1. Scottish Government Oral Health Improvement Plan
The Scottish Government published its long-awaited Oral Health Improvement Plan in January 2018. The plan, which represents the biggest shake-up to dentistry in Scotland in decades, mirrors some aspects of BDA policy (such as a focus on prevention), and plans to introduce an Oral Health Risk Assessment, reduce oral health inequalities and simplify the Statement of Dental Remuneration are all welcome. However, the plan is light on detail across a number of areas, and contains little information on priorities, timescales or additional resources.
In recent meetings with the Chief Dental Officer, BDA representatives discussed aspects of the plan (including their disappointment in the Government’s decision not to introduce water fluoridation) and urged the CDO to ensure that the BDA is appropriately represented on all relevant working groups. At the Conference of Scottish Local Dental Committees held on 20 April 2018, Shona Robison, Cabinet Secretary for Health and Sport announced that the CDO would set up an overarching steering group in May 2018, and that input from key stakeholders would play a central part. She also said that there would be regular updates to the profession on the work of the groups.
In early March, the BDA issued a survey to dentists in Scotland to gauge their initial views on the plan. Most responses to date have either been negative (especially around proposals to change payment arrangements) or indicated that more detail was required. The survey closes on 4 May, after which the BDA will collate the responses and prepare a summary report for discussion.
Since the plan was published, the CDO has indicated that the following five actions (of the 41 actions in the plan) would be the initial priorities over the next 12 months:
Community Challenge Fund to tackle oral health inequalities
Action 7 in the OHIP states that ‘Scottish Government will introduce a new three-year Community Challenge Fund for Oral Health Improvement. We will host an event with our partners to help develop key components of the fund’. The fund will allow organisations to bid for funding to work in deprived communities and support people to change their oral health behaviours. The Cabinet Secretary stated that an initiative would be launched later this year.
New Domiciliary Care Provision
Action 11 in the OHIP states that ‘the Scottish Government will introduce arrangements to enable accredited GDPs to provide care in care homes. These practitioners will also work with care home staff and the PDS to ensure the maintenance of good oral health and hygiene.’ At the Scottish LDC Conference, the Cabinet Secretary announced that by the end of this financial year, Scottish Government plans to establish a joint working group for GDPs and the PDS to address the shared care arrangements which will initially focus on care in care homes and will eventually move to address the needs of those living in their own homes.
Director of Dentistry
Action 20 in the OHIP states that ‘the Scottish Government will work with NHS Boards to introduce a Director of Dentistry in each Board area, to provide a point of contact for the delivery of national policy. BDA Scotland understands that the Scottish Government is currently developing a job description for the new role.
Practitioners with problems
Action 25 states that ‘the Scottish Government will: publish a pathway to support local dental practitioners locally; and, when necessary, ensure that NHS Boards use local disciplinary procedures and NHS Tribunals where appropriate.’ These measures aim to ensure that NHS Boards have satisfactory disciplinary processes to avoid unnecessary referral to the GDC. We await further detail of this action.
Action 34 in the OHIP states that ‘the Scottish Government will introduce an occupational health service for GDPs, members of the dental team and other practice staff’. At the Scottish LDC Conference, the Cabinet Secretary for Health and Sport announced that the Scottish Government will introduce this service for GDPs, members of the dental team and other practice staff in June 2018. The Chair of SDPC has since written to the Cabinet Secretary seeking more detail about how services will be made available and funded.
At the Scottish LDC Conference, the Cabinet Secretary also stated that Scottish Government planned to phase in an Oral Health Risk Assessment (OHRA) with a stronger focus on periodontal treatment and through discussions with patients assess risk factors such as smoking and diet. She explained that a patient’s treatment plan would be defined by the OHRA which may lead to some patients being seen more frequently and some less frequently. Future decisions would rely on evidence based data.
2. Minamata / Phase down of amalgam
Scottish Government asked SDPC to consider how the SDR might incorporate the necessary changes following the phase down of amalgam. The CDO wrote to P Grigor on 19 April with a proposal to accept two fees for composite restoration with a new single fee (new item 43) for a composite filling in permanent teeth for children under 15 years of age of £18.90 per tooth. For larger fillings where mesio-occlusal and/or disto-occlusal surfaces are involved, the fee would increase to £23.40 per tooth. Discussions are ongoing between BDA Scotland, SDPC, Scottish Government and PSD.
3. Buccal Midazolam
Scottish Government advised on 12 April 2018 that Buccolam syringes will be replaced with an unlicensed Midazolam Oromucosal Solution (Epistatus). The strength of this is 10mg/ml. The solution is presented as a 5ml bottle with 4 oral syringes necessary to draw up the required dose and dosing instructions based on the age of the patient. This is a temporary measure until the issues with the licensed Buccolam syringes have been resolved. Scottish Government would not expect GDPs to replace the revised box and revert back to a kit containing Buccolam syringes until the revised kit expires. The cost of the revised Emergency Dental Kit will be £120.00 + VAT.
4. Hep B Vaccine Shortage
BDA Scotland advised members that GSK agreed a supply management plan with Health Protection Scotland and NHS National Services Scotland for hep B vaccine and members were asked to contact their Scottish Regional Holding Centre for supply for patient groups 1- 3.
Subsequently, for information, BDA Scotland notified members that the Chief Medical Officer in Northern Ireland had stated that the vaccine remained available for those at highest immediate risk, i.e. priority groups 1-3, including dental nurses in NI. The vaccine will now become available for priority groups 4 (with the exception of travel) including patients with chronic liver disease, household or sexual contacts of chronic hepatitis B cases, and other healthcare and frontline workers. Vaccine ordering will be opened in a phased approach to ensure continuity of supply.
5. Scottish Council Oral Cancer Working Group
A meeting has been arranged for 16 May 2018 to discuss potential referral pathways for mouth cancer. Phil Grigor (BDA Scotland Director) is meeting with Anas Sarwar, MSP on 22 May 2018 to discuss oral cancer and other issues, and the Oral Health Foundation Mouth Cancer Action Month which will be held from 30 November 2018.
6. Extended Waiting Times for Child Extractions under GA in NHS GG&C
At the April 2018 Scottish Conference of LDCs the Chair of SDPC asked the Cabinet Secretary about the extended waiting times and the lack of response to BDA Scotland’s request to resolve the issue. Ms Robison was concerned to hear that children can wait up to six months for treatment whilst in pain and gave her assurances that if the matter required to be escalated to her office she would personally intervene.
7. Annual Conference of Scottish Local Dental Committees Conference – Friday 20 April 2018
Conference was attended by over 70 guests and delegates. The theme of Conference was about dentistry today, tomorrow and the in the future. Steve Tidman, Economist, gave an informative presentation about the drop in dental incomes and how that affects the profession today. Alan Whittet, Senior Dental Adviser, Practitioner Services Division (PSD), gave an update about PSD and how they are moving forward especially to an e-Dental platform. Shona Robison, Cabinet Secretary for Health and Sport spoke about the Scottish Government’s Oral Health Improvement Plan (see above). Gordon Morson, Chair of the Scottish Association of LDCs provided an update on the work of the SALDC over the last 12 months. Phil Grigor, National Director BDA Scotland provided a brief presentation on his reflections to date about the dental landscape and proposed plans moving forward. All sessions were followed by a lively question and answer sessions. Fifteen motions were debated and voted on during the afternoon session.
8. BDA Scotland Meetings
- Scottish Council – held its first triennial meeting on 22 March 2018. The Committee elected R Donald as Chair, D Cross as Vice Chair, and agreed representatives to a small number of external committees. The main topic of discussion was the recently published Scottish Government OHIP. The Committee will meet again on 16 August 2018.
- Scottish Dental Practice Committee – held its first triennial meeting on 21 February. The Committee elected D McColl as Chair, G Boyle as Vice Chair, and agreed an Executive Sub-Committee (4 members) and representatives on a range of external committees. The main topic of discussion was the recently published Scottish Government OHIP. The Committee’s next meeting is on 23 May 2018.
- SDPC Executive meeting – held on 28 March in Edinburgh. The Executive’s discussion involved a range of issues, including the planned phase-out of amalgam, emergency drugs, Occupational Health Services for GDPs, problems with the referral system to secondary care, clinical audit and quality improvement, and the DDRB.
- Scottish Government – held a meeting with SDPC Executive and discussed the issues raised at the Executive meeting, as well as future ways of working and the Oral Health Improvement Plan, including priority issues such as domiciliary care and the introduction of a Director of Dentistry in each Health Board. The next meeting will be held on 6 June.
- BDA Scotland and SDPC meeting with the Scottish Government – DDRB Expenses – D McColl and G Boyle, SDPC and, N Kaya met with D Notman, and S Osbaldstone, Scottish Government on 14 March 2018 at the BDA Scotland office. The group reviewed the draft template for a survey to be sent to Scottish independent GDPs who are 92% NHS committed in order to obtain expenses data. The draft PCA and joint BDA Scotland–Scottish Government letter was issued with the survey on 16 April, the deadline for the exercise will be the end of May 2018.
- Scottish Public Dental Services Committee – held its first meeting of the new triennium on Tuesday 27 February 2018. The committee re-elected G Smith as Chair and K Wiseman as Vice Chair. The main topic of discussion was the recently published Scottish Government OHIP.
- Scottish Joint Negotiating Forum meeting – P Grigor and E Bruce attended the Scottish Joint Negotiating Forum (SJNF) meeting on 27 March. The SJNF is a tripartite group chaired by the CDO and comprising the BDA, representatives of the SPDSC, Scottish Government and NHS Employers. The main discussion items were the Scottish Government’s Oral Health Improvement Plan and its implementation, reliable recording of Public Dental Service activity, waiting lists for paediatric extractions under general anaesthetic, and concerns around the Clinical Director role in some Health Boards. SJNF will meet again in October.
- Central Committee for Hospital Dental Services – E Bruce attended the BDA Central Committee for Hospital Dental Services meeting on 28 March 2018 at the BDA London office as the BDA representative on the newly formed Reference Group which will replace the formal SCHDS. M Elkhazindar (past Chair of SCHDS) and L Cross (past member) also attended the meeting and will form part of the reference group. The committee elected P Dyer as Chair and P Brotherton as Vice-Chair. The other topics for discussion included an update of the Consultant Contract negotiations, the outline of an agreement between the BMA and the Department of Health on Local Clinical Excellence Awards.
- P Grigor, National Director BDA Scotland – Introductory meeting with Aileen Bryson and Susanne Cameron-Neilson, Royal Pharmaceutical Society Scotland – P Grigor had an introductory meeting with Aileen Bryson and Susanne Cameron-Neilson (Royal Pharmaceutical Society Scotland) in Edinburgh on 12 March 2018 to discuss the work of the Primary Care Clinical Professions Group. The group includes a range of organisations in Scotland, including BDA, RCN, Royal College of General Practitioners, Royal Pharmaceutical Society and Optometry Scotland. Lewis Macdonald MSP (Convener of the Scottish Parliament Health and Sport Committee) has agreed to sponsor an exhibition by the group at the Scottish Parliament.
- P Grigor – Introductory meeting with NHS Education for Scotland – P Grigor had an introductory meeting with Dr D Felix, NES Post Graduate Dental Dean in Edinburgh on 14 March 2018. The main topics of discussion included BDA–NES communication, ensuring the factual accuracy of publications, and dental student intake planning.
- BDA Scotland and SDPC meeting with Practitioner Services Division (PSD) – P Grigor and N Kaya had an introductory meeting with M Morrison, Head of Delivery Service, PSD and A Whittet, Senior Dental Adviser on Tuesday 3 April 2018 at their Edinburgh office. A full meeting followed attended by David McColl, Chair of SDPC and the PSD team and the main issues of discussion included the impact of the Scottish Government Oral Health Improvement Plan on PSD, updates on PSD service delivery including prior approval waiting times being on target, an update on the e-Dental programme. The next meeting will be held in Stirling on Wednesday 29 August 2018.
- BDA Scotland meeting with General Dental Council (GDC) – P Grigor had an introductory meeting with I Jackson, MBE, GDC Director for Scotland on Thursday 29 March 2018. The discussion covered areas of mutual interest, including regulation arrangements, aspects of the Scottish Government OHIP (such as reducing unnecessary referrals to the GDC for disciplinary issues), and lobbying elected representatives. GDC will hold its Council meeting on 20 June 2018 at the Playfair Library, Edinburgh. On the 21 June members of the profession will be invited as observers to the public session meeting.
- NES Dental Stakeholders Conference – P Grigor attended the NES Dental Stakeholders Conference on 20 March. This invitation-only event was attended by around 80 delegates from various branches of dentistry, territorial Health Boards, special Health Boards (including NES and Practitioner Services Division) and other organisations. The CDO gave an overview of the OHIP and its focus on prevention, older people, reducing health inequalities, the dental workforce, and the interface between primary and secondary care. There were further presentations and breakout sessions on the challenges of delivering domiciliary care.
- BDA East of Scotland Branch meeting – P Grigor attended the BDA East of Scotland Branch AGM and meeting on 21 March. Representatives from NHS Lothian Oral Health Improvement Service gave a presentation on the local implementation of the four national oral health programmes: Childsmile, Smile4Life (for homeless people), Mouth Matters (for offenders) and Caring for Smiles (for care home residents).
- BDA West of Scotland Branch meeting – P Grigor attended the BDA West of Scotland Branch meeting on 28 March. The presentation reviewed the application process to Scottish dental schools, the BDS curriculum and how these had changed over the years to reflect changing policies and practices.
- Collaboration with ASH Scotland – BDA Scotland contributed to the ASH Scotland initiative to develop a dental referral card for GDP practices, and is currently developing a proposal to monitor the impact of the cards to help support Scotland’s Charter for a Tobacco-free Generation.
For information please see the link to the ‘new’ BDA Scotland news page: https://www.bda.org/about-the-bda/officers-and-contacts/bda-scotland
BDA Scotland April 2018