Minutes 24/02/15 Cathays Park Attendees: Mr Karl Bishop Mr Warren Tolley Mr Anup Karki Dr Sandra Sandham Mr Richard Birkin Mrs Sue Greening Mr Mark Hill Mr Mark Robotham Mr Mick Horton Prof Jonathan Cowpe Ms Ann Rockey Mr Nigel Monaghan Mr Ken Hughes Mr Gareth Lloyd Mr Craige Wilson Ms Mary Wilson Ms Esther Hitchings (Chair) Hospital Dental Services Sub-Committee (Vice-Chair) Powys Dental Services Advisory Group Aneurin Bevan Oral Health Advisory Group Betsi Cadwaladr University Health Board British Dental Association Wales British Dental Association Wales Cardiff & Vale Local Dental Committee Gwent Local Dental Committee North Wales Local Dental Committee Director, Postgraduate Education Dental School Public Health Wales Wales Committee for Community Dentistry Wales General Dental Practitioner Committee Assistant Director of Operations, Cwm Taf UHB Specialty Trainee Public Health Wales Dental Care Trainee Public Health Wales Welsh Government officials: Mr David Thomas Chief Dental Officer Mrs Lisa Howells Senior Dental Officer Mr Nigel Champ Committee Secretariat 1. Welcome and Apologies 1.1 The Chair welcomed members to the meeting in particular Mary Wilson a Dental Public Health Specialty Trainee and Esther Hitchings a Dental Core Trainee from Public Health Wales. Apologies were noted from Simon Hodder, Mike Lewis, Will McLaughlin, Rhiain Paul, Nick Moran, Edward Jones and Kirstie Moons. The Chair informed members that Hugh Bennett has stepped down from WDC Nigel Monaghan will be the temporary replacement. Rhiain Paul is standing down as Chair of Morgannwg LDC in April and details of Rhiain s replacement will be forwarded to the Secretariat and Sue Greening will be standing down as Chair of the BDA. The Chair thanked Hugh, Rhiain and Sue for their excellent contribution to the Committee. 2. Notification of Any Other Urgent Business 2.1 Lisa Howells would like 1000 Lives as a standing agenda item as agreed in a previous discussion on the Committee work plan. The Secretariat agreed to add 1000 Lives as a standing agenda item. Action Point 1: Secretariat to add 1000 Lives as a standing agenda item.
3. Matters Arising 3.1 Action Point 1 - Anup Karki commented that this work had been completed by one of the previous Dental Core Trainees. The Chair and Hugh Bennett had agreed to meet and fine tune the document. The Chair agreed to discuss the matter with Hugh Bennett. 3.2 The Chair expressed concern that no cover has yet been agreed for Mary Dodd s replacement on WDC he therefore intended to contact Bryan Beardsworth and Philip Sumner to identify an individual to represent Hywel Dda HB on the Committee. Action Point 2: Chair to discuss and fine tune the Referral Paper with Hugh Bennett. Action Point 3: Chair to speak to Brian Beardsworth and Philip Sumner to assist in identifying a replacement member from Hywel Dda following Mary Dodd s retirement. E-Referral Process - Mary Wilson informed the committee that she was leading a project to connect dental practices to the NHS network. This will provide each NHS dental practice who has applied to be provided with an NHS email address and connectivity. In addition a small pilot involving five practices based in CwmTaf will test a new e-referral process using the Welsh Clinical Clinicians Gateway. The CDO added that 360 dental practices would be participating each receiving a one off payment 500. A total of eight practices did not wish to be involved in the project and the remainder (xxx) had not responded. Lisa Howells asked if there was any technical support available, Mary Wilson stated that NWIS had a helpline to deal with queries. 4. Restorative Dentistry 4.1 The Chair provided an overview of the issues relating to the provision of consultant led RD Services he introduced Craige Wilson, Assistant Director of Operations, Cwm Taf UHB to update the committee on the situation in Cwm Taf. It was noted that there continues to be a delay in the appointment of a new RD consultant in CwmTaf and it had been over two years since the previous consultant had retired. Cwm Taf had indicated progress with this appointment via the local oral health plan monitoring process indicating that the job plan had now received approval from RCS England. Craige Wilson has been advised that recruitment may take some time as there is a limited pool of available candidates, however there now appears to be some debate as to whether the job plan has received RCS approval. 4.2 Craige Wilson informed the Committee that a tripartite meeting had taken place to discuss both interim and long term solutions. Currently a job plan has been agreed with Cardiff and money is being identified for the coming year to support a Restorative Dentist and support staff. The job description needs to be signed off and then they can move forward for the appointment. 4.3 There are interim arrangements in place in the form of support from a consultant based in Cardiff but there is general concern as to how successful they are going to be in attracting candidates for the position. 4.4 The Committee expressed concern at the lack of progress with Special Care Dental GA service in Cwm Taf. There has been no service for over two years since the retirement of Consultant RD. Craige Wilson agreed the situation is not acceptable and acknowledged that some patients have been waiting in excess of two years for treatment, he is now personally taking charge of this issue and a meeting has been
arranged on 25 th February to discuss the service with the HB and CDS in Cwm Taf and Cardiff and Vale. 4.5 The Chair noted progress and asked if WDC could offer any further assistance then Craige Wilson should contact either himself or the Secretariat. 5. Chair s Report 5.1 The Chair highlighted issues concerning referrals to Cardiff Dental Hospital. Issues had been raised in ABMU HB regarding the consistency of referrals management at the hospital. 5.2 The Chair provided members with the latest information regarding the review of the advisory structure. Any reform of the statutory advisory committees would take twothree years to implement and therefore a business as usual approach should be taken. The Minister has received the findings of the advisory structure review but would like to consider the matter further before making a decision. The Welsh Government (WG) does not have a timeframe but updates will be provided when they have more information. The Chair re-iterated that WDC must carry on as normal. 5.3 The Chair provided the Committee with an update of the last NJPAC meeting held on 24 th November. The CMO has now published her annual report and although data is not readily available for all aspects of services he was interested to note that there were almost two million dental treatments performed in 2014. Other topics discussed were Ebola and the Primary Care Plan. He reminded members that the CDO was due to talk on Primary Care Clusters later on in the meeting. 5.4 Members were informed that results from the all Wales audit of dental prescribing of antimicrobials were being analysed. Data on over 5000 prescriptions is available and a small working group has been established by the Deanery to identify learning points for Dentists in Wales. An update will be produced highlighting good practice and areas where Dentists in Wales could do better. The group will also contribute to UK e-learning resource. The audit is available to all Dentists in Wales. Anup Karki reported a 13% reduction in antibiotic prescribing in Wales but noted prescriptions for fluoride toothpaste were rising. There was some debate over the number of fluoride tubes that can be prescribed on each prescription, the CDO stated that up to six tubes can be prescribed on a single prescription although it was preferential if patients were prescribed fewer tubes initially. 5.5 The Chair considered that the problem with waiting times in dental specialties (excluding oral surgery) was exacerbated as LHBs were not mandated to meet RTT targets. It was noted that the Minister is not keen to introduce another target however members were concerned at the length of some waiting times. The CDO noted that WG monitors waiting times via the National Health & Safety Forum meeting and that Lisa Howells had used this process to highlight issues concerning long waits for GA treatment in Hywel Dda UHB. 5.6 The Committee discussed a paper (produced by Peter Durning) that outlined the affordability and achievability in implementing the recommendations of the Oral Surgery Report in Wales. The Chair felt that there were resource implications and questioned what happens next. Some Health Boards were taking the recommendations forward but there was some confusion about who delivers what and where? The CDO agreed to brief the Minister on this issue including the need to
develop MCNs in Oral Surgery to drive the process locally he noted that this process was part of a wider issue regarding the development of specialist dental services (as an intermediate tier) based mainly in primary care. 5.7 CDO noted that DH were about to publish a number of standards and clinical pathways (March 31) relating to different specialities. These included Special Care Dentistry, Orthodontics, Paediatric Dentistry, Oral Surgery and elements of Restorative Dentistry. The CDO suggested that following publication we need to be in a position to adopt the standards and produce dragonised versions for use in Wales. The CDO agreed to report progress at next WDC. 5.8 The Chair informed Committee that GPC Wales would like to send a representative to future WDC meetings they would decide on receipt of the papers for each meeting whether or not to send a nominated attendee. Some members thought it would benefit the WDC on matters such as the Primary Care Plan and GP Clusters whilst some members thought that inviting someone from the Welsh Medical Committee (WMC) would be more beneficial. The Chair, in discussion with the membership agreed that in the spirit of collaborative working between Committees the best option would be for the Secretariat to invite a member of WMC to attend future WDC meetings. Action Point 4: The CDO to brief the Minister on affordability and achievability in implementing the recommendations of the Oral Surgery Report in Wales and also the need to develop MCN s in oral surgery to drive the process locally. Action Point 5: Following publication of the standards and clinical pathways relating to different specialties the CDO to report back at the next meeting on progress relating to the adoption of standards and to the production of dragonised versions for use in Wales. Action Point 6: Secretariat to invite a member of WMC to all future WDC meetings. 6. Report from the Chief Dental Officer 6.1 The CDO reported on a number of issues relating to work in the Dental Division. These included: The publication of two Welsh Health Circulars relating to the delivery of new services to Care homes and improving access to Special Care Dentistry. A recurrent spend of just over 700,000. In addition Community Dental Services had benefited from a one off capital spend of 160,000 for specialist equipment. Evidence had been presented to the DDRB on dentists pay and the Division had consulted with BDA officials on DDRB issues and patient charges. CDO was currently seeking further advice from the Minister on three issues. These were o Patient charges increases for 2015/2016 o Retention of ring fenced dental contract allocations o Proposals for a new dental (GDS) contract in Wales CDO had received a further independent review of Orthodontics from Stephen Richmond, the review would be discussed at the Strategic Orthodontic Forum and new guidance/ regulations would be considered shortly. Noted that both SCD and Orthodontic strategic forums were timetabled to meet shortly. 6.2 The CDO gave a presentation entitled Cluster Working & the Development of the Prudent Healthcare Process, he asked the Secretariat to circulate the presentation to
the membership. Action Point 7: Secretariat to circulate the CDO s presentation on Cluster Working to the Committee. 7. NHS Dental Contract in Wales 7.1 The Vice-Chair noted that this is a standing agenda item for WDC and agreed that the NHS Dental Contract in Wales had been covered earlier in the meeting. 8. Updates 8.1 Lisa Howells reported that SEDG had not met however the CDO had received the revised Dental Nursing Training review, this includes a number of areas of relevance to the GDC the CDO has shared it with their CEO. Further work is needed to clarify and take forward the recommendations. WEDS has issued information on non medical / dental training in Wales to include increased numbers of Dental Therapists and Hygienists. 8.2 The National Quality & Safety Forum has met the reporting of patient safety incidents in radiotherapy services was discussed. Dentistry was not included and Lisa Howells asked the work stream lead to ensure it is not forgotten. 8.3 The Special Care Dentistry Group - the CDO reported that the group will produce an annual report, the next meeting in March 2015. 8.4 The Vice-Chair suggested that the Committee set up a small working group to look at primary care clusters and to make recommendations as to how dentistry can contribute to the work of clusters, Sandra Sandham, Sue Greening, Mick Horton and the Vice-Chair duly volunteered. 9. Consultations 9.1 The Vice-Chair thanked Hugh Bennett for his contribution to the Smoke Free Private Vehicles Carrying Children consultation and Anup Karki for his contribution on the Early Years Framework consultation. 9.2 There were two new consultations, Talk to Me 2 which focuses on suicide and self harm prevention and closes on 5 th March and Implementation of the Social Services and Well-being (Wales) Act 2014 - Consultation of the code of practice in relation to measuring the performance of social services which closes on 24 th April. After some discussion the Vice-Chair agreed that both consultations should be considered by WDC he asked the Secretariat to circulate the Talk to Me consultation to the membership and Sue Greening and Sandra Sandham agreed to take forward the Implementation of the Social Services and Well-Being (Wales) Act 2014 on behalf of the Committee. The Secretariat agreed to forward the links to the membership and to Sue Greening and Sandra Sandham respectively. Action Point 8: Secretariat to forward consultation link on Talk to Me 2 to the membership and Implementation of the Social Services and Well-being (Wales) Act 2014 to Sue Greening and Sandra Sandham. 10. Date of Next Meeting
10.1 The date of the next WDC meeting is Tuesday 12 th May 2015.