Presentation to Northern LDC

1. Presentation to Northern LDC Donncha O’Carolan Chief Dental Officer 5 April 2012

2. Overview of Presentation • GDS Budget & Pressures • New GDS Contract • Local Decontamination Guidance

3. DHSSPS Structure

4. GDS Budget

5. GDS Budget – Structure

6. GDS Budget – Structure

7. GDS Budget – Structure

8. GDS Budget – Structure  Net  Patient  Pressure

9. GDS Budget – Investments • £4 million (recurrent) into practice allowance • £3 million (non-recurrent) into QIS • £500k (recurrent) into VT grants • >£500k (recurrent) into extending registration period • £400k (recurrent) salaried dental services • £5.7 million Improve access via dental tender • £1.1 (recurrent) into commitment payments

10. GDS Budget: other investments • £120k CPD for DCPs • £300k for 5 additional dental students • £3 million re-equip school of dentistry • £100k additional registrar posts • Occupational health services for the whole dental team

11. GDS Budget: Proportion of Earnings

12. GDS budget – Overall Earnings & Expenses

13. GDS Budget – increased provision

14. GDS Budget

15. GDS Budget: Market Changes

16. GDS Budget: Market Changes

17. GDS Budget: Proposals for Savings- Principles • Must have potential to realise savings for GDS budget • Can be implemented within existing GDS contract or with minor regulatory change • Can be implemented within coming financial year • Must be consistent with direction of new GDS contract • Comply with equality legislation & other regulatory requirements.

18. GDS Budget – Proposals for Savings • QIS- £1.16m transfer to GDS budget • Core service • Molar endo – prior approval • Co/Cr – prior approval • Bridgework – posterior/large; prior approval • Veneers -all prior approval • Alter time bar on S&P

19. GDS Budget – Proposals for Savings • Orthodontic treatment – IOTN 3.6, all other ortho prior approval • Practice allowance –new criteria • Average of 750 patients/DS, with average 200 fee paying • Removal of commitment payments

20. GDS Budget: Potential Savings • QIS funding transfer to the GDS budget - £1.161m • Move to a core service under the SDR: ~ £2m; • Altering claims conditions on S&P: ~ £1m • Changes to the practice allowance: ~£344k • Ceasing commitment payment: ~ £3m • Restricting orthodontic treatment to IOTN 3.6: ~£1.5m (full year effect realised over a 24 month period)

21. Process & timeline • Restrict orthodontic treatment • This will require amendments to the GDS Regulations and the SDR • Consultation with BDA/PCC/ wider dental profession and public • Subject to the consultation/approval of the Assembly, could be implemented from summer 2012. • QIS funding to transfer to GDS budget • No changes to regulations or the SDR are necessary • The HSCB could action this with effect from 1 April 2012.

22. Process & timeline • Move to a core service under the SDR • This will require amendments to the SDR • consultation with BDA/PCC/ wider dental profession and public • Subject to the consultation this could be implemented from summer 2012. • Alter S&P time-bar • Will require amendments to the SDR • Consultation with BDA/PCC/ wider dental profession and public • Subject to the consultation, could be implemented from summer 2012

23. Process & timeline • Removal Commitment payment • will require amendment to both the GDS regs and SDR • Practice Allowance amendments to criteria • will require amendment of the SDR • Consultation with BDA/PCC/ wider dental profession and public • Subject to the consultation/ approval of the Assembly, could be implemented from summer 2012.

24. New Dental Contract

25. Primary Dental CareStrategy 2006 • Local commissioning of services; • Access to appropriate dental care for everyone who needs it; • A clear definition of treatments available under the health service; • A greater emphasis on disease prevention; • Guaranteed out-of-hours services; • A revised remuneration system, which rewards dentists fairly for operating the new arrangements.

26. Problems with existing system • Quantity not quality is rewarded; • Treatment rather than prevention is rewarded; • Demand led rather than needs led; • SDR > 400 items is administratively complex; • Patient charges are difficult for the public to understand

27. Problems with existing system • Dentists incomes directly related to the volume of treatment provided causes remuneration treadmill; • HSCB lacks control over targeting services at areas and patients with greatest need. • 50 year old system no longer meets the needs of patients, oral health care professionals or society at large.

28. Options for New System • Prof Ciaran O’Neill looked at range of remuneration systems • Retrospective Fee for Service (Item of service); • Prospective Payment System (Full capitation); • Salaried/Sessional system • Advised blended service

32. Essential Services • Periodontal treatment • Restorations • Endodontics (except molars) • Crown work • Extractions & surgical • Dentures –acrylic • Children’s treatment • Miscellaneous items

33. Exceptional Treatments • Molar endodontics • Co/Cr dentures • Bridgework • Veneers

35. Care Payments Quality care payments (QCPs) • Practice environment indicators • Practice inspection • Recognised charter-mark • Practitioner indicators • Peer review / clinical audit • Higher qualification

37. Patient Care Payment • Weighted Capitation formula • Adjusted for Age • Adjusted gender • Adjusted for additional needs • Adjusted for ‘new patients’ • Adjusted for list turnover

38. Orthodontics

39. Oral Surgery

40. Pilots • Use Pilot PDS • Consultation October 2010 – March 2011 • Responses very supportive • Oral Surgery pilot well advanced • Orthodontic contract will be phased in • GDS will follow oral surgery

41. Progress on New Contract

42. Why has it taken so long? • Resources • Addressing access issue • IT system at BSO • GDS budget – controlling pressures • Legislative problems – e.g. pensions, performers lists • Proposals from BDA?

43. How will new contract impact on profession? • Local commissioning – HSCB will target resource at need. • Control of entry –performers lists • Fixed GDS budget and global sum formula • Focus on prevention • Out of hours responsibility of HSCB

44. What’s in for Profession? • Limits number of dental practices • Increase value of practices? • Can opt out of Out of Hours • Work-life balance? • Performer/provider contracts • Career structure? • Capitation payments • Improved cash flow • Global sum • More stable budgetary position?

45. Local Decontamination Guidance

46. Content • Policy Background • Funding • Current Position • Regulation

47. Policy Background

48. A Protocol for the Local Decontamination of Surgical Instruments • Issued July 2001, • Health Estates DHSSPS • Key areas • All local decontamination outside of clinical setting where possible • Recommends automated washing • Downward displacement autoclaves- not suitable for processing wrapped instruments or hollow instruments • Do not re-use single use instruments • Described as short term strategy

49. BDA A12 • Issued February 2003 • Key points • Where possible instruments to be decontaminated in a separate room • Recommends washer disinfector over manual cleaning • Wrapped instruments must be sterilised in a vacuum autoclave • Single use instruments used wherever possible & discarded after use

50. Hine Review of Decontamination of Endoscopes • May 2004 problem identified with decontamination of endoscopes/ risk of cross infection with blood bore viruses • Review of effectiveness of arrangements for decontamination of endoscopes & lessons learnt • Service wide review of decontamination of all re-usable medical devices