Managing the COVID-19 crisis for dentists – An update from the CDO

On Friday evening Sara Hurley, Chief Dental Officer hosted a live webinar for anyone interested in the current issues affecting dental services. By 6pm on Friday evening Ms Hurley closed the session reporting they had received over 3000 questions from those participating through the webinar chat function. This highlights both the involvement that dental practitioners are keen to show, as well as the uncertainty ruminating throughout the profession. Questions of course couldn’t all be answered, but reassurance was given that the questions will steer the policy makers to provide greater clarity in areas generating more uncertainty than others.

Opening the webinar Ms Hurley praised the fantastic efforts dental practitioners have been taking to adapt and offer their assistance. Praise was given for the professions willingness to re deploy, offer services, and take advice.  What was made clear is that more substantive advice and guidelines will be published over the coming week. It is anticipated that further letters of preparedness from NHS England and further SOP’s amongst others will be published to aid understanding and cohesiveness.

Some of the highlights of discussion are outlined below.

Key priorities

Matt Neligen, Director of Primary Care and System Transformation summarised NHS England’s main priorities for dentistry as:

  1. Patient safety
  2. Offering safe services for both patient and practitioner
  3. Clear arrangements for staff who are uncertain as to what their roles are currently; how and when re-deployment may take shape
  4. Support for pay and contracts

Redeployment

Redeployment was a key factor discussed.  Conversations are taking place to produce guidance as to how best the dental profession can be utilised across the rest of the health service. As Ms Hurley termed it, dentists can in their own way be head and neck specialists. The skills of dental practitioners can be transferrable, especially in areas such as prescribing, maintaining airways, taking histories, cannulation, phlebotomy, communicating with families and relatives, amongst others. The competencies being considered reflect the whole dental profession, incorporating skills of whole teams, including dental nurses and hygienists. Redeployment roles are likely to be arranged divisionally depending on Trust need, and further information will be published as and when more structured plans are confirmed.

The GDC has been clear that dental practitioners are welcome to turn their skills to assist the wider healthcare community, but those doing so must work within their own competency, and those undertaking new roles will need to engage in clear training and inductions.

Consultation advice

Ms Hurley made the current position on what advice and treatment should be being given at this point in time very clear. Reiterating some of the points outlined in NHS England’s most recent letter of preparedness dated 25 March, these and some additional points are as follows:

  1. All routine non-urgent dental care should have stopped
  2. Remote and telephone triages should be available to all patients
  3. Prescriptions can still be written where appropriate
  4. The default position for treatment at this stage is, again as outlined in the NHS letter of Preparedness on 25 March, the three A’s:
      • Advice
      • Analgesia
      • Antimicrobial means where appropriate
  1. If further treatment is necessary these patients should be directed to the urgent dental care centres (UDC’s) being set up across the country. Practices will be advised regionally as to where and how these will function.
  2. As not all UDC’s are wholly up and running in all areas, some dental teams will still need to treat specific patients. Decision to do so should be made professionally, and with the correct PPE. Treatment of patients in this manner will not be acceptable where that practices local UDC is up and running.
  3. The use of aerosol generating procedures should have ceased, and cases where this is necessary will need to be referred to specific designated areas. Local dental networks and Commissioners should be able to assist and advise practices as to accurate procedure for their region.
  4. If there are concerns or queries regional dental leads can be also be a port of call.

Eric Rooney, Deputy Chief Dental Office for England advised that further standard operating procedures are hoped to be published next week covering the principles of systems, system providers, and service delivery going forwards.

PPE

Confusion has obviously amassed as to the correct and proper use of PPE. Ms Hurley clarified that Public Health England have published guidance on the use of PPE on Thursday 2nd April. Dental practitioners should refer to Table 2 of this guidance. A link to this guidance can be found here

The position is that those treating patients should do so (only in non-aerosol generating procedures) with a face mask, visor, gloves and apron. Ms Hurley also further dispelled the myth that an FFP3 mask can be used without a proper fit testing. She made it clear that those utilising an FFP3 mask are required to have the formal fit testing and those used without will risk both patient and practitioner safety. She advised practitioners against purchasing these through the internet if there was no access to proper fit testing services. Again, further advice and clarification will follow.

The offering of support and assurance to practitioners was clear from this webinar, showing the profession’s leads are engaging, listening to problems and considering the best way to advise and guide dental practitioners through such times. Often the guidance can change amidst final reviews of publications, and that is the reality of the situation faced. The health departments are working hard to provide reassurance and guidance to practitioners, and hope to continue to do so in the upcoming publications this week.  Dentists are encouraged to keep continual review of publications being made by the GDC, BDA and the four devolved NHS organisations.


Written by Holly Paterson, Solicitor, BLM
holly.paterson@blmlaw.com

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