1 “Working together to improve oral health”

NEWSLETTER

LOCAL DENTAL NETWORK—SHROPSHIRE AND STAFFORDSHIRE

Issue – 15 November 2016

Visit our website— http://www.england.nhs.uk/mids-east/lpns/shrop-staffs-dental/

Editorial

As another year comes to an end and a very busy year for the LDN as well, it is time to reflect on what has happened in the last 12 months. The work plans for the LDN continue to bear fruit with important initiatives on domestic violence providing valuable guidance for practitioners as well as the perennial drive to improve oral health with initiatives on smoking cessation and reducing excessive alcohol consumption. All the members of the network have been integral to the successful implementation of these initiatives and without their input many of these could not have happened. Special mention goes to Mark Dermont (Spr in Dental Public Health) who has come to the end of his training and will shortly be leaving the group to return to duties within the armed forces. He was integral to the development of the domestic violence and oral health work stream this year.

Commissioning of future dental services with the development of the D Strat document has also taken up a lot of the time of members of the network. It is hoped that with the development of this strategy document, the rather unwieldy commissioning guides will be easier to implement. There is still plenty of work still to do with dental commissioning in the coming months and years, but it is hoped that this task has been made somewhat easier. This work had led onto the realisation that an electronic referral management system is essential for this region and it is hoped that this will be procured and instigated very soon.

Dental contract reform, after having gone a bit quiet for a while, has resurfaced with more work being done to develop a workable system that can be implemented and then rolled out in stages across England (see page 21-22).

The LDN in Shropshire and Staffordshire continues to work tirelessly to improve the dental experience of the population that it serves. This cannot happen without the efforts of its members and the hard work of the individual dental practitioners in all their various specialties across the region. It is only by working together as a unified group that real change can happen.

May I take this opportunity to wish you all a very merry Christmas and a very prosperous new year.

"Try not. Do - or do not. There is no try."

Master Yoda - Star Wars Episode V: The Empire Strikes Back

2 “Working together to improve oral health”

Inside this issue NHS email addresses for dentists - UPDATED 3 Dental courses 4 Employment opportunities 5 Previous issues of the LDN Newsletter 5 Shropshire oral surgery MCN blog 6-9 Christmas and New Year arrangements 10 Management of controlled drugs 11 Smoking Cessation – Plain packaging 12-14 Shrewsbury BDA – Course 15

– What to look for, when to refer? Extended duties for Dental Nurses 16

- Application of Fluoride - Impression taking

Extended duties for Dental Nurses 17

- Sedation Stoke and Stafford BDA – Course 18

– Short term orthodontics NHS Choices – Keeping up to date 19-20 Dental Contract Reform News 21-22 Mouth Cancer Action Month 23 LPN contact list 24

3 “Working together to improve oral health”

NHS.net email accounts for dentists

Over the past few months there have been numerous requests from local dentists for NHS email accounts. This follows our initiative earlier this year to get as many dentists as possible to use this service. NHSmail can be used by Pharmacists, Optometrists or Dentists (PODs) to safely and securely exchange patient or sensitive information with other health and social care organisations. NHSmail has been upgraded to allow PODs to quickly and easily register and activate an account, so read through all the information below and then follow the steps to get started.

To register for an NHSmail account

1. Fill in the application form which is available by clicking on the link and then pressing the “Registering Pharmacists,

Optometrists and Dentists” tab. Once complete, email the form to Chris Riley. His email is chris.riley4@nhs.net

2. Chris will then review your request. Make sure he has all the information he needs so that he can pass it to the

appropriate NHSmail Local Organisation Administrator (LOA) to set up the account.

3. If you aren't eligible for an account they will let you know. You may not be eligible for an account if you only need to

exchange patient or sensitive information on an infrequent or adhoc basis with health and social care organisations, or

if you already use another email service that is publicly funded.

4. Before you are registered you will need to have completed the Information Governance toolkit. If you are registering

as part of a Practice, only one person per Practice needs to do this. If you are registering as part of a group of

practices, only one nominated headquarters needs to do this. This is an accreditation that is required for access to any

NHS national service to ensure that these services remain secure. Please see: http://www.igt.hscic.gov.uk

5. Your LOA will contact you with details of your new account and how to activate it. The LOA will text you a security

code and then call you with your account details. Once you have confirmed the security code you have received, they

will give you your username and a password which you will need to change the first time you log in.

6. If you have registered several accounts for your Practice, the LOA can allocate administrator rights to one or more

of them if required – this will allow that account holder to unlock accounts and reset passwords.

7. Once you have activated your account and logged in you will find a welcome email providing the following information: · How to keep the account secure · Account quota details · Your LOA contact details for ongoing administrative support · Where to find help and guidance

You can set up a shared account for your practice or site if you need to. The email address will always end @nhs.net

but you can specify the part of the email address before the @ sign.

As an example, the email address for John Smith of High Street dental practice could be John.Smith@nhs.net with the

display name (the name displayed to the recipient in their inbox) 'Smith John (High Street Dental Practice)'. A shared

email account for that dental practice could be highstreetdentalpractice@nhs.net (High Street Dental Practice).

4 “Working together to improve oral health”

Upcoming dental courses

Stafford—

29th Nov— Medical & Dental Emergencies

11th Jan 2017 – Endodontic Masterclass

Stoke—

11th Jan 2017 – Presentation of Head and Neck Cancer in Primary Care

8th Feb 2017 — Clinical Governance and Audit for the Dental Team

Telford—

23rd Nov— Medical Emergencies

5th Dec— “Ouch, I’m still not numb yet!” - Overcoming anaesthetic failures

5th Jan 2017 – TMJ

26th Jan 2017 - Facial Pain and update on Oral Surgery referrals

9th Feb 2017 – Infection Control Part 1

Shrewsbury —

18th Nov— Fibredontics

4th Jan – Ethical Fingerprints

9th Feb – Endodontic Update for the GDP

Burton—

29th Nov— Safeguarding Children

7th Feb 2017 – Medical Emergencies

PLEASE PRESS THE CTRL KEY AND CLICK THE LEFT MOUSE BUTTON TO GO TO THE

RELEVANT WEBPAGE.

5 “Working together to improve oral health”

Employment opportunities in Staffordshire and Shropshire

Throughout the year across the region several job opportunities arise and providers are finding it

increasingly difficult to recruit new performers. The local LDCs collate information about job opportunities

and can advise performers and providers alike on future career decisions. If there are any providers that

have vacancies or performers that are looking for employment, it would be advisable for them to contact

their respective LDCs for more information. Please see contact information below,

South Staffs LDC—Secretary—Adam Morby— secretary@southstaffsldc.com

North Staffs LDC—Secretary— Allan McCullloch / Clare Banks— ldcsecretary@yahoo.com

Shropshire LDC—Secretary— Rob Riley— secretary@shropshireldc.org

Previous issues of the Local Dental Network newsletters

All previous issues of the LDN newsletters can now be accessed from the South Staffs LDC website. Please see link below, http://southstaffsldc.com/South_Staffs_LDC/LPN.html

6 “Working together to improve oral health”

Shropshire Oral Surgery Managed Clinical Network - Blog

By Rajashree Sreenivasan (Specialist in oral surgery)

We recently had the third Shropshire oral surgery MCN meeting at Princess Royal Hospital (Telford).

A platform for all dentists to meet and an opportunity to discuss oral surgery case management

Since the inception of the oral surgery MCN, we have streamlined the referral criteria. Now we have regular audits of

referrals, and different cases treated by minor oral surgery providers.

We would like to encourage, GDP’s to attend and use this platform to discuss what they are expecting from this

service and discuss any cases they have had concerns or questions about.

Mr. Sunil Bhatia (consultant maxfac surgeon), is the chair of the MCN and it was noted that hospital TMJ referrals

were increasing significantly. .

The MCN is arranging a meeting for facial pain to discuss about the management of TMJ dysfunction and at the same

time airing the thoughts of the local GDP ‘s.

Since the inception of the minor oral surgery pilot scheme, it has encouraged GDP’s to refer patients directly to the

MOS providers.

At the hospital, all referrals are triaged and referrals that are not appropriate for hospital are now sent back to the

referring dentist.

The estimate is that in the month of May 2016 about 55 cases were referred back to GDP’s, with recommendations

to refer it to the minor oral surgery service.

NHS England has organised performance management of the minor oral surgery providers and NHS England will

ensure the referral criteria are met.

NHS England has flagged that the dental corporates have in house training and they do not usually attend external

meetings. The MCN will try to involve the corporates to send some dentists to the meetings and not just for oral

surgery but other MCN’s as well.

MOS providers presented interesting cases. Rajashree presented a case of concrescence at the last meet and

Sukvinder presented a case of impacted canine removal.

TREATMENT PLAN XLA LR3 – see photos

7 “Working together to improve oral health”

Concrescence – see photos

8 “Working together to improve oral health”

Dental cysts were discussed and cases of removal of cysts were presented - see photos

9 “Working together to improve oral health”

10 “Working together to improve oral health”

11 “Working together to improve oral health”

12 “Working together to improve oral health”

Plain tobacco packaging has arrived!

Let’s seize this chance and encourage our patients to quit

By Vicky Massey (Spr in dental public health)

Recently, the UK introduced standardised packaging of tobacco products. Standard packs are

designed to prevent uptake of smoking but they can also have a positive impact on quit rates. The

roll out of standard packs presents a great opportunity for dental teams to support patients that

smoke, to quit.

What does a standard pack look like?

What is the evidence standardised packaging prevents uptake of smoking?

1. The Stirling Review

-a systematic review of

many experimental

studies.

2. An independent review

of Standardised packaging

of tobacco undertaken by

Sir Cyril Chantler on behalf

of the UK government.

3. Real world data on Tobacco plain packaging from Australia (they introduced standard packs in December 2012).

13 “Working together to improve oral health”

What is the evidence standardised packaging has an impact on quit rate?

What can we do?

Although it is decreasing, a large proportion of our local adult population smoke:

Local Authority %age 2015

Stoke-on-Trent LA 18.8

Staffordshire 13.6

Telford and Wrekin 18.2

Shropshire 14.6

England 16.9

Currently, 2 out of 3 adult smokers say they want to quit and that proportion is set to increase over

the coming months. The dental team needs to be ready to make the most of this opportunity to

boost quitting rates in their areas. Don’t underestimate your potential impact. Prompts from

health professionals are the second most common reason for a quit attempt.

So, dental teams -

This is a chance to remind your patients about the health

benefits of quitting:

1. There was a 78%

increase in calls to the

smoking cessation

Quitline in New South

Wales, when standard

packs were introduced in

Australia. This peak

occurred 4 weeks after

the initial appearance of

standard packs and the

effect has been

prolonged.

Association between tobacco

plain packaging and Quitline

calls: a population-based,

interrupted time-series analysis.

2. Compared with

smokers smoking from

branded packs, smokers

who were smoking from

standard packs were more

likely to see their tobacco

as being lower in quality,

and they felt smoking

offered less satisfaction.

Importantly, they were

also more likely to think

about, and prioritise,

quitting.

Introduction effects of the

Australian plain packaging policy

on adult smokers: a cross-

sectional study

3. A review of

Standardised packaging of

tobacco products carried

out by the Irish

Department of Health

concluded that

standardised packing

could encourage,

motivate and support

current smokers to quit.

14 “Working together to improve oral health”

Ask every patient about smoking and encourage quitting. Provide Very Brief Advice (VBA):

ASK and record smoking status; is the patient a smoker, ex-smoker, or non-smoker?

ADVISE on the best way of quitting; the best way of stopping smoking is with a combination of medication and specialist support

ACT on patient response; build confidence, give information and refer.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367563/DBO

Hv32014OCTMainDocument_3.pdf (P.52)

Have your local stop smoking team’s number readily available in the surgery and on

reception.

Staffordshire: Tel: 0300 111 8006 or

E-mail: wellbeing.services@staffordshire.gov.uk

Stoke on Trent and Telford and Wrekin:

Tel: 0800 622 6968

Text: smokefree to 66777

Shropshire: Tel: 0345 6789 025

Local stop smoking services offer the best chance of success. A combination of behavioural and

pharmacological support is up to 4 times more effective than no help or over the counter nicotine

replacement therapy (NRT).

15 “Working together to improve oral health”

16 “Working together to improve oral health”

17 “Working together to improve oral health”

18 “Working together to improve oral health”

19 “Working together to improve oral health”

NHS CHOICES – KEEPING UP TO DATE

It is the responsibility of each individual contractor to keep their information up to date on NHS Choices and

practices should all have or will need to have a log-in to use the system.

Please see screen shots below, which I hope you will find useful on where to go on their website

(www.nhs.uk) to log-in, register or contact NHS Choices if you are having problems. The telephone number

for the NHS Choices service desk is 08454 023089 and their email address is

servicedesk@nhschoices.nhs.uk.

It is important to keep your information as up to date as possible as the website links into other NHS

databases and can cause problems when the information is out of date.

The Primary Care team do not have any access rights to NHS Choices and cannot make any amendments or

updates to the information displayed for practices. Please contact NHS Choices directly via one of the

options shown above.

Primary Care Team - NHS England, North Midlands

Anglesey House, Towers Business Park, Wheelhouse Road, Rugeley, Staffordshire, WS15 1UL

20 “Working together to improve oral health”

21 “Working together to improve oral health”

Dental Contract Reform News November 2016-January 2017

Welcome to the first Issue of the re-launched Dental Contract Reform (DCR) News which aims to

keep the wider dental community up to date with progress on contract reform.

The pilot practices began testing variations of a potential new contract model in April 2011. They

were testing a prevention based clinical pathway which included offering patient’s advice on diet

and good oral hygiene at an oral health assessment and follow up appointments where necessary,

to reinforce preventative messages or provide treatment such as fluoride varnish to support to

patients with self-care.

The learning from the pilots can be found here:

https://www.gov.uk/government/publications/dental-contract-pilots-evidence-and-

learning

Following the evaluation reports, and

wide engagement with the dental

profession in 2014, the Government

set out in January 2015 a possible

new system and its intention to

prototype that new system before any

decision being taken to roll out

nationally:

https://www.gov.uk/government/public

ations/dental-reform-next

The programme has therefore now

moved to a new stage of testing with

79 high street dental practices and 3

community dental services, known as

‘prototypes’, continuing to refine the

clinical pathway. The pathway will

continue to evolve over time as it

reflects up to date evidence and

guidance.

A full list of prototypes can be found here: https://www.gov.uk/government/publications/dental-prototype-agreements-directions-and-patient-information

Further information about the clinical philosophy can be found at: http://www.pcc-cic.org.uk/article/clinical-philosophy

The principles behind the dental contract reform programme align with the direction of travel for the NHS, set out in the Five Year Forward View, which emphasises the need to:

focus on prevention

empower patients to take control of their own health, and

make the most efficient use of NHS resources. The Five Year Forward View can be found here:

22 “Working together to improve oral health”

https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf The difference between the pilots and the new prototypes is that the pilots were

explicitly not testing a possible new remuneration system. The intention of piloting

was in fact to gather the evidence to design a new system of remuneration.

The 79 high street prototype practices are testing a possible new remuneration

system – the so called blended approach which mixes capitation and activity. Two

possible proportions (Blend A and Blend B) are being tested to capture evidence on

the best balance of incentives to prevent and treat periodontal disease and caries,

where present. Both blends have the majority of funding linked to capitation

payments. Together with the clinical pathway, this is now a test of a whole possible

new system.

For further information on the remuneration blends being tested please visit:

http://www.pcc-cic.org.uk/article/remuneration

An evidence and learning group has been established, which includes clinical and stakeholder representation, to oversee the evaluation of the prototypes. An initial evaluation is expected early in 2017. If the evaluation shows that the prototypes are delivering across a number of measures, implementation could begin nationally from 2018/19. These measures are as follows;

delivery of appropriate high quality care,

maintaining or increasing access,

delivering within the existing budget

working for patients, commissioners, dentists and businesses

The next Issue of DCR News will cover the broad areas being considered in the evaluation of the prototype system. In the meantime for further information about the prototype scheme please visit www.pcc-cic.org.uk/resources/dental-contract-reform.

“Working together to improve oral health”

23

“Working together to improve oral health”

24

Please share this newsletter with all members of the dental team. The purpose of

the newsletter is to be as inclusive as possible and to be an easy way to

communicate important information out to all dental stakeholders in Shropshire

and Staffordshire.

If you have anything that you would like to include in future newsletters, please

send it to Joanne Athersmith at jo.athersmith@nhs.net. If you know anybody

that has been missed off the mailing list or would like to add someone to the

mailing list, then please can you also contact Jo on the email address above.

LPN member contact details

Community Dental Services officer – Richard Beck

richard.beck@ssotp.nhs.uk

Local Dental Committee representative—Adam Morby

secretary@southstaffsldc.com

Primary care orthodontic GDP – Graeme Manzie / Philip Barton

graeme.manzie@yahoo.com

philipbartonorthodontics@talktalkbusiness.net

2 GDP representatives—Harj Basra / Kaushik Paul

harj123@aol.com

kaushik_paul@hotmail.com

Dental Care Professional representative—Helen Griffiths

oswynhouse@hotmail.com

Health Education England representative – Jane Davies-Slowik

Jane.Davies-Slowik@wm.hee.nhs.uk

Admin and secretarial

Joanne Athersmith jo.athersmith@nhs.net

Lucy Jones lucy.jones17@nhs.net

Chair – Nadeem Ahmed (Tony)

nadeem.ahmed9@nhs.net

Consultant in DPH – Kate Taylor- Weetman

kate.taylor-weetman@nhs.net

GDPA – Frank Hollinshead

frank.hollinshead@nhs.net

Primary Care Lead and deputy chair— Darrell Jackson

darrell.jackson1@nhs.net

Patient representative – Healthwatch Staffordshire

Jackie Owen— jackie.owen@ecstaffs.co.uk

Orthodontic Consultant in secondary care – John Scholey

john.scholey@uhns.nhs.uk

Maxillofacial Consultant in secondary care—Tim Malins

Timothy.Malins@uhns.nhs.uk

Restorative consultant in secondary care –

David Newsum / Stephen Brindley

d_newsum@hotmail.com

stephen.brindley@uhns.nhs.uk