The Scottish Government

Scottish Dental News July 2005

Contents

Funding
NHS commitment
General Dental Practice Allowance
SDR Simplification
Remote Area Allowance
IT
Patient Charges
Practice Improvement Funding
Premises
Independent General Dental Practice
Workforce
Oral Health Improvement

Funding

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The overall additional funding which the Executive has committed to improving oral health and dental services amounts to an extra £45m this year (2005/06), to £100m in 2006/07 and to £150m in 2007/08. The oral health programme will cost some £4/10/15m in these years, and the education and training developments some £4/10/15m also. This leaves the bulk of the additional funding (£37/80/120m) for enhancing primary care dental services. This includes the cost of the additional 200 dentists identified in the Action Plan. Some of these will be salaried dentists in areas where Boards are unable to attract or return independent dentists committed to the NHS. It is not possible to be precise about the split of the 200 between salaried and non-salaried, because of the need for Boards to respond quickly to changing local circumstances, but it is likely that at least a quarter will be salaried. The others will be additional dentists working in independent dental practice supported by the existing and new funding arrangements. The bulk of the additional expenditure in primary care dental services this year will be on:

• 50 additional dentists (salaried and independent)
• the increased general dental practice allowance
• the increased remote area allowance
• the premises costs reimbursement scheme
• the costs of clinical waste contracts
• practice improvement funding
• emergency/out-of-hours dental services
• new oral health assessment for patients aged 60+

NHS Commitment

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One of the basic requirements to qualify for the new reimbursements and allowances in the Action Plan is the level of NHS commitment. Traditionally this has been based on the proportion of NHS v private earnings or absolute NHS earnings. The BDA have suggested that a fairer way of measuring commitment would be purely on the basis of what a practice does for the NHS in terms of income and registered patients. An alternative would be on the basis of time (or sessions) available for NHS services. This is being actively pursued and we hope to reach an early conclusion so that practices can then make a realistic estimate of their entitlement from the new allowances etc. In the meantime, the existing arrangements for current allowances etc continue.

General Dental Practice Allowance

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This allowance has increased from April 2005 and will be calculated as 6% of NHS earnings. This is to address increasing requirements in relation to the provision of high quality premises, health and safety, staffing support and information collation and provision. The first payment of this allowance will be made in late July 2005.

Simplification of the Fee Scale

A clear message from the consultation last year was the need to simplify the Statement of Dental Remuneration. It contains well over 400 items of treatment along with complex definitions. Work has started on the implementation and a first draft has been sent to the BDA for comments. It is important to note that this is not about reducing what is available on the NHS, but making the whole system simpler for practices (and patients) to understand and use. There will be an opportunity to rebalance some fees which are clearly not recompensing practices appropriately. We intend the changes (with a reduction to about 50 items) to take effect from April 2006.

Remote Area Allowance

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This has been increased from £6000 to £9000 per practitioner with effect from April 2005. But, at the same time, we wanted to have a broader and fairer definition of remote than the present one. We have now reached agreement in principle with BDA on a new definition of less than 0.5 persons per hectare. The details of this are still being worked on and further information will be issued shortly. Every practitioner already receiving the allowance under the existing system and who is not covered by the new system will be protected. These arrangements apply to both independent and salaried practitioners.

Information Technology

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SEHD has already provided support to salaried primary care dental services to introduce an agreed clinical IT system. We are now turning our attention to independent dental practices. The plans consist of two main elements:

(a) connection of all practices to N3 (the successor to NHSNet); this will allow electronic communication between practices and other parts of the NHS system (e.g. for referrals and discharge information); full costs to be met by NHS.

(b) accreditation of clinical systems for use in practices, with reimbursement of costs as for medical practices. Those who have already invested in a system which is accredited will also be given financial support to recognise their earlier investment. Funding will be dependent on the level of NHS commitment.

A joint SEHD/NSS/BDA group is overseeing this work.

Patient Charges

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The English Department of Health has recently sent out a consultation paper on patient charges. In Scotland, we will be setting up a separate group involving the profession and consumer groups to look at the options. We are not bound to follow what is happening south of the border.

Practice Improvement Funding

£5m is being allocated this year targeted specifically at decontamination. Draft proposals for the use of this funding are with the BDA.

Premises

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The Action Plan announced the introduction of a scheme to reimburse rent or notional rent (for practice owners) in practices with a level of commitment to the NHS. We will shortly be arranging for a contract to be let for all independent practice premises to be valued. This will inevitably take some time, but the agreed reimbursement will be backdated to April 2005. In the meantime we will be looking at an interim payment based in rateable value and the details are being discussed with BDA.

In addition, we will be introducing a wide range of measures, similar to those available to medical practices to support improvements to practices or a move to new premises. Details will be sent to practices shortly.

Independent General Dental Practice

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The Action Plan announcements and the earlier allowances and incentives introduced in Scotland mean that general dental practitioners working in NHS committed independent practices are able to earn significantly more than counterparts in other areas of the UK. In particular a practice in Scotland will be able to access the following this year:-

• a general dental practice allowance - now 6% of NHS earnings - to help address the increasing practice requirements in relation to the provision of high quality premises, health and safety, staffing and other support costs
• practice improvement funding - a share this year of £5m targeted at decontamination
• the increased remote area allowance - now £9,000 per year per practitioner, with an extended definition of 'remote' to include more practices
• capital grants to establish new or expanded practices, or to support vocational training
• reimbursement of rent (or notional rent)
• cost of clinical waste disposal
• new oral health assessment payments for patients aged 60+
• support for emergency/out-of-hours services

For a typical 2/3 dentist practice committed to the NHS, this can mean some £25K in 2005/06

Individual practitioners in Scotland can also, depending on their circumstances access:-

• the 'golden hello' allowance (£10k-£20k)
• the VT allowance (£3k-£6k)
• new or re-entry 'golden hello' allowance (£5k-£10k)
• return to work scheme
• vocational trainer's grant and vocational training allowance (£13,300)
• seniority payments up to £14k

Workforce

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Discussions have been held between SEHD and NHS Education Scotland to agree a programme of action for 2005/06-2007/08 which will deliver the various workforce commitments on dentists, PCDs and support staff.

These include:

(a) Undergraduate Education:

• increasing dental student numbers to ensure an output of 134 dentists from 2006 onwards;
• increasing therapist student training to achieve an output of 45 graduates per year;
• increasing the number of dental nurse training places by 100 in 2005/06 and up to 250 in 2007/08;
• introducing a bursary scheme for dental students to enhance recruitment and retention;
• expanding dental and therapy student outreach across Scotland, in particular Aberdeen, Inverness, Dumfries, Tayside and a range of locations in West of Scotland.

(b) Vocational Training:

• increasing VT places to 135 in 2005/06 and to 155 by 2007/08;
• developing a VT year for dental therapists, starting in 2005/06;
• developing post-qualification clinical dental technician training by 2007.

(c) Career Development:

• delivering a minimum of 200 members of the dental team with assessed and accredited special skills by 2007;
• developing a new 'return to work scheme';
• enhancing existing arrangements for overseas qualified practitioners;
• improving the current Keeping in Touch scheme;
• developing a national training centre for 'back to work' clinical skills training and for training of overseas practitioners.

(d) Practice Team Development:

• introducing a GDP practice development unit to engage with all NHS dental practices by 2007;
• introducing career development for dental nurses, practice managers and other members of the dental team;
• extending the existing clinical effectiveness programme, including e-learning opportunities.

Oral Health Improvement

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We have secured dedicated time and support from Margie Taylor, CDPH, Lanarkshire and Graham Ball, CDPH, Fife to work with NHS Boards (in West and East/North Scotland respectively), SEHD and professional groups to implement the various programmes which are targeted at improving oral health, particularly of children. NHS Boards are being asked to develop and provide a core programme of activities within the first 18 months of the Action Plan period. This core service will comprise:

• oral health contact with the parent in the first year of every newborn child
• distribution of toothbrush, toothpaste and advice on diet and oral care to: every child in their first year, all infants aged 1-3 years in areas of deprivation, children starting nursery and children starting school
• daily nursery toothbrushing in all nursery years
• National Dental Inspection Programme for all 5 year olds on starting school
• daily toothbrushing in targeted primary schools with the most disease (some 25-30% of schools in Scotland)
• linking all this to "Hungry for Success", the Health Promoting Schools programme and pre-school promotion of healthy foods and drinks

It is important that Boards achieve this core service before moving to the next phase. This core service is estimated to reduce dental disease by 25% if undertaken to national standards.

The second phase relates to the development of two demonstration projects, with the first in West Scotland focussed on 0-5 year olds including:

• pre-school comprehensive care programmes for children in most need to include early contact with dental services on referral by a health visitor or by child care services.
• the identification of 70-100 child friendly practices, salaried and non-salaried, to receive these referrals and offer prevention-oriented programmes mainly led by dental nurses.

and the second in the East, focussed on:

• a comprehensive care programme for nursery and school children, offering preventive and treatment services, including the use of mobile clinics where needed.

NEXT ISSUE WILL FURTHER CONTAIN INFORMATION ON:

• CLINICAL WASTE CONTRACTS
• ORAL HEALTH ASSESSMENT WASTE
• PREMISES SUPPORT
• DENTAL ACCESS INITIATIVES