Last night, (28 May) NHS England published a letter to all dental practices (both NHS and private) and to all regional dental commissioning leads in England announcing the recommencement of dental services, and the reopening of dental practices from Monday 8 June for all face to face care. Note that the devolved nations are tackling this in very different manners, and the below detail applies to practices in England. To find out more about Welsh dentistry, and the changes being made, please click here.
A relief, I am sure, for many of those who have been unable to offer the required support to their patients in this time; from Monday 8 June dental practices in England can start their slow and steady return to some semblance of normal. Practices will unfortunately not be able to spring back into practice to the same extent as pre-Covid:19 as there are still significant measures required to be in place to protect dentists, staff and patients during this time.
NHS England has not mandated openings on 8 June rather they have allowed for openings. In order to open, practices will need to be able to satisfy themselves that they have clear safety standards, including the necessary personal protective equipment (PPE) required, and procedures for infection prevention control (IPC) as recommended by Public Health England. (Guidance for both PPE and IPC linked). Practices are still permitted to offer remote consultations and can continue to do so as part of the wider opening procedures.
There will likely be less patients being seen earlier on, potentially with a need for longer appointments to allow for cleaning and infection prevention control measures in-between patients. Additionally, waiting areas for patients will need to be configured carefully to allow for social distancing.
How many patients can be safely in the practice, and how waiting rooms are configured should be considering prior to any re-opening and professional judgement should be exercised at each step. The Chief Dental officer for England has published a ‘prompt to prepare’ document that highlights some of the considerations practices will need to consider for the practice, staff and patients whilst reopening, which can be found here.
Of particular importance is the requirement for Aerosol Generating Procedures (AGP). The reopening of practices for all face to face care can include AGPs if the practice has the necessary IPC and PPE to allow for this. As AGP is one of the highest procedures for the risk of transmission specific PPE will be required to carry out these procedures. Specific guidance on PPE for AGPs can be found here. Some of the recently formed Urgent Dental Care (UDC) sites will remain open to assist where necessary. It is key that any resumption of services must be safe, operationally deliverable and allow flexibility to meet both patients and the dental team’s needs.
Practices can begin to offer appointments and will want to consider the needs of their cohort of patients, the urgency of need, and provision of unmet needs whilst allocating appointments.
With regards to contractual arrangements, NHS England will maintain the current temporary arrangements into 2020-2021 whilst NHS England and the BDA iron out arrangements moving forwards. The intention is to reintroduce a link to delivery of activity and outcomes.
The devolved nations are addressing the reopening of dental services in different manners, for example in Wales AGP procedures will still be restricted for the time being, and contractual requirements are being overhauled. As such it is incredibly important therefore that all practices, irrespective of whether private or NHS, ensure that operating systems are carefully reviewed so as to ensure full protection for patients and staff and to ensure that the guidance applicable to their devolved location is applied carefully.
Holly Paterson, solicitor, BLM