Minutes

Present / Name / Job title / organisation
Mark Johnstone / Interim Chair, Clinical Director of Clinical Service, KCHCT
Gemma Michael / Business Support Administrator, NHS England
Annie Godden / Senior Contract Manager, NHS England
Andrew Elder / Restorative Consultant, East Kent NHS Foundation Trust, Restorative MCN Chair
Sarah Davies / Clinical Dental Lead MCH, Oral Health Promotion MCN chair
Stephen Lambert Humble / Post Graduate Dental Dean, HEE
Mark Ridgeway / Contract Manager, NHS England
Julian Unter / Secretary, Kent Local Dental Committee
Huw Winstone / Dental Practice Advisor, NHS England
Steve Innett / Chief Executive, Healthwatch
Apologies
Elizabeth Lines / Patient Representative, Healthwatch
Ken Hymas / Dental Practice Advisor, NHS England
Barry Hayes / Principal Orthodontist, Orthodontics MCN Chair
Nic Goodger / Oral Surgery Consultant, Kent and Canterbury Hospital, Oral Surgery MCN Chair
Alison Cross / Contract Manager, NHS England
Agenda item
  1. Welcome and Introductions
Introductions were made and the group welcomed Steve Innett from Healthwatch to the meeting. Apologies were given as above.
  1. Notification of any other business or matters arising
None declared.
  1. Minutes of the last meeting
JU queried on page 11, was ‘administrational’ a recognised English word.
Action: GM to check this via the Oxford dictionary.To change the wording on the minutes if it is not.
The minutes have been agreed by the group as a true and accurate record of the meeting.
  1. Actions from last meeting
Action 4. BD to contact SLH to ask if Older Person’s Project information can be shared with the group (This was an action from the joint LDN – 09/03/16) Update - SLH who is in attendance at this meeting, confirmed there will be no action for the next two months as there is some re-focusing, the group will be updated when more information is available.
Action 4. As part of DERS, BH and AE to make contact to identify level 3b cases that require multi-disciplinary care. Update - AE confirmed that there had been lots of work and this is progressing.
Action 5: Amendment on page 2 – Surname error, Andrew Elder should read Andrew Dibiase. Update – This amendment is incorrect and was Andrew Elder.
Action: GM to re-amend the previous minutes. GM to email Barry Hayes with this update.
Action: Barry Hayes to email Andrew Elder regarding the restorative pathway that relate to orthodontics.
11. Jeremy Collyer (JC) will need a response to his concerns regarding DERS safety. Update – A response was given to JC along with an invite to meet with Vantage so that any safety concerns could be addressed, he has not responded to the invite, so there is a presumption that he was happy with the written response.
12. SH and AE to make contact in order to discuss restorative care links. Update – Sarah Hurley had produced some interesting data with reference to Units of Dental Activity (UDA). AE had enquired the data source. AG did not think there was any real benefit to perusing this line of enquiry further due to upcoming changes, so no further action is required.
12. HW to feedback to BD and DE regarding the software changes needed and to inform AE. Update – HW confirmed that there are ongoing discussion with Vantage and there is works in progress. AE asked HW if he could be copied in any emails as upon reviewing the Sussex pro forma, the need for some changes became apparent and this has been bought to DE attention.
Action: HW to copy in AE emails with Vantage.
HW stated that molars were an issue in Sussex; they have been inundated with molar referrals. AG stated that although there is an awareness of the numbers, there is a need to wait until the commissioning guidance has been released.
AG stated that there was some mention in the guide of strategic importance, but there is no referral to shortened arch. AG explained upon receiving the guidance there will be a need to look at the services available and what services are needed going forward. This will be identified by the LDN in conjunction with the restorative MCN.
AG informed the group of an agreement due to the delay in the release of the restorative commissioning guide nationally. The agreement is to maintain the current position. West Sussex referral management was permitted even though it was known that there were some shortcomings. A meeting with restorative consultants on the 10th June 2016 to start to progress and improve the proforma.
22. TE to send SH the paper version of the Healthwatch presentation. Update – GM has spoken with TE and this is in progress.
Action: GM to email TE for an update.
All other actions have been completed.
5. Minutes and actions of the Core Group – 04/05/2016
The minutes of the Core group on the 04th May 2016 have been agreed that they are a true and accurate record of the meeting.
5. GM to seek approval from Sara Hurley to publically share the minutes from the joint LDN meeting on the 09/03/16. Update – The minutes of the meeting have been agreed by the rest of the group, it was decided the minutes can be shared on the NHS website.
7. AG to seek information from the Royal College of Anaesthetists and indemnity organisations regarding sedation inspections and the under 12’s year olds. Update – AG confirmed that she has not been able to make contact as yet. There have been discussions between AG and HW; they have been trying to find a consultant anaesthetist that would be able to do the inspections. This individual needs to be able to challenge sedation practice on children under 12, this individual is proving difficult to locate. Paul Sigston has been approached by HW and stated that he would send an email, unfortunately that has not been received even with a reminder, so another individual might need to be sourced.
AG informed the group that a letter went out to all practices from dental services from Sara Hurley and other Chief Dental Officers (CDO) colleagues in Scotland and Wales. There is the commissioning of a work initiative to independently review the evidence base of intercollegiate standards that have been published. There is some concern over allowing this commissioning to continue. NHS England hasn’t accepted the full standards, and there is difficulty challenging anaesthetists who perform this procedure.
The SAAD guidance requires that whoever will do the inspection should view the sedation procedure five cases per anaesthetist. Some practices may have 3 or 4 anaesthetists and this was not deemed acceptable due to the re-visiting requirements as there is no capacity to do this. An accepted procedure would be to review all the Standard Operating Procedures (SOPs) and be satisfied with those and have a discussion with the provider. It is the responsibility of the provider to ensure that those that deliver services are suitable, have the appropriate training, experience and are safe. If no one can be found inside of Kent, then AG informed the group that there might be a need to look outside of Kent.
Action: SD to make some enquiries for a possible contact ‘Chi Davies’ for the sedation inspections in Medway.
9. AI, SLH and Samit Shah to connect and discuss the current talks on the ST post for Oxford, Surrey, and Sussex. Update - SLH informed the group that John Darby has been offered the post of post graduate Dean in Oxford. A cross boarder STR is hoped to be appointed soon. Dental fellows will also be joining HEE shortly. SLH reference to Jackie Sowerbutts position has been moved to agenda item no: 13 at the request of AG.
11. AG to seek clarification on the responsibility of patients who require dental care whilst in hospital with dental care leads. Update – This was raised at the national dental leads meeting and all agreed that any form of inpatient healthcare which included dental treatment was the responsibility of the hospital Trust and they must commission this service.
11. SLH to email GM with the new Mouth Care Matters information. Update – SLH will attend a Programme Planning Board next week with the Academic Health Sciences Network (AHSN) They are holding funds from an underspend last year, once the planning board has taken place, the project plan can be released.
Action: SLH to send this project plan to GM.
SLH told the group that Mouth Care Matters has absorbed the Older Person’s Project and is now ‘Mouth Care Matters In Hospital and Outside of Hospital’. He also explained that it was likely that the care home element of the older person would be made relevant to people in sheltered accommodation.
Action: SLH and SD to correspond on this project going forward.
11. SLH to enquire about parking charges for East Surrey Hospital for the Challenges Event on the 05th October 2013. Update - SLH is in discussion with Alison Newlyn. The trust wants to enforce parking charges and Alison is seeking a reason why they should not. A response will be communicated shortly.
6. Healthwatch Update
SI expressed his thanks to the LDN explaining that the link between Healthwatch and the LDN is very positive.
He explained that focus was on 3 main areas.
1)General Understanding and accessing information.
2)Access for people with additional need
3)Strategic picture
SI put forward a proposal to starting a task and finish group. AG explained there was not the capacity to organize another meeting and to link up with the Managed Clinical Networks (MCN) particularly the Oral Health Promotion MCN. SD told the group that the Local Authorities sit on the OHP MCN. Libby Lines from Healthwatch has expressed interest in sitting on the OHP committee and will be invited to the next meeting.
Action: GM to add Libby Lines to the OHP MCN attendance list.
Action: SLH to speak with KE regarding attendance at the OHP MCN.
SI is keen for the LDN to send out leaflets and the group agreed that NHS England would assist in the distribution of the leaflets but that a covering letter on behalf of Healthwatch should accompany the leaflets. AG expressed some concern as contractually dentists have to use NHS England leaflets.
Hard copies of the leaflets are preferred; SI confirmed that an electronic version will be sent followed by the hard copy.
Action: SI to send me covering letter and send to GM for distribution to Kent only dental practices.
8. Plan on a Page
MJ presented the March 2016 – April 2017 plan on a page to the group and asked if there were any omission requests. It was agreed that the work would roll over to the next year.
AE announced that he had presented a plan for restorative care to the LDN.
The group all agreed that the plan on the page would be adopted for current and future work initiatives.
9. DERS update
AG confirmed that DERS is being used in Kent for Oral Surgery and Endodontics. AG explained that AE has given up a lot of his time to work on the Restorative pathways for DERS. A meeting is scheduled for next Thursday 16 June 2016 where restorative consultants across KSS will meet to discuss the work that AE, Brett Duane and David Ezra (from Vantage) have completed so far. Once agreed the restorative pathway will be rolled out via DERS; presently the system uses a number of pathways for endodontic/prosthodontics/periodontics as these differ across localities within KSS and have had to be developed independently to reflect our current provision.
The Orthodontic pathway is not currently being used in Kent but this is hopefully to be rolled out shortly. When the pathway is being actively used in Kent the Index of Treatment Need (IOTN) score will be calculated in the background. Upon an IOTN sore of 3, the practice can choose the aesthetic component or choose to upload photos. IPod touches have been ordered and once these are received in the office, they will be distributed to Kent practices and then the orthodontic pathway in Kent can go live. This will bring Kent in line with West Sussex and East Sussex practices who have been using the orthodontic pathway and uploading photos via the IPod where necessary.
Brighton and Hove – 27 June 2016
East Sussex – 1 September 2016
Surrey 1 December 2016
The whole of Kent, Surrey and Sussex will then be using DERS for Oral Surgery, Endodontic and Restorative care pathways. Special care and Paediatrics pathway has been delayed until all other pathways are live.
AG told the group that there will be referrals only from General Dental Practices (GDPs). Other services could explore choose and book where electronic referral are accepted, but care homes, looked after children and district nurses will still need to use paper referrals.
AE raised a concern regarding the fact that services are very different in Kent than in Sussex and this might create some issues on where patients are referred; he remarked that he thought it might mean more patients will need to be referred initially. AG responded that with regards to endodontics, Vantage has been asked to issue a programme re-write that addresses the anomalies.
AG went on to disclose that Periodontics has very limited provision, level 3 with some limited level 2. Prosthodontics only level 3.
AE advised that Guys Hospital was very limited in taking on prosthodontics. AG commented that Guys had recently sent out written correspondence that they had completed a new dental suite and now has a large capacity encouraging referrals.
It was acknowledged that there is the need to wait until the commissioning guides for restorative have been released to understand what NHS England should focus on commissioning.
10. Managed Clinical Networks (MCNs)
  • Restorative – The commissioning guides are due in September 2016 but this date may change. Once received work can begin to configure services.
Restorative clinical network – AE told the group that an important meeting is scheduled for next week, with David Cheshire, AE and Jimmy Kingsmill to review the DERS pathway. AE had extensive communications with Brett Duane and David Ezra to agree the pathways and its terminology. There is more improvement needed but AE agreed that it will be a fantastic tool but that it should not be a triaging tool.
AE informed the group that Huw Winstone has been managing the endodontic referrals. AE agreed that if a 2nd opinion was needed for referrals he could be contacted. AG to speak with Brett Duane and David Ezra so that AE had access to DERS as at the present time he is only able to gain access to the test pilot. This would only be for endodontics for Kent.
Action: AG to ensure AE has access to the DERS pathway.
AE expressed that activity reports would be very beneficial; AG agreed but stated that the pathways needed to be correct before a report could be generated.
SLH informed the group that the integration process was continuing and that there is some uncertainty what will happen within HEE but confirmed that the current 13 Local Education Training Boards (LETBs) will be going down to 4.
SLH is working on apprenticeships for dentistry as he explained this is likely to be the funding process for Dental Care Professionals (DCPs).
There will be 4 levels.
  • Educational Level 3 - dental nurse
  • Level 4 - oral health practitioner (advanced dental nurse)
  • Level 5 - Hygienist
  • Level 6 – Therapist
There may be a separation of the hygiene and therapist training due to therapists unable to secure roles upon qualifying.
1 or 2 DCP dental clinical fellow will be appointed in the next 2-3 months. Sara Hurley is very keen and they will have a role with Health Education England (HEE) and they will also work alongside Sara Hurley in the centre. Potentially they could be invited to attend the LDN as a DCP representative.
Action: SLH to speak with MJ and AG regarding the challenges programme for the event held in October.
Action: AE and SLH to communicate via email in regards to the apprenticeships with the dental technicians.
Oral Health Promotion – last meeting on the 24th May 2016. The terms of reference (ToRs) were discussed and some changes were made. The local authority Kent County Council shared with the group data from their oral needs assessment. SD told the group that they did not have community dental services (CDS) data or any General Anaesthetic (GA) data. SD challenged that the lack of this data would have an impact on the data already shared and therefore does not represent the true picture.
Special needs and Paediatric Dentistry – Last meeting was held on the 10th May 2016, it was very well attended. The group looked at the Terms of Reference (ToRs). It was agreed that special care dentistry and paediatric dentistry would be separate items on the agenda.
Sarah Crosbie has retired and therefore will no longer be a member of this MCN. Agi Tarnowski has agreed to feedback to the LDN.