Kenny Update and LDC Conference report

June 20th Lincolnshire LDC Update Number 55

It seems a time since we sent out our last update.

Well done England to draw with Scotland on Friday in the Euros …. And for giving all those who follow Scotland the chance to have their hopes dashed of further progress when we play Croatia on Tuesday!

Lincolnshire LDC had their AGM on the 25th of May and my Chairman’s report is enclosed. Thank you to all who took part. We had over 30 attendees on the night with good interaction to the many topics discussed. Thank you to Shawn and Jason for their presentations.

Last Saturday, 12th June, it was the LDC national Conference. Here is an excellent overview of the day’s events from our Secretary, Millie Coulby. The motions, bar one, are summarised in the enclosed word document

LDC CONFERENCE 2021 REPORT - 12TH JUNE 2021

Summary of GDPC Update

Shawn Charlwood – Chair, General Dental Practice Committee

Key Points

- Brilliant effort from profession for stepping up to the plate during these tough working conditions

- Vast majority of practices went well above 20% activity and then the 45% UDA target

- Infection prevention and control and social distancing continue to take their toll on dentists and practices

- Pandemic has resulted in an estimated 30 million lost appointments

- There has been a devastating impact on the professions moral and motivation; recent BDA analysis showed that 88% of profession stated morale has been impacted

- Patients and profession need a roadmap out of this current situation

- All four CDOs have committed to commission SDCEP to develop the roadmap for safe relaxation of restrictions

- We need a change in focus and intent on NHS contract and welcome commitment to reform, led by NHS England; this needs to be in place by April 2022

- In designing a contractual framework we need to decide what NHS dentistry delivers; laudable aspiration of NHS England to aim to improve patient access to NHS care and address inequalities but is this realistic? Key questions include level of investment decision, scope of care and scale of care?

- BDA is receiving a high number of enquiries re returning NHS contracts from practices and therefore there is a real threat to NHS ambition if we do not design an attractive NHS system for professionals

NHSE Priorities

Ed Waller, Director of Primary Care Strategy and NHS Contracts at NHSE&I

Key Points

- Thank you to all dental teams for the pandemic response

- Since services reopened access has steadily increased; currently sitting at around 60% in terms of UDA generated

- The system has managed successfully to prioritise urgent care; UDCs have greatly contributed to this and urgent care activity has remained above pre-pandemic levels since August 2020

- Regional commissioners are using flexible commissioning to address local need and lessons from these local models will inform national discussion for reform. ( we are not experiencing this in Lincolnshire)

- Integrated care systems are a positive move forward. Refer to the White Paper Integration and Innovation: working together to improve health and social care for all published February 2021. Four details themes: working together and supporting integration; reducing bureaucracy; enhancing public confidence and accountability; additional measures – to support social care, publish health and the NHS.

- Continued improvement within the recovery of dental service however we recognise challenges remain within the systems including access and addressing inequalities

An Update from the Chief Dental Officer

Sara Hurley, Chief Dental Officer, NHS England

Key Points

- A very tough year for dentists; new ways of working have been incredibly stressful and therefore a big thank you to the profession

- LDN chair colleagues supported by LDCs worked together to help set up UDCs, assist with Covid vaccination programmes and organise fit testing – these successes have been recognised

- Work between LDNs and LDCs highlight the importance of local dental clinical leadership

- A clear ambition for contract reform and national processes are already in place to review national guidance; aware that addressing inequalities and improving access is a key issue.

- Work continues to look at the current need for enhanced PPE; no definitive answers yet

- Commitment for responsibility for water fluoridation to be removed from local council to central government; we need to make our voice heard for the positive impact water fluoridation would have in reducing health inequalities

- Dental profession needs to become more inclusive and still clear barriers to success for many

Chief Dental Office – Clinical Updates from England focusing on Meeting Challenges of Access and Inequalities

Rebecca Harris and Jason Wong, Deputy Chief Dental Officers, NHS England

Key Points

- There are three major issues that currently face NHS dentistry – How do we rectify the widely acknowledged geographical imbalance in the supply and demand for dental services in the UK; how do we overcome problems of access to NHS primary dental care and how do we achieve this within current cash limits?

- Most pressing issues for NHS include offering to treat high needs patients; availability in some areas of the country and recruitment in rural areas

- The current UDA system does not adequately take into account treating high needs patients

- Clinical priorities include urgent dental care; oral cancer diagnosis and treatment and child XGA

- Ensure to keep up to date with the NHS Dental Services: Dentist Bulletin

A Thematic Analysis of Sustainable General Dental Practice Highlighting Opportunities and Best Practice

Steven Mulligan, GDP, Yorkshire and Clinical Teacher in Restorative Dentistry, University of Sheffield

Key Points

- Global temperatures are rising and this is caused by anthropogenic; little rise = huge impact

- Dentistry contributes to climate change and as healthcare professional we are ethically bound to first, do no harm

- Sustainable dentistry is ensuring that the dental care we provide today does negatively impact the environments or prevents the provision of similar care

- The 4 R’s – Reduce, reuse, recycle and rethink

Reduce – plan procedures to cut down unnecessary item use, purchase products with minimal packaging and go digital

Reuse - reusable gowns, bibs, face shields

Recycle – enabling waste separation, educating staff and providing facilities for staff to recycle their waste

Rethink – a linear economy to a circular economy with reduction, recuse and recycling at its core

- Issues highlighted in the literature – direct air pollution via travel, carbon release, energy use and water consumption. Recommendations – reduction via prevention, patient and staff travel reduction, energy/water consumption and staff and patient engagement

- Policy and guidelines recommendations – representation at national/LDC level, involvement at all levels, manufacturer responsibility and transparency, financial incentives

- Single use plastics recommendations – alternatives, audit so that hot spots can be targeted and minimal use if possible

- Materials recommendations – amalgam use (reduction and elimination), nitrous oxide (dynamic scavenging systems), gypsum (consider intra oral scanners)

- Procurement is the 2nd biggest contributor to carbon footprint and recommendations include better logistics, sustainable product options, engagement with suppliers and effective stock management to reduce waste

- Research and education – dentists know they are contributing to climate change but don’t know how to engage

Mental Health and Wellness Leads in the Dental Workplace

Roz McMullan, Immediate Past President of BDA and Advocate for Wellbeing in Dentistry

Key Points

- Framework to enable dental teams put wellbeing into the workplace - It will put wellbeing at the centre

- Framework means teams can adapt to work in their workplace – prevention, mental health wellness awareness for all team members, identify and train a mental health wellness lead, early intervention and safe signposting and reaching out to the community

- Why a framework? Patient safety, leadership domain, links with the key messages of HSE/NHS in all four countries, formalises what many workplaces already do, training and staff development and support

- What will the framework include? Risk assessment, mental health awareness training, competency based MHFA training (For mental health awareness lead) and suicide awareness training

Our Motion

Amelia Coulby, Lincolnshire LDC

This conference calls for a definitive strategy by NHSE&I and HEE to address recruitment and retention issues in rural areas such as Lincolnshire.

Supporting statement:

We are witnessing a growing crisis in recruitment and retention of not only dentists but, latterly, the whole of the dental team.

Even prior to the current crisis there were an unacceptable number of patients unable to access dental care. This situation is now becoming far worse.

In 2019, BDA analysis estimated that over one million patients could not secure a NHS dental appointment. It was shown that access was an issue across every English region but that this was significantly more pronounced in rural areas with for example, over 60% of patients in Lincolnshire wishing to access NHS dental care unable to secure an appointment. In rural areas there is very clearly a shortage of dentists with NHS vacancies in particular not being filled. The reasons are multifactorial including the combination of large practice lists and the current UDA system, combined with lower UDA values, typically found in rural areas.

This issue needs to be at the forefront of the NHSE&I and HEE strategy to ensure there is not a collapse of NHS dental care in rural areas, and any reforms should address this deepening crisis.

OUTCOME: FOR (96%)

Both Jason and Shawn gave excellent presentations. Shawn gave Ed Waller no doubt as to the concerns of the profession and the need for Contract Reform. Flexible commissioning, it would seem is the answer to most things yet in our area there seems a reluctance to embrace this. Whether this is a lack of willing or lack of manpower, or both, I’m not sure.

Lincolnshire Mental Health Helpline

The Special Care Dental service in Lincolnshire have been contacted by patients who are experiencing mental health issues and who are disclosing suicidal thoughts. Perhaps you have been in this position as well?

When these patients are seen in the clinic, their GP is contacted with the patient’s permission and some are directed towards the Single Point of Access (SPA) and Crisis team. Situations like this are very difficult to deal with and I have enclosed this phone number which could be invaluable if you find yourself in a similar situation and need help or advice.

And Finally ……………..Quite a bit to take in. The LDC Conference was very interesting and the compelling case for Contract Reform in 2022 stressed. The provision of NHS Dentistry is in crisis and I feel we are very much at a tipping point. The lack of service in this County is having a massive effect on our patients and it is no coincidence that 80-90% of complaints to Healthwatch relate to Dentistry, especially lack of an NHS Service and long waiting lists.

The LDC is here to support you. Please contact us on lincsldc@gmail.com if you need any help.

The next update will follow in 4 weeks-time unless there are any urgent issues beforehand.

Best wishes

Kenny Hume

Chair Lincolnshire LDC