The Prime Minister’s announcement on Sunday 10 May 2020 outlined the Government’s conditional plan to ease restrictions in England. One of the messages captured in Sunday’s speech was that anyone who can’t work from home should be actively encouraged to go to work. Understandably this comment created quite a lot of confusion for the dental world. Has the advice for dentists changed? Can dentists practice from home? Can they then return to practice? Should practices that have been closed now re-open for treatment?
Following the Sunday announcement the government published manuals for seven sectors, providing guidance to ensure workplaces are as safe as possible. The link to these manuals can be found here. Whilst we could try to place dentistry into some of the definitions of ‘sectors’ it plainly doesn’t sit comfortably.
Without direct instructions or guidance on the loosening of restrictions for dentists (or other healthcare professionals) the GDC’s position and guidance from around the dental community is at the moment, that the status quo is maintained. This is perhaps best summarised in the GDC’s tweet on 13 May which stated “Following the Prime Minister’s announcement about the conditional plan to ease restrictions, all dental guidance and Standard Operating Procedures currently in force remain unchanged. The Advice has not changed.”
The BDA also published an update confirming that since the easing of restrictions came into force on Wednesday 13 May, nothing has changed in relation to the guidance offered by the various UK administrations on the provision of dentistry.
NHS England explain in their ‘round up’ of 12 May, (found here) that the aim of the restrictions to dental practice is to ensure the safety of patients and dental teams as well as supporting the Public Health measures required to slow community transmission . This aim remains, and practice should still be limited and restricted in the manner it was prior to the conditional easing of some restrictions on Sunday.
The main advice is for dental practices can be summarised as:
- All routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise.
- All practices should establish a remote urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with:
- Antimicrobial means where appropriate
If the patient’s condition cannot be managed by these means, then the patient will need to be referred to the appropriate part of their Local Urgent Dental Care system. NHS England has published a letter of preparedness indicating that in the absence of a UDC services a dental practice may undertake non- aerosol generating procedures, face to face assessment and care with Level 2 PPE. It should be noted that this relates to where there is no UDC provision available as opposed to when there is a delay in appointment availability at a UDC. Further guidance can be found in the Standard Operating Procedure for Urgent Dental Care
- All community outreach activities such as oral health improvement programmes and dental surveys should be stopped until advised otherwise.
- Dental practices should provide accurate information to the public, updating messaging and websites in line with practice changes.
It is important to note that although the NHSE guidance relates to NHS dentists, the regulator’s message does not differentiate between private or NHSE practices and the CQC’s published position appears to indicate that no dentistry can be performed unless in an emergency situation.
Whilst the GDC have previously indicated that environmental and human factors would be taken into account when considering concerns raised during the Covid19 Crisis, it remains to be seen what approach the Council would take in relation to dental practices who endeavour to resume face to face patient consultations contrary to the published guidance.
Irrespective of whether care is currently provided on an emergency only basis (such as where treatment is required but there is no Urgent Dental Care centre), current guidance is clear that appropriate PPE and social distancing measures should be used. It is also clear that AGPs should not be conducted outside of a UDC. Social distancing is of course, not possible when actively treating a patient so clear risk assessments and policies should be in place so that practitioners are able to demonstrate the measures taken in these circumstances.
- For an overview of the current restrictions requirements and effects of Covid19 on dentistry, please see our previously published article, ‘Dentistry Amid the Covid-19 Crisis’ which can be found here.
- The NHS has published a series of letters to the Dental profession advising on steps to take as the virus continues to affect practice which can be found here.
- The BDA publish live updates, and do so frequently. A link to their live update page can be found here.
- The GDC news page can be found here.
- The FGDP also maintains an updated library of resources and guidance relating to the provision of dental care during the pandemic. This can be found here.
Holly Paterson, solicitor, BLM