The preparations to open the Urgent Dental Care Centres/Hubs (UDCCs) has progressed to the point of having the NHS England South Region Standard Operating Procedure (SOP) in its final drafted form ready for sign off this week. The LDC is aware that one of the GDS sites will be up and running on the 9th April in Winchester.
Thirty five sites have been identified across the SE region with 10 proposed sites in H&IOW:
CDS Sites:
Gosport, War Memorial/CDS LIVE
RSH, Southampton/CDS LIVE
Andover/CDS LIVE
Cowes/CDS LIVE
Somerstown/CDS Portsmouth – awaiting start up
Basingstoke/CDS Brambly’s Grange – awaiting start up
GDS Sites:
Winchester/ GDS Thursday 9th April – referral through triage form NHS.net (LDC website)
Ryde/GDS (awaiting PPE and Fit testing) Start-up week commencing 13.04.20
Cowes/GDS ?
Fareham/GDS (awaiting PPE and Fit testing)
The CDS will priortise the shielded and the vulnerable (increased risk) cohort of patients (Population Groups levels 2 and 3)
Group 2 Shielded
Group 3 Vulnerable/Increased risk
GDS will treat population groups 1 and 4.
Group 1- Patients who are possible or confirmed COVID-19 patients – including patients with symptoms or those living in their household.
Group 4- Patients that do not fit any of the other categories
Some of the UDCCs are still awaiting the appropriate PPE, including the supply water repellant gowns and possibly close fitting disposable visors.
The main problem has been access to FFP3 Respirators Fit Test Kits and the fact that the masks will only fit around 80% of clinical staff some of whom will have potential co-morbities and/or will have vulnerable family members which will eliminate them from front line services. We are also aware that some FFP3 masks are not water repellant and these must be used with a full protective face shield and/or goggles.
Most of the necessary PPE is in place for the GDS practices and PHE is ready to distribute PPE to the hubs sited in GDS. All sites will be regarded as ‘hot’ as the same PPE regimen will be the required operative sensitive, standard, to take account of asymptomatic COVID patients. Universal testing is some way off but clearly would be very helpful. In any case aerosol generating procedures (AGPs) should be avoided where possible and appointments will run hourly to give down time for appropriate air clearance and surgery wipe down procedures. A four-surgery practice might be able to see up to 16 patients per day.
At this week’s Standard Operating Procedures (SOP) meeting of the regional steering group it was agreed that Oral Surgeons would be best placed to undergo surgical procedures efficiently including extractions and there was a general consensus that our oral surgery colleagues should be attached to each of these first wave UDCCs. However, there are some practical obstacles to this preferred option which include the requirement for inclusion on the National Performers List.
The LDC understands that as a matter of course the MCN Chairs will be consulted by commissioners/LDNs on whatever arrangements are proposed in this regard when the fine detail is agreed, hopefully later this week.
NHSE is exploring the Hub practices’ surrounding dental surgeries’ capacity and they will be in contact with the MCN Chairs to bring a multidisciplinary networked approach to the implementation of these UDCCs.
A Dear Colleague letter has been circulated to all dental practices within the NHSE&I SE region to identify the available workforce. This workforce survey should be returned by the 10th April. The LDC launched a PPE survey on the 29th March and it has received a very good response. However, NHSE&I has now circulated its own COVID-19 Dental PPE request for supplies for the region and this should be completed and returned as soon as possible.
There will be other UDCCs identified in general dental practices over the coming weeks but these are likely to be in small numbers.
The remote triage will continue in general dental practices under their NHS contracts using the 3As and onward referrals will be actioned initially through NHS.net and then, when developed, through a DeRS urgent care pathway, therefore, ultimately, triage will be a three-stage affair.
Remote prescribing of medication is problematic and may have to be facilitated through dental practices dispensing analgesics and antimicrobials on site. The LDC is aware that DeRS is an electronic NHS.net based referral mechanism and not currently suitable for the facilitation of comprehensive record keeping. PCR will be collected at the UDCCs. The signing of PR forms and Medical Histories has been waived and tablets will not be used.
The LDC recognises that practices and the CDS clinics will run the UDCCs for the first 4 weeks (hopefully much less than 4 weeks) so many of the SOP details will have less impact on service delivery such as induction, familiarization with the practice software systems etc.
In the interim and following on from the CDO’s somewhat confusing webinar last week, we have an escalating urgent care access problem with some patients needing care that can no longer wait and the LDC is fielding many calls for advice in this regard. CQC and the defence organisations have a restrictive view on this and until all the UDCCs are up and running there will be a small number of practitioners prepared to take a high-risk strategy but at the end of the day they have a duty of care to patients that they may not be able to avoid. In this regard, the LDC is gravely concerned for the wellbeing of practitioners, staff and patients and the risk of inadvertently spreading COVID-19. BDA members can access the BDA’s excellent risk assessment advice to help with their compliance with the GDC’s guidance.
The CDO also stated in her Webinar that AGPs should only be performed in the designated locations with full PPE and no practice should be providing face to face treatment unless they are an authorized UDCC.
The CDO mentioned the plight of AQP IMOS contractors and this was also discussed earlier at last Friday’s GDPC meeting and we now know that this is being addressed. Dental business continuity is of paramount importance so that we can pick up the pieces in an unknown future state. Clearly, private practices must be protected due to the lack of capacity within the current NHS Dental services.
The LDC has been in contact with SCAS/111 and it seems that some practices are inappropriately sending patients direct to A&E or through 111 and the LDC does not support their actions unless there is a true emergency situation which should be around 1% of their patients seeking urgent care.
We are also aware that some practices are not offering advice and support during their contracted hours.
The NHS has produced the redeployment guidance/arrangements for dental professionals and their staff that includes the urgent dental care provision sites and within the wider NHS.
The 2019/20 year-end will be set at the 29th February and the 2020/21 year will commence March 2020. However, where practices activity was greater in March 2020 compared to March 2019 the former will be favourably considered by NHSE&I to avoid unnecessary contractual performance hardship. However, the advice from Sara Hurley CDO (England) and Matt Neligan Director of Primary Care and System Transformation was to contact your Regional or Local Commissioning Team.
There has been refreshed and more equitable guidance on the interpretation of the Treasury rules on Furlough Payments that take into account the proportion of private/NHS service commitment and this has already been circulated to the committee.
This week, the Office of the CDO will release their 4th version of their Letter of Preparedness which will, hopefully, more explicitly explain the current COVID-19 position and policies affecting general dental practice. This will be posted on the LDC’s website as soon as we receive it.
The LDC will endeavor to keep GDPs and their teams up to date as a matter of course.
Keith Percival BDS MGDS RCS FFGDP(UK)
GDC 45559
Hon Sec
H&IOW LDC
