OSG Chairman’s Report July 2010
A conference call took place in May between Sue Gregory (SG), Deputy Chief Dental Officer, Natasha Dogmetchi (ND), Les Joffe (LJ), Richard Jones (RJ) and myself (CW). ND represents the Department of Health and her role is to provide guidance to PCTs on orthodontic commissioning. SG and ND acknowledged that there had been considerable delays in orthodontic commissioning, due mainly to the difficulties related to resolving problems with GDS contracts. They were now focussing on orthodontics, however, and hoped to resolve some of the issues around contract renewal. RJ explained that there was inconsistency across PCTs; some had rolled over contracts for a further 5 years, while others were putting all contracts out to tender. Many PCTs remained silent. It was clear that PCTs are under pressure to obtain value for money and many were exploring additional services such as an out-of-hours service, but were not necessarily trying to reduce UOA values. SG and ND recognised that many PCTs were having problems understanding the exact nature of the PDS contract, as well as difficulties interpreting Vital Signs and PAR. In summary, the following conclusions were agreed : a joint initiative would take place between SG, ND and the BOS, with a remit to provide ongoing guidance to PCTs. ND promised a new guidance document for PCTs as soon as possible. This would include the message that in terms of quality of service, it may be appropriate in some areas to redirect contracts toward specialist practices. The message from the DoH is to remind PCTs that there is no requirement to tender in the original procurement guidance. Furthermore, a basic premise in World Class Commissioning is Continuity of Care and maintaining the stability of local services. Since that meeting, RJ has been frequently chasing ND for official PCT guidance.
A meeting of the General Dental Practitioners Association (GDPA), chaired by John Milne (JM), took place on May 7th at the BDA. There was considerable debate over the existing GDS contracts, which had led to widespread discontent. Further pilot schemes are planned for later this year to explore new models of service. A working group of the BDA have agreed that some Key Performance Indicators (KPIs) have no rationale and are therefore not true indicators of performance or quality. More work was needed to evaluate KPIs and their application. There was general concern that KPIs would be factored into future income. JM mentioned that he strongly supported orthodontists, especially since he had a small orthodontic contract.
On June 11th, the following people met at the BDA to discuss a strategy to move urgently toward orthodontic contract renewal : John Milne (JM), Eddie Crouch (EC), Les Joffe (LJ), Richard Jones (RJ), Colin Wallis (CW), Penny Whitehead (PW) and Hollie De la Fuente (HD). PW and HD are employed by the BDA as advisers on commissioning. The current concerns were explained fully to JM. These included the lack of central guidance, the inconsistencies across PCTS, reports of reduced UOA values, concerns regarding tendering, the urgency of contract renewal, misconceptions surrounding the nature of the PDS contract, confusion over practice goodwill values, problems relating to buying and selling practices, the difficulties facing new graduates looking for jobs and practices, as well as reports of problematic relationships between some members and their PCT. Nonetheless, HD explained how the BDA had supported an orthodontist, who was a BDA member. A letter had been received from their PCT saying that all contracts would be tendered. HD, acting as a BDA legal adviser, wrote directly to the PCT with advice not to tender their orthodontic contracts, which resulted in a reversal of the decision. HD offered to write a similar letter directly to all PCTs as soon as possible. JM offered to add further support to the BOS by writing directly to the Health Minister on these issues.
I hope the above information will be useful when dealing directly with PCTs over the coming months. I have been contacted recently by Lee Scott MP, who has helped us gain access to Health Ministers over the past two years. Having noted the contractual differences between orthodontics and general dentistry, he is making plans to set up an all-party lobbying group specifically for orthodontics. Meetings generally take place every two or three months and the Health Minister is usually in attendance.
The British Academy of Cosmetic Dentistry (BACD) invited the BOS to a meeting at the BDA on June 21st. This was attended by myself and Les Joffe (LJ). One item on their agenda was the setting up of an accreditation scheme in which orthodontists may participate with ortho/restorative cases. LJ pointed out that all orthodontic specialists had completed a three year full time course, which included treating a wide range of cases, including many that needed complex restorative support. We agreed that it was unlikely that many orthodontists would be attracted by this project, particularly since there had been little enthusiasm for similar ideas in the past. It was agreed, however, that there are many clinical topics of interest to both of our memberships. It was therefore suggested that we form a small working group to explore the possibility of producing some well written articles for the dental press, as well as jointly developing some presentations that may be of interest at our clinical meetings.
Two further initiatives have been planned for later this year. The BDA have offered to host a BOS course day on referral guidelines for their general practitioner members. The PCTs will be interested to know that efforts are being made to reduce inappropriate referrals. A course day is also planned to help our postgraduate colleagues toward entering specialist practice. Presentations will be given on contracts, interview techniques and how to assess an offer financially.
May I also remind members to invite their PCT commissioners to the special session that has been organised at the Brighton Conference on Wednesday September 22nd.
Finally, many thanks to our hard-working OSG committee, Harneet Mangat, Peter Brook, Gill Cottam, Ghite Bhavra, Anshu Sood, Michael Cheung, Mark Vaughan, Guy Deeming and Tom Witcher.
