Newsletter Feb 2017

Herts Local Dental Committee Newsletter Issue 10 Feb 2017

In this issue...
Help spread the word
Healthwatch Hertfordshire – Access to Dental Services Enter and View programme
Easy IOTN app
What has your LDC ever done for you?
Is my Patient Eligible for NHS Orthodontic Treatment?
Dose change for METRONIDAZOLE
Safer sharps survey
Update to FAQs for NHSE
A message from Jason Wong -Local Dental Network Chair
Managing dental services
News about sugar and tobacco
New toolkit lets dentists build on antibiotic prescribing success
Figures show morale crisis threatens future of NHS dentistry
The Good Practitioners guide to periodontology.
Local Professional Networks 
Reports of meetings attended by Herts LDC

I need your help

Hertfordshire Local Dental Committee is keen to keep members informed of local developments via this regular newsletter and email updates. All Herts General Dental Practitioners are LDC members because they pay a monthly levy deducted from their pay.

We would be grateful if you could help us by forwarding this newsletter to any Herts dentists you know so they can reply to the secretary ( to be added to our circulation list.

Even if you think they're already listed please forward this newsletter; they won't be added more than once.

Peter Tatton

Herts LDC Secretary

Available here- Healthwatch statement for dental complaints- A very handy leaflet to give to patients advising them what to do if they have a complaint about dental treatment.

Herts LDC Update (26th January 2017)

Healthwatch Hertfordshire – Access to Dental Services Enter and View programme

Legislation allows HwH authorised representatives to ‘Enter and View’ health and social care premises to see and hear for themselves how services are provided.Their first visits will start in mid-February to randomly selected dental practices in the Welwyn and Hatfield area (six in total). They will then review the process before choosing another district.

They describe the organisation as:

Healthwatch Hertfordshire (HwH) is the independent health and social care champion. Local Healthwatch is in place to gather the views and experiences of people accessing services, to use this information to influence decisions and to provide information and advice to the local community about health and social care services.

Read More

The British Orthodontic Society (BOS) has launched an app called 'Easy IOTN' for dental professionals and students that aids Index of Treatment Need (IOTN) classification. The resource has been developed to help improve the standard and accuracy of orthodontic referrals as well as support and inform the training of undergraduates and foundation dentists.

The new app, named Easy IOTN, guides the user to the correct classification via the quickest possible route, using simple clinical features. Traditionally, IOTN is recognised as potentially complex which has led to it being applied incorrectly. With increased emphasis on reducing referrals for those patients who do not qualify for NHS treatment, the timing of this product launch is ideal. Also included in the app is a CPD and training section which will provide one hour of verifiable CPD for the user.

The app can be downloaded now for free through the Apple app store and will be available for Android phones in the New Year.

What has your LDC ever done for you?

LDCs are the trusted voice of local dentists and work tirelessly as the link between NHS England  Area Teams and NHS dentists. Your LDC attends many meetings on your behalf to ensure that those who decide how NHS dentistry is managed in our area listen to the voice of working dentists.

LDCs are also a source of advice and support to local dentists from those who have knowledge and experience  and is keen to keep members informed of local developments. LDCs are democratic bodies, comprising dentists elected by dentists.

If you want to find out more about the work of your LDC you can read reports of all  meetings  attended on your behalf on the Herts LDC website at

Below is an extract taken from the British Orthodontic Society website

Eligibility for free-of-charge NHS orthodontic treatment is based on the severity of the malocclusion measured using the Index of Orthodontic Treatment Need (IOTN), and on the age of the patient.

The severity of the malocclusion is measured using IOTN. This is a rating system consisting of 5 grades, ranging from ‘no need for treatment’ to ‘severe need for treatment’. In order to accurately grade a malocclusion using IOTN the clinician should be trained and calibrated to use the Index.

Not all dentists making referrals are calibrated to use IOTN so an orthodontic referral guide has been developed, to make the referral process easier for dentists not familiar with IOTN. This form can be laminated and kept in the surgery as a handy guide.

You can download your copy of the BOS referral guide here

Most orthodontists working in primary care can only provide orthodontic treatment for patients under the age of 18. Patients over 18 with severe malocclusions may be eligible for orthodontic treatment in the Hospital Orthodontic Service (secondary care).

If you are not sure whether your patient is eligible for NHS orthodontic treatment you should make the referral and the orthodontist will make the final assessment.

Also a Quick Reference Guide to Orthodontic Assessment and Treatment available here

The dose of Metronidazole recommended for treatment of oral infections has been increased to 400 mg three times a day for up to five days, with review at three days. This dose increase follows advice from Public Health England (PHE). Doses for children have also increased.

Dentists will also be aware that in 2014 the dose of Amoxicillin for oral infections was increased to 500mg three times a day for up to five days, with review at three days, for all adults and children aged over 5 years old. This dose recommendation has been included in the BNF since September 2014 (BNF 68). It is essential that dentists are aware of antibiotic dose changes and prescribe in accordance with recognised guidelines to help limit further antibiotic resistance.

The following amendments have been made to the online version of Antimicrobial Prescribing For General Dental Practitioners and are available here



Metronidazole 400mg three times daily for up to five days, review after 2-3 days and discontinue if resolved


  • 1-3 years: 100mg three times daily for up to five days, review after 2-3 days and discontinue if resolved
  • 3-7 years: 200mg twice daily for up to five days,  review after 2-3 days and discontinue if resolved
  • 7-10 years: 200mg three times daily for up to five days, review after 2-3 days and discontinue if resolved
  • Over 10 years: 400mg three times daily for up to five days, review after 2-3 days and discontinue if resolved
The Health and Safety Executive (HSE) is carrying out a post-implementation review (PIR)* of the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (known colloquially as “the Sharps Regulations”).

As part of the review, the HSE is seeking dentists’ views on:

  • whether the requirements of the regulations are clear;
  • whether they work in practice; and
  • whether any issues have been encountered.

The survey takes between 10 and 20 minutes to complete - all responses will be treated as strictly confidential and will remain anonymous when the data is analysed.

We would urge you to participate in it, as it provides a good opportunity for the profession to feedback on what did or did not work and which aspects continue to annoy!

The BDA News article, written to accompany the 2013 implementation, is attached  here for your reference.

* A PIR is a statutory requirement and is designed to evaluate the effectiveness of the regulations once they have come into force.

Best wishes,
Tom King
Policy Adviser
020 7563 4579

British Dental Association

If you have a question for NHSE, to save you time on the phone the team have compiled a resource which answers all of the most frequently asked questions. So if you have a question refer first to the very handy information sheet here ,it covers;

  • Interpreting & translation services
  • Complaints
  • Whistle-blower Policy Contact for Practice Policies
  • Dealing with violent Patients
  • Time limits for claims-Training and travel expenses, business rates,UDAs
  • Adding a Performer to a Contract
  • I would like an NHS mail account
  • Request to relocate a practice to new premises
  • Contacts for out of area MOS referrals
  • Incorporation
  • Request for additional activity
  • Orthodontic transfers
  • Replacement dentures process
  • Travel/subsistence expenses
  • Superannuation declarations
  • Contract in year reduction requests
  • Contractors viewing activity actuals on Compass
  • Query - are we procuring any new NHS GDS Contracts
  • ARR issues
  • Orthodontic Contracts not carrying forward 2%
  • Orthodontic Claims – Over 18s 
  • Patient records,(including terminated contracts)
Click here for Issue 2 of Dental Contract Reform (DCR) News from NHSE - a quarterly publication which aims to keep the dental community up to date with developments surrounding the Dental Contract Reform programme.

Dear Colleagues,

I want to write and encourage you and your teams to attend the education and engagement events that are happening in your local area; the information is attached here.

23rd February – Hertfordshire and Bedfordshire

9th March – Northamptonshire and Milton Keynes

Whilst I realise the notice period is not as long as it could ideally have been we are hoping that this event will allow NHS England to support practices. Regardless of where you work within the Herts and South Mids region, please pick the date and location that suits you best.

These events are not only for the Dentists in your team and it is likely that your clinical staff and also practice managers will gain from the information and discussions that we are planning. There will be opportunity for shared learning and some free resource will be distributed on the day for the delegates.

I hope that members of your team will access this event which will also provide 6 hours of free CPD.

Please respond to the LDN Central Midlands email address ( ) to book your place with your name, practice, contact telephone number and preferred date. Please note that lunch and refreshments will be provided, so we would be grateful if you could also advise us of any dietary requirements.

Kind regards
Jason Wong, LDN Chair and The Dental Team
Primary Care Commissioning
NHS England, Midlands & East (Central Midlands)
Francis Crick House / Summerhouse Road / Moulton Park
Northampton / NN3 6BF
SB: 0113 824 8686

The Business Services Authority  published “Managing dental services A guide for commissioners, practices and dentists in England”. Available here.

However as of  31 January 2017 after intervention from the BDA the BSA  withdrew this document from its website.  From a reliable source “I understand they claim this is an early draft and ought never to have been put out at all”.

It does however give a clear guide to the way the DoH is thinking.

From the “Introduction”:

Maintaining and increasing access to NHS dentistry is a key objective for NHS England (hereafter known as the commissioner). Access to dental services is a priority enshrined in the NHS Constitution, but while access continues to improve, the availability of services, the value for money they provide and the oral health outcomes they deliver to local populations still often falls short.

Effective contract management is a key lever for change. Well managed contracts deliver value for money and the potential to treat the greatest number of people. Poorly managed contracts will mean that money that could be spent providing more effective treatment or treating more patients will be wasted.

While procurement of services offers limited scope for improvement, the potential for improved contract management is vast.

Today, over 90% of funding of NHS dentistry is committed in existing contracts. Year on year a number of practices fail to deliver their contracted activity.

Contract management will need to be focused on quality as well as productivity. A “getting the UDAs” approach to performance management will not on its own deliver better access, value for money or quality. Commissioners need to be clear what these payments are funding. Without robust needs assessment and clear understanding of gaps in performance, they will be unable to determine whether dentists are addressing access and health inequalities issues or simply increasing treatments of existing patients.

Cooperation between dental and finance teams is essential to monitor spending against dental budgets; to manage under-delivery, appropriate treatment patterns and recall and treatment intervals.

This document gives guidance to commissioners which is well worth noting. Our section starts on page 65 “Clinical guidance” for dentists.

Peter  Tatton

Herts LDC Secretary

The Swiss food giant, Nestle, says it has made a scientific breakthrough that can sharply cut the sugar in its chocolate. The company, which makes Kitkat and Aero, says its researchers have found a way to structure sugar differently, so that it uses 40% less. It claims this can be done without affecting the taste. Nestle says it is patenting the findings, and it would start using the new sugar across its range from 2018. Its scientists altered the structure of sugar so that it dissolves more quickly. This fools the taste buds, with the effect of raising the sweetness, claims Nestle. The company's chief technology officer, Stefan Catsicas, described the work as "truly groundbreaking research".

Philip Morris has launched a new, less harmful cigarette in the UK which it says could mean halting sales of its conventional tobacco products. The so called Iqos product heats tobacco rather than burning it. The tobacco giant claims this means smokers get the same nicotine hit, but 90% less of the toxins that come with cigarette smoke. It says trials - not yet externally verified - found the new cigarette had the same impact as quitting smoking. The firm is not pushing that finding, saying only that the new product is likely to cause less harm.

As new statistics reveal a fall in prescribing of antibiotics by clinicians across all NHS healthcare settings, dentists’ leaders have called on colleagues to build on this success by using a new toolkit to support effective antimicrobial stewardship. The toolkit, which includes an easy self-audit tool and patient-facing posters and leaflets, was developed as a collaboration between the Faculty of General Dental Practice UK (FGDP (UK)), the British Dental Association (BDA) and Public Health England (PHE), and builds on pioneering work from NHS Cheshire and Merseyside Local Dental Network.

Read More

The British Dental Association (BDA) has reacted to new government figures showing that morale problems have left half of primary care dentists who treat NHS patients thinking about leaving general dentistry.

The report Dental Working Hours – Motivation Analysis herecollected survey responses from more than 6,000 self-employed primary care dentists across the UK.

Read More

The British society of Periodontology (BSP) have launched The Good Practitioners guide to periodontology. This is a great reference tool and is considered  by  many to be the "perio bible".

A copy of the guide is available here. For more information, and an e-vesion of the guide visit