COVID-19 has had a significant impact on the provision of dental services across the UK with each of the devolved nations receiving advice from their respective Chief Dental Officers. On Friday 22 May 2020 the Chief Dental Officer for Wales, issued an update to the dental professionals in Wales. As we move into the next phase in the response to COVID-19 the letter explains what is proposed to give dental teams in Wales time to prepare.
Unlike England, practices in Wales have been allowed to stay open but with restrictions on what care could be provided. The current situation in Wales is as follows:
- All routine patient contact has stopped;
- If urgent dental care is needed, NHS and private patients should contact their dentist and are referred to Urgent Dental Centres (UDCs) if an urgent treatment need is confirmed at triage;
- Aerosol generating procedures (AGPs) are now only undertaken at UDCs;
- Dental practices with NHS contracts remain ‘open’ to telephone triage, the provision of advice and the issuing of prescriptions (analgesia & antimicrobials);
- Dentists can provide face-to-face assessments in practice and non-AGPs urgent care if absolutely necessary;
- Recommended PPE and decontamination (e.g. FFP3 masks) are available to dental teams providing treatment in the UDCs; and
- Dental team members can volunteer to support the UDCs and wider NHS effort if their capacity allows.
As the CDO sets out in her letter, restoring services is a complex process and dental professionals in Wales are part of an integrated approach to primary care services recovery across Wales.
The CDO’s update outlined the de-escalation of the red alert pandemic plan and helpfully sets out a proposed timetable with the differing stages. From 1 July 2020the first stage in the de-escalation plan is to step down from the current red alert, to a heightened amber response. Whilst red alert services were focused on urgent and emergency dental treatments only, high amber will also consider provision of services to those with dental problems and symptoms. Following that, services will begin to be provided to treat those with dental conditions, but with minor or no symptoms. This will be the low amber stage. Lastly, at the green stage, all routine dental care with resume, albeit maybe not in the same way that it was provided pre COVID-19.
Despite the de-escalation, UDCs will need to continue providing for those in need of AGPs, and AGPs will be confined only to specific service providers for the foreseeable future. Local Health Boards will consider the reintegration of AGPs as the plans progress, and we anticipate further updates will be published about this as time goes on.
Each phase of de-escalation will require risk assessments to manage the risk to patients and staff. SOPs will need to be drafted to include efficient use of PPE, pre-appointment checks, pre- treatment checks and the management of social distancing.
The response to COVID-19 has had a devastating impact on practices, and taking this into account, the CDO’s letter also sets out proposals for a new remuneration model for NHS dentists. This process will end the link between ‘treatment’ activity and payment. Instead, it will focus on a ‘care’ model in order to assess and meet need, address risk and maintain oral health, rather than incentivising check-ups and treatment. The newly considered approach is that each unique patient seen in a practice, in any one financial year, would generate one Unit of Dental Assessment (UDAS) per year, rather than a Unit of Dental Activity (UDA). This should be helpful in a time where social distancing and reduced practice would make meeting contracts for UDA would be incredibly difficult. Updated contract values, using the Assessment framework, will take into consideration practices with proportions of patients with high levels of oral health need.
The lessening quantity of patients teamed with the newly considered format whereby patients can receive an annual full assessment, and be provided with annual care plan, will hopefully allow for a slower, more considered approach to dentistry.
Further, the staged increase in provision of services will hopefully allow time for changes being made to be continually considered and, whilst may be more radical than before, will hopefully lead to a more sustainable system.
One thing is for sure in that restoring the services will be a complex process. There will be no one size fits all, and there is still a significant amount of planning, discussions and considerations to be had as to how the framework will work in practice. The plans are considered to be dynamic, and will be reactive depending on the transmission and infection rates of Covid:19. There is also the possibility of staged de-escalations varying by locations across Wales, in response to transmission levels. It is clear from the guidance published that the dental community are considering a slow and steady response, with the viability of practices being key to planning. Hopefully the changes being considered will be a step in the right direction to re-shaping services for a better. Although the timetable is different to the one announced in England yesterday it will be interesting to see how different patient access to routine treatment will be, in practice.
Jane Lang, Partner, BLM
Holly Paterson, Solicitor, BLM