Scottish Dental News January 2006
Contents
NHS Commitment
Oral Health Assessment
Premises Update
IT
Registration Period For Patients
Registration Fees and Care Pathways
Enhanced Fees for Endodontics
Staff Changes
On 29 November Lewis Macdonald, Deputy Minister for Health and Community Care wrote to all general dental practitioners outlining the detail of the definition of NHS commitment which will be used to determine whether a practice is eligible for some of the additional funding under the Action Plan.
- To be eligible a practice must provide NHS general dental services to all categories of patients.
- Practices will be required to have an average per dentist of at least 500 registered NHS patients of which on average at least 100 per dentist must be fee paying adults.
- Practices must have an average of £50,000 gross NHS earnings per dentist.
NHS National Services Scotland (NSS) Practitioner Services Division has written to each practice to inform them of their eligibility for the new allowances and whether they are classed as "NHS committed". To remain eligible for the new allowances practices must maintain or increase their NHS patient profile, i.e. number of patients registered under NHS arrangements, as at 1 October 2005. Failure to maintain such a profile without good reason may result in a practice not being eligible in that and subsequent quarters for the allowance. However, it is recognised that there may be reasons why patient numbers will not be maintained due to circumstances which are outwith practices' control e.g. patients moving from the area, dentists leaving practice.
NHS Commitment: Frequently Asked Questions
Q I am a practitioner who treats some NHS patients but mainly private patients, why are you disadvantaging my colleagues in my practice that are wholly committed to the NHS?
A A number of the allowances are now practice based rather than dentist specific, if the practice AVERAGE is met under the descriptor of NHS commitment then the practice will qualify.
Q Why am I being asked to increase my patient numbers year on year?
A GDPs are not being asked to increase their patient numbers year on year. If practices wish to be eligible for the new allowances they will be required to have an average of at least 500 registered NHS patients per dentist of which at least 100 per dentist must be fee paying adults and average gross earnings of at least £50,000 per dentist. Those practices not meeting these criteria will not qualify for the new allowances.
Q What if my practice is wholly committed to the NHS but does not meet all the criteria as laid out by Mr Macdonald in his letter of 29 November?
A If you have received a letter from NSS PSD saying that your practice does not appear to meet the criteria you will be able to write to Practitioner Services (PSD) to identify the practice's specific circumstances, e.g. being a specialist practice or practising in an area where it is not possible to register the relevant patient profile. Where a practice has one or more fully NHS committed part time dentist in the practice relevant dentists should complete and return form GP229 to PSD.
Q If I de-register my NHS patients why will all the allowances paid to me under the new NHS commitment be clawed back?
A NSS PSD will monitor patient profiles. If the profile drops without justifiable reasons the allowance will not be paid in the next quarter or any subsequent quarter until the profile is again reached.
Q What happens if an Associate leaves and I cannot recruit someone to replace them?
A This would be taken into consideration by NSS PSD
Extensive work has now been completed to develop a suitable framework for an oral health assessment in collaboration with Dental Health Services Research Unit, academics and the representatives of the dental profession.
In November 2005, workplace piloting of the Assessment framework was carried out. A brief summary of the findings is outlined below:
Piloting of the Oral Health Assessment
- 19 dental teams were invited to participate in the Phase 2 Pilot. Of these, 12 completed the exercise (7/10 independent dental practitioners and 5/9 salaried practitioners), a participation rate of 70%.
- 175 patient examinations were undertaken
- Patients and dental teams were then asked to feedback their experience of the Assessment.
Patient feedback
- Feedback from patients participating in the pilot was generally positive. Patients found it easy to complete the questions asked in the assessment, with 87% claiming to have no difficulty with the tasks asked of them.
Dentists' feedback
- The full range of clinical material used in the assessment took dental teams an average of 27 minutes to complete (this included those for whom English was not their first language).
- Of the 175 examinations undertaken, only 22% of the clinical forms required use of the guidance notes provided. However, this varied greatly by individual form, with the detailed dental assessment requiring most frequent reference to guidance material.
- Practitioners found the soft tissue examination form relatively straightforward to use, with 75% of forms correctly completed with respect to the key fields in the form.
- The majority of informal comments from the dental teams reflected concerns over the time taken to complete the forms and the need for staff training.
The Way Forward
The Oral Health Assessment represents a new and potentially unfamiliar way of working for the dental team and for patients, which will require careful and realistic management of change.
Next steps will therefore include:
- Full consideration of the findings of the Pilot.
- Working closely with the National Dental Advisory Committee to ensure that any future plans reflect the work being carried out to provide guidance on the dental examination.
- Development of a range of educational material and methods to support the introduction of the Oral Health Assessment.
- Consideration of the IT requirements for the Oral Health Assessment for both Salaried and Independent dental practice. Oral Health Assessment will be added to the agenda of future meetings of the Project Board for National Community and Salaried Dental IT Systems, and the Dental IM & T Working Group.
- Phased introduction of the assessment framework, linked to education and training
Once again, we would like to extend our sincere thanks to the staff and patients of the dental practices (both in the Independent and Salaried GDS) who participated in the Oral Health Assessment Pilot.
Further progress updates will be provided for colleagues in the next newsletter.
In the October newsletter we reported that Andy Kerr, Minister for Health and Community Care announced that a total of £30m had been made available for the two year period 2006-08 to help NHS Boards bring forward quickly more new dental centres. NHS Boards were invited to submit bids and Ministers are announcing the results of the bid process this month.
Reimbursement of Certain GDP Premises Costs
Practices who are "NHS committed" under the new definition will have received in this month's schedule the interim payment for rent reimbursement. This is based on the rateable value of the premises as at March 2005, subject to a maximum of £10,000. The remainder of the full payment due will be made as soon as the valuation work is completed.
Remote Areas Allowance
As reported in the previous newsletter work is progressing on this and Practitioner Services Division has been identifying the additional practices that will be entitled to this allowance. The additional practices, which may be eligible for the allowance, will be contacted shortly.
General Dental Practice Allowance
In the first two quarters £5.29m was paid in respect of this allowance. On 17th November Lewis Macdonald announced in the Scottish Parliament that, effective from 1 October 2005 and to reward those practices committed to NHS dentistry, we will be doubling the general dental practice allowance to 12% of gross earnings. This will apply to those who meet the new NHS commitment definition and is intended to further assist with practice costs, particularly support for practice staff. The eligible practices will receive their increased allowance paid in their December paid January schedule.
Greg Thomson of NHS National Services Scotland (NSS) has been appointed as the GDS IT Project Manager.
Forty practices have been identified to participate in the GDS IM&T Pilot in which the practices will be connected via NHS Net (N3) to a centrally hosted environment containing the Microsoft Office applications and an NHS Email account. The BT N3 installations are underway, the visits to install the appropriate cabling, power and PC and Printer in the practices will be taking place throughout January, with the intention that this is complete by early February. Although the new environment should be very simple to use, training will be provided for practices once their installation is complete.
Practices then have until the end of March to use and evaluate the central environment, during which time a working group will also be meeting to discuss requirements of a national clinical system.
REGISTRATION PERIOD
To support the ongoing care of adults and children in the NHS from 1 April 2006, the registration period for continuing care and capitation patients will be extended from the current 15 months to 36 months.
The fees for capitation and continuing care have been increased to reflect the need for flexible care pathways for patients. Memorandum to NHS: 2005 PCA(D)10 refers.
SEHD will clarify and define more precisely, as we develop the revised SDR, examination, risk assessment and review processes, what we expect from practitioners concerning the care of patients.
In general terms those patients with greatest need will need to be seen more often and those with little need less often. Registration fees for patients with the greatest need have the biggest increases with elderly and special needs patients' continuing care payments particularly enhanced.
Practitioners must clearly state on their clinical records the care pathway recommended for each patient. This information must be shared with the patient and the members of the dental team in the practice through accurate recording of disease, treatment and ongoing care arrangements i.e. identify expected date of future examination, review or preventive services to be offered by the practice.
ENHANCED FEES FOR ENDODONTICS
There is clear evidence that many practices cannot appropriately clean endodontic instruments and that many remain contaminated on reuse with new patients. These instruments because of their form and function pose an unacceptable risk of cross infection. It is strongly recommended that these instruments should be single patient use and then destroyed. We have therefore increased the fees for these specific items of service to facilitate single patient use. Memorandum to NHS: 2005 PCA(D)10 refers.
Practitioners who wish to reuse these instruments should only do so with instruments designed and labelled for reuse and ensure that, if they reuse such instruments, they meet the appropriate standards of decontamination. Practices would be expected to have specific protocols for such a process and assure themselves through testing that their enhanced procedures were sufficient to decontaminate these instruments. Even if this is done the maximum number of times such instruments should be reused should be limited.
USEFUL LINKS
www.scottishdental.org
http://www.show.scot.nhs.uk/publicationsindex.htm
Dr Hamish Wilson, Head of Primary Care Division retires on 19th January 2006 after a second period of secondment to the Scottish Executive from NHS Grampian. His successor will be Jonathan Pryce who will move from his post as Head of Transport Strategy and Legislation Division to take over the role as Head of Primary Care Division. We would like to thank Hamish for the work he has undertaken over the past few years in respect of NHS dentistry and the introduction of the Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland following the consultation in 2004 on NHS Dentistry.
I am sure that many of you within the profession that have worked with Hamish over the years will know that he has been instrumental to the development of NHS dental services in Scotland and join with us in the Executive of wishing him a long and happy retirement.
NEXT ISSUE WILL CONTAIN INFORMATION ON
- oral health assessment
- remote areas allowance
- revised access scheme
- deprivation allowance