HAMPSHIRE AND ISLE OF WIGHT LOCAL DENTAL COMMITTEE
COVID-19 UPDATE: 07.06.20
On the 28th May the OCDO followed up on the delayed A Prompt to Prepare with the announcement that all dental practices should resume their provision of dental services from the 8th June. The Prompt to Prepare document included a Consideration Pathway which clearly outlines 11 important considerations with numerous embedded links to further /expanded guidance. The long awaited practical guidance from the FGDP/College of General Dentistry was published on the 1st June as Implications of COVID-19 for the safe management of general dental practice (LDC website) and is a must read in partnership with OCDO and NHSE & NHSI publications (Dental Practice Checklist). An earlier publication (25th May) from the SDCEP is also a useful guidance and implementation reference tool. The BDA released its own COVID-19 special guidance: Returning to Face –To-Face Care on the 5th June and this toolkit is designed to help practices to return to safe clinical practice. There is a very helpful NHS Dental Practice Checklist Covid-19 circulated by NHSE that aims to assist general dental practice teams to prepare for re-opening of practices (LDC website www.hiowldc.org ). The H&IOW LDC has published on its website – Tips and thoughts on re-opening based on experiences within a UDCH
There have been a mere 7 working days since this announcement and a plethora of advice, guidance and many different SOPs have been generated from many eminent sources much to the dismay and emergent confusion of dental teams. This imposed, very short timeline has bewildered many practice teams as they struggle to get all their measures of compliance established within their practices. The support and advice from different regional commissioning teams throughout England has been variable but based on similar themes but because there was no national input at an early stage it has led to much duplication of effort. The H&IOW LDC has posted the majority of these published texts for information as it receives them. It is estimated that less than 35% of practices will be ready for face to face contact on Monday the 8th June. A recent BDA survey identified that the initial 35% will be followed by another 16% during week 1 and a further 16% will restart on the 15th June with only 15% carrying out AGPs. Only one third will have the necessary PPE. The UDCHs will continue to work alongside practices coming back on-stream and they will continue to accept referrals although there is an expectation that their activity will be more AGP based. AGPs will be contraindicated in a windowless surgery.
Apart from digesting and implementing the OCDO’s SOP and associated guidance the issue of PPE will limit any return to the provision of general dental services. The LDC is aware that national dental wholesalers received substantial supplies of PPE on the 4th/5th June but due to their internal processing, distribution is likely to be delayed until the early part of week commencing the 8th June. The cost of PPE has increased by 1000% and the WHO/PHE guidance has been difficult to reconcile with the availability of certain items of PPE for an AGP/AGE treatment scenario. There has been a PHE shift to fit tested FFP2and N95 masks for AGPs and these elements of PPE are more readily available than FFP3s. 3M is in the process of setting up its own dedicated factory. A further and pressing, serious problem is around the availability of fit testing kits and certificated Fit Testers. A list of Fit Testers can be found on the LDC website. In the London region, the commissioners have collaborated with the LDCs to provide free Fit Testing training and it envisaged that the way forward is for every practice or organisation to secure its own trained fit tester and the necessary fit testing kit. We understand that HEE is likely to be funded to provide fit testing training in the near future and Education Supervisors are being considered for this role. Every practice should consider having a fit testing PPE lead. As the supply of PPE is likely to be variable with different brands/models it is certain that there will be significant re-testing necessary to preserve the safety of individuals working within the surgery and their patient population. It is important to remember that PPE is not a medical device and is quality policed by the H&S Executive.
We are aware that many private practices resumed their dental service provision based on their individual risk assessments and preparedness within their own practices and organisations. Some private providers produced helpful webinars.
Some NHSE and NHSI commissioners (Midlands) sent out communications clarifying the message that there was no expectation on providers to implement an immediate return to routine care or to an activity based contract. The commissioners in the Midlands also produced an excellent Resumption of NHS Dentistry COVID-19 Response publication. It is fundamental that no practice should attempt to return to face to face contact/treatment unless they are fully and safely prepared to do so. The LDC will be requesting assurances from the commissioners that no practice that is reasonably prevented from returning to work through no fault of its own will be penalised eg PPE and fit testing availability.
On the 4th June, a mere one working day before the proposed return to a phased transition for dental practices towards the resumption of the full range of dental provision Version 1 04.06.20 document was released. This latest document is peppered with embedded links and can be found on the H&IOW LDC’s website. A revised COVID-19 Guidance and Standard Operating Procedure (SOP) for the provision of urgent dental care in primary care settings and designated Urgent Dental Care Hubs was also published on the 4th June.
The NHSE and NHSI South Region SOP for Urgent Dental Care Hubs during the COVID-19 pandemic Version 7.4 is ready but is awaiting endorsement/clearance to replace Version 7.3 (already on the LDC website). A SE regional SOP for the resumption of the full range of dental provision is being considered.
The 7 LDCs across the SE region have sent a joint letter of concern to the commissioners to highlight the many problems and unknowns facing NHS general dental practices during 2020/21.
NHSE and NHSI have issued (4th June) an online Dental Practice Statement of Preparedness for Reopening of Services form that needs to be completed and returned as soon as possible. This form seeks reassurances from practices that they have reviewed their individual circumstances in the light of national and local guidance. Furthermore, it seeks confirmation that all the necessary policies and procedures are in place to protect patients, staff and the general public.
BDA has an excellent Coronavirus FAQs on its website that addresses many issues raised by both associates and contract providers.
On the 25th May a NHS Dear Colleague letter to GPs and Primary Care Networks (PCNs) identified the antibody testing programme roll out for NHS staff and patients. NHS staff should progressively be offered antibody testing including those in primary, community and mental health care including community pharmacists. We await developments.
The BSA have issued a Compass Workforce Data Collection Form (Compass Application) for mandatory completion, originally by the 5th June amended now to the 19th June.
So, in summary but not limited to and in no particular order:
- Consider the FGDP Guidelines and remember that there is Aerosol Generating Exposure (AGE – high/low risk as well as Aerosol Generating Procedures (AGP)
- AGEs eg cough reflex
- No fallow time after non-AGPs but for AGPs its 60 minutes from cessation of AGE
- Consider any at-risk staff and any additional protective measures
- Risk Assess in the light of the current COVID-19 Alert. Remember the regional R number – the risk assessment should be based on: Safety, National Alert (currently between 3 and 4), Oral Health Needs, Personalised risk assessments for your team and your patients and keep abreast of the science and evidence
- Plan the pre-appointment processes – up to date communication, administrative tasks eg medical history, COVID screening, payment, forms, questionnaires by digital methodology wherever possible
- Check for those at higher and moderate risk (shielded or vulnerable)
- Social distancing measures, minimise potential contamination, restrict waiting in common areas of the practice and use of practice facilities. Offer strategically placed hand sanitisers
- Appropriate PPE and install screens – check the SOP for details if in any doubt
- Best Practice Infection Control and prevention – where possible but at least standard IPC
- Realistic appointment times
- Use more than one surgery
- Ongoing training
- PPE – AGPs at least fitted FFP2, visor and gown and use rubber dam and high-volume suction – check the SOP for more information
- Ventilation or negative pressure system
- Staff screening log
- Work rotas