Orthodontic Care

Summary

The request sought details on orthodontic consultant payments, staffing numbers, salaries, and travel costs for the Isle of Man's primary and secondary care sectors between 2017 and 2019. The Department of Health and Social Care disclosed that two consultants work under bank contracts with travel and accommodation covered, while primary care services were contracted out to Regent Health Services Ltd in October 2017.

Key Facts

• Two Consultant Orthodontists work on behalf of Primary Care Services under bank contracts, totaling approximately 0.52 whole time equivalent.
• The Department covers travel costs (boat or airfare) and accommodation for visiting consultants, often using Department-owned flats at Nobles Hospital.
• Primary care orthodontic provision was contracted out to Regent Health Services Ltd in October 2017, transferring patients from the Central Community Health Centre.
• A temporary Specialist Orthodontist from an agency worked from May 2017 to December 2018 to assist with patient transfers.
• Consultants contribute to the local economy through standard Tax and National Insurance deductions.

Data Disclosed

• 0.52 whole time equivalent
• 2017-2018
• 2018-2019
• October 2016 to December 2017
• September 2017
• October 2017
• March 2018
• April 2017
• May 2017
• December 2018
• 3 weeks in 4
• 1 week in 4
• 3 evenings per week
• FOI545033
• 7 September 2018
• 13th May 2019
• 30th May 2019

Original Request

Question 1. What monies are paid to consultants in orthodontic care within the primary care sector? Question 2. How many orthodontists and consultants worked within primary care in the periods 2017 - 2018 and 2018 - 2019? Question 3. What was the annual salary paid to these individuals, for both primary and secondary care in the periods 2017 - 2018 and 2018 - 2019? Question 4. Are travel and accommodation paid by the department for visiting orthodontic consultants? Question 5. Can the department provide figures for travel and accommodation for the visiting consultants both sets of figures broken down for 2018 -2019? Question 6. Can you provide a copy of the job description, advert and contract, terms upon which these visiting orthodontic consultants are employed or self-employed?

Data Tables (4)

Full Response Text

Chief Executive: Angela Murray Freedom of Information Team DHSC Crookall House Desmesne Road Douglas IM1 3QA

(01624) 642621 dhsc@foi.gov.im Website: www.gov.im/dhsc

Our ref: 817068 30th May 2019

Dear ###

We write further to your request which was received on 13th May 2019 and states:

"Question 1: What monies are paid to consultants in orthodontic care within the primary care sector? Question 2: How many orthodontists and consultants worked within primary care in the periods 2017 - 2018 and 2018 - 2019? Question 3: What was the annual salary paid to these individuals, for both primary and secondary care in the periods 2017 - 2018 and 2018 - 2019? Question 4: Are travel and accommodation paid by the department for visiting orthodontic consultants? Question 5: Can the department provide figures for travel and accommodation for the visiting consultants both sets of figures broken down for 2018 -2019? Question 6: Can you provide a copy of the job description, advert and contract, terms upon which these visiting orthodontic consultants are employed or self- employed?"

Our response to your request is as follows: We are pleased to be able to provide a response to your request with answers to your questions; however some of the questions asked have already been responded to via FOI545033 Orthodontic Service at Nobles & National Clinical Assessment Service which was published on 7 September 2018. Question 1:
What monies are paid to consultants in orthodontic care within the primary care sector? There are two Consultant Orthodontists (approx 0.52 whole time equivalent in total, based on the last working year) who work on behalf of Primary Care Services under bank contracts. As already published in FOI545033 the Consultants are paid for the hours they work and the Department of Health and Social Care covers the cost of their travel to and from the UK (either boat or airfare) plus their accommodation costs whilst they are visiting. Accommodation, where possible, is made available in the Department-owned accommodation flats on the Nobles Hospital site. The Consultants, whilst paid via bank contract, contribute to the Island’s economy via the usual Tax and NI deductions. Question 2: How many orthodontists and consultants worked within primary care in the periods 2017 - 2018 and 2018 - 2019? In 2017-2018 the Orthodontic Services were managed by two areas for the Department of Health and Social Care: • Nobles Hospital managed the Consultant Service which was run with 1 Consultant Orthodontist working 3 weeks in 4 per month at Nobles Hospital; and
• Primary Care were managing the primary care orthodontic services from the Central Community Health Centre (CCHC). This can be further split into: o the delivery of services by a Consultant Orthodontist for 1 week in 4 plus 3 evenings per week; and o a temporary agreement from October 2016 to December 2017 for a Specialist Orthodontist to work to allow for the transfer of all patients into the Department from the previous primary care contract provider.
This position remained until the end of September 2017 when the Department contracted out the primary care orthodontic provision. Information on the clinicians providing Orthodontic Services for Primary Care is set out in the table below. There has been significant change in service provision during the time period requested. The table below has also added (in blue) the services provided within the hospital, in order to give a full picture of the services provided from April 17 to date:

Time Line Orthodontists Working for Primary Care Provision provided in a hospital setting Working Hours April 2017- September 2017 Consultant Orthodontist 3 weeks in 4 1 week in 4 plus 3 evenings per week May 2017 – December 2018 Specialist Orthodontist from an agency 3 weeks in 4 Full-time Monday to Friday October 2017-Current Contract Holder for Primary Care 3 weeks in 4 (until end of March 18) Contracted for Primary Care Provision and commenced with new patients from November 2017.
April 2018 – Current Consultant providing both providing the Consultant-led Service (although this is now managed as one service by Primary Care) As required - agreement to reduce the secondary care provision back to its original requirement of approximately 1 week in 4 as soon as possible. A new Primary Care Contract Provider (Regent Health Services Ltd) was appointed in October 2017 and all primary care orthodontic patients who were previously under the care of the Service provided at CCHC were transferred under the care of Regent Health Services.
In March 2018 the Consultant, who had previously provided Consultant services in a hospital setting, left the Service and from April 2018 the whole provision for Orthodontics was transferred to Primary Care. This means that both the Consultant- led service (based at Nobles) and the contracted primary care service are both managed within primary care.
The totality of orthodontic services for the Island are therefore currently provided by 2 Consultant Orthodontists (0.52 whole time equivalent) who work under bank contract for Primary Care and 1 Specialist Orthodontist working for Regent Dental Care.

Question 3: What was the annual salary paid to these individuals, for both primary and secondary care in the periods 2017 - 2018 and 2018 - 2019? None of the individuals mentioned were on a set yearly salary. For the purpose of transparency, payments made in respect of time periods requested were as follows: - Time Period Orthodontists Working for Primary Care Gross Paid in Respect of April 2017- March 2018 This includes: Consultant orthodontist for Primary Care, Consultant Orthodontist for Secondary Care; and Oral Surgeon Consultant Costs for Secondary Care (as they relate to orthodontics) Specialist Orthodontist via a UK agency - Specialist Locum Network Limited Primary care contracting £475,904 April 2018 – March 2019 This includes: Primary care Contract Consultant orthodontists £438,205 As a comparison between total Consultants Costs 2017-2018 and 2018-2019:- 2017-2018 Consultant Fees Paid Accommodation costs Total Consultant Spend £298,000 £7,000 £305,000 2018-2019 Consultant Fees Paid Consultant Travel & Accommodation Total Consultant Spend £135,625 £14,986 £150,611 In 2018-2019, Primary Care Services reduced the cost of orthodontic provision, making a saving on spend for Consultant costs of £154,389. Additionally, in this last year: -  All patients who were in treatment or on the hospital waiting lists prior to 1st April 2018 have been seen  Patients assessed as suitable for their treatment to be carried out by a Specialist have been transferred to Regent Dental Care  There is a good working relationship between the Consultant Service and the Primary Care Orthodontic Provider, meaning transfers between the Services are smooth (both ways) and there is a good flow of communication.  Evening clinics have been made available as this is predominantly a children’s service and therefore this allows options for parents who find it difficult to get their child to a daytime appointment.  If patients require dental treatment or extractions alongside their Orthodontic treatment, they are referred back to their regular dentist

 The waiting list has reduced from 1-2 years (pre April 2018) to no waiting list.
From the point of referral by the dentist to the point of actually being seen following triage at the hospital for initial assessment is approximately 4-8 weeks.
For best practice, Primary Care wanted to get to a point of seeing patients for their first appointment with the Consultant within 12 weeks, so it has already met that target and improved on it within the first year.  Consultant time has reduced from 3 weeks in 4 to approximately 1-2 weeks per month on average. The consultant time required is based on patient need and demand. Question 4: Are travel and accommodation paid by the department for visiting orthodontic consultants? This information can be found in FOI 545033. To reconfirm, the Department covers the cost of travel between the Isle of Man and the UK plus accommodation cost for the Consultant Orthodontists. There were 36 visits made by the Consultants in 2018-2019 with a total cost of £14,986 inclusive. Question 5: Can the department provide figures for travel and accommodation for the visiting consultants both sets of figures broken down for 2018 -2019? Reimbursements to the Consultants for travel and accommodation per month for 2018- 2019 are as follows:- Worked Month No of Visits to IOM Travel & Accommodation Reimbursements Apr-18 3 £635.95 May-18 2 £224.97 Jun-18 4 £0.00 Jul-18 3 £527.83 Aug-18 4 £422.22 Sep-18 3 £532.38 Oct-18 4 £1,494.84 Nov-18 3 £181.37 Dec-18 2 £0.00 Jan-19 3 £315.94 Feb-19 2 £117.76 Mar-19 3 £129.97 Totals 36 £4,583.23 In addition to this, Primary Care transferred a further £10,403 to DHSC Accommodation (Nobles Hospital Site), bringing the total cost for travel and accommodation for 2018-2019 to £14,986.23.

Question 6: Can you provide a copy of the job description, advert and contract, terms upon which these visiting orthodontic consultants are employed or self- employed? Please refer to previously published FOI 545033 which answers this question and provided the job description and contracted terms for the Consultant Orthodontists. Please quote the reference number FOI 817068 in any future communications.

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Yours sincerely