30 Apr 2020  •  News, Orthodontic landscape  •  7min read

Managed clinical networks and contract changes

Richard Scarborough speaks to Joanna Dancer about the new requirement for Orthodontic Primary Dental Services (PDS) contract holders to attend Managed Clinical Networks…

Managed Clinical Networks (MCNs) are becoming increasingly important to those who have been awarded a new Orthodontic PDS contract.

That’s because engaging with the MCN is now a Key Performance Indicator (KPI) of the contract. This is measured by how many meetings you attend, which you will need to record in Compass.

To find out more about what the MCNs do, what reasons there are to attend – besides being compliant with KPIs – and what this could also mean for those in general dentistry, I spoke to Dr Joanna Dancer, MCN National Coordinator for the British Orthodontic Society.

Richard Scarborough (RS):  MCNs have been around, in some kind of guise, for several years now. Can you explain a little about how they came into being?

Joanna Dancer (JD): In my area, Lancashire, they started over ten years ago when Eric Rooney, now the Deputy CDO but then our consultant for Dental Public Health, wanted to start a system of clinical networks to manage and coordinate services across the area. So, each PCT team had a local orthodontic network that they met with regularly

When PCTs were dissolved around seven years ago, generally several PCTs were merged into one Local Area Team (LAT) who became the dental commissioners for that area. The orthodontic networks and pre-existing Local Orthodontic Committees (LOCs) were then brought together to form one MCN for the whole area.

In Lancashire and South Cumbria, each speciality area – Restorative, Special Care Dentistry, Oral Surgery – has an MCN and their Chair also sits on the Local Dental Network (LDN). This is a model which other areas aspire to and it’s essential that the LAT engages with the clinicians to enable this – they are the ‘managers’ of the Managed Clinical Networks.

RS: What is engagement like at the moment in terms of the profession attending meetings?

JD: It depends on where you are in the country. The number of LATs in England has reduced from 17 to 14 which means that, geographically, the area covered by each MCN has expanded, which can make it harder for people who have to travel further to attend the meetings.

In my area of Lancashire and South Cumbria we have around 45 orthodontic providers and we typically have around 15 to 20 who attend, but not always the same people. We also have annual audit meetings that some will attend, rather than the regular meetings that we have four times a year, but I now know pretty much every specialist in my area through the network.

RS: What do you think about engagement with MCNs being a contractual KPI and how that can be defined and measured?

JD: In my area we previously classified ‘engagement’ as attending at least one meeting a year and contributing to the regional MCN audits that we carry out. Whereas the Business Services Authority (BSA) has decided to monitor attendance at MCN meetings – although we don’t know how many yet.

Our meetings are in the evening for two hours every four months. The commissioners provide the venue but other than that, it is not funded. In other areas that have a bigger patch to cover, such as Kent, Surrey and Sussex, they are looking at putting on a one-day meeting once a year and inviting everyone to that, while a smaller core group will meet more regularly

In some networks that cover a large area the Chair of the MCN has become a paid position, which was always the NHSE intention. In these instances, they have local practitioner meetings and then every few months the MCN Chairs meet with the commissioners.

MCNs are now almost everywhere across England and Wales and have been around in one form or another for a while, so hopefully everyone should be aware of them. The only place they haven’t set them up is in London as the Chair of the LDN there has said they won’t do that until the orthodontic contract procurement is complete.

That was quite unexpected as the idea was that MCNs would engage with commissioners to advise on re-procurement contract issues such as lot sizes and needs assessments. But in London they set up a separate body to do that.

The MCNs are, on paper, the body to go to for clinical advice and we advise LDNs and commissioners on orthodontic matters but, in reality, we have no power and they don’t have to come to us for advice, unlike the CCGs in medicine who do have real power. Until recently it’s all been voluntary but in the new contract it won’t be because part of the contract payment is intended to pay for your attendance at these MCN meetings (albeit it’s only around £55 for a UOA).

One of the issues we have is that in some areas, commissioners won’t engage with the MCN, which can be frustrating, and it’s not for want of willingness from the clinicians.

RS: Do you think it’s important for those in general dentistry to be more aware of MCNs and engage with the networks?

JD: GDPs aren’t at the moment directly involved with MCNs, unless they have UOAs in their GDS contract, in which case they are an MCN member and should be attending meetings, but if they attend their LDNs or LDCs then they are probably aware of them. They will certainly be aware of the re-procurement currently underway in England and its impact on their local orthodontic services.

One of the things we do is look at referral guidelines and referral management systems, and tweak them where needed. But the turnover of associates, especially those working in corporates within general dentistry, can be challenging. Often the referral guidelines aren’t passed over to new associates, or by the time they come to need them they have moved onto another practice.

Communication, as always seems to be the case, is an ongoing challenge – the old relationship that used to exist with referring practitioners and specialists doesn’t seem to exist in the same way with central referral management systems. And, hopefully, networks like these could go some way to remedying that.

Better communication across the whole profession of dentistry, whether general or specialist, can only be a positive thing, particularly when many of us are facing drastic changes to our contracts and working arrangements, and we actively encourage MCNs and LDCs to work closely together.

GDPs might also find it useful to engage with MCNs and orthodontists as a group because soon there’s likely to be a discussion around UOAs and the GDS contract. I know in some areas UOAs have already been turned back into UDAs, which means they are lost to orthodontics with a reduction in local Orthodontic Service provision and, if and when the GDS contract reform happens, they may well remove UOAs from it altogether.

If that does happen, dentists who do a lot of orthodontics will need to think about how they make up that shortfall or provide their orthodontic services by other means. And referring practitioners may need to look elsewhere for local NHS orthodontic services for their patients.

Another issue is discrepancies of UOA rates. We currently have a situation where general dentists are on higher rates than orthodontists, often of around £70, because their activity hasn’t yet been recommissioned. Whether or not contract reform will have any impact on this also remains to be seen.

RS: Thanks to Joanna for shedding some further light on MCNs and their role, which seems likely to become increasingly important with the changes to contractual KPIs and future recommissioning of GDS contracts.


About Richard

Richard Scarborough is the Head of Medenta.

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