As many providers will be aware, the South East dental team has been carrying out an audit to confirm that patients are able to access urgent care in the form of triage and advice, analgesia and anti-microbials where appropriate (AAA) in a satisfactory way. The audit became necessary as a result of a large number of reports from dental practices that fellow practices were not giving AAA to patients, 111 that patients advised they have been told to contact them by a dental practice (direct or via a message on a practice’s answer machine), A&E that patients have advised they have gone there as they have not been able to speak to a dentist, as well as MPs contacting us on behalf of patients that have informed them they have not been able to speak to a dentist. The Dental Team very much appreciate that patients may not always give accurate information, particularly when they have not been able to access the care they wish, but the number of reports from various sources were too many and so a significant resource has had to be diverted into carrying out the audit phoning almost 1,200 practices that hold an NHS contract across the South East region.
For those that The Dental Team have audited that have been identified are providing triage and AAA in an appropriate manner, they thank you for continuing to provide remote urgent care to patients that contact your practice during this challenging time.
Although the audit is not yet complete, the findings to date support the feedback received for some practices; those practices will receive individual feedback on their findings. It also identified that the arrangements that some practices have in place are not in line with our guidance of 26 March 2020 about remote provision of AAA. They have attached their previous email as a reminder but they also attach further guidance that has been compiled as a result of the interim audit results. The Dental Team ask that you urgently review your AAA arrangements to ensure it is in line with the second attachment as it is imperative that any patient that contacts your practice receives triage AAA in a satisfactory way and, where appropriate, referral to an urgent dental care hub via DERS (also known as Rego) or where cancer is suspected a referral via the 2ww pathway on DERS.
A joint letter from Public Health England, the Colleges and BDA has been published to promote appropriate prescribing in response to concern by the profession regarding the prescribing of antibiotics in line with the advice provided by SDCEP and the antimicrobial stewardship toolkit which are referred to in the Urgent Dental Care SOP they circulated on 16 April 2020. Please ensure you bring the advice in the following link to the attention of all dentists that are delivering AAA https://www.fgdp.org.uk/news/open-letter-prescribing-antibiotics-during-covid-19-%C2%A0 they also direct your attention to the following pain relief advice http://www.sdcep.org.uk/wp-content/uploads/2020/04/SDCEP-MADP-COVID-19-drug-supplement-080420.pdf For ease of future reference both of these links have been copied into the attached guidance.
The Dental Team clarify that NO FP17 claim can be submitted and NO patient charge/fee collected for patients receiving triage/AAA or the issue of/collection of/delivery of a prescription. The only FP17 claims that can be submitted and patient charge/fee collected is for face to face care within an urgent dental care hub which is £22.70 for non-exempt patients as a band 4 urgent dental treatment charge; no charge/fee can be levied/collected where medication is given or a prescription issued to patients.
As a related matter, you should have received the communication below from the NHS BSA setting out the national requirement to capture AAA on Compass. Although there is a link to frequently asked questions (FAQs) on their website and their email address firstname.lastname@example.org for queries, they have received a number of enquiries as well. They answer below those that they are able to but ask that you use the FAQ link to their website to see if this answers any further queries you may have and if it does not (or you did not receive the original email from the BSA) please email the BSA direct on email@example.com rather than the South East regional team as the BSA are best placed to answer these and will enable them to update their mailing list and FAQ as a result of questions asked.
This requirement is to capture AAA carried out from Wednesday 29 April 2020 onwards. If you wish to retrospectively backdate this to 25 March 2020 when remote AAA was introduced, that would be appreciated, but backdating is not mandated. Where AAA is given to private patients it is not necessary to capture this information, however as some practices have entered into a consortia/buddy arrangement and so the dentist delivering AAA may not be aware if the patient is private or NHS (unless the clinical presentation is clearly private such as Invisalign or implants), so if in doubt please update AAA via Compass. Although concern has been raised that this duplicates records kept by each provider, this is required at a national level for every primary care provider (GDS, Ortho, CDS, out of hours EDS, UDC hubs, etc) to assist in identification of the future needs of patients so that plans can be put into place for exit from the current arrangements of triaging and urgent care for patients. Please note that regional teams have no discretion in this matter.
Although AAA must be delivered by a dentist, it is a local decision for each provider/practice who completes the Compass return after AAA by a dentist and the Compass task can be delegated to another member of the dental team (eg, receptionist, practice manager, dental nurse). Should you require additional staff to have access to Compass to facilitate that task, the person responsible for providing access to Compass will be able to add them and if you need any help in doing this please use the BSA Compass guide or if this does not enable you to do this or you have any queries, please contact the BSA via firstname.lastname@example.org
The Dental Team clarify that this Compass form is also required where a second triage is carried out by an UDC hub with the expectation that a free text comment is entered confirming that it is a second triage; this should be submitted under the new contract number set up specifically for each hub. Where patients contact any practice, including hubs, and receive first line AAA the Compass return should be submitted and in the case of hubs this would be under the practice’s original contract number.
The Dental Team thank you for your ongoing support in providing remote urgent care via AAA to any patient that contacts your practice during this challenging time.