A result for dentistry in West Midlands as BDA and LDCs unite on minor oral surgery

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The British Dental Association (BDA) has been pleased to see NHS England Birmingham, Solihull and the Black Country rethink plans to oblige dental practitioners to provide information on the minor oral surgery services they are able to provide.

The Area Team covering Sandwell, Dudley, Wolverhampton, Walsall, Solihull, Birmingham, Hereford, Worcestershire, Coventry and Warwickshire has now withdrawn a letter it issued to General Dental Practitioners following concerted pressure from the BDA and Local Dental Committees (LDCs).

The BDA were concerned that some dentists (particularly younger or newly qualified dentists) might be pushed towards delivering treatment that they are not comfortable with, or risk facing a breach of contract. It asked for the withdrawal of the letter to enable LDCs to discuss this issue with the Area Team before it went to individual practitioners.

Henrik Overgaard-Nielsen, Chair of the BDA’s General Dental Practice Committee, said:

“This is a result for thousands of dentists across the West Midlands, and it shows what we can achieve when we work together. The BDA and LDCs spoke with one voice, and NHS England responded. And it means Birmingham dentists are not being placed in a position where they could find themselves in jeopardy, or even breach of contract through no fault of their own.

“Our profession doesn’t seek confrontation. We want to see problems solved, and secure the best results for both patients and practitioners. We are seeing clear recognition from the Area Team that this kind of professional input was welcome. It’s a clear lesson, that if we are to avoid future impasses it will require openness on all sides and an end to last minute announcements. This gives me hope that other areas will act in the same spirit.”

Letter from BDA to NHS England Birmingham, Solihull and the Black Country, 4 August 2015

Re: Letter to contractors regarding minor oral surgery referrals

It has been brought to my attention this week that a letter has been sent by NHS England Birmingham, Solihull and the Black Country to dental contractors asking them to provide information on the minor oral surgery services they are able to provide. I am very concerned about the wording of the letter and the impact it may have on contractors, performers and patients in your area. The tone of the letter means that some, particularly younger colleagues might be pushed towards doing treatment they are not comfortable with. As far as I am aware, there has been no consultation with the LDCs in the area.

As you know we are currently in the implementation phase for the commissioning guides and we understand that NHS England centrally accepts that much work needs to be done before they can be used. Focusing on the content of these guides therefore seems inappropriate and at least premature.

The current contractual framework sets out the level of treatment expected of practitioners. By asking contractors whether they can provide level 1 care for all patients (except for those who are medically compromised), this seems to be attempting to re-define the GDS/PDS regulations inappropriately. At present, dentists are able to refer patients where they do not have the skills/training or equipment necessary to provide the clinical care that they need.

We are concerned that contractors are being required to confirm competence to provide treatment without full information and patient specific considerations being taken into account.

The letter does not cover appropriate issues that are referred to in the draft commissioning guides such as case complexity and patient related factors. Whilst we are sure that all contractors will be able to provide level 1 for the majority of patients, they will not be able to confirm this in every case. So being able to produce an action plan is almost impossible.

I ask that you withdraw the letter and discuss the proposals with the Local Dental Committees and the LPN/MCN. If there is an issue with referrals for simple cases being made by individual contractors, then this is a contract management issue and should be dealt with by discussion with the practices concerned. This blanket approach could be seen as an attempt to restrict referrals from all practices, which cannot be good for patient care. Good referral management means that the right cases are referred not necessarily that the numbers of referrals are reduced.

Yours sincerely,
Henrik Overgaard-Nielsen
Chair, General Dental Practice Committee