Coronavirus: England Updates

Last Updated: 29 January 2021

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The Chief Dental Officer England shares its 7th letter and within the details for contract arrangements for the fourth quarter (January to March 2021) dated 22 December 2020.

Click here to view the document

Letters of preparedness to the profession

During the course of the pandemic, we have regularly written formal letters to the NHS dental profession with important updates and information. They are online here.

Transition to Recovery: Dentistry's standard operating procedure

This document is the essential guidance for all dental teams in England. In it, we detail all the key things dental teams need to know about how to run their services safely, for patients and themselves. The latest version was published on Tuesday 27 October. Changes to the previous SOP are in yellow. You can read the SOP online here.

Urgent Dental Centres: Standard Operating Procedure

If you work in an urgent dental centre or are responsible for one as a provider, or as a commissioner, then the Urgent Dental Centre SOP should be your guide. Changes to the previous SOP are in yellow. It was updated on Tuesday 27 October and is online here.

The General Dental Council (GDC) has issued supplementary advice that has been developed to support decision makers in considering factors relating to the impact of COVID-19 on a professional’s ability to deliver care, and to provide a lasting point of reference.

Under legislation, context is usually considered at the Case Examiner stage. Case examiners are appointed GDC staff members with a statutory duty to make decisions on cases that have been referred to them for more detailed consideration. It is at this stage that a concern or complaint in the context of COVID-19 would be examined in more depth.

There have been multiple challenges during the pandemic for dental professionals.. The GDC has published a non exhaustive list of some factors brought about by COVID-19 for consideration when deciding whether there is a real prospect that a registrant’s fitness to practice is currently impaired. More information is available online.

In our last update, we confirmed that dental teams, along with other healthcare staff, are being prioritised for COVID-19 vaccinations. We are very pleased that the vaccine roll out continues at pace and many dental team members have received their first dose.

If you have not received an invite yet, don't worry, sit tight and the NHS will come to you. Until you hear from the NHS, do not contact the NHS, such as your local GP surgery. Dental teams are on the lists and local systems are working their way towards you.

The Scottish Dental Clinical Effectiveness Programme (SDCEP) have issued an update to their ‘Rapid Review of the Mitigation of Aerosol Generating Procedures in Dentistry’ within a new appendix and as a standalone document.

The four nation Working Group considered the implications of the substantial increase in prevalence of COVID-19 infections in recent months, the emergence of more transmissible variants of SARS-CoV-2, no reports of transmission associated with dental care, the greater availability of testing and the vaccination programme that has recently commenced. The Working Group agreed that at present, despite these developments, the agreed positions and other conclusions within the Rapid Review remain unchanged.

As such, the Chief Dental Officer England is clear that the current standard operating procedures (links are at the base of this bulletin) are unchanged and are still applicable in England and the dental IPC guidance remains the benchmark for safe practice and quality care.

There has been a minor change to the COVID-19: infection prevention and control (PIC) dental appendix. The change relates to the risk pathway table (page 7) and clarifies the definitions within the medium and low risk pathways. The change has been made to the dental guidance to align with changes in the main guidance. There have been no changes to the PPE requirement for dental teams.

A single result from a lateral flow device (LFD) antigen (Ag) test, whilst useful in some circumstances, is inadequate when considering on which pathway patients should be placed. A negative LFD Ag test result in an asymptomatic person should only influence pathway choice if the test was conducted as part of one of the variety of formal NHS testing programmes, and the meaning of the individual’s test result within the context of the specific testing programme is fully understood.

There has been no change to the IPC guidance since the emergence of the new variant of the virus. The IPC guidance continues to be reviewed regularly as evidence becomes available.

Please find attached joint letter from all Chief Dental Officers in the UK offering support to the dental profession throughout the second wave of covid-19.

Click here to view document

Please find attached an update letter from Professor Keith Willett NHS National Director for Emergency Planning and Incident Response:

https://www.england.nhs.uk/publication/covid-19-nhs-preparedness-and-response-notification-of-return-to-incident-level-4/

The letter confirms that in response to increasing coronavirus infections that the health service in England will return to its highest level of emergency preparedness, Incident Level 4, from 00.01 tomorrow, 5 November.

For all dental teams the information contained in our Bulletin published available here - Mon 02 Nov 2020 and SOPs published 27 Oct 2020 remain extant.

Please note the release of Chief Dental Officer England’s latest bulletin (available here- Mon 02 Nov 2020) which covers recent announcements and links to current guidance and relevant publications.

The bulletin includes confirmation from Chief Dental Officer for England that during the period of tighter restrictions dental services will remain open for face-to-face care. This includes delivery of both aerosol generating procedures (AGPs) and non-aerosol generating procedures. Dental care is to be delivered in line with the principles set out Transition to Recovery SOP published 27 Oct 2020 and with regard to the recently updated national infection prevention control and the accompanying dental appendix. Priority remains focussed on patients who require access to urgent care, patients at higher risk of oral disease, and patients with outstanding treatment needs that cannot be delayed. All dental practices should continue to provide remote consultations with triage and advice as necessary options. Dental practices will be asked to maintain their support to their local UDC system, face to face as well as remote. Co-ordination of the local UDC system lies with the NHS Local Area Team and all practices are encouraged to remain in close contact with their area teams. The principles for UDC systems and provision of urgent dental care are set out in the revised UDC SOP published 27 Oct 2020.

For COVID-19 related queries, please redirect your email to the following email address: england.spocskh@nhs.net. This is the Single Point of Contact for NHS England for all COVID 19 related queries. It will be logged and given a unique identifier in order that a response can be tracked through the system.

COVID-19 update for Dental Professionals, please click on the following link: https://www.england.nhs.uk/coronavirus/publication/preparedness-letters-for-dental-care/. “Issue 3 - Preparedness letter for primary dental care – 25 March 2020”

All COVID-19 guidance for Primary Care is consolidated at https://www.england.nhs.uk/coronavirus/primary-care/. Here you will find information specifically related to Dental via the DENTAL PRACTICE tab.

Please note: guidance, standard operating procedures and other publications are constantly being revised and updated – so do visit the site regularly for the latest updates and relevant information.

I am pleased to announce that the revised SOPs are now published and may be found at https://www.england.nhs.uk/coronavirus/primary-care/dental-practice/

The revised SOPs incorporate the recently published COVID-19: infection prevention and control dental appendix issued jointly by the Department of Health and Social Care (DHSC),Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS), Public Health Scotland, Public Health England and NHS England https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/928034/COVID-19_Infection_prevention_and_control_guidance_Dental_appendix.pdf

Key points to note

The IPC guidance and the revised SOPs address one of the key challenges facing dental practices; the duration of the post Aerosol Generating Procedure (AGP) downtime. The IPC guidance details the variable duration of the post AGP downtime, with detail of the required mitigating measures and ventilation parameters. In summary where a surgery’s ventilation system can achieve 6 to 9 Air Changes/Hour (ACH), a baseline post AGP downtime of 20 minutes is recommended. Where there are 10 or more ACH, a baseline post AGP downtime of 15 minutes is recommended.

I would also ask you to note that as detailed in the UK IPC Guidance for dental settings FFP3 masks are recommended for AGP procedures. It is important that all dental professionals are offered the highest levels of protection as recommended. However, we recognise that across the system there are existing stocks of FFP2 masks and it is understood that it may be necessary for practices to continue to use these until staff are successfully fit tested and supplied with the appropriate FFP3.

With regards the position of CQC – given the publication of the IPC Guidance and the clarification that FFP3 are now the recommended level of protection, we have discussed with the regulator the logistics of the transition to FFP3 for all staff involved in delivering AGPs. In particular the logistics of fit testing and FFP3 supply may take a reasonable period of time. Practices/providers are advised to have a plan in place to demonstrate the steps they are taking to complete the transition to FFP3 masks for AGPs in a timely and safe manner.

If anyone calls or emails to find out what is going on in dentistry, its business as usual at the moment, risk assessments permitting. SOPs still apply, esp the Transition to Recovery one. Don’t send this presentation out, but you can quote from it. Everyone (NHS and private) encouraged to sign up for nhs.net email address, so they are included in any announcements. Also to sign up for the dental bulletin shown on last slide.

Click here for presentation

Sara Hurley, Chief Dental Officer England provides further guidance about Urgent Dental Care and Transition to Recovery Standard Operating Procedures. All information can be found in the released documents available below.

Click here for Chief Dental Officer England Letter

Click here for Urgent Dental Care SOP

Click here for Dental Transition to Recovery SOP

Sara Hurley and Matt Neligan issued an update for dental care teams in light of Covid-19.

Click here to view document

A number of amendments have been made to both dental standard operating procedures (SOP) published earlier this month. The following changes are highlighted in yellow in the documents for ease:

Urgent dental care guidance and standard operating procedure

  • Appendix 2: Patient pathways
  • Appendix 3: PHE guidance for infection prevention and control in dental care settings
  • Appendix 4: Actions for dental services - Staff with symptoms of Covid-19 (page 24) and Staff exposed to someone with symptoms of covid-19 in healthcare settings’ (page 25). These subsections have been updated in line with new PHE guidance and for consistency with the GP SOP.
  • Appendix 7: Staff support and wellbeing
  • Appendix 8: Feedback – email template link corrected.

Dental standard operating procedure: Transition to recovery

  • Non-AGPs (page 19)
  • Appendix 6: Management of caries for the paediatric patient
  • Appendix 7: Management of (non-AGP) Endodontics

NHS Released their assets which are a section of public communication to explain what patients can expect once practices in England begin to re-open.

Accessing Dental Care

Access Dental Care - Changes

Dental Care - What to Expect

To assist to resumption of dental services, the Oral Health Foundation have joined with the French Dental Association and Unilever, to release some simple and easy-to-follow recommendations.

Click here to view the document

These guidelines are divided into five areas:

  • Organisation of the practice
  • Patients
  • Treatment
  • The provision of care
  • Bio cleaning and waste management

These recommendations, and more downloadable resources for dental practices can be found at www.dentalhealth.org/coronavirus.

For the provision of urgent dental care in primary care dental settings (from 8 June 2020) and designated urgent dental care provider sites. This is an updated to previous guidance and all changes are highlighted in yellow.

Click here to view the document

From 8 June primary care dental services (general dental practices and community dental services) may open to resume face-to-face care (both routine and urgent) for appropriate patient groups once they have appropriate social distancing and other safety measures in place.

PPE for dentists will be available from dental wholesalers for practices to purchase from 5 June.

PPE for dental practices will include equipment necessary for aerosol generating procedures (AGPs) including gowns or coveralls, and FFP2 respirator masks as recommended by the World Health Organisation as well as the Health and Safety Executive (HSE) and UK Government PPE guidance.

The HSE website has advice and training materials on fit testing respirator masks. Practitioners and staff involved in conducting AGPs can also book free fit test training via an independent Respiratory Protective Equipment (RPE) fit testing company. Contact their helpline if you are experiencing fit testing issues from 8.00am – 8.00pm seven days per week on 07947 968972 or 07947 968922. You will also be able to book on to online training courses for fit-testing via these phonelines (subject to availability).

Further PPE advice including on donning and doffing PPE is available on the Public Health England website.

The Department of Health and Social Care’s PPE plan sets out the actions being taken by the Government to secure and supply PPE.

This standard operating procedure provides information relation to "A phased transitition for dental practices towards resumption of the full range of dental provision".

Click here to view the document

The British Dental Association (BDA) has welcomed news the government has given the green light for the restoration of routine care services in England, but has cautioned that practices will need to move at different rates depending on availability and fitting of PPE, their ability to enact ongoing social distancing measures and time to implement appropriate cross-infection control.

NHS England and the Chief Dental Officer have now confirmed any practice that feels it is appropriately prepared can provide patient care from 8th June. This could see varying levels of treatments made available with immediate effect, with individual practitioners exercising their professional judgement on the pace of change.

The pace at which patient care can begin will be determined by a number of issues, such as stock levels of PPE. The availability of and ability to fit test ‘higher end’ PPE in particular may limit the universal restoration of a full range of dental care. The BDA has expressed the view that steps should be taken to integrate dentistry into the wider government strategy on PPE supply led by Lord Deighton.

Dentist leaders have also warned the whole business model that the service is based on could change unalterably upon reopening, with social distancing and cross-infection control reducing capacity and potentially access levels by as much as two thirds.

The BDA is continuing to press for the NHS contractual framework to reflect the new reality and for additional support for private dentistry, including a business rates holiday – already offered to leisure and retail sectors – to be expanded to dental practices, alongside other support to mitigate against reduced patient numbers.

Office of Chief Dental Officer England has released a document outlining the next steps in the second phase of the NHS response to COVID-19.

Click here for more information

Chief Dental Officer England has recently released "A Prompt to Prepare" statement and advice regarding safely resuming some elements of dental care. See below official documentation for more information.

Chief Dental Officer England Statement

A Promp to Prepare Document

The next webinar hosted by Sara Hurley, Chief Dental Officer and Matt Neligan, Director of Primary Care and System Transformation is taking place via MS Teams on Friday 24 April at 4pm.

Click here to access the webinar

NHS England has agreed to continue to make monthly payments in 2020-21 to all practices that are equal to 1/12th of their current annual contract value. As part of the funding package, the NHS encourages dental practices to support the redeployment of professionals and staff working in general dental services to underpin the wider NHS response, as is happening across the rest of the NHS.

However, there will be no obligation for any member of the dental workforce to provide services. This will be on a voluntary basis as stated in:

Redeploying the Clinical Dental Workforce to Support the NHS Clinical Delivery Plan for COVID-19

In recent weeks BADN sought confirmation of some points from NHS England and this was the response they have provided to us so far:

1) Dental nurses working in NHS practices should not be in the practice, but should still be paid their normal salaries

Response: "Yes, unless dental practices have appropriate PPE; are staff who are providing triage to emergency dental services/providing urgent dental services (AAA), as stated in the Issue 4, published last night."

2) Dental nurses from NHS general dental practice who choose not to volunteer must still be paid their normal salaries by their employers

Response: "Yes, as stated in Issue 3 & 4 of the Letter of Preparedness."

3) What guidelines there are for mixed practices for deciding who should be furloughed (i.e. paid 80%) and who should be paid full salary

Response: "This has been explained in the Letter of Preparedness, Issue 4."

4) Dental nurses in mixed practices who are furloughed should be paid 80% of their salaries regardless of what percentage of the practice is private (many mixed practices are telling their dental nurses “our practice is, for example, 20% etc private, so we can only pay you 20% of your salary”)

Response: "Yes, this has been explained in the Letter of Preparedness, Issue 4."

NHS has now published updated guidance documents in light of COVID-19 outbreak.

COVID-19 Guidance and standard operating procedures: Urgent dental care systems in the context of coronavirus. Delay Phase.

Click here to view the document

Issue 4 - Preparedness letter for primary dental care – 15 April 2020

Click here to view the document

Please note that guidance, standard operating procedures and other publications are being revised and updated on an ongoing basis. Please visit the webpage above regularly for the latest information.

Thanks to the efforts of the British Dental Association both the Treasury and NHS England confirmed that mixed practices can make full use of the furlough scheme in proportion to their private activity.

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The BDA advises that “Following ongoing BDA dialogue, it is our 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.”

Please note the release of Chief Dental Officer England’s latest bulletin (available here- Mon 02 Nov 2020) which covers recent announcements and links to current guidance and relevant publications.