practices in areas where general dental service availability is poor. For new practices we pay up to £100,000 and up to £50,000 to expand existing practices.

NHS Education Scotland

NHS NES have been allocated £5m to take forward points in the Dental Action Plan relating to workforce/education. £505,934 has been paid to NES for Vocational Trainee Golden Hellos. This is a payment of £3,000 or £6,000 in designated areas for newly qualified dentists taking up vocational training. The number of vocational trainees this year has increased to 126 from 123 last year.


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NEXT ISSUE WILL FURTHER CONTAIN INFORMATION ON:

• Deprived area allowance
• oral health assessment

Scottish Executive Health Department Contacts

0131 556 8400

Head of Primary Care Division Jonathan Pryce

Chief Dental Officer Ray Watkins

Deputy Chief Dental Officer Mary McCann

Dental Branch Staff

Eric Gray

Senga Robertson

Lynne Morrison

Donna Bryce

Sheila Taylor