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02 November 2007
As the seasons turn many aspects of dental practise within West Pennine are changing as both practitioners and the PCTs come to grips with the new contracts.
Although the first anniversary of the new contracts fell in April, it is only in the last month that final figures have been available. Although the Department of Health has made great play of PCTs being asked to look at a “basket of measures” when assessing practice performance, the UDA total achieved seems to be overwhelmingly important.
Both PCTs have decided to allow a 4% over-achievement to be carried forward this year; there is no guarantee that a similar tolerance will be allowed next year. Note: this means that if a practice managed this maximum (104%) the practice would have to produce 92% of the NHS work this year to reach the target
Similarly a practice achieving 96% of target will have to produce 8% more work to hit target next year. Practices dropping below the 96% of target will now have to discuss how this will be managed with the PCT; early indications are that in several such instances the dentist has had a period of sickness or other enforced absence and had not let the PCT know. This is a poor strategy as the Trust can arrange sick pay for you, they may be able to help with locum cover and they have discretion to allow catch up in the future rather than clawing back and reducing contract value.
The LDC Officers can help you prepare for such meetings and even attend if you feel it would help, please remember though that we are all practicing GDPs so please give as much notice as possible.
What is a “Patient of a Practice”?
The end of the old contract also saw the demise of the contract for continuing care and capitation; patients are no longer registered with a practice. This question was put to the LDC by Tameside & Glossop PCT last year after a small number of patients were declined care when they considered that they “belonged” to a particular practice. After taking advice from professional bodies the LDC consider that the only patients who have the right to urgent or emergency care under the contracts are those currently receiving a course of treatment (COT). Ethically however it would be unwise to draw such a tight definition and patients who have successfully completed a COT within the last 15-24 months should also be included.
The service you provide should be appropriate to the need and at least at the level provided by the in- or out-of-hours service for “unregistered” patients. This issue often arises in the difficult days such as those between Christmas and New Year which everyone else seems to consider holiday unless they have toothache! As it is always better not to have a complaint to deal with, we were given some common sense guidance by the defence organisations.
1. If you have decided not to offer appointments to a patient, (for example due to repeated DNAs) the patient must be informed when this decision is made.
2. Be very careful if you decline urgent treatment to a child however unreasonable the parents, as this makes good copy for the local press!
3. Ensure patient requests, offers of appointments and telephone advice are entered in the notes, and the time is recorded if this might later be important.
4. If you co-operate with a local colleague to cover your make sure you each understand the arrangements (see below).
5. Make sure all at your practice understand your procedures. Many complaints originate when a patients feels they have been fobbed off by the reception staff who on investigation prove to have been doing what they thought was policy and sometimes what they thought policy should be.
6. At difficult times (such as Christmas) try to explain at the earliest occasion the limitations of treatment, for example the closure of dental laboratories limiting what may be repaired.
Being Covered or Covering Another Practice:
1. Agree what service is to be provided, e.g. the arrangement to have an emergency session each day at a set time so that “urgencies” contacting after this will be expected to attend next day.
2. Agree times calls will be taken and incorporate this into your answering message.
3. Agree hand back procedures, e.g. a phone call when you are both working listing patients seen or advised and the treatment/advice given.
4. Accept that unless you list patients not to be seen, some “banned” patients may get back onto your list by accessing your emergency cover.
Levies and Subscriptions
Traditionally the Local Dental Committee (LDC) has been funded by a levy; a small percentage of your NHS earnings were remitted by the PCT each month. This was greatly disrupted for all LDCs by the contractual changes. No mechanism was built into the pilot PDS arrangements so practices paid an equivalent amount as a voluntary subscription; when nPDS and nGDS arrived this anomaly extended to all contracts. For a year the LDC has had to manage on reserves, now the payment on line system used by the PCT and DoH has been adjusted and levies should soon start to be collected again, we anticipate this to be at the rate of 0.08% of the contract value. Note that where there is a practice based contract this will have to be incorporated in the calculation of associate earnings, this will be the subject of a further letter when arrangements are settled.
Colleagues directly employed by the PCTs, (what older dentists such as I still refer to as the community service), are the subject of a separate scheme.
Sending traditional letters (such as this) individually to all colleagues is a significant drain on LDC resources. Unfortunately a request for email addresses did not produce sufficient numbers for this to be an option at present, however we do write several letters each time to colleagues practising at the same address. As you are individually members you have of course the right to have a copy of each letter written delivered to you if you wish. Thus please choose:
• If you are happy to have communications delivered to your practice address in a common envelope or practice alone please do nothing.
• If you wish to have an individual letter delivered please drop me a line.
• If you wish to receive letters by email please send an appropriate message please indicate whether you wish this instead of or as well as a snail mail.
Dental Access Centre (Hyde)
To meet a perceived access difficulty in parts of Tameside & Glossop the PCT is to commission an access centre. This will provide a single course of treatment to patients struggling to obtain care in local practices; there will also be a parallel scheme to provide access slots in existing practices. Contracts for both will be awarded after competitive tendering (see below) and the service is anticipated to commence next March.
This process will feature largely in the future of the NHS, bodies corporate are able to produce vast documents addressing the issues in the invitation to tender. This is an area where we all have great training needs, it definitely was not on the curriculum when I was at dental school. This training is available at considerable cost however Anita Maniak has arranged an overview given by Tim Parsons (Business Advisor BDA) on 24th October for colleagues in Tameside & Glossop and the PCT are paying; you should have had a flyer by post. I strongly urge you to take advantage of this, if the flyer has gone AWOL please contact Lynn Callaghan at Hattersley Health Centre ASAP.
If Oldham colleagues feel they might like a similar training evening, please let me know and we will ask if such can be arranged.
Other Dental News
DCP registration: The GDC has applied to increase ARFs for all; thus unless dental nurses and technicians have paid before 31st December they will have to pay more, probably about £20. I understand uptake has been glacial, only a cynic would suggest this is to drum up business and avoid a last minute rush in July!
Business Rates: A business in singe premises with a rateable value less than £10,000 is entitled to Small Business Rate Relief. This was formally automatic but as from this year it was only given when applied for, appropriate forms may be downloaded from the Council websites. Please note that PCTs will only reimburse on a sliding scale up to the net total after Relief whether you claim it or not.
Further requirements: At the recent LDC meeting the advisor in general dental practice mentioned that testing and certification for Hepatitis C and HIV will become compulsory in the way that Hepatitis B is at present. We will also at some point have to pay for CRB checks for staff.
Participation: The LDC is not a clique! We are all fellow practitioners and exist to represent colleagues and promote the interests of the profession locally, regionally and sometimes nationally. At our next meeting we will be reporting on the progress we have made in engaging the PCTs in negotiating contracts in general dental practice from April 2009. Please consider attending, in addition to your immediate colleagues other important dental movers and shakers often attend, (the Consultants in Dental Public Health, the Community Service Leads and the PCT Advisor in GDP for example). Find out and influence what is happening and going to happen.
Tameside & Glossop PCT have decided to make flu jabs available to all staff working in dental practices at a series of drop in clinics in October:
Thurs 11th 10 - 1pm - Age Concern, Ashton
2.30 - 4 - Parish Nursing Office, 21 Henry Street, Hyde
Weds 17th 10 - 12 - Board Room, New Century House, Denton
1.30 - 2.30 Shire Hill Hospital, Glossop
Friday 19th 10 - 12 - Hollingworth Clinic
Thurs 25th 10 - 12 - Board Room, New Century House, Denton
Friday 26th 8.30 - 10am Crickets Lane HC, Ashton
2 - 3pm Hattersley Clinic
Monday 29th 1 - 2.30pm Dukinfield Clinic, Dewsnap Lane
There is no doubt there are more and different demands being made on all of us are stressful, sometimes this can seem overwhelming. If you know of a colleague who seems not to be coping so well, or even if you feel this way yourself please remember the PASS is there to help. The Professional Advice & Support Scheme has several colleagues who have had some training in mentoring; we have access to trained colleagues in the neighbouring PCT area if you would rather nor be I contact with local colleagues. If you know of anyone who could be helped please make contact with me or with Brian Durgan.
firstname.lastname@example.org, (0161) 330 3419
60 Stamford Street East, Ashton under Lyne, OL6 6QH