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MINUTE of MEETING of the
HIGHLAND AREA DENTAL COMMITTEE
Centre for Health Sciences, Raigmore Hospital, Inverness
23 May 2007 – 6.30 pm
Present: Mr Adrian Hart (Chairman)
Mr Neal Drummond, GDP
Mr Ken Gill, GDP
Ms Catherine Lush, Clinical Dental Manager
Mr Alan Ramsay, GDP
In Attendance: Mrs Jan Baird, Director of Community Care
Mrs Alex Fraser, Dental Services Manager
Prof. Ruth Freeman, Dental Health Services Research Unit, University of Dundee
Mr Brian Mitchell, Board Committee Administrator
Mrs Helen Strachan, Regional Manager (North), Oral Health and Dentistry
1 APOLOGIES & WELCOME
Apologies were received from Mrs Susan Eddie, Mr Douglas Fraser, Mr Albert Hay, Mr John Herrick, and Dr Ken Proctor.
At the commencement of the meeting Mr Mitchell advised that it had not been possible to arrange Videoconference facilities for Mr Isaac despite timeous action in this regard. Mr Mitchell requested that the Committee agree to appropriate representation being made in this regard to the Acting Head of eHealth.
The Committee so Agreed.
2 MINUTE OF MEETING HELD ON 22 NOVEMBER 2006
The Minute was approved subject to the following amendments:
Page 1, Item 1, line 1 – remove “Henrick” and replace with “Herrick”.
Page 3, Item 3, Action Point 2 – remove “Mrs Fraser”.
The Committee agreed that the following Item be taken at this point in the meeting.
10 DELIVERING FOR HEALTH – COMMUNICATION PLAN
Mrs Baird gave a presentation to the Committee in relation to the Delivering for Health programme in NHS Highland for 2007/08 and outlined the ambitions of the organisation to have a community that is well informed, motivated and interested in its own health; to have good, accessible and flexible health services in place when people are in need of them; and to have well trained, supported and valued staff to support the community’s health and health care needs. There were a range of ever changing life circumstances and health inequality issues that affected peoples need for care that had informed the report ‘Delivering for Health’ and this in turn had influenced the NHS Board Clinical and Performance Management Frameworks. The principles behind Delivering for Health were outlined along with the factors that had informed this approach, including especially in the Highland area, an ageing population and the impact of Long Term Conditions. The National Framework for Service Change was to be a team based approach, and reflected that health services would require to change to keep pace with population trends, patient needs and medical advances.
The NHS Highland Clinical Framework was based on Clinical Quality; Patient, Public and Carer Experience, and Value for Money, all as more detailed and on the basis of right treatment, in the right place, by the right person and include a review of Rural General and Community Hospitals. The Framework would be delivered by virtue of CHPs being empowered to deliver the strategy locally in partnership with communities and staff, working to common goals, and driving efficiency in service delivery.
The Community Hospital Strategy was a national document issued in December 2006 and involved enhanced roles for staff, clarification of the role of Community Hospitals in individual locations, reassessment of the range of services provided in each Hospital, and would be integral to the delivery of relevant NHS Board Plans. The Review of Rural General Hospitals had been commissioned by the North of Scotland Planning Group.
Mrs Baird then outlined the workforce issues involved, including staffing age profiles and the Review of Community Nursing, in respect of which a Steering Group had been established with a view to providing a new model of community nursing on the basis of a sustainable workforce. The Performance Management Framework included a Local Delivery Plan and was based upon National HEAT targets involving 28 targets and 31 Key Performance Measures. Overall, for NHS Highland, Delivering for Health would mean resources being used efficiently, better support for self care, some services closer to local communities making use of local primary care teams, possible changes to existing provision of community hospitals, involve day care or short stays in hospital, and utilise new methods of providing specialist care such as telemedicine and other new technologies. For staff the key elements would be the promotion and support of self care, support for carers, adapting to opportunities for role development, working in integrated teams that are multi-agency and disciplinary, and learning to work with new technologies.
Mr Hart stated that the main challenge for dentists related to funding issues as the system of fees per Item of service meant that there were limits to what could be achieved, that prevention was preferable however the current scheme led to dentists being remunerated for repair work instead. Mr Gill referred to the Access element of the HEAT targets and stated that in dentistry terms this was very poor, with some members of the public not having access to services and patchy follow-up treatment. He added that Delivering for Health did contain admirable aspirations in terms of patient care, however, there was little mention of dentistry and Mrs Baird confirmed that there was a lot work to be done in this area. Ms Lush stated that building capacity levels was very much an aim and this included prioritising a range of different difficulties such as provision of premises. She added that as the prevention of hospital admissions was an aim the challenge for Managed Services would be working with CHPs with a view to working with identified patients in this regard. Mr Hart stated that there was a need to include all dental services, not only salaried practitioners as the issue would be how fees could be used to back up work in other areas of care. Ms Lush confirmed that there was an opportunity for dentistry to be heavily involved in this subject however there existed barriers that would require a political settlement to address, and Mrs Baird reminded that with a change in national administration the chance may exist to achieve this. Members expressed concern that dental services were no longer patient oriented, was based on numbers, and did not reflect the proposed advances being promoted for other health services through Delivering for Health.
After discussion, the Committee Noted the position.
3 MATTERS ARISING
3.1 Changes to Dental List 2007
There had been circulated letters advising of changes to the NHS Highland Dental List along with an up to date version of the List.
The Committee Noted the changes to the Dental List.
3.2 Mileage Rate
Mr Hart advised that there had been no further correspondence on this matter.
The Committee Noted the position.
3.3 Restorative Dentistry
There had been circulated letter from Mr S Robb and Mr Hart stated that there was a need for consultant input with regard to guidance on treatment. Ms Lush advised that the views expressed previously by Mr Stuart Robb were echoed by a number of practitioners. It was not a case of an unmanageable workload. Mr Ramsay stated this would come down to adequate financial resources and this would not be viable in many cases. Mr Hart advised that a restorative referral protocol was being produced by the Aberdeen consultants. Mr Drummond suggested that the availability of a hygienist within the practice be included in the protocol. Prof. Freeman queried as to whether Continuing Professional Development would be the most appropriate way forward for those practitioners unsure as to treatment and Ms Lush advised that in this regard a course on Periodontal work was to be held shortly. Mrs Strachan advised that the capacity issue was likely to improve after the appointment of a full time Restorative Consultant in Dentistry as part of the Centre for Health Sciences, funded by NES as there may be an opportunity for service provision. The post in question was to be supported by two Staff Grade appointments with a view to assisting with the Neck and Head Cancer Managed Clinical Network.
After discussion, the Committee:
Noted the position in relation to Restorative Dentistry and the actions underway.
Agreed that contact be made with Mr Donald McGovern with regard to provision of formal Periodontal training courses.
4 UPDATE ON NHS DENTISTRY IN HIGHLAND
Mrs Fraser advised that the number of committed practices to 31 March 2007 remained constant although one single handed practice in Argyll and Bute had given notice of intention to cease practice. There had been two appeals upheld against the withdrawal of committed status. There had also been circulated report detailing a breakdown on spend per CHP area and area of expenditure in relation to allowances for dental practice improvements in 2006/07. In this area Mrs Fraser requested that two representatives join with her and Dr Ken Proctor to consider issues for 2007/08.
Noted the position in relation to committed practices.
Noted the spend breakdown of allowances for dental practice improvements 2006/07.
Agreed that Mr Drummond and Mr Ramsay assist Mrs Fraser and Dr Proctor on 2007/08 spend issues.
5.1 Decontamination Advice
There had been circulated letter dated 19 April 2007 from the Chief Medical Officer and Chief Dental Officer giving advice for dentists on the re-use of endodontic instruments and Variant Creutzfeldt-Jakob Disease (vCJD) and it was stated that this would have a great impact on those utilising titanium files. It was also noted that the existing fee system was derisory when considering those items that are discarded and Mr Hart advised that representations had been made to SEHD in this regard with a view to further consideration of resource issues for those items. On the point raised by Mr Ramsay as to whether in respect of the purchase of endodontic reamers there was possibility of the NHS Board seeking to achieve economy of scale on bulk purchases, Ms Lush stated that as a fee scale existed there may be scope in this regard nationally. Mr Hart suggested that as there were a number of companies supplying such items that the NHS Board be requested to take this matter up with SEHD accordingly.
Noted the letter from the Chief Medical and Dental Officers.
Agreed that the Chair request that the NHS Board approach SEHD with regard to the bulk purchase of endodontic reamers.
5.2 Decontamination in Practice SDCEP Document
Mr Hart advised that all dentists had received a copy of relevant documentation and that there would be additional advice and guidance to be prepared and added. Mrs Fraser confirmed that additional revised guidance was to be issued and as a result of advice being received from a range of differing sectors stated that NHS Boards were finding it difficult to maintain a consistent message in this regard. Mr Drummond stated that the guidance was leading to confusion among dentists as to which equipment to purchase as there was no authoritative view. Mr Gill stated that he had found using disposable instruments the most cost effective method in which to proceed. Mrs Fraser added that NES was to take the lead role for training in this area and stated that they had become concerned and frustrated at the lack clarity in this area. Mrs Fraser suggested that an audit of procedures etc would be an appropriate first stage and Ms Lush stated that there was need to consider such issues as the Dental Property Strategy and an element in respect of independent practice which allowed for prioritisation of investment.
Noted the position in relation to Decontamination in Practice.
Agreed that the Chair write to the Chief Dental Officer emphasising the issues concerned and especially the current lack of clarity.
6 MAXILLOFACIAL SERVICES
Mrs Strachan advised that the North of Scotland Group was to meet on 14 June 2007 at which time she was to produce her initial findings on the issue of Maxillofacial services, after which a final draft report would be produced and issued for comment. The findings to be presented to the Group would be based upon the 60 day access target, the issues identified and those where further information was required, and recommendations in the short term. Mrs Strachan advised that NHS Highland and NHS Grampian had met at Consultant level with a view to agreeing a suitable way forward and that Mr Denholm had been involved in that process. There was a review of finance across NHS Boards in Scotland and consideration was being given as to how this could be utilised more effectively. There was also a need to augment the relevant existing needs assessment template, including elements relating to primary care. On the point raised by Mr Hart it was confirmed that Oban, Western Isles, Orkney and Shetland were part of the North of Scotland Dental services review although NHS Tayside were unsure as to whether to participate.
Mr Hart advised that Mr McIntyre had left his post and Mr Railton had been appointed on a locum Consultant basis, with a locum staff grade also being in post for a number of weeks. Given the pressure that the service was under the NHS Board was considering setting up an appropriate Service Level Agreement (SLA) with either NHS Grampian or NHS Greater Glasgow and Clyde, with respective professionals favouring the Aberdeen option. He advised that there had been weekend working in operation with a view to meeting waiting times targets. The SHO current contract was to end in August 2007 although there may be scope for extending this if necessary. Mr Hart added that the General Dental Council were in the process of considering the introduction of a Speciality in Oral Surgery that may include facial trauma. Ms Lush advised that this would bring Scotland into line with other European nations.
The Committee Noted the position.
7 ORTHODONTIC SERVICES
Mr Hart spoke to the circulated document ‘Report on the Hospital Orthodontic Service, Raigmore Hospital, Inverness, NHS Highland’ by the Scottish Consultant Orthodontists’ Group and advised that the service in question was struggling to cope with demand and had appointed two locum members of staff. At present there was one Saturday clinic being operated per month. He advised that Mr Chris Buchanan was to open a new surgery in June 2007 in respect of which it was hoped that an additional orthodontist would be recruited. Mr Hart added that 2 clinical assistants had been accepted onto the Diploma in Primary Care orthodontists but here were funding issues. He hoped the funding issues would be resolved.. On the point raised by Prof. Freeman it was advised that the second Consultant post was to be re-advertised in September 2007, that discussion had been held with a view to making the post more attractive to candidates, and in the meantime a locum was in post although not at Consultant level.
Noted the position in relation to Orthodontic Services.
Noted that the post for a second Consultant appointment would be advertised in September 2007.
8 OUT OF HOURS
Ms Lush gave a presentation to the Committee on the work of the Dental Out of Hours Steering Group, advising that an open evening meeting was to be held on 18 June 2007 to enable formal consultation to take place on the proposals regarding Out of Hours service provision. Ms Lush outlined the context of the proposals and advised as to the standards expected in terms of emergency and urgent care as well as advice and self help. In terms of timescale, publication of definitive National Dental Advisory Committee standards was awaited and the action plan target of March 2008 stated that all in Scotland would be able to access advice and support through NHS24, that all patients with a dental emergency be linked with the Emergency Dental Service within 1 hour, and that all patients be able to access urgent care within 24 hours. Features of the proposals included a single point of access, access based on clinical need, integration with NHS24, partnership working between NHS Boards, a set of published standards, and a governance framework. Challenges to be faced were to understand the potential demand on services and building of sustainable services. Projected activity in Highland was planned on the basis of highest demand and it was stated that there was no capping permitted in terms of the number of patients per session, in respect of which there was to be continuous evaluation. With regard to translating potential activity to service needs Ms Lush stated that this would mean either the provision of a single service site in Inverness (6 sessions Saturday, 5 Sunday) or the provision of multiple sites, based on a geographical basis. On the point raised by Mr Hart it was confirmed that each session would be for a period of three hours and that payment for services would be on a session rate. In terms of provision it was anticipated that the Inverness site would cater for cases from the outlying areas. It was agreed that Mr Robert Donald should be asked to attend the open evening meeting in June.
Noted the position in relation to Out of Hours services.
Noted that an open meeting was to be held on 18 June 2007.
Agreed that Mr Robert Donald be invited to attend that meeting.
9 ANY OTHER BUSINESS
Prof. Freeman advised the Committee that a Masters student was to undertake research in relation to access to care for adolescents with learning difficulties and requested that a good level of response be given.
On the point raised by Mr Ramsay as to issues relating to Disclosure Scotland checks it was advised that all employed by NHS Highland were subject to this, as were Vocational Trainers, although not necessarily all GDPs.
10 DATE OF NEXT MEETING
The next meeting of the Area Dental Committee will be held on Wednesday ??? 2007 from 6.30 pm to 9.00 pm.
The meeting closed at 9.00 pm
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