NHS England has published its first national primary care specification for the provision of occupational health services. The specification has been developed as an attempt to address inequity in the provision of services by Area Teams and historically by Primary Care Trusts, and to ensure services are now accessible to all NHS contracted practices in England. The new specification has three distinct elements – services funded by NHS England, including a core service for performers registered on the national performers list (NPL); services self-funded by applicants to the NPL; and services made available to practices, but charged for, to assist employees and non-NPL colleagues. NHS providers of services can be located online.
Access will be available five days a week covering normal working hours, Monday to Friday, 52 weeks of the year (excluding bank holidays). Provision of telephone access to an Occupational Health Adviser for all staff working in primary care on exposure to potential BBVs, will also be available 52 weeks of the year (normal working hours, Mon-Fri, excluding bank holidays).
Dentists on the NPL
Dentists on the NPL who are not already immunised will be able to access virology testing, vaccination for BBVs and a range of immunisations, including Varicella, Tuberculosis (BCG), Diphtheria, Pertussis and Tetanus, Measles, Mumps and Rubella. There is also access to a specialist tier of occupational health services for those who have a BBV. Those on the NPL will also be able to access an enhanced occupational health assessment, either by referring themselves or (with their consent), on referral from their GP or designated medical director within NHS England. This will enable access to support in relation to a health concern, or potential concern, which may impact on their ability to work safely and effectively. The specification also confirms the requirements relating to the occupational health screening/clearance and the provision of certification for dentists applying to join the NPL (including those re-entering the NPL after two years off the list). Applicants will be required to access commissioned Occupational Health services directly for screening/clearance, vaccinations and immunisations, as opposed to using GP services.
One of the areas where access to occupational health services has differed significantly around the country is the provision of services to staff members, and whether a fee accompanies this. The new national specification ensures access to an occupational health facility which employers can refer their staff, and for self-referral by employees. However, this provision will not be paid for by NHS England (except in the case of inoculation injuries, see below). Providers of the service will offer occupational health screening/assessment; virology testing for the presence of BBVs; immunisation against a range of infectious diseases; and referral for additional support where necessary to maintain health, wellbeing and safety to practice. Practices should be aware of the range of fees charged in order to compare this to other commercial providers to ensure they access a competitively priced service that meets their needs.
Managing inoculation injuries
Providing urgent and longer term advice to all those working in primary care (including staff and trainees) on exposure to potential blood borne viruses is a key part of the national specification. Outside the opening hours mentioned earlier, a 24/7 emergency telephone advice line will be in place to direct individuals to A&E for immediate management. All injuries resulting in potential exposure to BBVs should be classed as medical emergencies to ensure that, out-of-hours, dental staff get the appropriate priority when attending A&E. Advice on this should also be available on the occupational health provider’s website. NHS England will fully fund the provision of occupational health services to those with needle stick injuries (including the provision of prophylactic management if required). On-going monitoring for ‘fitness to work’ should be provided by the service, however where clinical treatment is required as a result of contracting a BBV, treatment will be provided through mainstream NHS health services.
The occupational health services commissioned by Area Teams should also be made available to non-NHS dentists and their staff on a fee for service basis – this provision will not be funded by NHS England.
Although published in March 2016, in some areas there will undoubtedly be delays to the role-out of this new specification. Some Area Teams may be contractually bound to existing arrangements with service providers for many months, preventing them from implementing the specification in full. Where this is the case, practices should engage with their local dental committee to ensure that access can be provided as soon as possible.
Northern Ireland, Scotland and Wales
In Northern Ireland, Health & Social Care Trusts provide occupational health services to NHS dentists and their directly employed staff. These services can be accessed through referral or self-referral. The range of services covered are detailed in a service level agreement. In Scotland and Wales, Health Boards are also responsible for the provision of services to NHS contracted practices. Fully private practices may find it more difficult to access the services they require and ultimately they may need to engage with a commercial provider.