Hampshire and Isle of Wight Dental Committee
COVID-19: Primary Care Dental Services within the Hampshire and IOW LDC Constituency
UPDATE: 22.03.20 Reviewed 23.03.20
Over the previous 2 months and especially the past 7 days the H&IOW LDC has been working very hard to support and communicate with GDPs, NHS England and NHS Improvement South East, the Wessex LDN, members of the Oral Surgery MCN, members of the orthodontic MCN, BDA, FGDP, UOPDA and other stakeholders to ensure that the LDC has the most up to date information for dissemination to dentists in our region. The situation and published guidance is rapidly changing.
The LDC, quite understandably has been inundated with queries, requests for support and advice from very concerned individual dentists and members of their teams.
The H&IOW LDC represents and endeavours to protect the interests of NHS providers and performers that carry out primary dental care services in our H&IOW STP area.
To date the H&IOW LDC’s website www.hantsiowldc.org has developed a dedicated page to post all the COVID-19 information as and when we receive it. The most important latest information posted is:
- COVID-19 NHS South East Region Dental Update 20.03.20
- LDC Confederation – London LDCs: https://mailchi.mp/ldc.org.uk/coronavirus-update-for-primary-care-dentiists-20200322
- BDA 22.03.20: https://www.bda.org/advice/Coronavirus/Pages/latest-updates.aspx
- CDO NHSE & I Publication approval reference: 001559 (Updated Preparedness letter)
- Emerging and Future Challenges for Dental and Oral Medicine: https://journals.sagepub.com/doi/full/10.1177/0022034520914246
- FGDP new guidance and support for the ‘delay’ phase: https://www.fgdp.org.uk/news/covid-19-new-guidance-and-support-‘delay’-phase
- COVID-19 PHE Communication Posters: https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-/resources
The Hampshire and Isle of Wight Local Dental Committee is a representative committee that can make representations on behalf of dental practices and individual dentists in our area but it does not have the authority to give clinical guidance or to direct your response to the developing COVID-19 pandemic.
Individual practitioners performing NHS dental services and dental practice contract providers must contemplate the information that they receive and consider a number of relevant and important factors:
- The risk associated with asymptomatic patients who may be infectious and particularly where there are aerosol generating procedures (AGPs). The UK Government is now at a delay position of self-isolation, social distancing, reduction in the use of public transport and use of health services so we should be mindful that as infection levels within the population increase there is a potential to spread COVID-19 within the dental practice environment. Therefore, to follow the current published guidance already issued, routine dental treatment activity should ideally be reduced or ceased wherever possible but individual dentists must, as professionals, weigh up the evidence and guidance issued and make their own decisions based on their own individual circumstances. Clearly, there are important safety and financial considerations and the LDC is aware that monthly payments to practices will continue so that dental practices providing NHS dental care remain viable. The LDC and in collaboration with the LDN has recommended that consideration should be given to an extension of the contract year from one to two or three years to allow practices to catch up on their activity. Furthermore, we have suggested to the LDN that the 2019/20 year is reduced to 11 months to avoid contractors falling below the 96% activity threshold. Going forward, breach notices and clawback will only jeopardise the viability and sustainability of NHS dental practices and deprive patients of the NHS care that they need and destroy dental teams’ livelihoods. Force Majeure dictates that under clause 350.1. you must ‘inform the other party in writing of such circumstances or events and of what obligation or duty they have delayed or prevented being performed’
- Practice Business Continuity Plans will need to be updated as the current situation develops and as dentists we have a professional responsibility to maintain our knowledge through the authorised PHE guidance on the Central Alerting System (CAS) https://www.cas.mhra.gov.uk/Register.aspx and the Guidance for Infection Prevention and Control in Healthcare Settings https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
- Supplementary to bullet 1 – consider if the current guidance should be more explicit and whether or not you should be carrying out any AGPs on asymptomatic patients if you do not have the appropriate higher safety level PPE which would include as a minimum, FFP3 respirators? The LDC suggests that as this situation evolves any emergency treatment will need to be carried out in designated, fully and advanced PPE equipped surgeries. To date we are not aware of these sites but we believe that they are at the planning stage within the NHSE&I South East Region. This was alluded to in the recent Dear Colleague letter dated 20.03.20 that included the latest preparedness letter from the CDO.
- Regulatory Standards (GDC/CQC) and how COVID-19 might impact on your compliance with protecting patients and dental teams? Any closure needs to be notified to the Care Quality Commission, this applies to temporary closure too.
- If you are considering closing the practice to the provision of NHS dental services you must contact the Local Health Protection Team www.gov.uk/guidance/contacts-phe-health-protection-teams for advice and implement the practice’s Business Continuity Plan and notify the commissioning team email@example.com . Failure to take this action will almost certainly be deemed a breach of contract.
- Private practices are not represented by the H&IOW LDC under our current Constitution but the LDC is very mindful of their predicament and our website is in the public domain. The LDC will be very happy to signpost any dentist to the most appropriate source of COVID-19 information.
- It is important to ensure that practice staff, colleagues and patients are kept up to date with clear signage and patient information posters should be positioned outside the practice and preferably practices should appoint a COVID-19 lead.
- It is imperative that practices recognise that COVID-19 can survive on cardboard for up to 24 hours and exist on hard surfaces such as plastic/stainless steel for up to five days.
- Washing hands is still recognised as a fundamental preventive measure with the detergent action the essential component.
- Social distancing is a minimum of 2 metres and the virus can be carried on exhaled breath that takes 30 minutes to hit the floor.
We know that this is an incredibly stressful and worrying time for dental teams and their families and we are trying hard to reach as many dentist’s as possible so please send us up to date email contact addresses and pass this information on to your colleagues who may not be aware of the H&IOW LDC’s communication processes. Information is disseminated by email and social media:
Facebook page: Hampshire and Isle of Wight Local Dental Committee
Facebook profile: Hampshireandiow Ldc
The H&IOW LDC’s stated position is that:
- General Dental Practices should immediately cease seeing routine patients
- Testing should be made available as soon as possible to eliminate doubt and misdiagnosis. This could be a situation that lasts for more than 6 to 12 months with possible sequential surges of viral infection in the population
- There should be a central contact number with appropriate professional triage and advice for patients
- All urgent dental treatment should be carried out in centres/hubs or practices that are fully equipped with full PPE including FFP3 respirators. Scope of practice should be determined
- The H&IOW LDC’s update should be cascaded to as many performing dentists as possible through all available communication channels
- There should be PPE training and necessary Occupational Health measures put in place
- There must be clarity around the sustainability and viability of general dental practices. Payments and force majeure issues must be explicitly addressed by NHS England and Improvement South East Region
- Going forward NHSE&I need to equitably address the reduced activity problems that contractors will experience surrounding end of year performance under their contracts for 2019/20. As the COVID-19 viral infection impacts on practices’ activity during 2020/21 provision should be made to prolong the contract year to an agreed longer period (2 or 3 years) to allow practices to fulfil their required activity.
- Practices Business Continuity Plans should be regularly updated as the current COVID-19 situation develops and impacts on dental care provision under the contract
- Dental practices need to keep comprehensive records of staff attendance and absence. A standardised dedicated spreadsheet would be much appreciated by contractors to avoid unnecessary challenges at a later date
- Dental emergencies in this current climate need to be defined. Traditionally, trauma, severe and escalating swelling and uncontrolled haemorrhage are considered to be emergencies. Additionally, dental conditions that have resulted in acute systemic illness or raised temperature, severe trismus and possible uncontrolled infection should be considered to be an emergency
- Urgent treatment (within 24 hours) may require an intervention above and beyond advice. Examples might include: Dental and soft tissue infections without systemic effect, Severe dental and facial pain that cannot be controlled and fractured teeth with pulpal exposure
- Clarity about dental practitioner’s indemnity and pensions needs to be explored
- Practices should have appropriately placed external signage for patients to read together with all other appropriate means of communication that clearly explains the practice’s contingencies in place for patients and their care https://campaignresources.phe.gov.uk/resources/campaigns/101-coronaviris-/resources PHE have a ‘when to use a surgical face mask or FFP3 respirator’ poster
- Practices carrying out endodontic treatment should consider the British Endodontic Society Statement on COVID-19 dated 23rd March 2020 britishendodonticsociety.org.uk
- Practitioners involved in Oral Surgery should consult with the latest advice and guidance on the BAOS &BAOMS Website 20.03.20