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Salaried Primary Dental Care Services

Summary agreement

November 2007

1Salaried Primary Dental Care Services Summary agreement, November 2007

ContentsSection 1: Introduction and key terms and conditions changes 4

• Hours of work 5

• Annual leave and statutory days 5

• Notice periods 5

• Appraisal and job planning 5

• Fees/additional income 5

• Service complexity 6

Section 2: Revised pay spine 8

• Salary progression 9

• Extended competency point 10

• Progression between bands 10

• Rewarding additional clinical leadership complexity 11

• Dentists with special interests (DwSI) 11

• Future specialisms 11

• Pay point credit 11

Section 3: Appraisal and job planning 14

• Appraisal 15

• Transitional appraisal process 16

• Job planning 17

• The annual cycle 17

Section 4: Competency framework 20

Section 5: Vocational dental practitioners 22

Section 6: Assimilation and transitional arrangements 24

• Principles of assimilation 24

• Definition of current earnings 26

• Existing dentists 26

• Existing assistant clinical directors 27

• Existing clinical directors 27

• Assimilation validation process 27

Annex 1: Competencies for band A – dentist 30

Annex 2: Competencies for band B – senior dentist 33

Annex 3: Competencies for band C – managerial dentist 37

Annex 4: Competencies for band C – specialist dentist (clinical) 42

Annex 5: Service complexity levels 45

Annex 6: References 49

2 Salaried Primary Dental Care Services Summary agreement, November 2007

SECTION 1: INTRODUCTION AND KEY TERMS AND CONDITIONS CHANGES

1

Section 1: Introduction

1. This document outlines the agreement between the British Dental Association (BDA)and NHS Employers, and sets out a new pay structure and associated terms andconditions for dentists employed within the salaried primary dental care services inEngland. This agreement changes the previously agreed national contract andshould not impact on locally agreed contract variations, as any change to these localvariations will be a matter for local negotiation.

2. The agreement includes the creation of a new single pay spine based upondemonstrable competencies which will replace the existing grade structure.Implementation of these new terms and conditions will be supported by annualappraisal and job planning.

3. This agreement builds upon Creating the future – modernising careers for salarieddentists in primary care,1 and is set in the context of Commissioning a Patient Led NHS.

4. The BDA and NHS Employers have agreed a new pay and career structure which willlead to an enhanced patient experience and service modernisation through the:

• more efficient deployment of skills

• encouragement of higher levels of competence

• better integration of salaried dentists into the wider dental workforce

• recruitment and retention of dentists into salaried employment

• improvement in the quality of clinical leadership.

5. This agreement will improve service delivery by clarifying the role and responsibilitiesof dentists, utilising dentists’ time in ways that best meet the needs of local servicesand priorities, and ensuring continued professional development contributing togreater quality patient care.

6. It is envisaged that all trusts employing dentists within the salaried primary dentalcare service (including community dental officers, senior dental officers, assistantclinical directors, clinical directors and dentists working in personal dental servicesand dental access centres) on the current national terms and conditions, or on localcontracts based on national conditions, will adopt these new arrangements.

7. There are two key elements to the agreement:

• a new single pay spine (see Section 2)

• enhanced career development structures (see Sections 3 and 4).


8. Career development will be enhanced through the introduction of:

• job planning and objective setting

• appraisal and personal development planning

• specified competencies for each pay band.

9. Used together, these new career development arrangements will allow dentists toidentify their training and development needs, and agree them with their employeralongside details of the development support which will be provided. A newindicative annual training allowance of £750 per dentist has been identified toexplicitly support training and development2.

10. Additionally, a number of key changes to the current terms and conditions ofservice have been made which are detailed below.

Key changes to the terms and conditionsHours of work

11. The hours of work for a full time employee will be 37.5 hours per week.

Annual leave and statutory days

12. For full-time employees, the two statutory days will be converted into an additionaltwo annual leave days.

Notice periods

13. Subject to flexibilities deemed appropriate at local level, the normal contractualnotice periods required by both the employer and the employee will be equalised at three months respectively.

Appraisal and job planning

14. Specific terms of service will be introduced which require participation in annualappraisal and job planning by both the employer and employee.

Fees/additional income

15. Where additional fees or income (e.g. fees for lectures) are earned during normalworking hours (i.e. those hours paid for by the employing organisation) the income becomes due to, and should be paid directly to, the employing organisation. Dentists cannot and should not receive payment twice for the sametime period.

16. Fees claimable for lectures under paragraph 170 of the old terms and conditions willno longer be claimable as they will be consolidated within the new agreement.

Salaried Primary Dental Care Services Summary agreement, November 2007 5


Service complexity

17. A service complexity weighting for band C managerial dentists, will be introduced torecognise the local variations in service complexity. The service complexityweightings developed for band C managerial dentist posts will supersede thecurrent teaching hospital and multi-district allowance supplements.


Salaried Primary Dental Care Services Summary agreement, November 20076

SECTION 2: REVISED PAY SPINE

2

Section 2: Revised pay spine

Salary Salary – Competency/ Salary –point pre complexity Nov 2007/08

Nov 2007/08 based progression

£ value £ £

Band A 1 35,525 0 36,0002 39,585 4,000 40,0003 45,675 6,000 46,0004 48,720 3,000 49,0005 51,765 3,000 52,0006 53,795 2,000 54,000

Band B 7a 55,825 2,000 56,0008 57,855 2,000 58,0009 60,900 3,000 61,00010 62,423 1,500 62,50011 63,945 1,500 64,00012 65,468 1,500 65,500


18. The current pay arrangements will be replaced by a single spine covering threecompetency bands:

• band A – dentist

• band B – senior dentist

• band C – specialist dentist and managerial dentist.

19. The competencies for bands A, B and band C managerial dentists have beendeveloped as part of this agreement.

20. The clinical competencies for specialist dentist posts will be those defined by theRoyal Colleges and accepted by the General Dental Council for entry to theirspecialist register. Leadership competencies have also been developed for thesedentists. Further details of specialist training pathways can be found atwww.rcseng.ac.uk/fds/training/documents.html

21. The identification of the relevant competency band will be defined by the employeron the basis of the competencies required to fulfil the duties of the post rather thanthe competencies of the individual.

22. The revised salary spine is detailed in the table below and includes the effect of theDDRB recommended 2007/08 pay award.

Band C 13bc 66,990 1,500 67,00014c 69,000 2,000 69,00015c 71,000 2,000 71,00016 73,000 2,000 73,00017 75,000 2,000 75,00018 77,000 2,000 77,000

– Vocational dental practitioner scales are not shown as these will need to align with the nationalapproach as set out in Section 6

a Salary point 7 is the entry level to band B but is also the extended competency point at the top of band A

b Salary point 13 is the entry level to band C but is also the extended competency point at the top ofband B

c Salary points 13–15 represent those available to current assistant clinical directors under the new pay spine

d Maximum salary points for band C managerial dentist posts are identified by complexity levels as follows:

Standard complexity maximum pay point 16Medium complexity maximum pay point 17High complexity maximum pay point 18

e Service complexity, for band C managerial dentists, is represented as follows within the pay scale:

Service complexity

Stan

dard

Med

ium

Hig

h

13

14

15

16

17

18

Pay point range


Salary progression

23. Each pay band is divided into six pay points. Pay bands A and B have a ‘gateway’ atthe third pay point. To progress onto and pass these gateway points (point 3 inband A and point 9 in band B) the dentist should be at least demonstrating the fullrange of competencies applicable to the post.



24. Progression in all bands will depend upon the dentist having:

• participated satisfactorily in the appraisal process

• participated satisfactorily in reviewing the job plan and setting objectives

• met the time and service commitments in their job plan

• met the objectives within the job plan

• completed any changes identified in the last job plan review and

• demonstrated development or maintenance of defined competencies, using agreed evidence.

Extended competency point

25. It is the intention that all dentists within bands A and B can aspire to developfurther skills and extend their competencies in order to be eligible for the extendedcompetency point, which is at the level of the first pay point of the next pay band.

26. Therefore, the employer and the dentist can agree, as part of the annual jobplanning and appraisal process to extend the competencies or scope of the role beyond those defined within the competency framework for the dentist’scurrent band.

27. To be eligible for consideration for the extended competency point the dentist must be:

• on the otherwise top pay point in the pay band

• demonstrating the full range of relevant band competencies, and

• achieving their individual objectives.

28. The dentist and their employer should agree the additional competencies and/orresponsibilities to be demonstrated which should contribute both to personal andorganisational development as well as patient care. These should normally be set inrelation to the competencies defined for the next band.

29. A timescale for the achievement of these additional objectives should be agreed. Itis anticipated that achievement against these objectives would be reviewed as a partof the annual appraisal and job planning process.

30. If at the agreed review date the objectives and competencies have been successfullydemonstrated then progress to the extended competency point will be authorised,subject to the continued demonstration of the requirements of paragraph 27 above.

31. Progress to the extended competency point will only be awarded following anagreed approach within the new appraisal cycle.

Progression between bands

32. Progression between pay bands will be determined by the identification of avacancy requiring the relevant competencies, which shall be subject to the normalappointment procedures of each employer and not solely by the competency levelof the individual dentist.



Rewarding additional clinical leadership complexity

33. In recognition of the varying levels of managerial complexity between services, bandC managerial dentist posts will be weighted to reflect the relative complexity of thelocal service. There are three complexity weightings: standard, medium and high.Points 13, 14 and 15 represent the respective minimum pay points. Points 16, 17and 18 of the spine respectively will represent the maximum pay point for each ofthese weightings. See annex 5 for more detail.

34. In reaching a weighting decision employers should give consideration to the extent to which the band C managerial dentist (clinical director) will have directmanagerial responsibility for the service and the degree of autonomy exercisedwithin the post.

Dentists with special interests (DwSI)

35. Dentists with special interests make an important contribution to the patient carepathway and their appointment is a matter for local commissioning. Commissionersmay therefore seek to develop such posts within the salaried primary dental careservice, subject to local requirements.

36. The determination of the appropriate level of reward for dentists undertaking suchroles is a matter for local decision; however, employers should, in making suchdetermination, have regard to such factors as:

• the level of competence being employed in the role

• the extent or limit of the sub specialist skills being employed in the role and the frequency with which they are used

• the degree of autonomy and responsibility

• the extent to which these competencies add to or substitute existing competencies within the job plan.

37. This list is not exhaustive but is intended to give an indication of the factors whichemployers should consider.

Future specialisms

38. Where new specialisms are announced or confirmed by the General Dental Council,which may allow a band A or band B post holder to apply for registration asspecialists, entitlement to band C pay points will be subject to approval by theemploying organisation. The employing organisation will need to confirm that localservice needs and organisational objectives require the appointment of specialistsinto these posts. Such consideration of service needs should take into account localcommissioning plans.

39. As with all other progression between pay bands, entitlement is subject to theexistence of an appropriate vacancy and successful recruitment into the post.

Pay point credit

40. Where dentists are recruited from outside the salaried service to positions on thenew salary scale, credit should be given for relevant competence and experience



gained from outside the service which would normally be evidenced through therecruitment process. Upon appointment the appropriate point on the salary scaleshould be agreed and performance reviewed in line with other staff through theappraisal and job planning process in order to substantiate the competencies andexperience for which credit was given. Where there becomes cause for concern theprocedures set out in section 3 should be followed.


SECTION 3: APPRAISAL AND JOB PLANNING

3

Section 3: Appraisal and job planning

41. Career development is central to the success of this contract for both dentists andtheir employers. To support this, all dentists will be required to take part in theannual appraisal and job planning process. Both the employer’s and the employee’scommitment to this is essential.

42. The appraisal and job planning arrangements should be aligned to form a singleannual process.

• Stage 1, Looking Back, provides an opportunity for both parties to review the objectives set as part of the previous appraisal and carry out a job plan review.

• Stage 2, Looking Forward, provides an opportunity to develop a new job plan (including objectives) and a personal development plan for the coming year.


YEAR 1

Job plan & PDP

YEAR 2 YEAR 3

Stage 1aLookingBackAppraisal &job planreview

Stage 2LookingForwardJob planning& PDP

Stage 1bReflectionanddocumentsign-off

Stage 1aLookingbackAppraisal &job planreview

Stage 2LookingForwardJob planning& PDP

Stage 1bReflectionanddocumentsign-off


43. The principles underpinning assessment are that:

• the process should be fair and clear, as straightforward as possible to implement and neither the process or the gathering and demonstrating of evidence should be onerous

• the evidence required should be as objective as possible and agreed at the previous appraisal and job plan review

• there should be ‘no surprises’ at any review. Good employment practice is to provide employees with feedback on an ongoing basis

• equally, where employees, despite their best reasonable efforts are prevented from achieving targets for reasons beyond their control, they must notify the employer as soon as the situation arises (see paragraph 59 below).

44. Individual dentists’ training requirements should be discussed as part of the annualappraisal and job planning process and this agreement will include a new indicative£750 annual allowance per dentist, for training linked to the new appraisal and jobplanning process.

45. The allowance provides an indicative £750 which should be flexibly implemented by each service in line with individual dentists’ job plan requirements. Thisarrangement should not undermine any existing training commitments. With theagreement of the band C managerial dentist and in line with the job plan, individualallowances can be rolled over into the next year to cover additional trainingrequirements.

46. Separate guidance and model documentation has been produced to support theimplementation of both appraisal and job planning in the salaried primary dentalcare service.

Appraisal

47. The aims and objectives of the appraisal scheme are to enable the employer and thedentist to:

• regularly review a dentist’s work and performance, utilising the competency frameworks relevant to the dentist’s post

• optimise the use of skills and resources to achieve the delivery of service priorities

• consider the dentist’s contribution to the quality of services

• set out personal and professional development needs and agree plans for these to be met, incorporating any organisational objectives

• identify any personal, organisational or environmental constraints which may affect the delivery of the agreed job plan and associated objectives

• provide an opportunity for the dentist to discuss and seek support for their participation in wider NHS and professional activities

• discuss development requirements for the forthcoming year and agree the level of support available.



Transitional appraisal process

48. In order to protect current dentists’ appraisal and development progression atransitional appraisal schedule has been agreed. The schedule applies the following principles:

• All existing date commitments for annual appraisal will be maintained for the next 12 months.

• All staff will be able to set objectives/work to the new competencies within their normal 12-monthly appraisal cycle.

• All staff will receive an appraisal no later than 12 months following their last appraisal (and if appropriate advancement to the next pay point will be authorised subject to paragraph 50 below).

• Where a dentist has historically had a different appraisal date to their appointment anniversary date (i.e. their pay increment date in the current pay system), the appointment anniversary date will become the operative new appraisal and therefore pay review date.

In detail the schedule will operate as follows:

Staff due a pay review before 31 May 2008

49. Staff with an appointment anniversary between 1 December 2007 and 31 May2008 will complete an appraisal on the anniversary of their appointment or existingappraisal date using the current appraisal system to assess their past year’sperformance. Objectives and competencies shall be set and used to plan theforthcoming appraisal year.

50. If, following successful appraisal, an incremental pay increase would have been dueunder the terms of the old pay and appraisal systems, the pay uplift received will berecalculated according to the assimilation tables set out at paragraph 74.

51. For all staff who have been on the old pay system maximums for over 12 months,the date of implementation for the new pay system will be deemed as the newannual appraisal anniversary. The table at paragraph 55 shall then be operatedduring the transitional appraisal schedule.

Staff due a pay review after 1 June 2008

52. Staff with an appointment anniversary between 1 June 2008 and 30 November 2008,shall have an interim appraisal set at six months from the anniversary of theirappointment, but normally no earlier than January 2008 to allow time to properlyunderstand the new competencies and terms and conditions.

53. Whilst the interim appraisal will review the past six months performance, in respectof the new terms and conditions it shall be used only to set objectives and definethe relevant competencies for the next full appraisal. It shall not include a formalperformance based element against the new competencies or objectives.

54. Objectives will need to be realistic and set with consideration for the length of timebetween the interim appraisal and full appraisal.


Date ofanniversary ofappointment orpay review

Before June 2007June 2007July 2007August 2007Sept 2007Oct 2007Nov 2007Dec 2007Jan 2008Feb 2008Mar 2008Apr 2008May 2008

Timescale for fullfinal appraisalcovering old t&c’splus assimilationreview and 2008/09objective setting

n/an/an/an/an/an/an/aBy end of March 2008By end of March 2008By end of March 2008By end of March 2008April 2008May 2008

Timescale formid-year reviewcovering oldt&c’s plus2008/09objective setting

Jan 2008Jan 2008Feb 2008March 2008April 2008May 2008Jun 2008n/an/an/an/an/an/a

Timescale for2008/09 appraisalcovering newcompetencyframework andobjectives

Jun 2008Jun 2008July 2008Aug 2008Sept 2008Oct 2008Nov 2008Dec 2008Jan 2009Feb 2009Mar 2009Apr 2009May 2009

Job planning

56. The aims and objectives of job planning are to enable the employer and the dentist to:

• discuss and agree the dentist’s weekly timetable of activities

• discuss and agree annual objectives

• identify any personal, organisational and environmental constraints which may affect the delivery of the agreed job plan and associated objectives

• consider any changes required to the job plan to take account of any changes to responsibilities and service delivery.

The annual cycle

57. Employers are responsible for providing appropriate assistance and support for setting reasonable targets for achievement. Performance must be reviewed should competence levels lapse or where the rate of progress fails to meetreasonable targets.


First full appraisal

55. The first full appraisal after the transition, or interim schedule has been completed,will use the new competencies and objectives to review performance.

The table below illustrates the timetable for implementing the new appraisal system.



58. Progression will still be considered in circumstances where the appraisal or job planare not carried out due to circumstances outside the control of the employee.

59. Good practice dictates that the employer and the dentist should identify problemsaffecting the likelihood of meeting objectives as they emerge, rather than waitinguntil the job plan review. In the event of identification of an issue which may affectprogression then an interim job plan review should be arranged as soon aspracticable.

60. If at the appraisal and job plan review the criteria for pay progression have not beenachieved then a further review date should be set for twelve months from this date.However, if the employer and employee agree that the criteria required for the nextpay point may be reached within the subsequent three months, an interim targetdate may be set. This date should be set within three months.

61. If at the new target date the required criteria for pay progression have beenachieved then the relevant pay progression should be awarded from that date. Theannual appraisal and pay review cycle is reset from this point. If the requiredcompetencies are not achieved, salary progression will not be awarded until thesuccessful completion of the next appraisal process. This will be twelve months fromthe extended appraisal cycle.

62. In circumstances where a dentist does not meet the required criteria the employershould ensure that a structured programme of support and training where requiredis put in place for the dentist. Where necessary, the employing organisation’sprocedures for managing poor performance should be followed. Employers’procedures should be supported by the principles of the current nationalagreements on Maintaining high professional standards3 and the NHS performerslist regulations4.

63. Following the appraisal and job planning meeting, if there are areas on either thenew job plan or appraisal report that the dentist disagrees with, then they areencouraged to discuss these areas again with their manager at a formal meeting. Ifat this meeting both parties are unable to resolve the issue, dentists should seekresolution through the employing organisation’s standard grievance procedure.

64. It is expected that all dentists aspiring to a specialist dentist post will hold specialistregistration with the General Dental Council. They will be expected to demonstratethe required competencies of their clinical specialism and the other band C specific competencies outlined in this document, in order to progress beyond thefirst pay point.


4SECTION 4: COMPETENCY FRAMEWORK

65. Appraisal and job planning will be informed and supported through the use of thecompetency framework detailed in annex 1. This will assist dentists in the planningof their careers and will provide employers with a benchmark against which toassess performance.

66. In order to set an appropriate pay band for a post and to assist in drawing up theperson specification, a range of competencies have been identified for each payband. Employers will need to determine those competencies applicable to the post.

67. The competencies considered as essential for the post are those which must bedemonstrated in order to progress beyond the ‘gateway’ of the pay band, asdescribed in Section 2.

68. The use of these objective criteria to allocate posts to a pay band will ensureconsistency of service and competence across the NHS, clarify expectations fordentists and employers and, together with appraisal and job planning, support theearly identification and management of poor performance.

69. The competencies are presented in groups called domains. The domains reflect theheadings identified in the competency framework developed for foundation trainingin dentistry published by the Conference of Postgraduate Dental Deans(www.copdend.org.uk), with the addition of the teaching and training domainwhich features within competency frameworks for the clinical specialties developedby the Royal Colleges. The domains are:

• clinical

• communication

• management and leadership

• professionalism

• teaching and training.

70. The clinical competencies for a specialist dentist post are those defined by therelevant Royal College and accepted by the General Dental Council as beingrequired for entry to the relevant specialist list.


Section 4: Competency framework

SECTION 5: VOCATIONAL DENTAL PRACTITIONERS

5

71. Vocational dental practitioners should be employed under the same terms andconditions as other dental employees in the salaried primary dental care serviceswith the following exceptions:

a. Vocational dental practitioners – should be employed on the same salary scale as their peers in general dental practice and laid out in the GDS and PDS Statement of Financial Entitlements.

b. Annual leave – full-time vocational dental practitioners are entitled to 22 days of annual leave plus eight bank holidays. This annual leave entitlement includes two statutory days that have been converted to annual leave.

c. Study leave – full-time vocational dental practitioners are entitled to either one day’s study leave per week during term time or up to 30 days’ paid study leave per year.

d. Hours of work – full-time vocational dental practitioners are required to work 35 hours per week including one hour per week designated as protected tutorial time.

72. The competencies for this staff group are those developed by the Conference ofPostgraduate Dental Deans for vocational training in England.

Section 5: Vocational dental practitioners


SECTION 6: ASSIMILATION AND TRANSITIONAL ARRANGEMENTS

6


73. Assimilation is the process by which existing dentists are transferred onto the newpay spine and the associated terms and conditions.

Principles of assimilation

74. When an employee moves on to a new contract there is a general assumption thatthere will be no detriment to the individual arising from the move. The followingtable identifies the new salary point for each existing level of post:

Section 6: Assimilation and transitionalarrangements

Band 1 PCT dental service dentist/salaried PDS dentist (pay code LA 51)

Currentpaypoint

Current salary –1 April 2007 post DDRB £

Assimilation pay point

Salary on assimilation £

£increase

Salary 1 Nov 2007 post DDRB £

0 32,521 1 35,525 3,004 36,000

1 35,235 2 39,585 4,350 40,000

2 37,948 2 39,585 1,637 40,000

3 40,661 3 45,675 5,014 46,000

4 43,375 3 45,675 2,300 46,000

5 46,088 4 48,720 2,632 49,000

6 48,801 5 51,765 2,964 52,000

7 51,515 6 53,795 2,280 54,000

Section 6: Assimilation and transitional arrangements


Assistant clinical director (pay code LA 71)

0 62,667 13 66,990 4,323 67,000

1 63,656 13 66,990 3,334 67,000

2 64,638 13 66,990 2,352 67,000

3 65,624 13 66,990 1,366 67,000

4 66,609 14 69,000 2,391 69,000

5 67,596 14 69,000 1,404 69,000

Band 2 senior dental officer/senior PCT or PDS salaried dentist (pay code LA 61)

Currentpaypoint




£increase


0 46,908 7 55,825 8,917 56,000

1 50,701 7 55,825 5,124 56,000

2 54,494 8 57,855 3,361 58,000

3 58,287 9 60,900 2,613 61,000

4 62,080 11 63,945 1,865 64,000

5 62,917 12 65,468 2,551 65,500

6 63,752 12 65,468 1,716 65,500

Currentpaypoint




£increase



75. The assimilation process assumes that current dentists can demonstrate the definedcompetencies for the relevant new spine point. This should be confirmed during theassimilation validation process described below.

Definition of current earnings

76. For the purposes of assimilation the assessment of current earnings should, whereappropriate, include:

i. basic salary

ii. current teaching hospital supplement

iii. current multi district allowance.

77. Any London allowance should be excluded from this assessment.

Existing dentists

78. Existing band 1 dentists will assimilate to band A of the new pay spine onto thenext pay point, at least 2 per cent above their current earnings.

79. Most existing band 2 dentists will assimilate to band B of the new pay spine, againon the next pay point at least 2 per cent above their current earnings. However,some senior dental officers may assimilate to band C – specialist dentist posts.

80. Assimilation to a band C post will be subject to the existence of an appropriate postbeing identified by the employing organisation. Where there are more eligible staffthan specialist posts, assimilation will be subject to competitive recruitment.


Clinical director (pay code LA 81)

Currentpaypoint




£increase


0 62,741 13 66,990 4,249 67,000

1 63,712 13 66,990 3,278 67,000

2 64,683 13 66,990 2,307 67,000

3 65,624 13 66,990 1,336 67,000

4 66,625 14 69,000 2,375 69,000

5 67,597 14 69,000 1,403 69,000

6 68,568 15 71,000 2,432 71,000

7 69,555 15 71,000 1,445 71,000

8 70,526 16 73,000 2,474 73,000

9 71,497 16 73,000 1,503 73,000


Existing assistant clinical directors

81. Existing assistant clinical directors will assimilate to band C – managerial dentist.Subsequent progression will be limited to the first three pay points of band C (i.e. points 13–15).

82. Some existing assistant clinical directors will assimilate to band C specialist dentistposts. In this case paragraph 80 applies.

83. All assistant clinical directors will assimilate using a calculation of their basic salaryplus current allowances as defined in paragraph 76 above. They will assimilate tothe next higher pay point on the new scale. If this assimilation point does notprovide a minimum 2 per cent increase then they will move to the next higherpoint, up to a maximum of point 15 which is the highest pay point for currentassistant clinical directors.

Existing clinical directors

84. Clinical directors will assimilate to band C – managerial dentists. A complexityassessment of each clinical director post should be undertaken by the employingPCT as set out in paragraphs 33 and 34 above and at annex 5.

85. Clinical directors will assimilate using a calculation of their basic salary plus currentallowances as defined in paragraph 76 above. They will then assimilate to the nexthigher pay point on the new scale. If this assimilation point does not provide aminimum 2 per cent increase then they will move to the next higher point, up to amaximum of point 18 which is the highest pay point for any employee within thesalaried primary dental care service.

86. In the event that this causes their salary to be a point over and above the maximumfor the complexity of the post, salary will be frozen on a marked time basis. This willextend for two years following assimilation onto the new scale, unless the value ofthe appropriate maximum point for the service complexity reaches or exceeds theirassimilation value within the two year period.5

87. If, at the end of these two years, the agreed complexity level of the post remainslower than the assimilated salary, then the dentist will be moved to the appropriatepay point and salary commensurate with the complexity level of the post.

Assimilation validation process

88. In the first year of implementation, the assimilation validation process will form akey part of the appraisal cycle and should confirm that employees are meeting thecompetencies for the level to which they have been assimilated.

89. If, at the first annual appraisal as set out in paragraph 55 above, employees areunable to demonstrate the required competency level they will receive a further twoyears of supported training and development to enable them to achieve therequired competencies.

90. During this period their salary will be frozen and they will not receive any furtherpay awards or cost of living increases until the required competencies aredemonstrated (unless the salary point commensurate with the level of competenciesthey are demonstrating rises above their protected salary).



91. If, at the end of these two years, an employee is still unable to clearly demonstratethe competency level for the post and salary point to which they were assimilated,their salary protection will end and their salary will be realigned to the appropriatesalary point according to the actual competency level being delivered.

92. If, as a result of this process, a potentially serious performance issue is identified this should be referred to the medical director or equivalent to take appropriateaction. Supporting guidance is available in General Dental Council Standards for dental professionals6 part 1, paragraph 1.7, and its supplement, Principles ofraising concerns, maintaining high professional standards and the NHS performer list regulations.7


ANNEXES

Suggested evidence

Clinical

Annex 1: Competencies for band A – dentist

Patientexamination anddiagnosis

Treatmentplanning andpatientmanagement

Undertakes thorough examination andassessment of patients

• Clinical logs

• Clinical evidence

• Audit of cases

• Case mixstatistics

• Complimentsand complaints

• Trainingevidence

• CPD records

• Record oftrainingdelivered

Plans and manages care for a range ofpatients

Healthpromotion anddiseaseprevention

Plans, develops, implements and evaluatesappropriate interventions to prevent diseaseand promote health for individual patients

Medical anddentalemergencies

Can identify commonly occurring medicalemergencies and lead the dental team in theappropriate first line management of theemergency, using appropriate techniques,equipment and drugs

Anaesthesia andpain control

Uses appropriate local anaesthetic and patientmanagement approaches to control pain andanxiety during dental treatment

Sedation Use of sedation where required

Periodontaltherapy andmanagement ofsoft tissue

Undertakes the diagnosis, selection ofappropriate periodontal techniques anddelivery of periodontal care in an effective way

Hard and softtissue surgery

Routine exodontia and/or simple surgicalexodontias

Non surgicalmanagement ofthe hard tissuesof the head andneck

Undertakes appropriate assessment ofpatients to determine the need for specialistadvice.




Suggested EvidenceManagement ofthe developingdentition

Undertakes appropriate investigations duringpatient examination to determine the need forspecialist advice in the management of thedeveloping dentition

Restoration andreplacement ofteeth

Undertakes the diagnosis, selection ofappropriate restorative technique and deliveryof restoration or replacement of teeth in aneffective way

Financial Understands the financial frameworkgoverning the delivery of oral health care inEngland and the constraints that mightimpose on service delivery

Suggested evidence

Communication

Patient andfamily

Clinical teamand peers

Communicates with a range of patients, andtheir families, on individual clinical issues

• Minutes of usergroups

• Patient notesand records

• Communicationaudit

• Patient surveys/questionnaires

Communicates with all members of the clinicalteam and peers in an appropriate manner

Otherprofessionals

Communicates appropriately with otherhealth and social care professionals involved inthe care of patients

Management and leadership

Personal andpracticeorganisation

Responsible for the running of the immediateclinical environment him/herself, and theimmediate dental team

• Appraisal (selfand staff)

• CPD records

• Finance activityrecords

• Standards ofBetter Healthcompliance

• Job plans

• Incident reports

• Staff sickness &absence reports

• Staff turnover

Legislative Understands the legislative frameworkgoverning the delivery of oral health care inEngland

Leadership andtraining

Understands and puts into practice theleadership of the immediate dental team

Additionalmanagementcompetencies

Understands responsibility for health andsafety issues

Governance Participates in clinical governance

Suggested evidence



Suggested evidence

Professionalism

Ethics Demonstrates the application of the principlesof ethical behaviour relevant to dentistry,including honesty, confidentiality, personaland professional integrity, and compliancewith the standards for dental professionalslaid down by the GDC

• Appraisal

• PDP

• Audit

• Complaints (selfand patients)

• Clinical incidentsPatients Offers and provides care to patients within asound ethical and professional framework

Self Demonstrates a professional clinical approachincluding participation in appraisal, peerreview, clinical audit and continuingprofessional development activities


Behaves in a professional way towards theclinical team and peers, and understandshis/her responsibilities with regard to issuessuch as poor or under performance

Suggested evidence

Teaching and training

Training

Teaching

Participates in the training of individuals on alocal clinical basis

• Job plan

• List of trainingand teachingdelivered

• Publications

• Presentations

• Student/traineefeedback

May undertake teaching/supervision as part ofa predetermined programme

Epidemiology Participates in dental epidemiological fieldwork

Research Participates in clinical research under thedirection of approved and registered researchlead


Annex 2: Competencies for band B – senior dentist

Suggested evidence

Clinical




• Clinical logs


• Audit of cases




• CPD records


Plans and manages care where there arecomplex medical co-morbidities or thesituation requires the involvement of otherprofessionals and/or carers to resolve complexpatient management issues


Can identify commonly occurring medicalemergencies and lead the dental team in theappropriate first line management of theemergency, using appropriate techniquesequipment and drugs

Keeps up to date with developments in thisarea and/or able to advise other members ofthe team

Takes responsibility for organising the trainingand resources for the acute management ofmedical emergencies within the service


Plans, develops and implements programmesto prevent disease and promote health intarget groups within the population

Anaesthesia,sedation andpain control


This may include the use of sedation

Responsible for organising training andresources in support of the availability ofsedation in all or part of the service



Suggested evidencePeriodontaltherapy andmanagement ofsoft tissue

Undertakes the diagnosis, selection ofappropriate periodontal techniques anddelivery of periodontal care in an effectiveway


Routine exodontia and/or simple surgicalexodontia

Non surgicalmanagement of the hardtissues of thehead and neck

Undertakes appropriate assessment ofpatients to determine the need for specialistadvice



Undertakes a range of restorative techniquesutilising developed skill resulting in moreefficient delivery of restorative care

Management ofthe developingdentition


Suggested evidence

Communication

Patient andfamily


Communicates with a range of patients andfamilies on complex clinical issues and/ or indifficult situations





Communicates with the clinical team andpeers in a range of clinical and/or leadershipsituations in a professional and appropriatemanner, which inspires confidence, motivationand teamwork

Otherprofessionals

Communicates with other health and socialcare professionals on a range of issues relatingto oral health and oral heathcare

Organised usergroups

Communicates with a range of user groups ofcarers and families on complex clinical issuesand/or in difficult situations

Financial Has sufficient knowledge and experience ofthe financial framework to provide advice orsupport on such matters to other members ofthe dental team



Responsible for the wider clinical environment,or has responsibilities for specific organisationalor clinical issues within a service

Legislative Has sufficient knowledge and experience ofthe legislative framework to provide advice orsupport on such matters to other members ofthe dental team


Provides leadership and training in specificareas to a range of staff


Understands responsibility for health andsafety issues and can advise others in theservice on these issues

Governance Participates in and leads teams

Suggested evidence


• CPD records



• Job plans



• Staff turnover

Suggested evidence

Professionalism

Ethics Has sufficient knowledge, confidence andexperience to provide advice and/or supportto colleagues or managers on ethical issues

• Appraisal

• PDP

• Audit


• Clinical incidents

Patients Involved in providing care which requires theapplication of sound ethical and professionalprinciples in a more complex clinical, physical,social or intellectual context

Self Demonstrates a professional clinical approach,including participation in appraisal, peerreview, clinical audit and continuingprofessional development activities

Has sufficient knowledge confidence andexperience to appraise others or lead peerreview, clinical audit or CPD activities


Has sufficient knowledge, confidence andexperience to deal professionally with issuesof poor or underperformance in colleaguesand other members of the dental team





Suggested evidence


Training

Teaching

Organises clinical training programmes, deliverstraining and supports others in that role

• Job plan


• Publications

• Presentations


Organises clinical teaching/supervisionprogrammes, delivers teaching and supportsothers in that role

Epidemiology Organises dental epidemiology programmesand may train examiners. May be involved indata analysis and report

Research Participates in clinical research under thedirection of approved and registered researchlead and may take the lead in clinical researchprojects falling within their competencies


Annex 3: Competencies for band C – managerial dentist

Suggested evidence

Clinical




• Clinical logs


• Audit of cases




• CPD records


Plans and manages care where there arecomplex medical co-morbidities or thesituation requires the involvement of otherprofessionals and/or carers to resolve complexpatient management issues


Can identify commonly occurring medicalemergencies and lead the dental team in theappropriate first line management of theemergency, using appropriate techniquesequipment and drugs

Keeps up to date with developments in thisarea and/or able to advise other members ofthe team. Takes responsibility for organisingthe training and resources for the acutemanagement of medical emergencies withinthe service


Plans, develops and implements programmesto prevent disease and promote health intarget groups within the population

Anaesthesia,sedation andpain control


This may include the use of sedation

Responsible for organising training andresources in support of the availability ofsedation in all or part of the service

(Note: for these posts, particular emphasis should be placed on the management andleadership competencies.)



Suggested evidencePeriodontaltherapy andmanagement ofsoft tissue

Undertakes the diagnosis, selection ofappropriate periodontal techniques and delivery of periodontal care in an effective way


Routine exodontia and/or simple surgicalexodontia

Non surgicalmanagement of the hardtissues of thehead and neck

Undertakes appropriate assessment ofpatients to determine the need for specialistadvice



Undertakes a range of restorative techniquesutilising developed skill resulting in moreefficient delivery of restorative care

Management ofthe developingdentition


Suggested evidence

Communication

Patient andfamily


Communicates with a range of patients andfamilies on complex clinical issues and/or indifficult situations





Communicates with the clinical team andpeers in a range of clinical and/or leadershipsituations in a professional and appropriatemanner, which inspires confidence, motivationand teamwork

Otherprofessionals

Communicates with other health and socialcare professionals on a range of issues relatingto oral health and oral heath care


Communicates with a range of user groups ofcarers and families on complex clinical issuesand/or in difficult situations

Financial Has sufficient knowledge and experience ofthe financial framework to provide advice orsupport on such matters to other members ofthe dental team, with additional skills in thefinancial modelling of specialist care

Has a fundamental knowledge of businessplanning, budget setting and management.Understands the commissioning process andthe marketing of clinical services



Takes managerial responsibility for an entireclinical service across multiple sites and staffgroups


• CPD records



• Job plans



• Staff turnover

Legislative Has sufficient knowledge and experience ofthe legislative framework to provide advice orsupport on such matters to other members ofthe dental team

Understands the legislative framework ofspecialist registration and the provision ofspecialist and specialised care

Has a detailed understanding of the statutoryframework on employment, premisesmanagement and the provision of services tothe public


Provides managerial and clinical leadership toa service operating across multiple sites, withseveral staff groups and providing a variedportfolio of differing clinical services

Suggested evidence





Suggested evidenceAdditionalmanagementcompetencies

Additional management competencies

Can manage in a changing environment(political and clinical)

Can lead appraisals and personal developmentfor clinical and non-clinical staff

Can manage clinical performance, includingthe quality of care

Can manage a clinical service, includinghorizon scanning

Can manage clinical and non-clinical staff,including job planning

Can manage external relationships with seniormanagerial and clinical colleagues

Understands and develops user and carerinvolvement and engagement

Can manage organisation and delivery ofintegrated governance systems within a multi-site service

Governance Leads service-wide integrated governance

Suggested evidence

Professionalism


• Appraisal

• PDP

• Audit



Patients Involved in providing care which requires theapplication of sound ethical and professionalprinciples in a more complex physical, socialor intellectual context







Suggested evidence


Training

Teaching

Organises clinical training programmes,delivers training and supports others in thatrole in their specialist field

• Job plan


• Publications

• Presentations


Organises clinical teaching/supervisionprogrammes, delivers teaching and supportsothers in that role in their specialist field

Epidemiology Organises dental epidemiology programmesand may train examiners. May be involved indata analysis and report


Clinical

Annex 4: Competencies for band C – specialist dentist (clinical)

Clinical competencies for specialist dentists (clinical) are determined by the RoyalColleges and accepted by the General Dental Council.

Suggested evidence

Communication

Patient andfamily


Communicates with a range of patients andfamilies on complex clinical issues and/ or indifficult situations within their specialist field





Communicates with the clinical team andpeers in a range of clinical and/or leadershipsituations in a professional and appropriatemanner, which inspires confidence, motivationand teamwork within their specialist field

Otherprofessionals

Communicates with other health and socialcare professionals on a range of issues relatingto oral health and oral heathcare within theirspecialist field


Communicates with a range of user groups of carers and families on complex clinicalissues and/ or in difficult situations within their specialist field



Takes responsibility for organisational andclinical issues within a recognised specialistclinical service


• CPD records


Legislative Understands the legislative framework ofspecialist registration and the provision ofspecialist and specialised care

Suggested evidence


Suggested evidence

Professionalism


• Appraisal

• PDP

• Audit



Patients Involved in providing care which requires theapplication of sound ethical and professionalprinciples in a more complex physical, socialor intellectual context





Suggested evidenceFinancial Has sufficient knowledge and experience ofthe financial framework to provide advice orsupport on such matters to other members ofthe dental team, with additional skills in thefinancial modelling of specialist care


• Job plans



• Staff turnover


Provides leadership and training in specificareas to a range of staff plus the provision ofclinical and/or organisational leadership andtraining in a recognised clinical specialistdomain

Governance Participates in and leads specialist team


Not applicable


Annex 4: Competencies for band C – specialist dentist (clinical)


Suggested evidence


Training

Teaching

Organises clinical training programmes,delivers training and supports others in thatrole in their specialist field

• Job plan


• Publications

• Presentations


Organises clinical teaching/supervisionprogrammes, delivers teaching and supportsothers in that role in their specialist field

Epidemiology Organises dental epidemiology programmesand may train examiners. May be involved indata analysis and report in their specialist field



Introduction1. In recognition of the varying levels of managerial complexity between services, band

C managerial dentist posts will be weighted to reflect the relative complexity of thelocal service. There are three weightings: standard, medium and high.

2. The relevant weighting for each band C managerial dentist post will be decidedlocally as it will not be possible to set a national framework which can take intoaccount the full range of possible local variations and nuances. In reaching aweighting decision, employers should recognise that there will be a broad range ofexpected core components in any salaried primary dental care service and a highercomplexity weighting would only normally apply where a particular range ofcomplexities apply to a service over and above the range of core components.

3. Employers should also give consideration to the extent to which the band Cmanagerial dentist has direct managerial responsibility for the appropriatecomplexity and the degree of autonomy exercised within the post. (e.g. thepresence of a teaching hospital is in itself not a justifiable complexity if its presencehas no impact on the service delivery, planning or organisation of the SPDCS).

4. The following list is intended as a guide to support the local determination ofcomplexity weighting. It is neither definitive nor exhaustive and the key determinantwill be the range and mix of complexity at a local level. In all cases the weightingwill be deemed to be standard unless clear documented evidence can justify ahigher complexity of service.

5. These new arrangements for recognition of service complexity replace the previoussupplements and allowances covering such issues as Multi-District Service andTeaching Hospital Supplement.

Guiding complexity issues6. As a guide, the following issues may help in determining the relative complexity

weighting:

• Footprint – either large dense urban with multiple sites, or substantial rural with widely dispersed clinical locations.

• Deprivation – all services will exhibit a spread of social factors but a complex service would be expected to show a substantial proportion of highly socially deprived population. Frequently, but not exclusively, a dense urban issue.

Annex 5 – Service complexity levels

“A” salaried primary dental care service (standard)

“A” is a rural area, covering about half the county with several towns and many villages. There is some rural deprivation and one town has no NHS dentists.

The primary care trust dental service provides an access centre in one townand a service from six part-time clinics throughout the county. Patients tend to be adults who have difficulty finding an NHS dentist and children fromdeprived areas. There is a mobile unit which travels to more remote schools. A small amount of sedation and domiciliary care is undertaken.

“B” salaried primary dental care service (standard)

“B” is a medium sized market town in a fairly rural area with good road andrail links and little deprivation. There are several residential care homes. Thereis satisfactory access to NHS dentistry.

The primary care trust dental service provides a service from four clinics, oneruns full time the others run on a part-time basis. The team provides clinicbased and domiciliary care for children and adults with special needs. Onedentist also looks after residents at care homes. The service provides sedationat one clinic for anxious children.

The service receives referrals from general dental practices, particularly forsedation and domiciliary care.


• Services – all services provide care from clinics and most will engage in some form of domiciliary, mobile and long stay hospital activity. Factors which lead to a service being complex are the presence of a significant number of:– Responsibility for managing the delivery of service to one or more

prisons/young offender institutions– Responsibility for managing local out-of-hours service (not just for own service

emergency calls)– Direct involvement with a dental teaching hospital within or adjacent to the

geographical footprint– Responsibility for managing or co-ordinating regular or ongoing

undergraduate clinical teaching within the service– Responsibility for managing the delivery of a range of specialist services– Responsibility for delivering a service to more than one PCT.

7. To aid the local weighting process the following case studies have been provided todemonstrate typical services which would be deemed as standard, medium and highcomplexity.

Examples of standard service complexity


Examples of medium service complexity

“C” salaried primary dental care service (medium)

“C” is a city with areas of social deprivation and relatively affluent areas.There have been difficulties in access to NHS dentistry in some areas, so thereare two dental access centres run by the primary care trust dental service.

The primary care trust dental service operates from eight clinics and doessome outreach teaching of undergraduate dental students and trainee dentalnurses, at two clinics. The service provides clinic based and domiciliary services.Sedation is carried out in three clinics.

“D” salaried primary dental care service (medium)

“D” is a county, largely rural, but with one large city and several markettowns. The population is geographically spread, with some rural deprivation.Access to NHS dentistry is good in the towns but does involve some travel.

The salaried primary dental care service has a clinic in each town, providingcare for children and adults with special needs. All provide sedation. “D”salaried primary dental care service also provides a general anesthetic servicefrom the district general hospital. “D” has three mobile clinics which visit ruraland outlying areas to provide care for children. The service is investigating thepossibility of extending this to adults.

Examples of high service complexity

“E” salaried primary dental care service (high)

“E” is a large city with severe inner city deprivation and pockets of outer citydeprivation. There is a dental teaching hospital, prison and several largehospitals. There are two primary care trusts in the city, the salaried primarydental care service is hosted by one primary care trust but provides a service inthe area of both primary care trusts.

The salaried primary dental care service provides a service from 12 clinics,mobiles and domiciliary care. Sedation is provided from most clinics. Theservice is responsible for providing care at the prison, the regional secure unit,plus several long stay hospitals. The service has close links with the teachinghospital, with some interchange of staff, and is heavily involved inundergraduate dental student outreach teaching. The service provides the out-of-hours for both primary care trusts.



“F” salaried primary dental care service (high)

“F” is a large county with several large towns spread across a largegeographical area. Access to NHS dentistry is limited. There is also a numberof large hospitals at which “B” primary care trust dental service provides ageneral anesthetic service for several sessions a week.

The dental service provides a treatment service for children and adults withspecial needs from 14 clinics and two mobiles. The service is responsible forproviding a mobile service to the homeless and a full range of specialistservices on referral. The service has a high level of commitment to trainingand has a number of trainees – vocational dental practitioner, and a specialistregistrar, as well as running county-wide dental nurse training for their ownstaff and for general dental practitioners in the area. The service provides theout-of-hours service at centers in north and south of the county.




1. Creating the future – modernising careers for salaried dentists in primary care.Department of Health, 2004.www.dh.gov.uk/en/Consultations/Closedconsultations/DH_4108023

2. The indicative training allowance is linked to the new appraisal and job planningprocess and should be flexibly implemented by each service in line with individualdentist’s job plan requirements.

3. Maintaining high professional standards in the modern NHS: a framework for theinitial handling of concerns about doctors and dentists in the NHS. Department ofHealth, 2003. www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4065697

4. The National Health Service (Performers Lists) Regulations 2004.www.opsi.gov.uk/SI/si2004/20040585.htm

5. During the marked time period an employee will not receive a cost of living, DDRBor pay point award until the appropriate level for the post equals or exceeds thevalue of the frozen point.

6. Standards for dental professionals. General Dental Council, 2005. www.gdc-uk.org/NR/rdonlyres/23636B75-1E3F-463E-930E-9E21EAF72141/17062/147158_Standards_Profs.pdf

7. Principles of raising concerns. General Dental Council, 2006. www.gdc-uk.org/NR/rdonlyres/B477209F-6B1C-448E-B9E9-77EEA7E5FB56/37958/Concerns.pdf

Annex 6 – References

Published November 2007

Ref: EINF03701

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