Venue: the Medway Room, York House, Horley, RH6 7DE

Surrey and Sussex Dental Local Professional Network (LPN) 7 May 2015 from 2.00 – 5.00pm

Venue: The Medway Room, York House, Horley, RH6 7DE

Present: Amit Rai (AR) - LPN Chair Annie Godden (AG) - Senior Contract Manager Paul Mellings (PM) - Dental Practice Adviser Agi Tarnowski (AT) - Dentist, West Sussex LDC Sarah Crosbie (SC) - Clinical Director, Special Care Dental Service Brett Duane (BD) - Consultant in Dental Public Health Jeremy Collyer (JC) - Consultant Maxillofacial Surgeon

Apologies: Stephen Lambert –Humble (SLH) - Dental Dean

Minute taker: Janet Mitchelson

ACTION 1. Welcome and Introductions: Introductions made by the panel and AR welcomed Jeremy Collyer to the meeting as the secondary care representative. Attendance from Healthwatch still has to be defined.

2. Review of Minutes of Last Meeting: Agreed amendments to be made to draft minutes of 12 March 2015 and the final version circulated.

Summary of Actions: Panel requested new format for Action Log.

Upload of minutes onto website is not currently possible due to changes in IT personnel within the national team.

Update on previous matters:  Fluoride Toothpaste prescribing - to be added to Plan on a Page. BD to develop a Shared Care Document with Pharmacy colleagues at Guildford and Waverley Clinical Commissioning Group (CCG) which will need to go out under the NHS England logo. Panel discussed the elderly population who suffer with dementia, have difficulty in cleaning their teeth and having a high level of sugar in their diet. There is a health risk if treatment is not prevented and ultimately results in treatment under general anaesthetic. JC will be attending a secondary care AR/BD/JC meeting where he will highlight this issue.

 Information is now in place to send out the letter to Consultants in Oral Maxillofacial Surgery to establish an Oral Surgery MCN. AR will send the information and letter to JC for his input. IMOS AR/JC Performers will be invited to join the MCN at a later date.

1  As SLH sent his apologies, improving the Oral Health in Older SLH Person’s Initiative will be on the action log for the next meeting.

 The Challenges Conference on 7 October 2015 will take place at the Holiday Inn in Gatwick. The agenda needs to be fluid enabling the clinicians invited to attend for the whole day as half a day is not always possible and this would be more beneficial to them. The agenda and invites should be finalised and in place by the next meeting.

 Oral Health in the Homeless Groups/Fluoride varnish in Children BD/SC - BD/SC will meet outside of this meeting.

 SC feedback on letter sent to SLH re the issue/complaint on HEKSS website.

3. Managed Clinical Network – Update: AR/AG attended the National LPN Assembly where a presentation was given on the draft NHS England Dental Commissioning Guides. Documents are anticipated to be distributed after Purdah and following final stakeholder engagement. These Guides will means that there will be greater consistency in commissioning. Needs Assessments will need to be carried out for each service and will require wide stakeholder engagement, this has begun for the Orthodontic Needs Assessment. AA feels dentists should be consulted as this can affect business and have an impact on the existing contract.

MCNs need to be established in all disciplines to enable services to be delivered in line with the national Commissioning Guides, in particular for quality assurance, these need to be in line with the boundary of LPNs: Oral Surgery – JC to provide contact details to assist with this MCN being set up. JC Special Needs/Care – as these services are mainly provided by Trusts, it is believed there are existing quality assurance systems and it had originally been intended that this would be the final MCN established as national guidance was required to identify the remit of this particular MCN. AR asked if an MCN Special Care Dental was needed across the KSS geography or by each LPN area. There are only 2 Special Care Providers in Kent and 4 in Surrey/Sussex. This was discussed at the Kent LPN which felt it would still be of benefit to establish an MCN in advance of the national guidance and it was felt that due to the small number of services that it would be beneficial to have a KSS MCN at least in the first instance. Mark Johnstone of East Kent CDS agreed to contact all clinical leads across KSS to begin the process to develop a Special Care MCN. National guidance on MCNs has not been developed yet, in the absence of this the panel recommend that each MCN elects their own chair and although the national steer is that these are anticipated to be consultant led as leadership skills are developed as part of their core training, a consultant is not essential if non-consultants have the necessary skills.

2 Action – AG to provide information on all 4 providers in Surrey/Sussex AG

Orthodontic MCN – a letter had previously gone out from AR requesting that one MCN across the LPN geographical area be established to enable engagement to/from the LPN and NHS England. The Surrey and Sussex Orthodontic MCNs have responded that they do not wish to combine at the current time and the reasons given were discussed; the Surrey MCN had subsequently retracted their original response and JM will circulate their revised letter of response. It was discussed that only one MCN can feed into the LPN as it is not possible to engage with more than one due to capacity and the time it takes to consult/reach consensus on matters when more than one group is involved. The LPN agreed that this does not prevent smaller clinical forums in smaller geographical areas being sub-groups of the main MCN but that these would not have attendance/direct input from the LPN or NHS England. Action – JM to circulate the revised letter from Surrey MCN. AG to draft a letter of the opinions for the panel’s comment prior to circulation to JM/AG the MCN Chairs.

4. Health Watch - update: The panel still need a health watch representative from Surrey or Sussex. AR explained that no one had come forward and that he had attended the Health Watch committee to explain the need for a lay representative. Health watch explained that they do not have the resource even though they acknowledge that Dentistry high on their agenda.

5. Improving the Oral Health in Older Person’s Initiative: This was discussed at length by the panel. Funding is available to develop dental health education in care homes; Heather Lloyd has now been replaced as lead by Rob McCormack. A letter had been drafted by BD and SC in relation to concerns with some aspects of the project. BD agreed to play a more integral role in the steering group and emphasised the importance of engaging care homes in piloting Oral Health initiatives. Fluoride mouth wash had been introduced and BD explained how this was progressing. It was agreed to send the letter out and the panel agreed the pointers. Action – BD to continue to feedback as member of the steering group. BD

6. Plan on a Page: AG gave feedback from DCQAP on issues regarding the various needs assessments and procurement.

 Orthodontic - proposal is that the contracts are rolled over to 2017 to allow time for wider stakeholder engagement and finalisation of the Needs Assessment before procurement can commence.  Sedation - proposal is that this also be rolled over to 2017 for the

3 same reasons as the orthodontic contracts.  EDS and Oral Surgery (IMOS) contracts - proposal is to roll over to 2018 as Needs Assessments have not commenced and national guidance is not yet available (draft Oral Surgery guidance only is available). AG explained there are significant variances in EDS services across KSS with the majority of the treatment provided being urgent that often could and should wait for daytime care, rather than emergency. Changing to the Surrey model would mirror what many other areas are doing or are proposing to change to, but this may not be received well in Kent or Sussex as it would be a significant change in service delivery. PM felt that a change in EDS should happen sooner than 2018 and this could release funding for other dental service provision; to do this consistently across KSS the earliest this could be implemented would be 2017 as some contracts do not end until then, although contracts in some areas end in 2016 so a phased change could be considered. AG advised that the same procurement process must be followed whether it is for a small area or across the whole of KSS and that procurement is a time consuming process as a full Needs Assessment is required before engagement and development of a service specification can take place following which the actual procurement itself can take up to 6 months; AG advised that the capacity within NHS England and Public Health England (Dental Public Health) would need to be considered to undertake the Needs Assessment, engagement and procurement, as well as the procurement support from the Commissioning Support Unit (CSU) due to the number of other procurements that are also required. It was suggested that this would be a good agenda item for the Deanery Challenges/LPN Workshop on 7.10.15 and this will be suggested to SLH. Further discussion is required to establish if the Needs Assessment and procurement could take place earlier than originally proposed. Action - AG to discuss with BD and take the feedback of the panel to the DCQAP on 19.5.15 to establish if EDS can be considered earlier, possibly in a phased way. Action – AR to circulate current Plan on a Page to the panel for their AG/BD comments and feedback. AR

AOB:  The panel felt that providing deputies, other than to Chair a meeting in the absence of the Chair would not be necessary. BD agreed to be Deputy Chair but only in a facilitator role.

 Further discussions took place regarding the Challenges Conference. Invitations to go to: Local Authorities – BD to send AR names and email addresses Local Dental Committees-LDC. Clinical Commissioning Groups (although it was anticipated they were unlikely to attend due to other priorities, but this would be their decision) Secondary Care Trusts South East Coast Ambulance Service (due to EDS discussions)

4 111 – Helen Medlock and Peter Stott (due to EDS discussions) Health Watch rep from each area. Format for the day:  CQC – John Milne – speaker  Improving the Oral Health in Older Person’s Initiative  Break out session on Emergency Dental Service(EDS)

Action – AR to liaise with Christopher Allen and SLH. AR

Dates of Meetings for 2015/2016 Thursdays from 2.00 – 5.00pm on

9 July 2015 10 September 2015 29 October 2015 7 January 2016 10 March 2016

The Medway Room York House, 18-20 Massetts Road, Horley RH6 7DE

Ratified Minutes 09th July 2015