LDC Conference 2011

LDC Conference at the Connaught Rooms, central London

10 June 2011

Preface from the Chair of Conference, Mick Armstrong

At such an important moment in the history of our profession, I am both honoured and proud to be

able to chair the 60th LDC Conference. Changes to the NHS, coupled with regulatory changes and the

piloting of a different kind of dental contract are coming together in a sort of ‘perfect storm’ for the

dental profession. There is uncertainty on all fronts at the moment: how will dentistry be regulated

in future, what will the contract look like and how will the NHS function once the Government has

completed its reforms?

These are all questions of concern for us. I am glad that the Conference is there to enable

representatives to debate and vote on these and other issues and I am a great believer in the

importance of the profession coming together to debate the issues.

I hope you find this report useful and informative. I wish you and the members of your LDC well for

the future, and particularly through these coming years of reform and change. Let us all work

together to ensure that it is change for the better!

Mick Armstrong, Chair of LDC Conference 2011

Speech from the Chair of Conference, Mick Armstrong

Distinguished guests, ladies and gentlemen; it is with great pleasure – and no little trepidation – that

I have the honour to speak to you this evening, on the occasion of the 60th LDC Conference Dinner.

Although I have attended the last ten LDC Conference dinners, tonight is a revelation to me and I am

seeing things in a new light, as up to this moment I have been an alcohol free zone. For those

involved in the sweepstake, I will remain so for the next 18 minutes.

My anxiety is that I will fall short of your expectations but that has been tempered by the support of

my wife Carol who helpfully informed me that they are probably not that high anyway and by the

fact that the chief heckler and loosest of cannons in recent years is securely lashed to the top table

and is indeed standing in this very spot.

I can reassure you that there will be no name dropping this evening, so you may lay down your

teaspoons, nor will there be the silky smooth presentational skills and eloquence of last year’s chair

Richard Emms, whose speech was succinct, pertinent and truly excellent.

And I have agreed with the Chair of the Executive Board that should I revert to type and gratuitously

use the “f” word, this will result in a fifty pound donation to the Benevolent Fund.

So, all I can offer tonight are a few disjointed thoughts of an over promoted LDC Chair from

Castleford, and an NHS practitioner for over 25 years. But, I do welcome this opportunity to get a

few things off my chest!

As I look at this chain of office, the roll call is indeed impressive if not exactly overpopulating the 50

most influential people in dentistry and I am mindful that it has decorated much more talented

persons than I. And also that the engraving looks like it has been performed by an IQE graduate with

a £100 Chinese air rotor!

How can I match the vitriolic rant of Eddie ‘Grouch’; the gravitas of Henrik ‘Overstated’ Nielsen or

the wit and repartee of Jerry ‘Arsequith’? I can’t. But it was my friend Jerry who gave me the best

piece of advice: “just be yourself, Mick”. So here goes.

Now some of the following is true, some of it false and the rest of it, well, you will just have to die

wondering. But it will, in those respects no doubt, be the same as tomorrow’s address from the CDO.

Indeed it was Jerry who started the year rolling by inviting me for a round of golf and some lunch

with a few of his chums.

So, because Jerry had organised it, there were five of us; Nelson Mandela, who knows Jerry very well

because Hillingdon is actually twinned with Robben Island; Dame Margaret Seward and Lord Lucan.

Now Nelson was upset because there was no room in the buggies we had hired and he had to walk

with his clubs. Lord Lucan was worried sick that he might be exposed to the authorities, but I told

him that this was unlikely as he had been attending Jerry for a three-monthly scale and polish since

1975 – ticking the exempt box – and nobody had noticed.

And Dame Margaret couldn’t stop apologising for not being able to attend tonight’s dinner, as she is

in fact a tax exile by dint of her many gold-plated pensions.

I suppose you’re all dying to know who won. Well Dame Margaret, of course; which just goes to

show that despite the clever cheating of the dentists, civil servants have a lot more time on the golf-

course than we do.

Indeed, as I tried to contact the CDO on the Tuesday, following the last Bank Holiday Monday, I was

informed that the Department would be closed until Wednesday. Efficiency savings I assume!

My main reason for telling this tale is to introduce you to Dame Margaret who was present at my

first LDC conference dinner where, primed by my mischievous LDC secretary, John Milne, and

eleventeen pints of Stella, I managed to button-hole Tony Kravitz, GDSC Chair at the time, Dame

Margaret, and Alan Duncan, the then opposition spokesperson for Dentistry; all in the space of ten

minutes.

Tony dismissed my pleas for strike action with irascible aplomb, rather akin to Captain Mainwaring

rebuking Pike with “STUPID BOY!” Alan Duncan displayed no knowledge or interest in dentistry

whatsoever and actually mistakenly thought I was propositioning him (I think it was the shaven head

and dodgy tash, although I do have some form in this department having previously secured a

private interview with Michael Portillo for a mere tenner).

Dame Margaret: God bless her! I am an unashamed fan of Dame Margaret, who has been President

of the GDC and CDO, and nearly everything else in dentistry. She is a genuine advocate of the

importance of LDC conference and, although I didn’t realise it ten years ago, compared with what

followed she had steered the profession with a steady and empathetic hand. Although she did think

at that time the GDC was due for reform and that the pace of change was not fast enough.

How even the unflappable Dame Margaret must be at shocked at the recent developments on

Wimpole St; the sudden resignation of Alison Lockyer is a very worrying and sad development and I

am concerned that it is another nail in the coffin for the façade of self-regulation.

The current GDC seems to perform none of its designated functions particularly well. It is responsible

for the undergraduate curriculum, but has it taken its eye off the ball in this area? Just what are they

teaching the undergraduates in the 5 years they are studying for? None seem capable of diagnosing

caries, let alone treating it. Faced with a heavily restored, failing dentition, they react like rabbits

caught in headlights.

They appear to graduate believing that nearly all dental disease has been eradicated and that which

remains can be treated with a blob of Fuji 9. The process of re-training them, even in two years

foundation training, is becoming increasingly onerous for the trainers and offers meagre rewards. So

is it the education or the admissions policy? Who knows? But sometimes I feel it would be easier just

to take on a spotty-faced apprentice straight from a secondary school!

And, if I am totally honest, I have grave reservations about the abilities of DCPs to replace us, as they

have received no foundation training whatsoever.

The GDC also seems positively to

relish the endless navel-gazing of

the title ‘doctor’ debate. Is

anybody really bothered? I’m not

and nor are my patients. Why not

just ban the title altogether, as

even the medics themselves

appear to be ineligible to use it!

Fitness to practise cases are

increasing faster than the number

of premiership footballer

injunctions. The outcomes seem

more inequitable to dentists, and the sentences, increasingly draconian. More worrying still is the

adverse press coverage of unproven allegations against dentists whose cases have yet to be heard.

And now they are about to launch revalidation which, on current form, will go down like the Titanic

and, no doubt, will not be free at the point of delivery.

We seem to think that the GDC is better than any alternative but, colleagues: the “self” has

disappeared! Let us at least look at the alternatives, rather than keep ploughing our money into a

seemingly endless black hole. However, I am sure that Kevin will have more to say about the GDC.

In Manchester, the Teflon suited, Andrew Lansley admitted that the Department of Health got it

wrong in 2006 and the Deputy CDO, Sue Gregory has also said the same.

In his presentation tomorrow it would be nice if the CDO also admitted his part in the UDA disaster

and went one step further and offered an apology, but then again, maybe not. I have been told in

the past that I am so wonderfully naïve, but I prefer to think of it as just living in hope.

Like I actually believed pre-election promises to cut ‘red tape’! Quite remarkably though, this seems

to be on an endless rise. ‘Information governance’, CQC requirements, Legionella risk assessments;

what, I wonder, will be next? Assessments of our practices’ ability to resist earthquakes or tsunamis?

Or to the safeguards we have in place to minimise the possible abduction of our patients by aliens? I

think that perhaps the word proportional needs to be introduced somewhere along the line.

It is difficult enough just to ascertain which regulatory body is actually on the phone or on the

premises, never mind actually complying with all their inappropriate regulations.

Just where is the evidence that all of this makes for better dental health or a better patient

experience? There is none. But it certainly makes dentists less healthy and more stressed, and it

makes the job, less enjoyable and less rewarding. Indeed, it seemingly and makes us more resentful,

more sceptical and more cynical. But hey-ho! Whoever cares about us or about our wellbeing?

I sometimes hope that there will come a day when instead of the Government viewing us as

unwelcome, but necessary leeches on NHS resources, they simply acknowledge our contributions

and reward us appropriately and with the good grace of a pat on the back. And, of course, pigs might

fly and cavities might remineralise!

Presumably, in a few years’ time, the Department of Health will produce the figures and therefore

the evidence of how rates of Hepatitis C contracted in a dental surgery have plummeted due to HTM

01 05. And likewise, how the relentless march of BSE (that’s Bovine Spongi- nope sorry can’t even

remember what it is) has been achieved and is all down, no doubt, to the CDO’s edict on single use

endodontic files.

And for me this is the bit of HTM that makes no sense. Surely, if the Department of Health’s

evidence-base is so overwhelming, why are we and our patients not in operating greens with the

patients’ faces swabbed in iodine? Is that not a logical extrapolation of the theory?

Similarly, figures on how many children and vulnerable adults have been saved from abuse by CRB

checking our staff, would be useful if only to reassure us that our time, effort and expense were

worthwhile. Indeed, why is this down to dentists at all? Why can’t the Government hold a central

register on us all and have a look at that? Or is that just too simple?

And a clinical example of red tape: does anybody really understand where we are on tooth

bleaching? In ‘Cas Vegas’ we play it safe. In reception we have a whitening boutique which consists

of false tan, dark red lipstick and Tippex. Tippex is brilliant; it’s cheap, reversible, instant and

remarkably effective. It also delivers a pleasant high during application and, crucially, there’s nothing

that Essex trading standards can do about it.

All in all, it’s just so confused and arcane! Is it any wonder we struggle to keep up – to conform –

when we are busy focussing on what we do best: providing an excellent professional service to our

patients (which we always have done) in spite of the regulations, rather than because of them. And

if you don’t believe us Barry, just ask them. Oh sorry, you’re going to.

That’s not to say there are no bad apples in dentistry but at least not Denplan, whom I thank for

their generous sponsorship.

There are bad apples in all professions and it is most interesting that the Minister, Earl Howe, should

know this well. He has a background in banking and is, patently, also a politician. Well, just maybe

you should have put your own house in order before coming to us. Perhaps then we would not be

searching for a 4% pay cut from our back pockets, in what is surely already the most cost effective

and efficient part of the National Health Service. Please don’t ask us to do any more! We just find it

extremely insulting!

I am sorry that Earl Howe, or Freddy as Jerry calls him, will be unable to join us tomorrow; to expand

on the plans set out by the Secretary of State at the recent BDA conference. Perhaps he fears the

views of a less fresh-faced audience, which seems most strange as – apparently – the government is

in ‘pause and listen’ mode at the present time.

“Pause and listen!” I wonder which highbrow, Oxbridge spin-doctor thought up that one. In

Yorkshire, we have a different phrase: “dithering like a shite-ing dog!” It just seems to me that the

Department of Health is circling endlessly and looking for somewhere to drop its load. But don’t

worry Andrew, we dentists are nothing if not adaptable and we will no doubt clean up any mess for

you, just as we have done previously.

The dithering also applies to the central plank of the Department’s strategy of prevention. Sorry

Susie, but I’m just going to have to use the “F” word – Fluoridation. Lansley says it is now the

responsibility of local authorities to carry this out. Yeah right! A delegation of responsibility? No its

simply passing the buck to organisations whose pusillanimous nature is legendary. It simply will NOT

happen fast enough, if at all.

Isn’t it strange how when faced by a profession of intelligence and integrity the Government is all big

and brave and faces us down with relish, using a dubious evidence-base. But when faced by a

handful of ill-informed, paranoid tree huggers, it runs for the hills and ignores all proper verified

research. Quite pathetic! Just instruct all local authorities to fluoridate and then your commitment to

prevention will be proven and we will believe you.

Actually, I’m personally against fluoridation as I have become aware of a little know side effect; that

of early adulthood fluoride-induced obesity. When I began my degree in fluoridation – sorry,

dentistry – under the tutorship of Prof JJ Murray in 1980 up in Newcastle, I was thirteen stone and a

scrum half at probably the finest rugby club in the world, the Medical RFC. After five years of

consuming the fluoridated water I was a nineteen stone prop. Anecdotal coincidence you may think,

but I have recently discovered that Clive Harris, Michael Watson and Malcolm Farr all studied in

fluoridated areas. So for me, that settles the issue. Sorry, I have digressed.

So as we speak pilots are belatedly underway and engagement between the Department and the

GDPC is in full swing. I can report from the top table that Little Bazza and Little Johnny are getting

along famously; and maybe that is how it should be, rather than the childish squabbling of previous

years. But a word of warning John: just beware of the ‘kiss and tell’ civil servant.

These pilots should be allowed to run their course fully and evaluated properly, if not independently,

and if the evidence from them shows that the dental needs of the population are greater than the

recent, rather cursory, Adult Dental Health Survey showed, then the Government must be prepared

to put more resources in place. Particularly as, historically, it has never committed all of its

earmarked funding.

Of course, the Government believes that if you listen to NICE and the surveys, then the dental health

of the population is massively improved and is continuing to improve. Therefore they believe that

less funding will be required. This, of course, is all down to fluoride toothpaste and has nothing to do

with us at all.

In fact, we have been over-treating our patients for years; recalling them far too often and carrying

out unnecessary treatments. What nonsense! The fact that our health messages and examinations

are reinforced on a six-monthly basis, is surely one of the most important reasons for this

improvement. We seem far more aware of the demographics of our ageing dentate patients than

the Department. The ‘heavy metal generation’ ain’t going anywhere soon! But until we reach

Shangri-la, the best we can hope for is a contract that allows us to deliver appropriate dental

treatment for our patients in a professional manner; be remunerated accordingly; and, crucially, one

that is implemented at NO financial penalty to the profession.

I understand the persons responsible for the confused and restrictive UDA narrative have now left

the Department and I’m sure we all wish them well in their new posts re-writing the constitution for

Kim Jong Il’s Peoples’ Democratic Republic of North Korea. We can only hope that our new narrative

is unambiguous, clear and not written in a way that regards us all as potential criminals. That the

Department polices the overt fraudsters firmly, with properly trained Dental Reference Officers, and

that it changes its attitude and vocabulary, deleting such phrases as gaming and value for money

and instead, reinstating the words professional, trust, quality and – above all – thank you.

The Government must also recognise that in addition to being a health care provider we are also

businesses and independent contractors, often with a highly skilled team of employees and very

significant capital sums invested. It is only this investment – our investment – that has allowed any

quality NHS dentistry to be delivered at all for over 60 years. I feel all governments have consistently

refused to acknowledge this. We need to be able to market our practices freely, and to generate

sufficient profits to maintain them to the highest possible standards.

Conspiracy theories abound: are they trying to get our practices for nothing and make us salaried? It

would be an interesting idea (I can feel a prolonged absence from work due to stress coming on, and

then an ensuing case for constructive dismissal). Or are they hoping for a mega corporate takeover?

Perhaps not anymore, as Southern Cross disappears down the toilet, without a trace.

Or is it just one great prolonged cock-up? Well, heaven only knows, but some honesty and clarity

from the Department on just what NHS dentistry is going to provide in the new contract would not

go amiss, whatever the grand plan. So, the picture I have painted is one of us dentists as innocent

victims, waiting upon the deliberations of the Department. Is this true? Well hopefully, not entirely.

We will have our part to play in the pilots and I hope that we will carry out our responsibilities with

diligence and honesty, and I am confident that we will. We must, I feel , engage fully with process at

this point, but not perhaps accept all the whims and wishes of the Department during the process

and so the GDPC needs to be eagle-eyed in spotting potential pitfalls along the way. Most

importantly, in the end, it must be prepared to reject any new contract that is not acceptable to the

vast majority of the profession.

Mr Lansley has identified an important role for LDCs in local implementation of a new national

contract and I look forward to the CDO confirming that this role, if it is so important, is to be clearly

identified and enshrined unequivocally in statute, in his address tomorrow.

LDCs need to be well informed, vibrant and fully representative of all local dentists in the area and

this means we need to engage with our associates, those working for large dental corporate bodies,

community and hospital services, many of whom are much younger than many of us. It is their

future, more than ours, which is so very important for our profession.

Finally, we need a strong and unified profession to achieve the best deal for our patients and

ourselves, and this is where the BDA must play a key part. Once it has agreed a new constitution, it

needs to perform as both a company and more importantly, I feel, as an effective trade union, which

makes safeguarding the interests of its members its primary responsibility. I know that this is a

Gordian knot – a Sisyphean task, but it must be un-picked and approached with determination and

fortitude.

Yes! I am an optimist. I would like to leave you with the thought of one of my heroes; the great

French writer, philosopher and lover, Albert Camus (whom I resemble in none of these respects).

“Where there is no hope, it is incumbent on us to invent it”.

Ladies and Gentlemen – and especially Carol – thank you for your forbearance. I’m off for a pint and

a cig… Room-service, please!

LDC Conference 2011 – Conference Agenda

Registration, coffee and exhibition

Chair’s opening address

The future of NHS dentistry and the pilots (Dr. Barry Cockcroft, Chief Dental Officer for

England)

Conference Motions

Coffee break and exhibition

GDPC update: piloting changes to the contract (John Milne, GDPC Chair)

Conference Motions

Report of the Honorary Treasurer to the Conference and Accounts for the year to 31

October 2010

Elections

i. Chair Elect of Conference 2011/2012 with nominations taken from the

floor (two minutes will be offered to candidates to make an election

address to Conference prior to the vote)

ii. Honorary Treasurer of Conference with nominations taken from the floor

iii. Two Honorary Auditors to the Conference with nominations taken from

the floor

iv. One Representative to the Conference Agenda Committee (who is not a

member of GDPC at the time of election) with nominations taken from

the floor

v. Two representatives to the GDPC with nominations previously submitted

vi. One Representative to the Board of Managers of the British Dental Guild

with nominations taken from the floor

Lunch

Report of the British Dental Guild (Julie Williams, Chairman)

Presentation by the Dentists’ Health Support Trust (Rory O’Connor, National Coordinator)

Presentation by the BDA Benevolent Fund (Bill Nichols, Honorary Treasurer)

The new NHS: what role for local contractor committees and LDCs? [Panel discussion]

Local Government Association (Councillor David Rogers OBE, Chair,

Community Wellbeing Programme Board, Local Government Group)

Picker Institute (Mike Warburton, Associate with Picker)

Integrated Dental Holdings (Steve Williams, Clinical Services Director)

NHS Commissioning Board (Helen Hirst, Commissioning Development)

GDPC (John Milne, GDPC Chair)

Coffee break and exhibition

Conference motions

Induction of new Chair 2011/2012 and address to Conference

Closing remarks from Chair of Conference

Barry Cockcroft – the future of NHS dentistry and the pilots

The Chief Dental Officer, Barry Cockcroft, thanked Conference for the invitation to speak and

conveyed Earl Howe’s apologies for being unable to attend.

He began by setting out the current situation, but wanted to look to the future for NHS dentistry and

explore the vision of the profession and how to this might be achieved. He d the shift of the policy

landscape as a result of the change of government and suggested that this was an exciting and

opportune period for dentistry and the profession. The recent ‘Dispatches’ television programme

had painted the profession in a negative way and he saw some behaviour in that programme that he

had been uncomfortable with. He said that he supported the BDA in stating that this depiction didn’t

represent the profession as a whole. In his view, however, it was not the result of the payment

system: any system could be abused by a small minority, regardless of the payment mechanism for

that system.

Looking at the future, the priorities of Government policy were:

Improving the oral health of children

Improving the oral health of the nation

Caring for the ‘heavy metal generation’

Improving general health

Patient access to dental services

Delivering a new dental contract

The Minister for Quality (which included dentistry), Earl Howe, felt that oral health inequalities were

unacceptable, as many dental diseases (for example caries) were preventable. The recent Adult

Dental Health Survey showed that England, Wales and Northern Ireland had the lowest rates of

tooth decay in 12 year-old children across the EU. These findings masked inequalities, however, as

70 per cent of five year-olds had clear signs of tooth decay. Tackling this would require a joined-up

approach. It must be dealt with on a population basis, a community basis and practice basis. Across

each of these, there needed to be an inter-disciplinary approach that linked with social care and

education. He also mentioned the crucial role of fluoride and the importance of increasing the

fluoride concentration in children’s toothpaste.

The CDO spoke of his pride at being part of the Department team that produced ‘Delivering Better

Oral Health’ in 2007, which was both evidence-based and practical.

The Department of Health had received 570 expressions of interest for the new contract pilots and

the process of selecting the pilots had been undertaken using pre-agreed criteria which required any

practice identifier or identifying data to be hidden in order to ensure that the process was not

biased.

Importantly, the CDO also felt that LDCs would have part to play in local intelligence gathering in a

new system but they needed to break away from their sometimes insular tendencies and engage

with all areas relating to dentistry and oral health. From primary to secondary care, community care

to other public service sectors such as schools and centres of education, LDCs had an opportunity to

be involved and position themselves as local experts.

Questions and answers

Dai Gingell (Sandwell LDC) was pleased to hear that LDC could be engaged in any new system and

asked whether they would be statutory and whether there would be a definition of what statutory

meant in the regulations. The CDO clarified that LDCs currently had statutory functions despite not

being statutory bodies. He suggested that in the new NHS landscape LDCs needed to fully embrace

their role and make themselves worthwhile.

Roger Levy (Enfield & Haringey LDC) said the elephant in the room was the current extent of

regulation and he had the impression that there was inadequate understanding of the pressures and

difficulties of providing current primary dental care. Given this, he asked for comment on the

growing burden of regulation for primary care dental practices. In response, the CDO stressed that

he was a dentist on the GDC register and that he visited practices around the country. He felt he

understood the difficulties of dental practice. He noted that he was employed by the Department of

Health and with that came accountability. He was fully aware of the CQC registration process and

the handling of situation.

Paul Kelly (Dorset LDC) queried the view that the issues raised in the

Dispatches programme were not linked to the system within which the

profession was working. He asked whether, in the view of the CDO, the

system had no relation to undesirable behaviour. A small minority of any

profession might abuse the system, said the CDO, whatever the type of

system they were working in. What ws needed was a good system for the

vast majority of dentists working for the good of their patients.

In response to a question from Phil Davenport (Birmingham LDC) about

how practices were selected for the pilot, the CDO reiterated that the

process was blinded and that the selection criteria were agreed by the

national steering group. The names were removed and the selection panel

matched each expression of interest against those criteria.

Jerry Asquith (Hertfordshire LDC) was very pleased to hear the response to the question from Dai

Gingelland asked whether LDCs should look to begin clustering together or stay as independent

entities. The advice from the CDO was for LDCs to wait until the NHS National Commissioning Board

was formed, before ensuring that their local structures would match with those of the NHS.

Ian Gordon (North Tees LDC) asked whether the Department of Health was imposing national

recruitment for vocational and foundation training and if so did the CDO share the concerns that

there would not be enough VT/FT places for United Kingdom graduates in 2012? Dr Cockcroft said

that the DH was not imposing central recruitment: COPDEND decided how recruitment was

undertaken and the DH merely supplied the funding. Dr Gordon noted that 2012 was likely to be a

difficult year as more EU graduates arrived and the bulge from the UK dental schools emerged, to

which the CDO responded that ‘freedom to roam’ legislation had been in place for a number of years

and that the Department of Health and COPDEND had got it right so far so there was no reason to

think otherwise now.

Richard Heathcote (South Cheshire LDC) raised two big concerns. The first was whether the contract

value would be guaranteed to allow for practice finance and business planning; and the second was

what would be required of practices for that guaranteed contract value and whether it would end up

being ‘more for less’. The CDO said that a new system and what the pilots were trialling was

designed so that practices would do things differently. He thought it likely that the profession would

see contract values remain the same but what they did for that might be different and not paid on

activity. All this would depend on the outcome of the pilot process and that activity would depend

on the oral health needs of the population.

Eddie Crouch (Birmingham LDC) said that despite the graph in the presentation showing that access

had increased, in some places access had fallen and in Birmingham there were 50000 fewer patients

accessing NHS dentistry. Given the money that had been spent on improving that access, would this

be called value for money? In any reform process, responded the CDO, you invested money although

the benefits were long term. Despite this, the proportion of people not being treated was small and

the figures were continuing to grow. In Birmingham, certain areas showed access decreasing but

others had shown it increasing as people changed their travel patterns to seek treatment at a dental

practice. He acknowledged that there had in some areas of the country been ‘over-commissioning’

because, although PCTs had a duty to meet need, they had not needed to keep growing access

indefinitely.

Stephen Shimberg (West Pennine LDC) noted that the new GDS contract was described in 2006 as ‘a

brave new world’. The new pilots were now looking like that brave new world. What had changed in

five years to make the Department of Health change the system? The CDO acknowledged that

mistakes had been made but the single biggest mistake of 2006 was the overestimate and

misjudgement about the ability of PCTs to respond to the flexibility within the regulations. In

designing more changes to the system he advised that contract reform was an evolutionary process

and in order to make any system right, changes needed to happen.

Bill Sidhu (Coventry LDC) said that dental graduates now had difficulties finding practices because of

the need to tender for contracts. He feared that dentists would eventually become employed as

resource-rich dental companies would move into the market, instead of small businesses. He would

like PCTs to be encouraged to help dentists to set up practices. The response was that PCTs should

tender for services where there was need. The Department of Health could not go back to an old

system where dentists chose where practices were located and so where access was.

John Milne, GDPC Chair: piloting changes to the contract

John thanked Conference for the invitation to speak. He especially wanted to thank LDCs for

supporting the British Dental Guild, as it was the Guild that supported and funded the time of GDPC

members in representing the profession.

Turning to the pilots, John described how GDPC was fully engaged in the development of the pilots,

but was engaged with extreme vigilance. In the past, the profession’s trust in the engagement

process had been lost and this trust was hard to regain. The conduct and evaluation of pilots needed

to be open and transparent on all sides. An objective for GDPC, in supporting the pilot process, was

to minimise perverse incentives that exist in the current system.

He highlighted the key points that were important to GDPC in any new system:

A system of capitation had been consulted on and demonstrated to work through evaluation

Contracts should not be time-limited

Contracts should be transferable to enable sale of practice and allow return on investment

The length of registration period had been agreed with the profession

IT system changes were fully funded for practices

Clarity on the NHS offer and the level of advanced care included

Reassurance that patient behaviour would not affect contract performance

Failure-to-attend charges should be re-introduced

The UDA system should be scrapped

A quality-based system should have incentives and not punitive measures

Contracts for particular groups should be continued (e.g. for children)

Practice finances should be protected in a period of contractual change.

There were both risks and benefits to capitation and pilot practices should carefully monitor how the

pilot was working for them to ensure full and proper evaluation at the end of the process. The real

enemy in the NHS was that resources were limited as was time per patient. It was crucial that pilot

practices recorded accurately the time that was needed per patient. He urged practices taking part

in the pilots to hold their nerve and follow the pilot process honourably and diligently.

He also repeated that dentistry was an honourable profession and that patients needed the right

care at the right time and in the right way. And the Department of Health needed to provide a

system to enable this. In conclusion, he said that he would accept a ballot by the profession on a

new contract and, if he remained Chair of GDPC, he would not accept a new contract that had been

rejected by the profession.

Questions and answers

Bruce Porteous (Central Lancashire LDC & Sefton LDC) asked how a new contract would allow

practices to expand and develop their business model based on commissioning processes and

numbers of patients, rather than being able to deal with PCTs. John Milne replied that the profession

was currently in the piloting stage so he did not know how things would develop. But a national

capitation value would put a value on the needs of the patient and therefore money would follow

the patient.

Ben Atkins (Salford LDC)noted that previous pilots were ineffective and did not influence the

contract that followed. He asked whether this new pilot system would work, given these

experiences. In reply, John Milne stressed that GDPC had engaged with extreme vigilance. The end

result was unlikely to be exactly the same as what was being piloted because there would be

learning from the pilots. Patient charges would have to change but that would need a change in

legislation and these pilots were building blocks to those changes.

Richard Grant (Cramlington LDC) told Conference that he had been in the profession for just under

40 years and had frequently seen the mood of the profession change. If there was a cash-limited

system how could the GDPC support a full and comprehensive service in such a system? If the

government wanted a full and comprehensive service it could provide it if the available funds for

treatment were limited. He suggested that if the Department of Health was going to limit funding, it

could only expect practices to supply a core service. John Milne replied that the service would be

based on the Steele advanced care pyramid and treatment would be limited by an individual

patient’s condition. Data from the pilots would show the needs of the population and this should

influence the type of service.

Panel discussion: the ‘new’ NHS: what role for LDCs?

In the afternoon, representatives heard presentations and a panel discussion on how the

role of Local Dental Committees should develop in the new NHS where dentistry was to be

commissioned centrally, but where local Health and Wellbeing Boards would develop local

health strategies.

Cllr David Rogers, Local Government Association

Councillor David Rogers explained that the Local Government

Association (LGA) was the national voice of virtually every

local authority in England and Wales. At the moment the

whole system of health and social care was in an interesting

place. Because of the government pause and the Future

Forum, some issues were still far from clear. What the LGA

anticipated will remain following the pause was :

The transfer of public health back into local

authorities’ responsibility

The strengthening of the roles of Health and

Wellbeing Boards.

There needed to be business case for dental health as for

other health areas. Cllr Rogers warned local authorities not to

wait for legislation but make a start now and there had been great enthusiasm for this. He

encouraged local professions and local structures to begin building new relationships and

encouraged good ideas and positive behaviour, not suspicion about what others were doing. In any

system change there were opportunities and challenges and that there was always the risk that

existing expertise would be lost or isolated. Because of this it was important that recognised

expertise was properly applied in any new system of working.

In relation to public health, there was a question about where the balance would be struck between

local and national responsibility particularly around areas such as health protection. As yet, the

details were far from clear. One of the current difficulties was to work out the level of existing

resources to use as a baseline to go forward. It would also be important to ensure that all public

health outcomes were prioritised and tax payers’ money was spent wisely to meet this.

As for now, there should be a combination of national and local level engagement. At national level

engagement had taken place within the primary care policy network and the LGA had met with GP

and public health interests. Locally – it was important to start making links and building relationships

now.

Mike Warburton, Picker Institute Europe

Mike Warburton thanked Conference for inviting Picker to

talk about patient experience. He stressed the importance of

the patient voice as a central plank of the new reforms and

that Picker were a major player in that field as they ran all the

major patient surveys in NHS.

In future, GP consortia would have duty to consult on any

changes to service. This year in the dental pilot contract,

patient experience featured highly. Of the ten per cent of the

quality element of the pilot contract, 30 per cent was patient

experience or 3 per cent of the overall contract value.

Questions that are in the patient survey will be for example:

How satisfied are you with your NHS dentist?

How helpful were staff?

Were you involved in decisions about your care?

Would you recommend this practice to family and friends?

Picker worked with Birmingham Dental Hospital to look at outpatient services to design a benchmark

for measuring patient experience. He advised that Oxford University had done a piece of work called

Healthtalk Online and 2000 patient stories had been recorded. Of the common issues that arose for

dentistry, it was mainly about customer care and patient information.

He saw a real role for LDCs in supporting and helping standardise the provision of information to

patients to prevent this being reinvented across the country.

Steve Williams, Integrated Dental Holdings

Steve Williams opened by saying that the current mantra seemed to be ‘more for less’ and that in

the recent CDO letter the focus had remained on increased access, increased quality, importance of

child oral health while achieving four per cent efficiency savings across NHS dentistry. As well as

increased patient expectations, the profession had also seen over-commissioning in some parts of

the country, and as a result, practices had to compete for patients. There was still variability in the

reaction of some PCT to exception reporting. Some PCTs were working with practices to improve

while others simply demanded money back for under-performance.

The focus was on increased patient expectation and we must engage patients in their treatment

more. IDH was trying feedback schemes like the screens seen in GP surgeries and these were linked

to individual dentists. Vital signs data was at practice level so IDH had developed its own software

that looked at individual clinicians. Since introducing this there had been a real change in dentist

behaviour following appraisal using this data.

With regard to clinical quality the profession was aware that standards needed to be raised. IDH was

using peer review groups and both internal and external courses for their staff and was working with

the Eastman Dental Hospital on these courses. It was also setting up an academy in 2012 with

functional surgeries, meeting rooms, a lecture theatre and phantom heads to raise the clinical

standards of their practitioners. All new starters would have their clinical skills assessed before they

started in practice.

He hoped that the future for LDCs would be one of sharing good practice and the networks that

were already established, because strong local representation would be important.

Helen Hirst, Department of Health

Helen Hirst introduced herself as part of the NHS

Commissioning Board development team responsible

for designing what the new commissioning structure

for dentistry would look like. Because the

Commissioning Board does not yet exist, she could not

pre-empt anything that might be in the Future Forum

report or the Government response at this time.

Helen was working in an inclusive process of

engagement with the entire profession including LDCs

and other dental professionals. She noted this was the

first time that primary care clinicians had been involved

in designing the system. Her ambition was that the

structure of the system would be designed correctly

and that it would be safe, agile, fair to patients and fair

to clinicians. Realistically, commissioning was not

steady state but the system must be able to keep up

with the expectations of clinicians and patients. It was

important in any national system that things that might

be done better locally still could be. She wanted to see

clinicians working to support commissioners locally but also working at a strategic planning level and

that everything that was brought to the table should be considered from the clinical perspective.

She advised that the idea and concept of the Local Professional Network (the LPN) was borne out of

engagement with the professions to create something locally that would talk to the local Health and

Wellbeing Boards and prevent professions working in isolation. This would also feed into the

provider skills networks and overall make the commissioning of dentistry much stronger.

The features of the system would be:

Single operating model

Stronger patient voice coming from local communities

National consistency with local sensitivity

Clinically driven with proper managerial support

Risk-based approach to contract management

Resources should be targeted at realising outcomes.

Particularly for LDCs, this was a complicated world. The local professional network was the place for

engagement with other professionals and which, in turn, was an avenue for professions to talk to

the Health and Wellbeing Boards and the local NHS commissioning staff. Without being prescriptive,

she hoped that the Consultants in Dental Public Health would be part of the Local Professional

Network. It was envisaged that the LPN would be the forum for a dialogue with the local community,

the acute care sector, the provider skills networks, the CQC and whatever other local organisations

existed in that area. She stated that it looked to be a vibrant and positive view forward for LDCs but

they were still proposals. No decisions had been made yet; work was continuing and refinements

still being made.

If a system gave power and influence to local networks, it was important to build in secondary

services. There was general concern about whether there was enough clinical leadership and enough

professionals who would want to be involved. She would look at this seriously and at ways to grow

clinical leaders.

She talked about the conflict of interest issue and, whether real or perceived, it was important to

address the concerns. She said that the commissioning consortia and LPNs would be required to

develop formal methods of governance and demonstrate how they would make appointments. She

closed by stressing that she would listen to everyone’s hopes and fears, but at a local level she urged

LDCs and practitioners to go back and start having conversations in their local communities.

John Milne, GDPC

John queried whether there were enough

clinical leaders and enough clinical engagement

by the dental profession. In 2010 he attended a

clinical leadership training programme

spanning two days and, following the success

of these, the Department of Health planned to

run out the workshops at SHA level and invite

people from all professions to attend. Many

dentists were reluctant to attend because

there was no reimbursement for attendance

and this would cause difficulties in missing UDA

targets and incurring financial losses. When this

problem was raised with the Department it was

clear that no payment would be available as

there was no budget. The message from the

profession was that if there was a national

drive for clinical leadership then it must be

properly resourced and practitioners should

not be disadvantaged in engaging with the

process.

The question of representation was vital and

John saw his role to promote the interests of

the profession first. At meetings he had heard criticism that LDC officials were male, pale and stale

and he noted that if LDCs were to represent the profession they needed to adapt and attract a wider

span of members. He closed by telling Conference that the fledgling Health and Wellbeing Boards

and GP Consortia did not know very much about dentistry, whilst the LDC members certainly did!

LDCs needed to ensure that they were indispensible in the local area, as they were the logical first

point of contact for local organisations. There were relationships to be built. John challenged LDCs to

go out and open discussions and begin making those relationships.

Debate

Vijay Sudra (Birmingham LDC) commented that many people wondered why the dental profession

was demoralised. He was sceptical about the transference of health responsibility to local authorities

particularly as many did not have a good track record for the use of resources. He agreed that

seeking patient experience data was important but was also concerned the dental profession was

being ignored and that the profession should be treated with respect and dignity.

Ian Haire (Wakefield LDC) stressed the importance of local representation but asked why it was

difficult to collect the LDC levy from IDH PDS practices and why they discouraged associates from

interacting with LDC?

Steve Williams replied that all new dentists on induction were given a presentation by the LDC and

advised to go to meetings and pay the levy but IDH could not force them to do so. IDH was setting

up peer review groups and clinical directors were contacting some LDC members in this room to

attend those peer review groups. He agreed that they needed more LDC support.

Eddie Crouch (Birmingham LDC): PDS contracts were fixed term and sensitive to local commissioning

and needs but required a high level of management at local level. How would these be managed by

a national body and would it mean there would be no more fixed-term contracts?

Helen Hirst responded that all contracts must be managed at the local level. The NHS Commissioning

Board would be in place before any new dental contract was introduced. Currently they were trying

to take different approach, looking at a risk-based approach to performance management. This

would not be a burden on the workforce as the monitoring and interaction would be done

electronically to make the system more efficient. The aim was to target the right resources in the

right place. Before the transference of contracts from PCTs the NHS Commissioning Board would

need to do some complex due diligence in preparation.

In response to a comment from Anthony Lipschitz (Bedforshire LDC) that the Government was more

concerned with consulting patients than dentists, David Rogers said that Local authorities and the

LGA had both reached out to various stakeholders and would continue to do so. He hoped that the

theme emerging from the Future Forum would be integrated care and mean that more engagement

was needed with all the healthcare professions.

Mike Warburton commented that putting clinicians in the lead was a central part of the government

reforms but they were also keen to have a strong patient voice. GPs had been hugely consulted but

less so other professions.

Mark Ter-Berg (Norfolk LDC) asked that the difference between Primary Medical Care, secondary

care and dentistry was recognised because in dentistry patients had the option to vote with their

feet, unlike in medicine. The PDS+ contract was over complex and was not considered a success.

Mike Warburton said that PDS+ was of its time. At that time all contracts were highly specified and

contained lots performance management. Today a similar contract would not be designed in the

same way. The KPIs were good however and the background work would move into the new

contract. PDS+ was a part of the dental access programme, which was a bigger project. Since the

programme began, more than two million additional patients had accessed NHS dentistry, and so it

was a successful programme.

Paul Kelly (Dorset LDC) asked whether the LGA was telling local authorities about the importance of

dentistry and how much knowledge LDCs had to give? He noted that recognition of dentistry by local

authorities had been sadly lacking to date but took on board the plea for clinical leadership and

asked whether there wass an open door? David Rogers said that as a membership organisation, the

LGA could lead and encourage local authorities to think about dentistry and to engage with the

dental profession locally.

Roger Levy (Enfield and Haringey LDC) was concerned about due diligence and what this would

mean for the profession. Would it be something on top of CQC meaning more work and which the

profession would have to pay extra for? Helen Hirst explained that due diligence was a technical

process that looked at risk assessment of contracts before they were transferred to the NHSCB and

that should not require anything from the profession. They were looking at risk because they did not

expect to be able to look closely at every single one of the 33000 contracts that would be

transferred. She reassured that this would not impact upon the profession unless someone

happened to have an illegal contract.

In response to a question about the constitution of Health and Wellbeing Boards, David Rogers

said the Bill was clear not to prescribe how each board should be set up in each location but the

response from the Future Forum might change this. In his view the set up and membership of the

board should be a matter for local determination.

Henrik Overgaard Nielsen (Hammersmith, Fulham and Ealing LDC pointed out that In the past LDCs

had had problems being heard by PCT and funding their activity and suggested that now was the

right time to look at the nature and funding of LDCs so this issue could be concluded.

Helen Hirst did not realise that LDCs did not have formal recognition until in she started working at

the DH as the PCT she had worked in had formally recognised the LDC. She advised that certain PCTs

did view it as formal. The establishment of local professional networks could not be considered

without looking at the role of LDCs within that framework and that was where the issue should be

explored. It would come to the table as part of that discussion.

Scott Aran (Hertfordshire LDC) referred to the 30 per cent of the pilot DQOF being based on patient

feedback, and asked what level should be based on clinical skills. Mike Warburton explained that ten

per cent of the contract value was quality and 30 per cent of that was patient feedback. The

remaining 10% covered clinical standards.

John Milne agreed that 7 per cent of the 10 per cent wass mostly based on clinical outcomes. It was

quite exciting but quite scary as well. The dental reference officer used to look at clinical treatment

of patients and some would like to see that return.

Phil Davenport (Birmingham LDC) asked about conflict of interest particularly as he had concerns

about corporates getting involved in the local professional networks. Where did the panel see

conflicts of interest occurring in dentistry?

Helen Hirst said that there had often been concerns expressed about perceived conflicts of interest,

for example where an OHAG member succeeded in getting a better contract. This needed to be

understood when establishing local professional networks and designing mechanisms for

appointments.

Phil Martin (Leicestershire LDC) raised the patient survey as part of the PDS+ contract, but felt that

the problem was that it used a very small sample size. Statisticians needed a sample size of 30 to

obtain meaningful result. Going forward, would the patient surveys be conducted on statistically

appropriate sample sizes to make them meaningful? Mike Warburton replied that the pilots were

looking at capturing between 100-200 responses. The aim was to try to capture feedback from all

patients.

Tony Lynn (Hampshire & Isle of Wight LDC) said that patient surveys covered decoration and the

friendliness of the receptionist. Patients often knew nothing about what was done in their mouth.

He would like to see patients of the future able to see and understand the quality of the clinical

dentistry in their mouths. He would like to see this supported with an IT dental strategy. How could

the profession consider entering this brave new world without empowering patient about clinical

quality?

John Milne felt that the electronic patient record would enable this vision. The travesty of the NHS IT

system is that was not in place as dentists should be able to give their patients that degree of

understanding.

In response to a question from Mick Armstrong , David Rogers explained that responsibility for

decisions on water fluoridation was to transfer to local authorities but the difficulty was that water

supply areas were not the same as local authority areas. There was lots of evidence pointing to the

benefits of fluoridation but patient fears pointed in the other direction.

Motions passed at LDC Conference 2011

CONTRACTUAL REFORMS

1. Barnet LDC (Alan Ross)

This Conference recognises that the current contract, including UDAs, is fundamentally flawed. This

Conference further notes the Government’s recognition of the failings of the current dental contract

and its intention to reform the contractual arrangements for NHS dentistry in England, but that this

will not happen before 2014 or 2015, depending on the pilots and transition period.

Conference therefore calls upon the Government to scrap the UDA immediately and return to the

old PDS system prior to the introduction of a properly piloted new contract.

2. North Yorkshire LDC (Richard Emms)

This Conference welcomes the new Government’s recognition of the failings of the UDA-based

contract and the overdue need for reform. Conference notes that the current pilots are exploring

capitation-based contractual systems.

Conference further notes the wide variation in UDA values across England and that the variation

does not necessarily reflect patient needs.

In order to prevent irreversible damage to practices and a subsequent reduction in the provision of

NHS dental services, particularly in areas of high need, Conference insists that the DH ensures that

no practice suffers a reduction in its current contract value as a result of the transition to a new

contractual arrangement.

3. Norfolk (Nick Stolls)

This Conference notes the requirement for digital charting of tooth-surface level data within the oral

healthcare pathways set out in the pilot contracts currently operating in England. It also notes the

necessity to record and report on patient cohort characteristics under the pilot agreements.

This Conference further notes the new online portal, currently being rolled-out by NHS Dental

Services and which provides a web-based account for providers and performers to monitor their

contractual performance and pay electronically, is further evidence of the move to digitise and

computerise NHS dentistry and NHS dental practices.

Conference therefore demands that all hardware, software and internet connection costs which

become technical pre-requisites for practices providing dental services under a new contractual

system must be met by the NHS with additional funding.

4. Birmingham (Dipesh Parmar)

This Conference demands GDPC ensure that, following the piloting of new contracts, advanced

mandatory services are clearly defined clinically and are unambiguous to general dental

practitioners when providing NHS dental treatments.

5. Birmingham (Vijayabhasker Somisetty)

This Conference notes the existing problems with the current dental contract.

Conference therefore demands that GDPC ensures any new contract makes provision for the

development of associate dentists, and has systems in place so that they are not exploited by the

contract and that any tendering exercise for new contracts does not preclude anyone who has yet to

run their own practice.

6. Birmingham (Dipesh Parmar)

This Conference insists that GDPC demand any new contract will have provision for adequate

additional capital investment that may be required to abide with any future new regulation and will

not be hampered by fixed contract values that take no account of such changes.

7. Birmingham (Phil Davenport)

This Conference demands GDPC insist on independent evaluation of new contract pilots after an

appropriate term of piloting.

8. Birmingham (Dave Cottam)

This Conference demands GDPC insist on a ballot of all performers of NHS contracts before any new

contract is implemented by the Department of Health.

REGULATION

9. North Yorkshire (Ian Gordon)

This conference believes that disproportionate regulation now interferes with what has been the

traditional professional relationship between dentist and patient.

GDC stated values allege that:

regulation is proportionate, targeted, consistent, transparent and accountable

resources are managed effectively, efficiently and sustainably

And CQC priorities are that they will:

regulate effectively, in partnership

be sensitive to the requirements that we put on those we regulate.

This conference calls for these and the other regulatory authorities to start to apply some

proportionality to their decisions and cease to pay mere lip service to their stated aims.

10. North Yorkshire (Ian Gordon)

This Conference calls for the patient charges regulations to be amended so that dentists can use high

quality non-precious metal alloy (NPMA) for the manufacture of in-lays and on-lays without fear of a

GDC referral for use of a regulatory inappropriate material, where it is clinically appropriate.

11. Birmingham (Vijay Sudra)

This Conference demands GDPC negotiate with CQC, a standardised practice inspection protocol and

for CQC to share this protocol with providers prior to practice inspections.

12. Salford LDC (Ben Atkins)

This Conference notes the confusion around the use of the title Doctor by dental practitioners and

the absence of a definitive decision by the GDC.

This Conference believes that changes like this not only confuse the general public needlessly but

also cause confusion within the dental community, since many dentists qualifying in Europe obtain

doctorates in dentistry and use the title ‘Doctor’.

This Conference therefore demands that the title ‘Doctor’ be retained by UK dentists, in order that

patients are not misled about a sudden change in our apparent professional status and that we

continue to use the title in line with our European colleagues.

13. Cumbria (Peter Pearson)

This Conference believes the restrictive transfer clauses within NHS dental contracts (sole trader

contracts) to be unfair as such clauses prevent practitioners from realising the goodwill from the sale

of their practices.

This Conference therefore insists that practice owners should be allowed to sell or change

ownership arrangements of practices, without the imposition of "control clauses" and interference

from the NHS.

This Conference calls for the GDPC to negotiate with the Department of Health the removal of such

clauses from future dental contracts.

14. Birmingham (Dave Cottam)

This Conference demands GDPC negotiate with the Department of Health changes to the regulations

which prevent PCTs or their successors terminating contracts of providers that have mitigating

circumstances for the late payment of GDC registration fees.

REGULATORY COSTS

15. Devon (Ben Jones)

This Conference supports dental nurse registration and training but deplores the additional burden

placed on trainee dental nurses by the GDC, when taking the national certificate. This Conference

notes that this burden was imposed without any consultation or funding to support it.

The Conference therefore demands that the GDC postpones enforcement of these changes to allow

for a proper consultation with the profession.

16. Cumbria (Martin Montgomery)

This Conference notes that the introduction of new regulations such as HTM 01 05 and CQC are

bringing practice morale to an all-time low. Conference further notes that, with NHS practices on

fixed budgets, any regulatory change must be cost-neutral, or practice owners will suffer real

financial hardship which will ultimately damage their ability to provide dental services to the public.

Conference therefore demands that additional funding is urgently provided directly to practices, to

cover the real and considerable costs associated with various regulatory changes to dental practice.

17. North Tyne (David Rundle)

This Conference notes the position of NHS dental practices as small and efficient NHS organisations.

Conference further notes that as providers of NHS services, all costs associated with complying with

the regulatory framework around dentistry should be met by the NHS, in order to allow practices to

focus on investing on the quality of their service for patients.

This Conference therefore insists that all annual CQC registration fees to for NHS dental practices

must be directly reimbursed in full by the NHS.

18. Wakefield (Jo Hendon)

This Conference believes that it is not appropriate to ask practitioners to bear the cost of increasing

expenses through "efficiency savings".

Increasing expenses should be reimbursed fully by DDRB awards.

19. Glasgow (Roy McBurnie)

This Conference demands that registered dental nurses employed in NHS dental practices, be

included in the NHS superannuation scheme.

INFORMATION FROM PCTs

20. Milton Keynes (Evean Chand)

This Conference notes the Government’s recent renewed emphasis on better information sharing

across the NHS. In addition to providing better information to patients, the Conference believes that

there is considerable value in providing more comprehensive information and NHS reporting to both

LDCs and individual providers to inform their performance management.

This Conference therefore calls for PCTs to openly share information with providers. The information

made available to LDCs and individual practices should include, but not be limited to:

PCT meetings and minutes

the local primary care dental budget

patient referrals to specialists

prescribing profiles

patient complaints

LDC OFFICIALS’ DAY

21. Gwent (Nigel Jones)

This Conference notes that the expenses for the BDA Officials Day (formerly known as the LDC

Secretaries Day) are shared by the BDA and Conference with Conference being responsible for the

reimbursement of the travel and accommodation expenses of one delegate per LDC. The ‘one

delegate rule’ is a relic from the Secretaries Day when only one delegate per LDC was invited.

This Conference recognises that as more than one official from each LDC is entitled to attend these

meetings, there is no need to restrict the expenses paid from Conference funds as before.

This Conference directs the Agenda Committee to reimburse the travel & accommodation expenses

of all LDC delegates attending the BDA Officials Day.

NHS REFORM AND THE ROLE FOR LDCs

22. Birmingham (Vijay Sudra)

This Conference notes the expert local knowledge of dental services that LDCs are in possession of.

Conference further notes that PCTs are in the process of being abolished.

Conference therefore demands that the NHS Commissioning Board consults with LDCs in any

regional structure that is developed, or directly if no such structure is present, to ensure that the

best local knowledge is available to commissioners and those with responsibility for commissioning

decisions.

23. East Midlands (Philip Martin)

This conference notes that the Health & Social Care Bill requires healthcare organisations to consult

“appropriate” healthcare professionals. Conference believes, as the democratically elected

representatives of the profession, Local Dental Committees must be consulted and calls on the

government to introduce a statutory requirement for LDCs to be recognised and consulted by

healthcare bodies, in respect of dental issues.

24. Birmingham (Eddie Crouch)

This Conference notes that the NHS Commissioning Board will be reliant on good local dental advice

in the absence of PCTs.

Conference therefore insists that anyone offering advice to the NHS Commissioning Board should

have no conflict of interest and, in the event of the NHS Commissioning Board having a regional

structure, any dental advisers should be acceptable to the dentists within the locality and have no

local conflict of interest that might undermine their ability to act and advise in an impartial manner.

25. Hampshire and Isle of Wight (Tony Lynn)

This Conference deplores any governmental/DH interpretation of the recent White Paper that

challenges the accepted statutory representative role of local dental committees.

This Conference recognises that LDCs are the only ‘in statute’ funded grass roots voice of salaried

and general dental practitioners that provide a comprehensive support and advisory service to their

constituents and primary care organisations. Furthermore it is recognised that LDCs are of

fundamental importance in the provision of supporting funding streams for the national

representation and health support of dentists through the British Dental Guild and other dentist

support organisations and charities.

This Conference therefore, urgently calls for the Department of Health to immediately re-affirm the

role for LDCs within the future commissioning of dental services.

26. Birmingham (Clive Harris)

This Conference deplores the perennial frustrations that some LDCs encounter in relation to the

collection and payment of the statutory LDC levy by PCTs. Conference notes the opportunity to

resolve such anomalies that presents itself at the introduction of the NHS Commissioning Board.

Conference therefore demands GDPC negotiate fair collection of statutory LDC levy by the NHS

Commissioning Board.

ADDITIONAL MOTION

27. Birmingham (Dave Cottam)

That conference requests that where necessary action is required by the GDPC to act on a motion

carried, a detailed written response including relevant dates, meetings, agendas and outcomes are

provided for the following conference.

That conference should also be allowed to discuss the GDPC responses.

John Milne, GDPC Chair, responded to this motion, agreeing that communications could be improved

and committing to improving the degree of explanation in responses to Conference motions. It was

also vital for GDPC members to be in regular contact with their LDCs so that they can be updated on

the progress of GDPC activities.

LDC Conference Election results

Chair Elect for Conference 2012 Richard Elvin

Honorary Treasurer of Conference Tim Harker

Two Honorary Auditors to the Conference Brett Sinson & Jonathan Randall

Conference Representative to the Agenda Committee Roy McBurnie

One Representative to the GDPC Roger Levy

Representative to the Board of Managers of the British Dental Guild Peter Hodgkinson

The Chair closed Conference by noting the pleasure he had got from chairing the Conference. He

thanked everyone for attending and playing their part in representing the profession. He then

invited Jim Lafferty (Chair Elect for Conference 2012) to say a few words about his Conference

planning.

The Chair Elect thanked Conference for the honour of chairing next years’ Conference. He spoke

about his plans to use his term of office to fight for increased funding for dental IT and to explore the

issues around the connectivity of dental practices.

Conference Chair, Mick Armstrong, hands the Chain of Office to the new Conference Chair for

2011/12, Jim Lafferty (pictured right)

Conference closed