This page has been setup for the dedication of any information relating to COVID-19. The Hampshire and IOW will give you all the available and latest information for you to make your own considered decision in consultation with your NHS contract lead. It is NHSE’s responsibility to officially communicate with you
NHS England and NHS Improvement South-East Covid-19: Delivery of Urgent Dental Care GDP and Urgent Dental Care Hub Briefing
Update from the Chief Dental Officer – 23.09.2020
Following yesterday’s announcements by the Prime Minister I would like to confirm the current intent and approach to maintaining dental care services in England:
- Practices should continue to restore activity in line with letters and SOPs currently in force.
- The current Standard Operating Procedure (SOP) for Primary Care Dentistry – Transition to Recovery SOP (28 Aug 2020) continues to apply and the version of 28 August contains updates to reflect some changes to support management of the second wave.
- Practices should remain open for the delivery of face to face care, whilst triaging patients remotely in advance, and using remote consultations where appropriate. There remains a need to focus on ensuring face to face urgent and emergency care is available, reviewing interrupted patient care pathways and restarting where appropriate, and patients who normally attend the practice are prioritised for care in terms of their risk.
- In the event of a local outbreak clearly local direction and decisions will take precedence. Please review your practice contingency plans in preparation for your practice’s response to any local lockdown direction, guidance from Public Health England or advice from NHS England and NHS Improvement.
Further updates will be published by NHS England and NHS Improvement in conjunction with your local team.
Please continue to be vigilant and maintain communication with your local dental network chair for advice and guidance on any changes in local restrictions and public health measures.
Thank you again for your continuing support,
Issue 6 of the NHS England and NHS Improvement – South East Newsletter.
Please see below the Issue 6 of the NHS England and NHS Improvement – South East newsletter.
Please see below yesterday’s NHSE/I Primary Care Bulletin which contains guidelines around the use of facemasks in primary care and community settings.
Should you wish to sign up to the Primary Care Bulletin the link is below:
Covid-19: Delivery of Urgent Dental Care, GDP and Urgent Dental Care Hub Briefing:
Please see below the Covid-19: Delivery of Urgent Dental Care GDP and Urgent Dental Care hub briefing Newsletter:
- They are valved and therefore do not fog up visors or glasses
- They are re-usable. Therefore a mask costing about £30 is re-suable. The only thing that needs to be changed is the filter, which costs about £15 per pair, and according to manufacturers instructions need to be replaced every 4 weeks. This significantly reduces ongoing costs, considering that the cheapest disposable FFP3 mask costs £8 and lasts no more than 1 AGP.
- They are made of plastic and the outside can be disinfected with Hypochlorous acid or alcahol wipes.
- The straps are made of material and are more difficult to disinfect, but can be worn under a head cap.
- They can be dismantled and the parts can be washed fully with detergent
- Speaking is a problem because you can’t be heard. What we do is conduct the examination using Level 2 PPE, and only wear the mask when we commence the AGP
- They are bulky, but they can be worn with glasses and loupes quite easily. There are visors that cover the whole face that are worn perfectly with these masks.
- The unvalved FFP2 masks cause fogging of the visors, so it is more comfortable to wear a P3 half mask than to wear an FFP3
- I have attached types of P3 masks below
- Fluid resistant gowns that are designated as single use should be disposed of after an AGP. We found that these can be placed in a pouch and autoclaved in a vacuum autoclave. They are still fluid resistant, and although very creased can be worn again. We have autoclaved gowns as many as 5 times before discarding. The cost of disposable fluid resistant gowns varies from £7 to £12.
- A better option is using re-usable hospital gowns. These can be washed at a high temperature using detergent. What we tried was wearing a reusable gown, then removing it after the AGP and placing it directly into an empty pillow case. At the end of the session, we then placed our scrubs into the pillow case and this was washed at 60 degress with detergent. The cost of re-usable gowns varies from £15 to £25, but you only have to wear it 2 or 3 times to get good value for money.
A Prompt to Prepare
Please see below the Prompt to Prepare documentation from the CDO:
Important Update to Weblink: Updated Guidance for Primary Care Dental Services – Hub Update
Further to the Dental Team’s email sent out on the 16 April, we are now able to confirm that a number of the Urgent Dental Care hubs have a limited supply of PPE that will enable them to provide treatment for the most urgent patients. Generally patients that are shielded or at increased risk of severe illness will be treated in hubs run by our Community Dental Services with all other patients treated in hubs run by General Dental Service providers that are staffed by both their own practice workforce as well as those from other practices. The Dental Electronic Referral System (DERS) will automatically send referrals for shielded patients and those at increased risk of severe illness to the local CDS for the patient; dentists will need to select the closest GDS hub for all other patients. At any point should a hub not have the required stock of PPE they may need to temporarily stop face to face treatment, in which case the hub will redirect the referral to an alternate hub following secondary triage. Please do not advise patients the address of the hub you select on DERS as this may change or secondary triage may determine an appointment is not offered; this will ensure the safety of staff and patients at the hub as it will prevent patients that do not have an appointment from attending. Patients will be advised the hub address if an appointment is offered following secondary triage.
All referrals to the Urgent Dental Care System can only be made through the DERS (also known as Rego). Any previous referral arrangements are no longer to be used with immediate effect and any referrals made outside of DERS will be returned by the hub. The referral must be made by the dentist that undertook the latest triage and gave urgent care to the patient through AAA.
The Dental Team appreciate that practices will have a list of patients they have already provided telephone triage to but they ask that you do not make the referral on the basis of this and instead a dentist should contact those patients to obtain their up to date symptoms and assess whether they still require further treatment or whether AAA given previously has made their condition manageable. Should any of those patients still require urgent treatment, the dentist should make a referral on DERS.
Each hub will re-triage all referrals to confirm that the patient does need to be seen urgently and further assess their COVID-19 status. The Dental Team therefore ask that when a dentist makes a referral, they advise the patient that the provision of referral does not guarantee that they will be given and appointment and that they will have to go through another clinical assessment, due to the limited number of appointments during this pandemic. To manage patient expectation as to the treatment they may receive, please also advise them that where an appointment is given, the treatment that can safely by undertaken during the pandemic is very limited and may be temporary in nature.
To make a referral on DERS, the dentist should use their usual log in details. Where the dentist is making a referral from home they will need to log onto the following website https://ref.management/login to access the system; they have attached guidance on how to do this and the use of the secure key for accessing the site securely. They also ask that questions on the use of DERS are not made to the Dental Team as they will not be able to answer these and instead questions should be made to Vantage by telephoning 0207 993 5870. Once online if you have any further queries, you should ideally use the webform or the live chat function in DERS rather than phoning.
In addition to making a referral into the UDC system, DERS can now be used to email a prescription to the patient’s choice of pharmacy. The previous instructions sent on 16 April are no longer applicable and instead have been updated here to reflect the use of DERS to send a prescription to a pharmacy:
- Patients should be advised to purchase over the counter pain relief wherever possible rather than including this on a prescription, as this is impacting on pharmacy supply chains and increased workload to dispense
- FP10D must include the standard prescription details; ensure the medication dose and duration are clearly annotated
- Prescription must be signed and dated
- Check NHS.uk to see pharmacy opening hours as a number of pharmacies have reduced their hours and ask the patient which one they would like to use
- Prior to finishing the AAA call with the patient
– ensure they know the prescription may take some time to be dispensed at the pharmacy
– advise that if they or a member of their household is symptomatic or self-isolating, that they MUST NOT attend the pharmacy to collect the medication and should request a neighbour or friend to collect on their behalf; shielded patients and those at increased risk of severe illness (previously referred to as vulnerable patients) should be advised to ask someone else to pick up the prescription although in some cases the pharmacy may deliver
– the person collecting the prescription should check pharmacy opening times (all pharmacies are open Monday to Friday 10am to 12pm and 2pm to 4pm as a core minimum)
– the person who is collecting the dispensed medication must inform the pharmacy that their prescription has been sent to the pharmacy nhs.net email address from their dentist
– ask the patient to contact you if they are unable to obtain the prescription
- Once a pharmacy is agreed, you must ring the pharmacy to advise them that you will be sending a prescription and it will be on their nhs.net account awaiting action, noting that pharmacies are experiencing very high levels of demand at the moment
- If you are unable to contact the agreed pharmacy, then you will need to find another and inform the patient where the prescription has been sent
- Log into DERS using normal log in details
- Add patient details ie, name, address, telephone number DOB to create a record and unique reference number (URN) for the patient
- Select Prescription Pathway, follow the prompts on the screen to create a record of the prescription, selecting the appropriate medication, dose, route and frequency, ensuring it is the same as the written prescription
- Answer the prompts as to the patient’s COVID-19 status
- Download the App from the Apple App Store called ‘Rego Uploader’ (this is only necessary the first time you use DERS to send a prescription to a pharmacy), there is no cost to downloading and using this App. This will allow an image of the prescription to be uploaded onto DERS (as you would do for uploading an x-ray), the image does not stay on your phone/tablet so is fully IG compliant; follow the prompts on DERS and on the App to upload the image
- Complete the prescription notification by clicking on ‘send’, DERS will then send the prescription through to the chosen pharmacy via email to the pharmacy’s nhs.net account
- An email copy of a paper prescription does not fall within the definition of a legally valid prescription so the original FP10D should be sent to the pharmacy as quickly as possible as this must be received no later than 72 hours after the emailed copy
- Keep a record of paper prescriptions sent and confirmation of receipt by the pharmacy
The Dental Team have received increased reports from 111 that patients have been advised by their dentist to contact them. With the exception of patients that consider they have COVID-19 and require advice relating to COVID-19 symptoms (and not for dental advice), patients should not be advised to contact 111 as 111 are unable to give any additional advice than a dentist can using the AAA outlined below in our email of 16 April (and preceding emails).
They thank you for your ongoing support in providing remote urgent care via AAA to any patient that contacts your practice during this challenging time.
Redeploying the Clinical Dental Workforce to Support the NHS Clinical Delivery Plan for COVID-19
Please see below the latest NHS England Redeployment document:
NHS and private financial support for mixed practices in England
Following ongoing BDA dialogue, it is the understanding that NHS England now confirms that the application of the principles outlined in the preparedness letter of 25 March 2020 for practices benefitting from continued NHS funding are intended to apply to NHS income only. Contract holders wishing to claim against additional Government support schemes should ensure that this is in relation to the proportion of private revenue only.
In line with the methodology of determining private and NHS income used for business rates reimbursements contractors are advised to use the proportion of gross income that relates to GDS/PDS contract value as NHS revenue, the balance being private share. Those contractors who claim business rates reimbursements will have this data readily available.
NHS England expects that as part of the 2020/2021 reconciliation process practices will be expected to declare that they have not applied for any duplicative Government funding and provide evidence of the portion of NHS/private income used in any applications for additional support.
Version 3 COVID-19 CDO Publication 001559 25/03/20
Please see below the latest Version (3) of the CDO’s Preparedness letter, 25/03/20:
COVID-19: Primary Care Dental Services within the Hampshire and IOW LDC Constituency
UPDATE: 22.03.20 Reviewed 23.03.20
Over the previous 2 months and especially the past 7 days the H&IOW LDC has been working very hard to support and communicate with GDPs, NHS England and NHS Improvement South East, the Wessex LDN, members of the Oral Surgery MCN, members of the orthodontic MCN, BDA, FGDP, UOPDA and other stakeholders to ensure that the LDC has the most up to date information for dissemination to dentists in our region. The situation and published guidance is rapidly changing.
The LDC, quite understandably has been inundated with queries, requests for support and advice from very concerned individual dentists and members of their teams.
The H&IOW LDC represents and endeavours to protect the interests of NHS providers and performers that carry out primary dental care services in our H&IOW STP area.
To date the H&IOW LDC’s website www.hantsiowldc.org has developed a dedicated page to post all the COVID-19 information as and when we receive it. The most important latest information posted is:
- COVID-19 NHS South East Region Dental Update 20.03.20
- LDC Confederation – London LDCs: https://mailchi.mp/ldc.org.uk/coronavirus-update-for-primary-care-dentiists-20200322
- BDA 22.03.20: https://www.bda.org/advice/Coronavirus/Pages/latest-updates.aspx
- CDO NHSE & I Publication approval reference: 001559 (Updated Preparedness letter)
- Emerging and Future Challenges for Dental and Oral Medicine: https://journals.sagepub.com/doi/full/10.1177/0022034520914246
- FGDP new guidance and support for the ‘delay’ phase: https://www.fgdp.org.uk/news/covid-19-new-guidance-and-support-‘delay’-phase
- COVID-19 PHE Communication Posters: https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-/resources
The Hampshire and Isle of Wight Local Dental Committee is a representative committee that can make representations on behalf of dental practices and individual dentists in our area but it does not have the authority to give clinical guidance or to direct your response to the developing COVID-19 pandemic.
Individual practitioners performing NHS dental services and dental practice contract providers must contemplate the information that they receive and consider a number of relevant and important factors:
- The risk associated with asymptomatic patients who may be infectious and particularly where there are aerosol generating procedures (AGPs). The UK Government is now at a delay position of self-isolation, social distancing, reduction in the use of public transport and use of health services so we should be mindful that as infection levels within the population increase there is a potential to spread COVID-19 within the dental practice environment. Therefore, to follow the current published guidance already issued, routine dental treatment activity should ideally be reduced or ceased wherever possible but individual dentists must, as professionals, weigh up the evidence and guidance issued and make their own decisions based on their own individual circumstances. Clearly, there are important safety and financial considerations and the LDC is aware that monthly payments to practices will continue so that dental practices providing NHS dental care remain viable. The LDC and in collaboration with the LDN has recommended that consideration should be given to an extension of the contract year from one to two or three years to allow practices to catch up on their activity. Furthermore, we have suggested to the LDN that the 2019/20 year is reduced to 11 months to avoid contractors falling below the 96% activity threshold. Going forward, breach notices and clawback will only jeopardise the viability and sustainability of NHS dental practices and deprive patients of the NHS care that they need and destroy dental teams’ livelihoods. Force Majeure dictates that under clause 350.1. you must ‘inform the other party in writing of such circumstances or events and of what obligation or duty they have delayed or prevented being performed’
- Practice Business Continuity Plans will need to be updated as the current situation develops and as dentists we have a professional responsibility to maintain our knowledge through the authorised PHE guidance on the Central Alerting System (CAS) https://www.cas.mhra.gov.uk/Register.aspx and the Guidance for Infection Prevention and Control in Healthcare Settings https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
- Supplementary to bullet 1 – consider if the current guidance should be more explicit and whether or not you should be carrying out any AGPs on asymptomatic patients if you do not have the appropriate higher safety level PPE which would include as a minimum, FFP3 respirators? The LDC suggests that as this situation evolves any emergency treatment will need to be carried out in designated, fully and advanced PPE equipped surgeries. To date we are not aware of these sites but we believe that they are at the planning stage within the NHSE&I South East Region. This was alluded to in the recent Dear Colleague letter dated 20.03.20 that included the latest preparedness letter from the CDO.
- Regulatory Standards (GDC/CQC) and how COVID-19 might impact on your compliance with protecting patients and dental teams? Any closure needs to be notified to the Care Quality Commission, this applies to temporary closure too.
- If you are considering closing the practice to the provision of NHS dental services you must contact the Local Health Protection Team www.gov.uk/guidance/contacts-phe-health-protection-teams for advice and implement the practice’s Business Continuity Plan and notify the commissioning team firstname.lastname@example.org . Failure to take this action will almost certainly be deemed a breach of contract.
- Private practices are not represented by the H&IOW LDC under our current Constitution but the LDC is very mindful of their predicament and our website is in the public domain. The LDC will be very happy to signpost any dentist to the most appropriate source of COVID-19 information.
- It is important to ensure that practice staff, colleagues and patients are kept up to date with clear signage and patient information posters should be positioned outside the practice and preferably practices should appoint a COVID-19 lead.
- It is imperative that practices recognise that COVID-19 can survive on cardboard for up to 24 hours and exist on hard surfaces such as plastic/stainless steel for up to five days.
- Washing hands is still recognised as a fundamental preventive measure with the detergent action the essential component.
- Social distancing is a minimum of 2 metres and the virus can be carried on exhaled breath that takes 30 minutes to hit the floor.
We know that this is an incredibly stressful and worrying time for dental teams and their families and we are trying hard to reach as many dentist’s as possible so please send us up to date email contact addresses and pass this information on to your colleagues who may not be aware of the H&IOW LDC’s communication processes. Information is disseminated by email and social media:
Facebook page: Hampshire and Isle of Wight Local Dental Committee
Facebook profile: Hampshireandiow Ldc
The H&IOW LDC’s stated position is that:
- General Dental Practices should immediately cease seeing routine patients
- Testing should be made available as soon as possible to eliminate doubt and misdiagnosis. This could be a situation that lasts for more than 6 to 12 months with possible sequential surges of viral infection in the population
- There should be a central contact number with appropriate professional triage and advice for patients
- All urgent dental treatment should be carried out in centres/hubs or practices that are fully equipped with full PPE including FFP3 respirators. Scope of practice should be determined
- The H&IOW LDC’s update should be cascaded to as many performing dentists as possible through all available communication channels
- There should be PPE training and necessary Occupational Health measures put in place
- There must be clarity around the sustainability and viability of general dental practices. Payments and force majeure issues must be explicitly addressed by NHS England and Improvement South East Region
- Going forward NHSE&I need to equitably address the reduced activity problems that contractors will experience surrounding end of year performance under their contracts for 2019/20. As the COVID-19 viral infection impacts on practices’ activity during 2020/21 provision should be made to prolong the contract year to an agreed longer period (2 or 3 years) to allow practices to fulfil their required activity.
- Practices Business Continuity Plans should be regularly updated as the current COVID-19 situation develops and impacts on dental care provision under the contract
- Dental practices need to keep comprehensive records of staff attendance and absence. A standardised dedicated spreadsheet would be much appreciated by contractors to avoid unnecessary challenges at a later date
- Dental emergencies in this current climate need to be defined. Traditionally, trauma, severe and escalating swelling and uncontrolled haemorrhage are considered to be emergencies. Additionally, dental conditions that have resulted in acute systemic illness or raised temperature, severe trismus and possible uncontrolled infection should be considered to be an emergency
- Urgent treatment (within 24 hours) may require an intervention above and beyond advice. Examples might include: Dental and soft tissue infections without systemic effect, Severe dental and facial pain that cannot be controlled and fractured teeth with pulpal exposure
- Clarity about dental practitioner’s indemnity and pensions needs to be explored
- Practices should have appropriately placed external signage for patients to read together with all other appropriate means of communication that clearly explains the practice’s contingencies in place for patients and their care https://campaignresources.phe.gov.uk/resources/campaigns/101-coronaviris-/resources PHE have a ‘when to use a surgical face mask or FFP3 respirator’ poster
- Practices carrying out endodontic treatment should consider the British Endodontic Society Statement on COVID-19 dated 23rd March 2020 britishendodonticsociety.org.uk
- Practitioners involved in Oral Surgery should consult with the latest advice and guidance on the BAOS &BAOMS Website 20.03.20
BDA Coronavirus Blog