Secretary’s Report
23rd May 2020
COVID-19 Local overview
The opening of all the Urgent Dental Care Hubs (UDCHs) across the SE Region is now complete. The management of these UDCHs has progressed to the point of having the NHS England South Region Standard Operating Procedure (SOP) signed off and published (website). The SOP Version 7.2 is a living document which is reviewed bi-monthly. The associated working sub groups in the South East Covid-19 Urgent Dental Care Steering Group have merged and continue to feed into the main group. The three GDS and six CDS sites in our area are all working well in H&IOW. However, the future sustainability of some PPE is still very concerning. An excellent Webinar on PPE for the Hubs was presented by 3 members of the Urgent Dental Care Working Group on the 19th May.
There is a total of forty sites across the SE region with 9 sites in H&IOW. There are 26 CDS and 14 GDS sites. There have been more than 2000 referrals in the past three weeks with 80% in the GDS. The rejection rate is averaging at around 20% with a higher demand in Winchester and Fareham and lower on the IOW. Most of the Hubs are now or will be set up for 7days a week working. Patient feedback is good but there are a small number of DNAs. Many local dentists are helping out at the Hubs. The AGP to non AGP split is around 20/80%. The Hubs are becoming progressively busier working 8.00am to 8.00pm in some locations and booking up to 4 days ahead. It is clear that we need a 4th Hub in GDS and the CDS sites are also increasing their activity levels.
The commissioners have stated that there are no plans to increase the number of Hubs. The LDC is concerned that the Hubs will be overwhelmed with potential high stress levels.
We are aware of mounting pressure from private practices to reopen in the near future with a significant number planning to open in the first week of June.
In H&IOW:
CDS Sites:
Gosport, War Memorial/CDS LIVE
RSH, Southampton/CDS LIVE (Hot/Cold)
Andover/CDS LIVE
Cowes/CDS LIVE
Somerstown/CDS Portsmouth – LIVE
Basingstoke/CDS Brambly’s Grange – LIVE (Hot)
GDS Sites:
Winchester/ GDS LIVE
Ryde/GDS LIVE
Fareham/ GDS LIVE
The CDS is prioritizing 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 is treating 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. However, identified COVID19 positive patients will be referred to a ‘hot’ site.
Group 4- Patients that do not fit any of the other categories
The main problem for the future seems to be access to FFP3s and FFP3 Respirators’ Fit Test Kits and the fact that the masks (there are more than 40 variations of the FFP3s) will only fit, at best, around 80% of clinical staff some of whom will have potential co-morbitities and/or will have vulnerable family members which will eliminate them from front line services. Some dentists that have failed the Fit testing are sourcing positive pressure hoods. 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. Likewise, any non-liquid repellant gowns should be supported with an appropriate protective apron underneath. Any change of FFP3 brand or type requires further fit testing to ensure the wearer’s safety. The current UDCCs PPE guidance is demonstrated within the SOP.
The LDC has been assured that the necessary PPE is in place for the UDCH in GDS practices. However, sourcing PPE is an ongoing issue and when private practices return to work in early June the PPE supply chain will be further compromised.
We have an escalating urgent and non-urgent care access problem with some patients needing care that can no longer wait and the H&IOW LDC is continuing to field many calls from NHS and private providers for advice in this regard. Additionally, patients are contacting the LDC through Facebook and via the website. Many practitioners are keen to start seeing non-AGP patients but the CDO has stated that urgent care sites must be approved in line with the national SOP or its regional/local SOP that are based on the CDO’s national SOP. We are aware that this situation is rapidly developing and may change. Due attention should be given to the Coronavirus Act and CQC guidance when considering re-opening services. We are aware that the FGDP is rapidly working with other eminent organistions to provide guidance (first week in June) that will help practices to return to clinical care operations in the future.
The LDC is gravely concerned for the wellbeing of practitioners, staff and patients and the risk of inadvertently spreading COVID-19.
We are aware that some practices are not offering advice and support during their contracted hours. An NHS SE Region survey has already taken place and it is likely that in some circumstances NHSE&I will consider future options such as remedial breach notices and abated funding measures.
The LDC is receiving a growing number of complaints from associates who are having their contracts/agreements unilaterally changed with inappropriate changes made to their monthly payments, UDA rates, deductions for laboratory expenses and their general terms and conditions by contract Providers. NHS England and NHS Improvement is well aware of those contract providers who are acting outside their contractual obligations. The Commissioners in the SE Region expect contractors to honour payments to their associates and staff at 100%. We are aware that NHSE&I are consulting with counter-fraud (NHS Protect)
Other News
Locally, PAGs have been postponed to September but PLDPs continue to be held virtually.
The LDCs have continued to meet and other videoconferences have increased exponentially.
Locally, the procurement process for mandatory dental services in Alton, Tadley and Portsmouth is continuing albeit at a much slower pace.
The Welsh CDO has announced (22.05.20) her recommendations for the restoration of dental services post Covid-19 based on a model of a unilaterally imposed reformed contract that replaces the UDA with the Unit of Dental Assessment (UDAS) and Assessment of Clinical Oral Risks and Needs (ACORN) with KPIs. There are no plans for AGPs to be seen in general dental practice in Wales before September.
The Annual Conference of LDCs that was due to take place in November in Brighton is now cancelled and will be held as a virtual conference on Saturday the 25th July 2020.
The Scottish Chief Dental Officer has released (20.05.20) his phased approach plans for the Remobilisation of NHS Dental Services in Scotland. Phase 3 is the introduction of AGPs into dental practices. The Scottish UDCCs will move to dealing with urgent dental care as laid down in the SDCEP RAG guidance to provide an expanded list. General Dental practices are now working towards phase 2a (face to face consultations) as part of a staged recovery.
There are more than 500 UDCCs throughout the country and GDPC has regular meetings (2) with the OCDO and NHSE&I on a weekly basis. It is suggested that all practices look to providing their own fit testing but pay due attention to any potential indemnity issues arising from this action. Nationally there is probably a need for around 70,000 fit tests with many of these needing to be repeated in due course. It is thought that NHSE&I should keep a list of approved Fit Testers.
The LDC is aware of three private UDCs in the North where a surcharge of £80 to £100 is applied to the treatment costs. The Coronavirus Act impacts on the provision of non-essential/non-urgent treatment in any setting.
The new British Association of Private Dentists (BAPD) has more than 10,000 dental team and some non-dental team members. They are currently developing their articles of association and will shortly establish their Executive Officers.
Very recently the BAPD issued a letter expressing no confidence in the Office of the Chief Dental Officer in England with more than 1600 signatories. The CDO has not resigned.
England will undoubtedly, follow a staged approach to the restoration of clinical practice based on the ‘R’ number and infection rates possibly tied into regional activities such as school opening. There will be a revised SOP for return to clinical practice (RTCP). The success of Test Track and Trace will certainly help dental practices in the future.
More practices are looking into air exchange and purification systems such as Radic8 and Dentair
BDA is taking an in-depth look at around 20 service-interruption insurance policies to see if practice claims might be successful.
The abatement negotiation issue is still deadlocked with NHSE&I set on a target of 20%, however, this does not address practice’s variable costs eg re-setting up costs. BDA is looking to negotiate a smaller percentage.
The Minister responsible for Dentistry Jo Churchill (under-Secretary for Health) is meeting with the BDA on a weekly basis which is a great improvement on past communication with the Minister of the day. She is willingly engaging with the BDA.
Nationally the provision of PPE is currently patchy and in many areas in short supply so when 500 Hubs become 10,000 practices there is going to be some acute shortages unless the national picture improves. Also of concern is the amount of counterfeit PPE.
The funding of the HUBs is very variable and GDPC will be pressing for a national not regional policy to ensure that the UDCCs are treated fairly. When there is a RTCP it will be difficult for the Hubs to return to their normal contracted activity.
There is still no clarification around the financial/activity management of the 202/21 contracted year.
Keith Percival
