Dear Colleagues
During the COVID-19 pandemic, there has been a been a significant increase in the numbers of patients trying to access urgent dental care, which has placed pressure on dental practices as well as other areas of the urgent care system such as 111, Emergency Departments and GP practices. This has been particularly difficult for patients that do not have a regular dentist and while practices have been asked to provide urgent care to any patient that contacts them, within their NHS capacity, we appreciate that for many this has been challenging and has meant that some have not been able to resume non-urgent care for their list of regular patients as quickly as they would have liked. We thank you for the work you and your teams have done to date and now wish to outline a proposal to further address care for patients that do not have a regular dentist that will enable you to resume care for your regular list of patients sooner.
Our Proposal
Short term funding has been identified to manage this cohort of patients. We are kindly asking for practices to consider submitting an Expression of Interest (EOI) to provide face to face treatment for new patients that are not on their list of regular patients.
EOI may only be made by contractors who hold a current NHS contract to provide mandatory dental services to all categories of patient (children, exempt adults and fee-paying adults). The programme will not be available to providers who have restricted contracts (eg child only or child and exempt adults only).
While the focus will continue to be patients that have an urgent or pressing need, there will be greater flexibility in the term urgent need. Treatment will not be limited to that detailed in Schedule 4 (Urgent Treatment) of the NHS Patient Charges Regulations and the focus should be on providing definitive treatment to prevent the need for the patient to access urgent care again in the future, eg where remote prescribing initially addresses a patient’s urgent need they should be followed up with face to face appointment(s) to treat the reason for the swelling/pain in the first place; or where a permanent restoration is not possible at the initial appointment, the patient should receive this at subsequent appointment(s); or where the initial appointment extirpates the tooth, the endodontic treatment should be completed and a final restoration should be provided at subsequent appointments; or where the patient presents with an urgent need for a particular tooth but examination identifies other treatment is needed that if left may result in the need to access urgent care at a later date, this is also carried out at that or later appointment(s) – this list of examples is not exhaustive and practices will use their clinical judgement to do what is in a patient’s best interests and consents to receive, to prevent them needing to access further urgent care in the future.
This programme will be funded on a sessional basis rather than specified number of UDAs and the focus should be on banded courses of treatment rather than an urgent followed by a banded course of treatment. Given the variance of fallow time, which is dependent on the type of dental procedure undertaken and local circumstances, the number of patients seen in any given sessions will vary but it is anticipated that practices will see between 4 and 6 patients per session.
Expectations of Providing Additional Sessions
These sessions are to operate outside a practice’s current NHS commitment/contracted hours and as it is a short term programme it is not anticipated that new staff/performers would be recruited with staff/performers instead carrying out overtime. To reflect this, funding is offered at £400 per 3.5 hour session which is BDA Guild rate +33%.
These sessions may be week day evenings and/or Saturdays, Sundays as either a half or full day. Where practices wish to participate but do not want to do the full 3.5 hours as one session but instead work 1-2 hours over several days, this is also possible. Practices may choose to have one or multiple surgeries running at the same time.
The intention is for these to start as early in January as possible and will run initially until 31.3.21. If evaluation of the programme is positive we will submit a further business case to continue this into 2021/22 to further deal with the backlog of patients since the pandemic began. Once we are aware of the funding required for this particular programme, we will consider similar initiatives to deal with the backlog of treatments with the various referral services.
Practices that wish to participate will be given a new contract number specific to this programme so that activity is discreet from their contracted activity. Practices will be required to email their day book for the surgery(ies) this programme is delivered from to monitor the uptake and determine if the number of funded sessions in a given area needs to be increased or decreased.
We appreciate that practice and staff’s circumstances may change and so if you accept this offer you may withdraw at any point. If that is necessary we do ask that if you have already made appointments for patients that you rearrange these to treat them under your usual contract number so they are not faced with the difficulty of finding another practice.
Even where there is a good uptake of this programme, it is still anticipated there will be more demand than sessions provided and so we will continue to ask that all practices provide urgent care to any patient that contacts them, within their NHS capacity. However, those that are part of this programme may be able to book all/most of these patients into one of the funded sessions which means they will be able to resume non-urgent care for their regular list of patients sooner.
Criteria
Practices will need to meet the following criteria to be eligible to apply for additional funding:
- Their contract must have delivered a minimum of 90% of contracted activity in the previous year (2019/20).
- The contract must be able to provide additional access (3.5 hour session) outside of normal contracted hours between January and March 2021.
- The contract must provide both AGP and non AGP procedures, ensuring a definitive treatment outcome for the patient.
- Patients accessing the additional sessions should not have a regular dentist and should not have been seen by your practice in the preceding 24 months, apart from patients that you have provided urgent care to during the pandemic period. Where your own patients require urgent care, this should be provided during your normal contracted hours.
Next steps
If you wish to apply to take part in this programme of work, please complete an EOI using the following link:
Responses are not required from those that are not eligible or do not wish to participate. We would appreciate receiving your EOIs as quickly as possible and by Friday 8 January 2021 at the latest so that we can determine which will be in the first tranche. We appreciate that practices will need to speak to staff and establish if they are able and willing to work overtime and co-ordinate this and so everyone may not be able to meet this deadline so we will keep this offer open throughout January to March 2021 as practices that do not feel able to be part of this programme now may wish to do so in the future if circumstances change.
We expect to advise contractors of the outcome of their EOI week commencing 11 January 2021 and would ideally like services to commence the following week. Once you have received confirmation of acceptance, rather than a contract variation we will issue a Memorandum of Understanding (MOU) in principal for signature. We will also confirm how patients will be directed to your practice, which will vary across the region depending on local 111 and Helpline arrangements.
Thank you once again for your continued support during this exceptionally difficult time. We very much look forward to working with you to meet the needs of this patient cohort that will have a positive impact on your regular list of patients that will be able to resume non-urgent care sooner.
If you have any questions please contact the dental team via the generic email address – england.southeastdental@nhs.
