Neil Oastler
BAOS Council Member

First may I take this opportunity to wish you all a happy, prosperous and healthy 2017.

At the end of November Eric Rooney the Deputy Chief Dental Officer for England wrote to Area Team Dental Leads, Chairs of Local Dental Networks and Directors of Commissioning giving them details of agreed model Terms of Reference (ToR) for Managed Clinical Networks (MCNs) and a model Job Description (JD) for MCN Chairs. These have been developed by the Dental Commissioning Guide Implementation Working Group and have been signed off by NHS England’s Primary Care Delivery Oversight Group (PCDOG). The ToR and JD have been developed so that they can be used for a MCN for any of the dental specialty, not just Oral Surgery.As models, they are intended to be a framework that will allow reasonable local variation and modification when considered appropriate by the Local Dental Network (LDN).

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Martin Curran
BAOS Council Member

As the festive season is fast approaching most of us will take in our stride with a few sighs and groans. Unfortunately, some of us will find it a traumatic time mentally. With the rigours of modern life and pressures of working in the dental community, none of us are immune to mental health issues. It is essential we are able to recognise the symptoms of stress, personally, within others in our work environment and in our patients. Many of you already have experience of supporting colleagues in times of personal and professional difficulty.

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Please note; this blog does not represent the views of BAOS or its Council, not intentionally anyway.

Ok so I am a little on the edge at the moment.  But bear with me. Oh, the old ones are the best.  Sing along with me; ‘Nelly the elephant packed her trunk and said goodbye to the circus, off she went with a trumpety trump. Trump. Trump? Trump!?’

The seemingly unbelievable has occurred.  As many of us are still reeling from the outcome of the Brexit vote, it seems we have been trumped (verb; to outdo/ surpass) by the Americans this year in the shock-vote stakes.

We need to look at why this could happen…..is this the result of Hillary facing a trumped up (phrasal verb; to devise fraudulently) charges? Or is this genuinely what the US wanted?  Have they played their trump (noun; a key resource to be used at an opportune moment) card to cut themselves off from the rest of the world in search of self-preservation after the global crises we have had to face in the last decade or so?

How could have this been prevented?  More of the US population voting, possibly.  Only about 50% of those with voting rights actually did.  Now, on a slightly smaller scale, if needed, voting for new BAOS Council members will be happening soon….please use your vote to get the best candidates elected.  If you are up for election, I hope you have got your nomination in and make sure you seek support.  Don’t leave it to chance.  Learn from the past. Please vote!  As a member of Council, I highly recommend it to those interested in seeing Oral Surgery develop as a specialty and a service.  You will get to know some lovely people and have a great time in the process.

Back to Trumpton (an imaginary place where all are happy and all is well; the residents of which have no idea about what is going on in the real world), I think basically this the US is guilty of delivering a huge, stinking trump (verb slang Brit; to expel intestinal gas through the anus) to the rest of the world and we are going to be subject to its unpleasant stench for some time to come.

Or perhaps President Elect Donald will turn up trumps and we will all end up smelling of roses!

Dear All,

I hope you have all recovered well after a superb conference-it is always a great experience and was absolutely fantastic this year with excellent speakers and great social events. I thought I would use my blog to bring everyone up to date with what is happening from the SACs perspective. We have been focussed on three main areas-national recruitment; further developments with Dentists with enhanced skills (DES); and the GDC curriculum review.

National Recruitment

All the Dental Specialties have been asked to develop a strategy for national recruitment, and each was to go in turn, orthodontics was first; followed by restorative dentistry and paediatrics and now it is the turn of oral surgery. A small working group was established to initiate the process and our first meeting was in June when we went along to observe the orthodontic recruitment. We are going to follow a similar format with multiple stations and we have spent the last four months developing these to ensure the process is both fair and robust. The likely timeline will be that all posts advertised before 31^st December will be local recruitment but any posts after this time will be included in the new process. The posts will be collated and then the advertisement will go out in March for applications, and the actual interviews will be held in a centre (likely Elland Road Leeds) in May.  A national person specification has been produced and applications that do not meet this specification will be longlisted out.  Applicants invited for interview will be scored on each of the stations and the scores collated to produce a “ranking”.  Applicants will be asked to preference the available jobs and then the jobs will be offered on the basis of the ranking and the preferencing. Having observed the process with orthodontics we are all confident that it is very fair and robust and we are all happy to move forwards with it.  Individuals who have been appointed to academic posts will also have to go through the same process to be “benchmarked” before being awarded an academic NTN ie. They will have to achieve an appropriate ranking in an identical manner to non-academic trainees.

DES

The publication of the commissioning guides has resulted in commissioners requesting guidance as to the possible assessment of applicants who wish to provide a tier 2 (IMOS) service.  The CDO has established a working group to produce this guidance and requested that the initial focus was on three dental specialties-oral surgery; endodontics and periodontology.  The focus of this guidance is to establish a method (hopefully common to the three specialties) of verifying the applicant’s clinical competency to be awarded a contract.  This work has been very time consuming but everyone has contributed a great deal to the process.  Each lead established a small working group to produce the documentation including colleagues from primary and secondary care; specialists and current tier 2 providers to ensure that the process that was suggested was fair; equitable and actually “do able”! The initial suggestions have been submitted for discussion and the process in on going ie still a “work in progress” but it is definitely starting to take shape and hopefully will be completed by the end of the year.  The one thing we have all insisted on is that the assessment must be for the individuals actually carrying out the treatment, not the contract holder-as we all know there have been instances where contracts have been awarded, but the actual treatment is carried out by a separate third party which we do not feel is acceptable. The likely format will be a submitted portfolio of evidence including training; experience; CPD; work place based assessments; patient feedback etc and this will be reviewed by a panel of specialists to ensure appropriate governance is in place.  I have no doubt there will be many further discussions on final structure; funding and indemnity but it is progressing to become a robust process with patient safety and governance being paramount.

GDC curriculum review

The GDC is undertaking a review of all the dental specialty curricula which obviously oral surgery is part of. The initial focus was to establish a generic curriculum for all the specialties in the non-clinical aspects of training eg management skills; communication; patient safety; governance etc.  This was completed last month and was available for consultation on the GDC website.  It is very thorough and comprehensive and accurately reflects the non-clinical skills a specialist should be trained in within a modern NHS. The next stage is for each SAC to develop the clinical part of the curriculum for their specialty and present this to the GDC-this should be completed by the end of 2017.  The oral surgery SAC are already starting to do this and we are currently looking at each aspect of the current curriculum in terms of its relevance and application within modern oral surgery practice.  We have also reviewed the current trainee’s experiences and will be incorporating this into our review.  It is a daunting task and involves a huge amount of work but we are very hopeful that the end result will be to produce excellent high quality training for the oral surgeons of the future.

I would like to wish everyone in advance “all the best for 2017”-there will be a lot happening in our specialty next year!

After Pippa’s excellent blog last month on ‘Reflection’, I felt it would be timely to reflect upon what the BAOS council does behind the scenes for you, the membership.

There are 18 members on Council supported by the admin team who provide us incredible support, led by Roger Manson. Sarah and Louise provide additional part time support to the ever increasing BAOS workload. Martin Curran leads a team developing performance indicators for the admin staff in recognition of their increased workload.

Honorary Secretary Rebecca Hierons, now President Elect, has been a formidable secretary and overseen an update of the T’s and C’s for BAOS, and with Pippa, clarification of Council job descriptions for officers and the admin staff. Other council officers include Mike Murphy who remains Honorary Treasurer (and Lead for MCN consultation), Paul Coulthard Editor of the JOS (Chair of Commissioning working groups) and Pippa Blacklock Past President who leads annual teaching study days as well as the ever popular Teaching and Learning course and herself has developed a Masters Programme in OS.

The council have allocated duties, Rhian Jones, Rebecca and Greg Gerrard comprise the Primary Care group resulting in the production of national tariff recommendations and trial of PREMS and PROMS which we hope will advise NHS commissioning. Anna Dargue is regional rep lead (supported by Hannah Nasse in organising regional and annual rep study days), Colette Balmer is SAC chair and as a result leads as Training Advisor (and conceptualised the February commissioning day), Rachel Evans Media PR lead (resulting in increased PR and conference sponsorship), Sami Stagnell and Claire Harwood are Trainee advisor and rep, Julie Burke is lead scientific organiser for the Conference and lead for annual CPD study days. Greg Gerrard is lead for Audits and BAOS publications. Pete Brotherton is Website lead, Neil Oastler is lead for OS dental services and Rob Bunyan is lead for secondary care group.

Now I want to provide some examples demonstrating BAOS council influence.

OS Careers          Colette Balmer is leading the development of national recruitment for oral surgery which starts May 2017. The number of OS NTNs continues to increase in contrast to other specialties, however, progress remains slow due to delayed implementation of the commissioning guides, and establishment of functional MCNs and Local Dental (professional) Networks.

I have participated in the GDC consultation of Specialty Curricula, which in turn will lead to new curricula for all specialties, possibly 3 plus 2 or 4 year run through for all dental specialties. These will be established in 2017. This consultation has provided an excellent opportunity to directly discuss OS specialist list representation of the actual OS workforce and inequalities and the lack of opportunities for SAS grades and career development. The open access to Membership specialty examinations is gaining progress and will be facilitated by the GDC review of the Specialty Curricula. Level 2 dental services are continued to be discussed by GDC but as yet there is no quality assurance or recognised training pathway.

There have been issues with Deaneries not providing support for trainees to attend the BAOS Conference and Colette Balmer (Chair of OS SAC) has provided a clear overview of study leave entitlements for Trainees and study leave . BAOS support the inter-specialty trainees meeting annually.

National Consultations

BAOS council is now in a strong position with regular invitations to participate on National Level Consultations, ensuring that Oral Surgery has a voice at the most influential levels.

• NICE
  • Third molar Guidance (me)
• GDC
  • New curricula for FT, CDT and a Generic specialist curriculum
  • Duty of candour
• NHS
  • Workforce -Public Health England -(work ongoing)
  • MCN lead by Mike Murphy (MCN TOR)   (MCN Example)
  • Commissioning: The 2016 BAOS Commissioning Day led by Colette Balmer was considered a great success (Link to OS Commissionong documents)
  • Clinical coding (Anna Dargue and Rob Bunyan)
  • Antimicrobial stewardship (ESPAUR) I have developed a scenario based CPD/ mandatory training tool that BAOS is to trial before rolling out nationally. Working with Nick Palmer and Noha Seoudi development of secondary care guidelines for AMS.
  • Patient surgical safety expert group (PSSEG) OS is leading the development of LocSSIPs  (I am involved with this group)( Link to NatSSIPs)
  • Out of hours dental services Thanks to Neil Osler for his excellent feedback to this consultation

Meetings           

The highlight of the year is the BAOS Conference (link) for which we get fantastic feedback every year and is well worth the registration fee.

• Commissioning meeting- regular meetings with the CDO have resulted in BAOS primary care group developing evidence for a national Tariff and trial and validation of PROMS and PREMS
• Teaching and Learning course led by Pippa Blacklock continues to be a success and has been invited to develop in Australia  – Anna Dargue is to take it there
• FDS RCS BAOS joint study day Tsunami Silver Surfers 17th June included 80 delegates, with excellent feedback. This is the fourth joint national study day I have organised.
• GDC Forum invitation for BAOS participation
• Regional rep days gain strength in quality and number and provide excellent local opportunities for networking and supporting BAOS members

Audit

The BAOS audit for 2015 M3M audit will shortly be published in JOS The 2016 audit will be a trial of a clinical scenario testing knowledge for antimicrobial stewardship. This will be rolled out for all specialties once validated

So on reflection you can see that the BAOS council is incredibly active on behalf of the BAOS membership in all aspects of training, commissioning, service development and in raising the profile of Oral Surgery. Our membership continues to expand and remains the heart of our Association. I very much look forward to seeing you all at the 2016 Annual Conference in Edinburgh later this month which will be a fantastic way to gain high quality CPD, catch up with old friends and make new ones. Lastly, we are launching a new Conference App this year (thanks to Claire Harwood) which will truly bring our meeting into the 21^st Century!

Best wishes to all

Prof Tara Renton

President of BAOS

“I do not measure someone’s success by how high they climb but how high they bounce when they hit the bottom!”

This definition of resilience as described by George S Patton an American Second World War soldier remains applicable today.

Resilience is defined as an individual’s ability to properly adapt to stress and adversity and is demonstrated when they can face difficult experiences and rise above them. As Jung said ‘I am not what happened to me I am what I chose to become’

Think about the sportsmen and women in the Olympics after four years of training striving for success perhaps to face ultimate disappointment. How resilient are you when you receive news of your own success or cope with disappointment following DCT and SPR posts or job interviews and exam results? How resilient are you in the face of the political and economic changes both in day to day life and within the NHS or changes in family circumstance that affect us all?

Resilience is a dynamic process whereby an individual can exhibit positive behavioural adaption when they encounter significant adversity, tragedy, threats or sources of stress. Luckily resilience is found in the average individual and can be learnt or developed by virtually anybody as it is a process rather than a trait.

I read a fantastic article in the National Association of Clinical Educators Journal by Liz Spencer who is a Consultant Anaesthetist and Medical Educator which gave useful insights into resilience and how to develop it and from which I quote.

“Resilience does not mean you experience negative emotions but you have the ability to effectively and relatively easily navigate your way around crises and utilise effective methods of coping balancing the negative emotions with positive ones.”

How do we develop those positive feelings during the surgical removal of a difficult lower wisdom on a locals list which is over running while you are also teaching two dental students I hear you ask?

Various factors that build resilience, promote wellbeing and protect against risk have been identified by research.

Those quoted by the American Psychological Association are;

1. To maintain good relationships with close family members, friends and colleagues

2. To avoid seeing crises or stressful events as unbearable problems

3. To accept circumstances that cannot be changed

4. To develop realistic goals and move towards them

5. To take decisive actions in adverse circumstances

6. To look for opportunities of self-discovery after a struggle or loss

7. To develop self-confidence

8. Keep a long term prospective and consider the stressful event in a broader context

9. Maintain a hopeful outlook expecting good things and visualising what is wished

10. To take care of one’s mind and body, exercising regularly, paying attention to one’s own needs and feelings

Other factors that promote resilience that I felt were relevant included seeking help and disclosing issues when needed ,having  an identity as a survivor as opposed to a victim, finding positive meaning from the stress/ trauma and helping others as we all do in our day to day work as Oral Surgeons

Though I am never going to be an Olympic athlete, I in my job as an Oral Surgeon and as I am sure you do in yours, I face a multitude of ever changing events and stressors at work never mind the chaos at home. By being mindful and working on developing my resilience enables me to continue to enjoy my profession and more importantly my life!

Attending the upcoming BAOS conference is a sure fire way of developing and promoting your personal resilience (though not evidence based!).  It is an opportunity to renew old friendships and cultivate new, gain information about training or job opportunities, develop self-confidence by signing up for a masterclass, discuss difficult cases or work issues with likeminded colleagues and use your positive emotions to counter the negative while presenting your free paper!

I and all of BAOS council look forward to welcoming you in Edinburgh next month.

Pippa Blacklock

Immediate Past President BAOS

“I do not measure someone’s success by how high they climb but how high they bounce when they hit the bottom!”

This definition of resilience as described by George S Patton an American Second World War soldier remains applicable today.

Resilience is defined as an individual’s ability to properly adapt to stress and adversity and is demonstrated when they can face difficult experiences and rise above them. As Jung said ‘I am not what happened to me I am what I chose to become’

Think about the sportsmen and women in the Olympics after four years of training striving for success perhaps to face ultimate disappointment. How resilient are you when you receive news of your own success or cope with disappointment following DCT and SPR posts or job interviews and exam results? How resilient are you in the face of the political and economic changes both in day to day life and within the NHS or changes in family circumstance that affect us all?

Resilience is a dynamic process whereby an individual can exhibit positive behavioural adaption when they encounter significant adversity, tragedy, threats or sources of stress. Luckily resilience is found in the average individual and can be learnt or developed by virtually anybody as it is a process rather than a trait.

I read a fantastic article in the National Association of Clinical Educators Journal by Liz Spencer who is a Consultant Anaesthetist and Medical Educator which gave useful insights into resilience and how to develop it and from which I quote.

“Resilience does not mean you experience negative emotions but you have the ability to effectively and relatively easily navigate your way around crises and utilise effective methods of coping balancing the negative emotions with positive ones.”

How do we develop those positive feelings during the surgical removal of a difficult lower wisdom on a locals list which is over running while you are also teaching two dental students I hear you ask?

Various factors that build resilience, promote wellbeing and protect against risk have been identified by research.

Those quoted by the American Psychological Association are;

1. To maintain good relationships with close family members, friends and colleagues

2. To avoid seeing crises or stressful events as unbearable problems

3. To accept circumstances that cannot be changed

4. To develop realistic goals and move towards them

5. To take decisive actions in adverse circumstances

6. To look for opportunities of self-discovery after a struggle or loss

7. To develop self-confidence

8. Keep a long term prospective and consider the stressful event in a broader context

9. Maintain a hopeful outlook expecting good things and visualising what is wished

10. To take care of one’s mind and body, exercising regularly, paying attention to one’s own needs and feelings

Other factors that promote resilience that I felt were relevant included seeking help and disclosing issues when needed ,having  an identity as a survivor as opposed to a victim, finding positive meaning from the stress/ trauma and helping others as we all do in our day to day work as Oral Surgeons

Though I am never going to be an Olympic athlete, I in my job as an Oral Surgeon and as I am sure you do in yours, I face a multitude of ever changing events and stressors at work never mind the chaos at home. By being mindful and working on developing my resilience enables me to continue to enjoy my profession and more importantly my life!

Attending the upcoming BAOS conference is a sure fire way of developing and promoting your personal resilience (though not evidence based!).  It is an opportunity to renew old friendships and cultivate new, gain information about training or job opportunities, develop self-confidence by signing up for a masterclass, discuss difficult cases or work issues with likeminded colleagues and use your positive emotions to counter the negative while presenting your free paper!

I and all of BAOS council look forward to welcoming you in Edinburgh next month.

Pippa Blacklock

Immediate Past President BAOS

From adversity can come great opportunity….

Whichever way we voted many of us woke last Friday morning with utter disbelief to the news that Britain was to leave the EU. The unexpected and unplanned for had happened and we were in shock. Did we break something that really didn’t need fixing? Did we not realise what we had till it was gone? Were we suffering a bout of affluenza?

At our last BAOS conference Trevor Dale taught us about the Swiss cheese model. Unexpected events or disasters occur where multiple factors/mistakes line up. Maybe Brexit was a Swiss cheese moment. Maybe if just one of the toxic mix hadn’t happened we would still be in the EU. David Cameron called the referendum to end in house Conservative fighting. The EU wasn’t appearing to be acting democratically and gave little response to Cameron’s renegotiations. Levels of migration were at an unprecedented high. Pressure on public services meant the NHS was struggling. School places and housing demand outstripped supply. Labour had a lack of leadership and English and Welsh people outside of London felt they had no voice and no representation other than UKIP. Eton educated politicians were out of touch with what was happening in the provinces in Boston, Barnsley and Blackpool. And then ordinary people are given a vote. The plane falls out of the sky.

I do not believe that 52% of the population are ignorant, stupid or racist. I do believe that the Brexit campaign was divisive and compelling. Who was not tempted by an extra £350 million per week going straight to the NHS?

At BAOS we owe a lot to Europe. European law means that the speciality of Oral Surgery could not be ignored by the GDC. European Specialists in Oral Surgery existed before they did in the UK and thus an additional speciality other than the medical speciality of Oral and Maxillofacial Surgery had to be recognised. BAOS is an active member of the European Federation of Oral Surgery Societies. We recruit European Dentists and Oral Surgeons to work in our NHS. We also have an equally large number of superb healthcare workers such as Indian doctors and Filipino nurses from outside the EU who have to undergo robust English language tests and clinical competency assessments before they can work here.  Large corporate dental companies employ dentists from Continental Europe as they will often accept lower pay and poorer working conditions than UK graduates. Wage depression doesn’t just happen out in the asparagus fields of Lincolnshire.

Having been glued to the news all weekend I went to work on Monday. I couldn’t believe that everyone was going about their duties as normal. Hadn’t Armageddon just happened? In specialist practice I asked my principal whether she was worried about her business. She said to me that sometimes from adversity can come great opportunity. Perhaps the country did need to re-boot after all. Maybe Brexit will deliver more money to the NHS. Maybe better control of our borders will reduce the demand on public services and give equal access to our excellent medical colleagues from outside of the EU. Maybe our economy will thrive on a world platform with reduced bureaucracy from the EU. It is possible.

At BAOS we can learn from the current events.  We can show strong democratic leadership from our council uniting all the nations of the British Isles. We can make sure all our evidence is supported by robust research. We can show compassion and caring to each and every member of society without discrimination. Let’s use this great opportunity.

Hannah Nasse

Hi everyone and welcome to the June BAOS Blog.

One of my roles within BAOS is to lead on all things MCN so thought this would be a good opportunity to raise awareness of this subject.

I have been chairman of the Birmingham, Solihull and Black Country Oral Surgery (BSBC) MCN for the last two and half years, during this time we have seen the development and publication of the Commissioning Guide for Oral Surgery and Oral medicine. As a result much of the agenda for the MCN meetings has centred on discussing this document and its implementation.

Those of you familiar with the Commissioning Guide will know that it places great importance on MCN’s as a vehicle for local implementation and quality assurance. One of the national implementation work streams is considering MCNs and their role, part of this has been to develop a generic MCN Terms of Reference and a Job Description and Person Specification for the MCN Chair, I have had some input into this group.

The Guide identifies that an early piece of work needed to inform any changes in procurement of services is a clear understanding of current local referral patterns. In BSBC we have addressed this by introducing a minimum data set referral form for use across the entire MCN area. This was introduced in February 2016 and has been well taken up. Alongside this for the last three months a data collection exercise has been running to attach a complexity level, as described in the Commissioning Guide, to each oral surgery referral to secondary care providers from GDPs. The aim is initially to analyse this data with Commissioners to identify GDPs tending to refer higher than average numbers of level one activity. The reason for these referrals can then be assessed. If it is a contract performance issue then the Commissioners can take the appropriate action, but if it is a confidence/competence issue then the plan is to offer these GDPs a structured 6 month clinical attachment in secondary care as a means of boosting their confidence and competence. The goal being to reduce the numbers of level 1 activity referred to secondary care through a supportive approach while not destabilising current teaching and training activities.

The next significant agenda item is likely to be assessment of level 2 referrals to secondary care and a discussion with Commissioners about how level 2 activity should be provided in the BSBC region considering local needs and available skill mix, using the Commissioning Guide as a framework. The role of the MCN moving forward with is I see as vital. Through engagement with potential level 2 providers and Commissioners the MCN can ensure that level 2 complexity treatment is carried out by the right clinician in the right place, in short offering a quality assurance envelop, again using the metrics within the Guide as a framework.

I have been very lucky so far in having good administrative support for the activities of the MCN and also really good engagement from clinical colleagues, Commissioners, Public Health England and the Local Dental Network.

My concluding message to you is to seek out your local Oral Surgery MCN and get involved with it. If there isn’t one then get one started with the help of your LDN Chair. There is a real chance to influence the future Commissioning of Oral Surgery services and it will be through MCNs that we as working clinicians can exercise this influence.

So yes MCNs are the way forward!

Best wishes to you all

Mike Murphy