Friday 28 August 2020
England: New SOP and update on fallow time
The CDO for England, Sara Hurley, has
written to practices to announce the updated
Urgent Dental Care and Transition to Recovery Standard Operating Procedures (SOP) in England.
The new framework reiterates the requirement that, while we operate against a backdrop of sustained community transmission, we continue to adhere to fallow time guidance as published by Public Health England (PHE).
However, there is one notable change. Practices are informed that a reduced figure of 20 minutes of downtime is feasible if they can achieve 10-12 air changes per hour (ACH) in a single room.
We welcome this update and believe it will be helpful in improving the capacity of dentists providing services to patients, and we look forward to more guidance as it develops.
In particular, we anticipate the imminent publication of the SDCEP report which should provide further clarity and detail, including options for practices who cannot comply with the 10-12 ACH recommendation.
The updated SOP also includes further guidance on pathway principles for clinically vulnerable patients, isolation requirements and quarantine advice.
Scotland: Dentists urged to drop out-of-date PPE
Today we have advised dentists in Scotland not to use stocks of free Personal Protective Equipment (PPE) provided by the Scottish Government due to the lack of robust evidence to support claims that "revalidated" face masks - some of which are well past their expiry date – are safe.
Despite repeated attempts to secure clarity, NHS National Services Scotland (NSS) has failed to provide categorical proof that expired masks have been robustly assessed.
The information we have received, including test certificates, does not provide firm proof that these masks are fit for purpose. None of the measures in the test certificate achieved a pass, and the manufacturer (3M) has not verified the material or provided clear reassurance that revalidated masks are safe to use.
Using masks which have passed their expiry date may present significant risks to patients, dentists and their teams. In the absence of firm evidence that these masks are safe to use, the BDA has advised its members not to use these masks and called on NSS to make alternative arrangements for supplying PPE to dentists.
David McColl, Chair of the Scottish Dental Practice Committee (SDPC) said: "Dentists willingly donated their PPE to hospices, pharmacies and hospitals at the onset of this pandemic. In return the Scottish Government has offered us out of date masks, and no evidence they are safe to use.
No dentist should use this kit until Ministers provide hard proof it offers needed protection to both staff and patients."
The latest on general practice contractual arrangements in England
Dentists working in general practice in England continue to operate under current NHS contractual arrangements which have included assessment of activity since 20th July. Courses of treatment and patient triage are being counted and at least 20% of previous course of treatment volumes are expected. Practices are also expected to maintain the same NHS to private proportions as occurred pre-lockdown.
During this time, many of the existing contractual provisions rules continue to apply. Patients requiring an urgent appointment should be offered the next available slot, whether or not they have been treated on the NHS previously at the practice. Contractors have been advised by the NHS to prioritise patients with urgent care needs. NHS England advice is that the sequencing and scheduling of patients should take into account the urgency of needs; the particular unmet needs of vulnerable groups and practices' available capacity to undertake activity.
We are currently in discussions about what the NHS contract should look like for the rest of this financial year. As our discussions with NHS England continue over the coming weeks we will again be seeking a balanced approach that recognises ongoing constraints and increased cost pressures on practices. It must also be flexible as the pandemic's progression is unlikely to be predictable or consistent across England.
Whilst there are some specific requirements on practices, this current framework relies on trust. We need the profession to do the right thing during this period in providing high quality patient care in the spirit as well as the precise wording of these current arrangements. If that does not happen, it will inevitably influence the framework for the second half of this year and potentially beyond.
If colleagues act outside of the spirit of the interim contractual framework agreed, their actions are likely to jeopardise our position as a profession. In particular, the 20% volume of care requirement to receive full contractual payment is not a minimum, it is a threshold. Practices must continue to spend the same amount of time seeing NHS patients as prior to the pandemic. Priority should not be given to private patients where NHS capacity still exists.
NHS England's July letter of preparedness indicated that it expected all practices to be providing face-to-face interventions, delivering as comprehensive a service as possible (whilst recognising that capacity may still be constrained). There is nothing to stop practices doing routine assessments, but there is an expectation that priority must be given to patients in pain, irrespective of whether they are new patients or not to a practice.
As a profession, we have risen to the demands made by this dreadful pandemic. If we get the current period right, it sets the tone for what can be agreed for the rest of this year and beyond. We might even see some good come out of this in the shape of longer-term NHS contractual provisions that are finally fit for purpose. If we get it wrong, we are much more likely to see a return to low trust, high scrutiny contractual arrangements.
Elections: Do you want to represent your profession?
Today nominations opened for six seats on the BDA's board. If you are interested in influencing positive change for dentists and dentistry, we encourage you to
nominate yourself for the relevant regional seat and/or UK-wide seat. The following seats are up for election:
- North West
- West Midlands
- UK-wide (One of the two UK-wide seats is a by-election, the term for which will be until 31 January 2022).
All members (apart from student members) are eligible to self-nominate, if they have been a member since 28 August 2019. Learn more about how you can get involved and
the work of the BDA board today.
Thursday 27 August 2020
Wales: Updated guidance from Welsh government
The CDO for Wales, Colette Bridgman has
written to all primary care dental teams in Wales in order to update the industry on the progress of reinstating NHS dentistry.
The letter includes a
review of the Standard Operating Procedures (SOP), which includes changes in SOP settle time following AGP and non-AGP procedures.
The SOP review also covers the reintroduction of more services in low amber phase, latest news on eRMS and future intentions and opportunities for NHS dentistry in Wales that will inform the dental contract reform programme in April 2021.
Scotland: Guidance for submitting queries to Practitioner Services Division
Today we met with Practitioner Services Division (PSD) officials to discuss issues regarding dentists' queries about Covid-19 support payments. The answers to many queries can be found on PSD's
Covid-19 Frequently Asked Questions which are updated regularly.
PSD continues to receive a vast number of queries from dentists about the Scottish Government's NHS support funding package and how it relates to their individual circumstances. PSD deals with such queries in the order they are received, therefore it may take some time to receive a response. Members are reminded of the importance of completing PSD information request forms accurately, and to only send from an NHS email account.
BDA Scottish Dental Practice Committee representatives previously peer-reviewed PSD's process for calculating the financial support payments to individual practitioners. They were satisfied that the PSD approach was fair and transparent, and commended PSD on their efforts to address dentists' queries.
England: New NHS stats don't yet show impact of COVID
We have warned that the latest NHS Dental Statistics do not fully show the unprecedented fall in access to dental care caused by the COVID pandemic.
Dave Cottam, Chair of the British Dental Association's General Dental Practice Committee said:
"This is data is from another era. Since March patient access has fallen off a cliff, and there is no certainty when or if it can be restored… Access was in bad place pre-pandemic. We should lament how few children and adults made it to an NHS dentist last year, but the real question now is how we can even bring the service back to these levels."
Practices are facing significant barriers to expanding capacity, including the need to leave surgeries fallow for 60 minutes after an aerosol generating procedure. Unless regulations evolve, we have warned that tens of millions of patients in England will effectively lose access to dental services.
Wednesday 26 August 2020
Prison dentistry: Exceptional Delivery Model and SOPs published
Dentists in prisons in England should note that Her Majesty's Prison and Probation Service (HMPPS) has published an Exceptional Delivery Model (EDM) and Standard Operating Procedures (SOPs) for dental services in prisons for the third stage of pandemic management.
Secure environment establishments are expected to work urgently to agree a plan for the delivery of dental services based on this guidance and the accompanying risk assessment model. This should be done jointly between the Governor and the Head of Healthcare, as with the previous healthcare EDMs.
High Security Prisons will retain the use of FFP2/3 respiratory protection with fit-tested staff for the interim period until receipt of the battery-powered Respiratory Protective Equipment (RPE), which are currently being procured. In the interim period, other prisons should apply the Aerosol Generating Procedure (AGP) risk assessment model.
These documents apply to England only and will be available through the HMPPS intranet. Further documents for stage 2 are currently in development.
In the news this week
We speak to national and local media daily to represent you and your interests. Here's some of the coverage we've received this week:
The Independent and the
Guardian are among news outlets to cover the high cost of treating dental disease in children and calls to reverse funding cuts this week.
- Mick Armstrong, the chair of the British Dental Association, also appeared on Radio Five to discuss the impact of the COVID-19 crisis on oral health.
Have you made a risk assessment declaration?
Risk assessments are an essential part of managing your dental practice in the context of COVID-19. That's why, we've provided
risk assessment tools and guidance to support practices in fulfilling their legal responsibilities towards staff.
NHS primary care dentistry contractors should also
submit a risk assessment declaration by 23.59 on Monday 31 August 2020. This will help provide confidence that, as a profession, dentistry is taking the necessary steps to protect patients and staff.
BDA museum: Collecting and COVID-19
Our museum has been researching stories and identifying objects to collect in response to the COVID-19 pandemic. These items will provide a permanent record for future generations of medical, cultural and personal responses to the outbreak and chronicling its impact on society.
We have been collating NHS, government, BDA advice and newspaper articles but we are keen to document the pandemic and its effect on dentistry through objects. If you have any photographs, PPE equipment, health and safety equipment, signage to donate, then please email email@example.com.
Or if you would like to hear more about the work of the BDA museum, you can sign up to
receive their monthly newsletter..
Tuesday 25 August 2020
COVID-19 and children's oral health
Charlotte Waite, Community dentist and chair of England's CDS Committee, has written a blog reflecting on
the impact of the pandemic on oral health inequalities and calls on the Government to include oral health in public health planning.
Revealing new and shocking data, she argues that the Government's recent focus on obesity should not side-line efforts to tackle tooth decay among children.
"There are 177 operations to remove teeth in hospitals in England every working day. This is astonishingly high. New data also shows that the problem is increasing…[A] pandemic is precisely the wrong time to lose sight of the oral health challenges we're facing… It is time that prevention is put at the heart of our fight against tooth decay and backed by a real commitment to and proper investment in dentistry."
NHS survey of female staff raises burnout concerns
The COVID-19 pandemic has placed unprecedented pressure on health and care staff. The NHS Confederation and the Health & Care Women Leaders Network (HCWLN) today published a report which focuses on the impact of the pandemic on women working in the sector.
The network is concerned about burnout among female staff, who make up more than three-quarters of the NHS workforce. Almost three-quarters of those surveyed reported that their job was having a more negative impact than usual on their emotional wellbeing. And just over half reported a negative impact on their physical health. Also of note were the disparities in experience between staff from BAME backgrounds and white staff, including increased levels of stress and anxiety caused by the disproportionate impact of the virus on BAME communities.
BDA members can reach out to our
24-hour support and counselling service. NHS dentists and their teams can also reach out for confidential support by calling the staff support line on 0300 131 7000 (07:00-23:00) and can receive bereavement support by calling 0300 303 4434 (08:00-20:00). To find out more about the resources available to you, see the
NHS People website.
BDA Library: Resources on dentistry and COVID-19
Our library building remains closed to visitors due to the pandemic, however many of our services are still available to members. We invite you to
download e-books from the library and remind you that our literature search and document supply services are still available.
We've also put together a package of research into
COVID-19 and dentistry to support you. Recently added articles include:
- Effects of oral care on prolonged viral shedding in coronavirus disease 2019 (COVID-19), which looked at whether poor oral care led to prolonged viral shedding and an extension of patients' hospital stays
- Rapid response: activity from a hospital based Urgent Dental Care Centre during the COVID-19 pandemic, which describes the setting up of the UDCC at Queen Mary's Hospital Sidcup and the treatment undertaken.
Monday 24 August 2020
Travel advice for dentists and their teams
The government has said that no travel is "risk-free" during the pandemic and that people returning from some countries should self-isolate for two weeks. However, people arriving from exempt countries do not need to self-isolate. There is a
list of exempt countries on the gov.uk website.
Dentists and their teams should take note that travellers returning from the following countries are no longer exempt from self-isolation requirements: Austria, Croatia and Trinidad and Tobago (since 04:00 on Saturday 22 August). Whereas, Portugal is now on the list of countries exempt from quarantine requirements.
Our advice is to check whether you are returning from one of the
countries which are exempt from the quarantine guidelines. Please note, this list changes regularly. If you are in Scotland, please refer to the
specific advice from the Scottish Government (Northern Ireland and Wales currently follow the same guidelines as England). If the country is not on the exempt list, you will need to self-isolate for 14 days.
Northern Ireland: Changes to Urgent Dental Care Provision
The Health and Social Care Board have
written to all GDPs in Northern Ireland announcing changes to how Urgent Dental Centres will operate between 1 September and 31 March. Only two out of the five UDCs will operate a full seven days per week service in September. From 1 October, UDCs will offer a weekend service only. GDPs are required to triage and treat urgent dental cases during the week between the hours of 09:00 - 17:00 for their registered patients. At weekends/bank holidays, GDPs are required to put arrangements in place to ensure registered patients receive prompt care and treatment as soon as its appropriate – this may take the form of phone triage delivered remotely.
New guidance for remobilisation and infection prevention published
The NHS and Public Health England have published
new UK-wide guidance applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance. This should be followed as we move from a period of high community and hospital incidence into a period of low prevalence with isolated outbreaks.
This guidance places primary care dentistry in the medium risk pathway, and where AGPs are delivered in the high risk pathway. For those caring for patients/individuals on the high or medium risk pathways, there is no change in the level of PPE needed to protect staff.