SCOTTISH DENTAL NEWS Issue 2 Scottish Executive Primary Care 1 ER St Andrews House Regent Road EDINBURGH October 2005 CONTENTS NHS COMMITMENT CLINICAL WASTE CONTRACTS ORAL HEALTH ASSESSMENT PREMISES SUPPORT DENTAL ACCESS INITIATIVES NHS COMMITMENT Following discussions with the BDA we are now finalising the definition of NHS commitment in relation to the new funding support for independent dental practices. This will be based on the level of gross NHS earnings of principal dentists and require all categories of patients to be treated with a minimum number of patients in each category. Calculation will be based on the average NHS earnings of a practice given that practice support will be the main focus of the new infrastructure support and allowances described in the Dental Action Plan, rather than the individual NHS commitment of each dentist. The allowance will be payable in bands and have a minimum threshold. Any practice below the threshold will not be entitled to the allowance. Provision will be made to recognise part-time dentists who are committed to the NHS. Further information on the details of this will be issued shortly. FUNDING As a result of the Ministerial announcement on 17 March, we have committed to a record amount of new and additional funding to improve oral health and dental services. This amounts to an extra 45m this year (2005/06), to 100m in 2006/07 and to 150m in 2007/08. Cumulatively, this amounts to 295m over 3 years. Of the 150m additional spending by 2008, 120m will go towards enhancing primary care dental services. A further 30m capital funding will be made available for new dental centres, further information on this is contained below. GENERAL DENTAL PRACTICE ALLOWANCE The first payment of the revised General Dental Practice Allowance was paid in July. In total over 2.6m was paid to 805 practices. The average payment was 3,260 but some practices benefited by up to 18,000.
CLINICAL WASTE CONTRACTS PURCHASING CONTRACTS This initiative is part of a wider programme to support dentists in Scotland by developing a range of opportunities for them to benefit from central or, where appropriate, local contracting arrangements for purchase of key dental goods and services. Central Contracts To date the project group, working closely with Scottish Healthcare Supplies, has set up central contracts for purchase of: Sterilisation equipment; including autoclaves, washer-disinfectors, ultrasonic baths and single-use endodontic instruments: Amalgam waste separators Dental Waste The Action Plan made a commitment to support dentists in meeting the costs of clinical waste disposal. Work to date The project group has considered a range of options for taking forward this commitment. A Waste Survey was commissioned to inform future contracting requirements for dental waste. The Survey demonstrated that the majority of NHS Boards in Scotland currently have in place robust local arrangements which could be adapted to meet the dental waste commitments set out in the Action Plan. The Project Group concluded that a local model would be efficient and effective and would have the potential to be delivered to a shorter timescale than a centralised model of waste collection. We are currently working towards building on existing local models for dental waste uplift and will be writing to NHS Boards in the near future to clarify Board responsibilities with respect to dental waste issues. ORAL HEALTH ASSESSMENT The dental examination forms the basis of entry to dental care and plays a vital part in monitoring the ongoing needs of patients and providing them with the information they need to maintain their own oral health. In Scotland, the importance of this measure was recognised through A Partnership for a Better Scotland: Partnership Agreement (The Partnership Agreement). This made a commitment to systematically introduce free eye and dental checks by 2007. The Action Plan provided further detail on how this was to be implemented in Scotland, indicating that a free oral health examination would to be available for all NHS dental patients over the age of 60 by the end of 2005.
Extensive work has been undertaken with Dental Health Services Research Unit, key academics and the representatives of the dental profession to develop a framework for an oral health assessment which is now being piloted in the workplace setting, in both the salaried and independent General Dental Services. Work to date has included: A scoping exercise to consider the nature and range of the over 60 examination, linking this to the latest available research evidence on this subject. Development of a menu of supporting proformas for the examination with associated guidance to help clinicians and staff in using the forms Preliminary testing of an assessment protocol in the salaried primary care environment A review of the education and training needs of the dental team to ensure that clinicians and their teams have the necessary information to become comfortable with using the oral health assessment Future work will include: Evaluation of the Oral Health Assessment Pilot Development of any training resources required to support the introduction of the oral health assessment, following the evaluation of the Pilot. Linking the OHA work to the National Dental Advisory Committee (NDAC) Clinical Effectiveness Programme Group looking at Examination of the Patient. Considering how the assessment might be modified in future to reflect the needs of children. We would like to extend our sincere thanks to the staff and patients of the dental practices (both in salaried and Independent GDS) who are participating in the Oral Health Assessment Pilot. Further progress updates will be provided for colleagues in the next newsletter. SCOTTISH DENTAL ACCESS INITIATIVES Scottish Dental Access Initiatives, introduced in 1997, were designed to improve access to general dental services in parts of Scotland where patients were experiencing difficulties in locating dentists willing to treat them under NHS arrangements. In April 2004 the conditions attached to each grant and the level of grants available under the scheme were revised. A grant of up to 100,000 became available for dentists establishing new NHS practices in areas of unmet demand or high oral health need and up to 50,000 for dentists extending existing NHS practices.
The table below shows the number of SDAI s received since April 2004 to 30 September 2005. NORTH 1 EAST 2 WEST 3 TOTAL Applications 4 12 35 51 Received Rejected 1 1 0 2 Withdrawn 0 1 1 2 before offer Extensions 1 8 28 37 New Practices 2 2 6 10 1. North comprises Grampian, Highland, Orkney, Shetland and Western Isles NHS Boards. East comprises Borders, Fife, Forth Valley, Lothian and Tayside NHS Boards. West comprises Argyll & Clyde, Ayrshire & Arran, Dumfries & Galloway, Greater Glasgow and Lanarkshire NHS Boards. 2. 3. Information on the application process can be found in 1997 PCA(D) 11, 1998 PCA(D)12, 2004 PCA(D)4. REIMBURSEMENT OF CERTAIN GDP PREMISES COSTS Circular PCA(D)6 provided dentists with preliminary information on arrangements to phase in the reimbursement to dentists of certain premises costs incurred in delivering NHS general dental services (GDS), as provided for in the Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland. These schemes are based on similar arrangements available to support General Medical Practitioners. The intention is to introduce respectively: a. the reimbursement of the current market rent (CMR) of general dental practitioner premises as professionally assessed by a valuer appointed by the Executive. The reimbursement will be nondiscretionary for premises in use on the date of this Memorandum and will be effective from 1 April 2005, and, b. the reimbursement of certain prescribed costs incurred by dentists when either improving premises or moving to new accommodation more appropriate to the delivery of GDS than that vacated. Reimbursement under this heading will be discretionary. Reimbursement will be subject to NHS commitment. Finalised details of the schemes will follow shortly.
The subsequent Circular PCA(D)8 requests General Dental Practitioners (GDPs) to provide basic data to help the valuer appointed by the Department to set Current Market Rent valuations, GVA Grimley in association with the Valuation Office Agency (VOA), to be used in calculating any future reimbursements of rental costs. GVA Grimley will contact practices to arrange convenient times for premises visits and will seek to minimise any disruption to normal working. FUNDING ANNOUNCEMENT FOR NEW DENTAL CENTRES On 17 August the Minister for Health and Community Care, Andy Kerr MSP, visited the new Lynebank Dental Centre in Dunfermline. This has been opened by Fife Health Board to improve access for patients in the Dunfermline area to emergency dental services. A similar facility will also be provided shortly in Kirkcaldy. This is one of the new developments being funded under the Primary and Community Care Premises Modernisation Programme which has supported a number of infrastructure initiatives associated with NHS dentistry. These include: a dental treatment centre in Edinburgh, opened in Spring 2005; dedicated new facilities in Stromness-Orkney, Banff, and Wick; improved dental facilities in Health Centres in Pollok & Springburn, Glasgow; and new dental outreach training facilities at Easterhouse Health Centre, Glasgow. Ministers have decided to extend this programme and Mr Kerr announced during his visit that a total of 30m is now therefore being made available for the two year period 2006-08 ( 15m in each year) to help NHS Boards bring forward quickly more new dental centres, tailored to local needs and offering the right blend of routine and emergency service provision, improved access to dentists, allied professions and other specialist services, and which can also support training of dentists and professionals complementary to dentistry in the community. NHS Boards have now been invited to bid for these funds. They may be used to support new premises provision (large new or substantially improved centres, or for smaller centres where that provides a cost effective alternative), adaptation/improvement of existing premises, or provision of associated equipment. Boards are also making use of all other supporting programmes and mainstream funding to optimise the benefit that can be derived from use of these capital funds. The Department wishes NHS Boards to investigate joint working options with other agencies such as local authorities, and to share expertise gained during the commissioning of the previous tranche of this programme and other emerging proposals, such as a particularly innovative proposal relating to
Dumfries, which NHS Dumfries and Galloway have agreed to make available to colleagues in other Board areas to stimulate innovation and debate. The full text of the invitation to bid is available at http://www.scottishdental.org/. DRAFT GUIDANCE ON THE DESIGN OF NEW NHS DENTAL ACCOMMODATION In addition the Property and Environment Forum is seeking comments on draft guidance on the design of new NHS dental accommodation to assist NHS Boards and contractors considering commissioning new premises and adapting existing premises. Further details are available from Peter Haggarty Director of Property and Capital Planning NHS Scotland Property and Environment Forum 4th Floor, Empire House 131 West Nile Street Glasgow G1 2RX Telephone: 0141 332 3455 Fax: 0141 332 0703 Email: peter.haggarty@pefex.scot.nhs.uk REMOTE AREAS ALLOWANCE As indicated in the previous newsletter, we have been working with colleagues in our Analytical Services Division within the Executive to identify those practices which would fall into the revised category of a remote area. This work is nearing completion and we will shortly be liaising with Practitioner Services Division with a view to contacting the additional practices which may be eligible for the allowance. INFORMATION TECHNOLOGY Following on from the update in the July issue we have commissioned NHS National Services Scotland to carry out a programme of work to take forward the connection of all practices providing NHS dental services to N3 and access to an accredited clinical system. An initial project is being implemented with approximately 20-30 practices who will have access to Microsoft Office products, Internet and significantly NHS Contact which is the UK wide secure email system for the NHS. The pilot practices will be of varying geographical spread, size of practice and spread of usage/type of system. A NEW DENTAL RESOURCE August saw the launch of a new web portal bringing together a wide range of dental resources for Scotland. The main aims of the website www.scottishdental.org are to provide access to most currently available Scottish web-based dental information and for the site to become the first point of contact for people seeking dental information in Scotland. Initially
scottishdental.org has been developed and supported in collaboration with representatives from NDAC-CEP, SDPBRN and the Dental Health Services Research Unit at Dundee, and has now received funding from the SEHD. The success of Scottishdental.org will depend both on the level of use of the site and the involvement and sense of ownership by both the dental profession and the public. NEXT ISSUE WILL FURTHER CONTAIN INFORMATION ON: Oral Health Assessment NHS commitment SCOTTISH EXECUTIVE HEALTH DEPARTMENT CONTACTS 0131 556 8400 Head of Primary Care Division Chief Dental Officer Deputy Chief Dental Officer Dr Hamish Wilson Ray Watkins Mary McCann Dental Branch Staff Eric Gray Senga Robertson Lynne Morrison Donna Bryce Sheila Taylor