Present
Tony Jenner
Roy Greenhalgh
Catherine Friend-Brown
Amit Bose
Helen Knight
James Spencer
Elizabeth Jones
Agenda
- 18 Week Pathway/Training Exemption
- New/Review Ratios in Orthodontics
- Payment by Results Tariff
- National Service Framework for Children, Young People and Maternity Services
Outcomes:
18 Week Pathway/Training Case Exemption
Provisional agreement after extensive discussion. The discussion covered the following points:-
- 18 weeks will happen because Trusts have to fulfil the target without exception
- Hospital cases (cleft, OGN, Special needs etc) will have to within 18/52
- Consultants should be doing difficult hospital cases
- DOH thought training cases comprise IOTN 3s only. This was clarified and discounted.
- No dispute that FTTA training should be undertaken in secondary care
- DOH considers that SpR training should be in primary care as that is where most will practice. The rationale behind this statement was accepted but with many provisos.
- PCTs will have to find solutions for long waits – increase contracts for present providers or significant contracts for new providers
- SpR cases are primary care cases
- UG cases are exempt from PBR because they are seen as primary care cases
- It was suggested that a solution to the ‘training’ waiting list issue would be for PCT’s to hold and administer Waiting Lists. DOH thought this unlikely.
- DOH wondered why trainees could not have staggered starts throughout the year. This was explained and understood
- It was accepted that training would suffer if a cohort of patients not recruited at the beginning of a training programme
- Secondary care can bid for monies to provide orthodontics and this could be an avenue for training
- DwSI's exist and they have had competencies agreed with consultants. This was refuted.
It was agreed the 18 week pathway would be fulfilled for cases suitable for Consultants and FTTAs care i.e.
- Multidisciplinary cases
- MOS
- Facial deformity
- Restorative
- Special needs
- Complex medical history
Training Case exemption
It was accepted that training cases could be considered to be suitable for treatment in the Primary care setting. It was accepted that training needed to be undertaken on cases of that level of complexity.
Stumbling block is the involvement of Consultants in the initial treatment planning.
There was a feeling that perhaps this difficulty could be overcome and the problem will be discussed with the18 week pathway team to find a solution.
Training in Primary Care
There is an enthusiasm at the DOH for Specialist Registrar training to be undertaken in Primary sector. It was suggested that Consultant could go out to train in Primary Care sector. In principle it was agreed that it was possible in some circumstances but timetabling would be difficult.
The obvious advantages for DOH – exemption from 18 weeks pathway and the elimination of a huge number of patients on waiting lists. The other main advantage cited by DOH was the fact that the majority of SpRs will work in the primary sector following CST award and so would provide insight and experience within that sector.
DOH would like to pilot the idea. A pilot was supported but with the rider that it would only be the most enthusiastic specialists who volunteered and may not represent the average practitioner
In principle there was some support for this suggestion but there were serious reservations:
- Quality assurance
- Suitably trained trainers
- Duplication of facilities
- Payment rates for specialists
- Practice disruption/efficiency
- Long term responsibility/commitment
Consultant Practice in areas where no alternative provision for orthodontic care
It was agreed that all treatment waiting lists would be validated. Those patients currently on waiting lists which do not fulfil the criteria for Consultant practice should be returned to their General Dental Practitioners. This will then trigger discussions with the local Primary Care Trusts and a local solution devised.
New : Review Ratios
DOH now understands the issue. In essence there is confusion over terms of reference. Review appointments need to be separated from in-treatment adjustment appointments.
It was agreed James Spencer and DOH will draft a paragraph for inclusion in the next PCT Newsletter/Directive to highlight the special nature of orthodontic ‘review appointments’ and the in applicability of the current ratio target for orthodontics.
Payment by Results
The whole area is to be revisited in September 2007. It was agreed there are very obvious imbalances in the system. To be addressed and agreed that COG representative would be involved.
NSF for Children
For new build Specialist Centres for children ie Children’s Hospitals, adult treatment is not permissible.
Discussed the problem for orthodontics in the new Brighton Children’s Hospital.
The only option is to establish an off site facility to treat adult facial deformity patients. Immovable.
