GDPC/LDC RLG: South Central(Wessex) Report

19th May 2017

Website: The new H&IOW LDC’s website has been officially launched and it is hoped that this will be well received.

Procurement: The Regional (South) Dental Procurement Steering Group met again on the 20th April and meets again at the end of May to continue progressing the planned two phases of the procurement process for orthodontic contracts due to terminate 31st March 2018. The timelines associated with this orthodontic service procurement exercise are under very significant pressures from a number of sources. BDA’s legal challenge against NHS England’s use of a ‘Dynamic Purchasing System’ (DPS) in its tendering of £1/2 billion of orthodontic services initially in the South of England. A recent message has been circulated that suspends the DSP end date requirements for an indefinite period. The notice mentions that this suspension is to allow for Health Needs Assessments, which will determine the Lots size. The LDC is concerned that this system is highly likely to be rolled out to include other dental commissioning in the future. The issues identified are:

  • Unfavourable treatment of small providers and especially the financial standing criteria and the proposed large LOT sizes/ consortia.
  • Clinician engagement has been poor and the NHS tendering rules have not been implemented as these require the commissioning process to be the subject of constructive engagement with a high level of information.
  • Patient and public engagement has been very limited in the majority of areas and therefore NHS England is not aware of the impact of these proposed contracts on the best interests of patients. The rules of this procurement have been solely determined by NHS England rather than by a collaborative approach with providers and the public as determined by law. It is unclear how NHS England’s procurement of orthodontic services without appropriate public engagement can justify their selection of those dentists that will be providing orthodontic services. A very limited orthodontic needs assessment has been carried out in most areas with the exception of Wessex prior to the introduction of this procurement system.
  • Equality assessment and its analysis has not taken place as required under the Equality Act 2010 with no indication that NHS England has had any regard to reducing inequalities between patients with respect to accessing the orthodontic services. Reduced provider areas and sites and thereto the numbers of providers are likely to impact on equality outcomes.

NHS England South (Wessex)/LDC Capital Funding (Electronic Referral & AED) Schemes: The final report for the electronic referral element has now been compiled with a total expenditure of £125,965 and this achieved part funding for 25 digital x-ray sets and 22 intraoral cameras (38 sites). The LDC is still awaiting feedback from all the recipients of this second phase funding but so far the response has been very positive.

This now underlines the successful and responsible distribution of the H&IOW LDC’s proportion of the original £282,000 funds through this scheme and the preceding AED Scheme.

Occupational Health: A letter was sent out on the 28th February to announce the new service starting 1st April and the LDC has received a number of queries that includes the scope of this new service provision and especially the provision of the service to dental team members that have experienced a ‘needle stick’ (NS) injury. The LDC understands that the service is mainly unchanged in respect of NS injuries to dental practice staff but is awaiting formal assurances that dental teams are covered by this service during normal working hours (A&E outside) and the detail surrounding the pathways associated with access to the new OH service. The current OH service has been commissioned from Heales Medical but details of locations of services and supporting guidance is not readily accessible by practices. Currently the LDC is trying to facilitate the dissemination of accurate information by its website and by group email. Of particular concern is the list of extra charges published by Heales Medical and that the service is fundamentally provided through its online portal which is not fully operational.

Future LDC CPD events: The LDC has already hosted four CPD events this year including cyber crime and DERS. We occasionally workin collaboration with the BDA Wessex Branch Council. The LDC is organizing two more CPD events later this year:

  • 4th July 2017 - Leadership, Coaching and Mentoring; Janine Brooks
  • 11th October 2017 -CQC Update; John Milne

We are having discussions with our other partners in CPD provision and there will be other events during 2017. We are concerned that the Deanery budget is to be reduced by 30%. We are also aware that there are changes to the management of the Foundation Training by Equivalence Scheme now called Performers List Validation by Experience (PLVE).

Additional UOAs and UDAs: These were offered to contractors that satisfied certain conditions at the end of 2016 and over-performance was allowed 16/17 up to 120% and in some cases at an even higher percentage rate. These contractors were contacted again earlier this year to complete a table of their UDA activity and this needed to be returned by 3rd March 2017 to facilitate the payment. This over-performance payment was visible on Compass from the 1st May and is 50% of the projected over-performance with a second payment in October. NHS England-South (Wessex) have confirmed that this enhanced level of UDA activity will be carried forward into 2017/18 and 2018/19. The orthodontic UOA model differed from the UDA one in that this over-performance was offered for 2016/17 and 2017/18.

PCSE: A Dear Colleague letter was generated in March to update dentists on the current performers list applications position. NPL1 applications for foundation dentists have now been processed and applicants have been advised in writing that they can work. Outstanding applications from qualified dentists have been given priority status and currently routine NPL1 applications take up to 12 weeks to be processed. Other performers list requests are being processed as quickly as possible. PCSE were contactable by:

  • Email:
  • Phone: 0333 0142884

A further Dear Colleague letter has been generated (End of Year Reconciliation) 2016/17 which states that no breaches will be issued on the sole basis of under performance. NHS England-South (Wessex) have apologized for the impact of Performers List delays but they have further stated that they are not responsible for any financial losses to practices or individual performers. Clearly the question is ‘who commissioned Capita’ was it not NHS England? They have issued an interim policy and guidance that enables NHSE commissioners at our local level to flexibly manage dental contracts. This is meant to mitigate the impact on dental practices that have been unable to fulfill their contract as a result of Performers List delays. Any practice that can prove that it has been affected by a significant delay (more than 16 weeks) in recruitment may apply to carry forward under-used UDAs for delivery in 2017/18. However, they will need to generate an action plan that demonstrates how this additional activity will be delivered and thereto ensuring that there is no detrimental effect on their normal contractual activity. If contractors feel that this is not achievable by 31st March 2018 or even part of it, then clawback will apply and this must be settled before 31st March 2018. A template form has been generated and has to be returned by 31st May 2017. There is no mention of compensatory/goodwill payments to performers (£2k per month).

LDN Activity: There was a recent LDN Facilitation Day followed by an LDN Core Meeting both of which were not viewed favourably by the attending Dorset LDC representatives. Concerns were raised that there were noGDPs (apart from the LDC reps) present and NHS England’s views are that any GDPs attending (these are in any case limited to 3 on the Core Group) are employees of NHS England and working to implement NHS England’s commissioning plans. NHS England do not seem to recognize that dentists in general dental practice are independent contractors that chose to contract with the NHS and that they may also treat patients under private contract. The message from Wessex is that GDPs attending the LDN are there to feed in their clinical expertise but the offer of 50% BDGR for attendance has been rejected as being unacceptably low and unlikely to attract local dentists to attend. In any case there does not appear to be any local initiative to actively recruit GDPs. Wessex are now looking at an hourly rate which could range between £50 and £80 per hour. We are unsure when the various MCNs will have formally appointed and funded Chairmen. The whole of the Local Professional Network and associated MCNs is chronically under-funded and NHS England are relying on the goodwill of practitioners and other dental professionals that attend core meetings and the various MCNs. Evidently the threat of lost CQUIN payments is used to enforce the attendance of local consultants at LDN/MCN meetings.

Rebasing Dental Contracts: The LDC has received concerned queries from contractors that have low UDA rates (£20 and below) and where their staff pay and practice improvements are limited by these low rates. Generally there are demands from dental staff and associates in these practices to uplift their pay. It is becoming more difficult to recruit associates and if their UDA rate is not uplifted there is a real danger that they will be lost and not easily replaced with a negative contract performance knock on effect.

Keith Percival