General Dental Services
The HSCB dental pilot. Becoming a pilot practice
Wave 1 of a Northern Ireland pilot to test a potential capitation-based model for primary dental care started on 13 November 2014 and has paved the way for a larger intake of practices in Wave 2, commenced in August 2015, for a period of one year.
Michael Donaldson, Head of Dental Services, Health and Social Care Board (HSCB), has already written to all General Dental Practitioners to invite them to consider participating in Wave 2.
These pilots aim to test the efficacy of a new contract model.
The pilot will assess one possible way of delivering dental care and treatment in the future, along with an alternative remuneration system.
The perceived advantages would be that:
- income for dentists would become more predictable
- working arrangements for the dental team move away from an item of service model
- the new contractual arrangement encourages the provision of preventive care
- the HSCB budget would no longer be demand-led
Northern Ireland Ebola guidance for dental care teams
The recent Ebola case in Scotland has highlighted the risk to UK health care workers returning from West Africa.
Below is guidance that has been issued, by letter, to dental practices and explains the categorisation of those who have arrived in the UK from an Ebola affected area.
This includes a flowchart that should be followed should a returning UK health care worker seek dental treatment at your practice.
The Chief Medical Officer has issued the following documents to update clinicians and to reinforce the need to remain vigilant for any cases that may be imported into Northern Ireland.
Copies of these letters have been sent out to General Dental Practitioners with the October payment schedule, and have been cascaded to other dentists
Amendments to the Misuse of Drugs Legislation and Regulations and dental relevance to Tramadol
General Dental Practitioners will receive formal notification of changes to the Misuse of Drugs legislation coming into effect in June 2014.
Whilst several drugs are affected by the changes, from a dental perspective the only potential implication will be for any dentist who may decide that they believe that there is a clinical indication to prescribe Tramadol, one of the opioid analgesics, to a patient.
This narrative aims to explain the changes, the potential relevance for dentists, and to offer guidance in these respects.
Under the Misuse of Drugs Act 1971 (Ketamine etc) (Amendment) Order 2014 a number of drugs will be brought under the control of the Act as of 10 June 2014.
The key implication for dentists is that of a change in the classification of Tramadol, an opioid analgesic, which now becomes a Class C drug and there are implications should it be possessed or distributed inappropriately.
The Act allows for secondary legislation to be made in respect of drugs named therein to allow their use for medical purposes and to provide the correct controls to prevent diversion and misuse.
As such, amendments to the Misuse of Drugs Regulations come into effect Northern Ireland on 26 June 2014 (as made by the Misuse of Drugs (Amendment No. 2) and Misuse of Drugs (Safe Custody)(Amendment) Regulations (Northern Ireland) 2014)).
The key implication for dentists is that Tramadol is being added to ‘schedule 3’ of the Misuse of Drugs Regulations (Northern Ireland) 2002, which means that it becomes subject to the relevant controls, although it will be exempted from the statutory requirement for secure storage in the Misuse of Drugs (Safe Custody) (Northern Ireland) Regulations 1973.
Tramadol is not listed in the Dental Practitioners’ Formulary in the British National Formulary (BPF) and as such HSC (health service) prescriptions cannot be written for patients to receive this medication.
If the use of Tramadol was indicated the only mechanisms would be through a private prescription of a controlled drug using the PCD1 form or through a dentist maintaining a private stock.
It should be noted that there are other analgesics available, as listed in the Dental Practitioners’ Formulary in the British National Formulary (BPF), and as such HSC prescriptions can be written.
The potential for misuse and diversion of Tramadol, or other opioid analgesics, should always be borne in mind.
Whilst dentists are appropriate practitioners under the Human Medicines Regulations 2012 for any Prescription Only Medicine and may lawfully order any medicine for a private patient through a private prescription, they should consider whether Tramadol is really indicated.
GDC standards 7.1 “Provide good quality care based on current evidence and authoritative guidance “ and 7.3 “Update and develop your professional knowledge and skills throughout your working life” would appear to be relevant GDC Standards for the Dental Team 2013 and additional GDC general guidance on prescribing medicines.
Standard 8 of the Northern Ireland Minimum Standards for Dental Care and Treatment 2011 would also be relevant “Your care and treatment is provided according to recognised current best practice and Guidelines”.
Dentists may find the BNF guidance on prescribing in dental practice useful when considering which analgesic to prescribe, and especially in this case the link to the ‘Dental and orofacial pain’ section.
Dentists may also find the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance Drug Prescribing For Dentistry Dental Clinical Guidance Second edition published in August 2011, useful, particularly Chapter 7 on Odontogenic pain and Chapter 8 on Facial pain.
Please find below links to a copy of HSS(MD) 16/2014, the DHSSPS letter of 16 June 2014 from the Chief Professional Officers, and a copy of a FAQs document for dental practitioners on changes to the Controlled Drugs legislation produced by the HSCB in conjunction with DHSSPS.
These documents provide further detail and the latter copy offers references for further information and a route to communicate any queries relating to the Controlled Drugs legislation changes.
List of HSC Occupational Health Services
These services are operated by the individual Health and Social Care Trusts.
The list is a compilation of their information and is included here for ease of reference.
- OHS - Belfast Trust
- OHS - Southern Trust
- OHS - South Eastern Trust
- OHS - Northern Trust
- OHS - Western Trust
Management of Sharps Incidents in dental practices & GP practices
The Regional Governance Group of the Occupational Health Service (OHS) has produced a guide to the Management of Sharps Incidents in Dental Practices & GP Practices.
OHS recommends that practices print this guide and display it prominently so that staff can refer to it.
If you have any queries, please contact your local OHS on the number shown in the contact guides above.
CDO letter to dentists regarding oral cancer
The Acting CDO wrote to all general dental practitioners regarding the success of the British Dental Health Foundation's (BDHF) Mouth Cancer Action Month and the importance of raising public awareness of oral cancer and the risk factors associated with this disease.
Mouth Cancer Action Month website
HSCB regional referral guidelines for Oral Medicine
NIMDTA CPD on Oral Medicine/ Oral Cancer
dentalcare.co.uk oral cancer course
Smile-on Healthcare Learning oral cancer programme
BSOM/CRUK joint statement on mouth cancer
The British Society for Oral Medicine (BSOM) and Cancer Research UK (CRUK) have co-ordinated the release of a joint statement on mouth cancer diagnosis and prevention.
The British Dental Health Foundation's Mouth Cancer Action Month is being held in November this year (2013).
The release of the joint statement coincides with the Foundation’s campaign to raise public awareness of dental and oral health and promoting good dental health practices.
More than 6,500 people in the UK will be diagnosed with oral cancer this year and that without early detection half will die.
These numbers have increased by almost 50 per cent in the last decade and more people died from mouth cancer in 2010 than from cervical and testicular cancer combined.
The most recent available data from the Northern Ireland Cancer Registry shows that 216 new cases of oral cancer were diagnosed here in 2011, an increase in the average annual number of cases, from 191 since 2007.
If oral cancer is diagnosed early, by a dentist or health professional, then the chances of a survival are good.
However many people with oral cancer only go to their dentist or doctor at too late a stage.
Prevention messages for the public are to:
- visit their dentist regularly
- watch for any changes in the mouth that don’t resolve
- reduce smoking and drinking
- reduce the chances of contracting HPV by practicing safe sex
- use sun-block cream on lips in hot weather
- eat a healthy diet, rich in the protective vitamins A, C and E
Oral Medicine Referral Guidelines
The HSCB has developed regional referral guidelines for Oral Medicine.
These were issued to the dental and medical professions in early October 2013.
The full referral guideline package can be downloaded from the BSO website (the page also contains information on referrals to HSC Trust Consultant Orthodontic Services).
The need for referral criteria and referral pathways for Oral Medicine was highlighted in the recommendations of the Dental Hospital Inquiry Report (July 2013) and the Regional Review of Consultant of Consultant-led Hospital Dental Services consultation document (July 2012).
The development and dissemination of these guidelines is also a key action from the DHSSPS Action Plan in Response to the Dental Hospital Inquiry (July 2013).
In addition, the Action Plan– highlights the need for training dental practitioners on the prioritisation of referrals and referral pathways, and on the management of simple oral medicine conditions.
The GDC guidance on CPD for dental professionals lists Oral Cancer: Early Detection as a recommended (verifiable or general) CPD topic.
NIMDTA has scheduled a number of CPD events on both Oral Medicine and the early detection of Oral Cancer in their Dental Course Programme (September 2013 –March 2014).
Additional CPD resources on this topic are also available from other providers.
If you have any queries about the Oral Medicine Referral Guidelines please contact Donncha O’Carolan, Regional Lead for Hospital, Community and Public Health Dentistry (HSCB).
Decontamination in General Dental Practices - PEL (13) 13
Health Estates Investment Group (HEIG) issued Professional Estates Letter (PEL) (13) 13 on 1 October 2013 advising General Dental Practitioners of the 2013 update to HTM 01-05 and the specific policy amendments to the guidance that apply to Northern Ireland.
PEL (13) 13 replaces PEL (12) 23 which is now withdrawn.
Health and Safety (Sharp Instruments in Healthcare) Regulations
The Health and Safety (Sharp Instruments in Healthcare) Regulations (Northern Ireland) came into effect on 11 May 2013.
The Regulations build on existing legislation and place specific duties on healthcare employers and contractors to protect employees from injuries caused by medical sharps.
The regulations were proposed by the Health and Safety Executive to implement the European Council Directive 2010/32/EU on the prevention of sharps injuries in the hospital and healthcare sectors.
A public consultation was held from 8 August 2012 to 8 November 2012.
The Regulations require the use of safer sharps (incorporating protection mechanisms) where it is reasonably practicable to do so.
Needles must not be recapped after use unless the employer’s risk assessment has identified that recapping is itself required to prevent a risk (e.g. to reduce the risk of contamination of sterile preparations).
In such limited cases, appropriate devices (for example needle blocks) to control the risk of injury to employees must be provided.
The regulations require an employer to provide information and training, developed in co-operation with representatives, to employees at risk of injury caused by medical sharps.
The regulations also require an employer to record, investigate and take measures to prevent the recurrence of an injury to an employee caused by a medical sharp, where notified.
Employers must also take immediate steps to ensure that employees who may have been exposed to a biological agent as a result of such an injury receive medical attention and treatment, and must consider providing the employee with counselling.
The regulations require employees to notify any incident at work which results in that employee suffering an injury from a medical sharp to their employer or person responsible for health and safety.
The link below will take you to a copy of the letter issued by DHSSPSNI and includes information from the Health and Safety Executive Northern Ireland and a link to the legislation itself.
Should you require any further information on the new regulations you are asked to please contact the Health and Safety Executive for Northern Ireland
Guidance on the use of Midazolam in sedation