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Presentation to Northern LDC

On April 5, 2012, Chief Dental Officer Donncha O’Carolan presented an overview of the General Dental Services (GDS) budget and proposed changes under the new dental contract. The presentation detailed budget pressures, investments, proposals for savings, and the new commissioning strategies to improve dental care access. Key areas addressed included funding allocations, service delivery challenges, and the shift towards preventive care. Stakeholder consultation and potential implementation timelines were also highlighted as part of the restructuring efforts.

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Presentation to Northern LDC

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Presentation Transcript

  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

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

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

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

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

  33. Orthodontics

  34. Oral Surgery

  35. 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

  36. Progress on New Contract

  37. 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?

  38. 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

  39. 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?

  40. Local Decontamination Guidance

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

  42. Policy Background

  43. 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

  44. 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

  45. 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

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