All practices were required to be open for face to face care from Monday, 20th July 2020 and the Dental Team are grateful to those that have done so. Where a practice was not open on Monday 20 July 2020 please urgently email your named Contract Officer to explain the reason for this and the date you anticipate you will be open – email confirmation is required even where you have previously advised via our online surveys, phone or email that you did not believe you would be open on 20 July 2020. If your opening status changes at any point in the future, you must immediately email your named Contract Officer to explain the reason for this and the date you anticipate you will re-open. The Dental Team are required to report this information to the national team but will also be sharing with our urgent dental care (UDC) hubs so they are aware which practices may need to continue to refer patients for non-aerosol generating procedures (AGPs) and if your practices is not identified any referrals you make for non-AGPs will be rejected.
The Dental Team have also learnt that some providers believe that it is not necessary to provide aerosol generating procedures (AGPs) to NHS patients despite letter 5 advising that practices are to make all possible, proactive efforts to deliver as comprehensive a service as possible. Although the Dental Transition to Recovery SOP advises that you should be aiming to minimise AGP where possible, this is not the same as saying you do not have to carry out AGP and for the avoidance of doubt we confirm that all practices are required to provide AGPs where risk assessment identifies this is clinically appropriate and means that patients should not be advised that they cannot receive an AGP on the NHS but can receive this privately if they wish or be referred to a UDC hub for an AGP. If practices have not yet undertaken fit testing of their workforce to enable AGPs to be carried out, they should urgently consider booking a member of their team on one of the previously circulated details of fit test training that is provided free of charge. Once that training has been carried out, those fit testers will carry out a programme of fit testing at key sites across the South East, with those delivering the fit testing being given “activity credit” to their practice in recognition of the fact that they are fit testing outside of their own practice. The UDC hubs will be kept updated which practices have been fit tested and at that point will reject referrals from practices that are then able to carry out AGPs, with the exception of urgent care for shielded patients Individuals at the highest risk of severe illness from COVID-19 that cannot be deferred. Where staff and performers fail a fit test to a particular make of mask, providers should source alternate makes of mask or provide hoods (which do not require a fit test) to enable AGPs to be carried out where clinically appropriate.
To be eligible for ongoing 1/12th NHS contract payment you must continue to pay your staff and performers their historic NHS earnings; any provider that has not done this to date must urgently address this by retrospectively making these payments. For the avoidance of doubt, this principle (and the associated assurance mechanism that letter 5 refers to) applies to all individuals providing NHS care in the practice whether directly employed, employed as a locum or engaged through a contract for provision of service on any basis; this applies to all staff groups including dentists, dental hygienists, dental therapists, dental nurses, non-clinical and administrative staff. Performers should not currently be remunerated for actual UDA delivery as letter 5 recognises that capacity is constrained and that it may not be possible to deliver historical UDA levels at the current time. Although there is a relaxation in UDA delivery, practices are to perform the highest possible levels of activity with no undue priority being given to private activity over NHS activity. Practices are to be open for face-to-face care for their contracted hours and should have the number of staff and performers working the same hours that they ordinarily would have, had you been required to deliver full contracted activity (some may deliver face-to-face care, some may deliver remote triage/risk assessment, some time will be fallow following AGPs) – this will define your NHS capacity.
111 are increasingly advising that many practices are no longer prepared to provide urgent care to patients that are not regular patients of the practice; this leaves these patients with no way of accessing urgent care apart from the out of hours services which is an inappropriate use of those services and results in patients that have a genuine out of hours urgent need not being seen. The Dental Team have also heard that some practices are applying the same strict criteria that was necessary for hubs to apply during lockdown and so many patients that have an urgent need are advised they do not meet criteria to be seen. While it was necessary for hubs to apply strict criteria as there were just 40 hubs to provide urgent care on behalf of in excess of 1,200 NHS practices so prioritisation identified the most urgent patients, now that practices are open they should not be applying the same rigid triage and should provide care for all patients with an urgent need.
While many practices now want to concentrate on their regular list of patients, all practices need to maintain the provision of urgent care to any patient that contacts them that they are able to deliver within their NHS capacity. This may be remote advice, analgesia and antimicrobials where appropriate (AAA) in the first instance but if a patient needs face-to-face care, practices should provide an urgent course of treatment. The Dental Team hear from hubs that where some practices have given AAA to a patient that isn’t on their list of regular patients and the patient needs to face-to-face care, they are referring these patients to UDC hubs despite the practice being open for face-to-face care for their regular list of patients. This is not the purpose of hubs and unless all practices play their part in ensuring all patients can access urgent care, until they return to pre-Covid times, this mis-use of hubs will lead to them not having sufficient capacity to provide treatment on referral for the times when practices have to temporarily close (eg, when there aren’t enough staff due to them having to self-isolate after test and trace or being unwell), local lockdowns or periodic occasions when practices are unable to provide AGPs. It also runs the risk of this additional pressure on hubs leading them to stop providing this service.
The transition to providing a full range of dental care is a phased approach based on risk management which will take time. Where practices have the capacity to maintain urgent care for any patient, have followed up on those that received AAA and/or treatment at a UDC hub during lockdown, as well as those with an open course of treatment and are ready to resume routine care, you should still be seeking to prevent unnecessary patient journeys and also help patients maintain social distancing. You should be aiming to minimise AGP where possible, which is not the same as saying you do not have to carry out AGP and instead for exam and scale and polish, ultrasonic scaling will usually not happen. The risk assessment as part of screening has to be applied and so:
- You will not be seeing shielded patients Individuals at the highest risk of severe illness from COVID-19 for routine care; where shielded patients require urgent care that cannot be managed by AAA they should be referred on the UDC pathway and will be given urgent care by a CDS hub.
- You may advise those patients that are clinically vulnerable (70 or older, pregnant or usually need a flu jab for underlying medical conditions) that routine care could be postponed as they are higher risk. Where your risk assessment confirms these patients can be seen, if their examination identifies treatment is needed this would be provided by your practice and not via a referral to a UDC hub.
- There is no reason not to start a band 2 or 3 course of treatment and delay completion for several weeks/months, if that is most appropriate for a specific patient, or if the need for urgent care increases for any patient that contacts your practice, meaning routine care for your list of regular patients needs to be delayed, if that is in wider patients’ best interests.
While many practices are already following the above and which The Dental Team thank them, they hope the above makes clear the expectations of practices that are not yet carrying this out.