Friday 25 September 2020
SDCEP, fallow time and AGPs: What you need to know
Our former Chair Mick Armstrong is a member of SDCEP’s working group that published today's report on AGPs in dentistry and the associated risk of COVID-19 transmission.
his blog Mick gives us an insight into how this highly revered group came to tackle the most contentious topic in dentistry since the outbreak of COVID-19 - and what it's going to take to ensure these recommendations become Government policy.
BDA Indemnity and the SDCEP report on AGPs
BDA Indemnity recognises the important contribution that the Scottish Dental Clinical effectiveness program (SDCEP) rapid review of aerosol generation procedures (AGPs) in dentistry has in the management of risks facing the dental profession looking after their patients.
The risk of transmission from dental aerosols is a potential one that is yet to be confirmed and the SDCEP document put this into context whilst setting out environmental and procedural mitigation to reduce the fallow times. The Working group had subject specialists in a wide variety of relevant discipline and produced a very thorough appraisal of the existing evidence.
Practices wishing to use this review to inform their risk assessments need to do so recognising that fallow time is a small part of a large package of measures designed to keep staff, patients and the operator safe. This includes, amongst other measures: pre-screening of patients, social distancing, hand sanitising, screens in waiting rooms, appropriate PPE, including fit tested FFP2/3 masks for staff during AGPs, and rigorous decontamination and adherence to infection protection controls already published.
Each devolved nation will be reviewing their Standard Operating procedures and guidance in the light of this review.
Report on AGPs and fallow time published
The Scottish Dental Clinical Effectiveness Programme (SDCEP) has today published its
report on aerosol generating procedures (AGPs) and COVID-19.
This report is not new government guidance, but rather a review which aims to inform policy makers. We’re urging all four nations to consider this report’s recommendations and to move forward in a clear and coordinated way.
The SDCEP reviewed available evidence relating to the generation and mitigation of aerosols in dental practice and the associated risk of COVID-19 transmission, and reached a number of agreed positions on fallow time and other mitigation measures.
Dentists and dental patients all over the country want clarity on how these essential treatments should now be provided. Patients in particular should note that any changes from these recommendations will not mean a return to “normal” dental care.
Until new guidance is issued, we urge you to follow existing government guidance on AGPs and COVID-19.
NHS or private? Confusion among patients and in the media
This week our members have been on the radio discussing why some patients are reporting greater availability of private appointments over NHS.
Due to the pandemic measures currently in place, there are a limited number of appointments available each day. These must be split between NHS and private treatments, according to the practice's NHS: private ratio. A patient may phone for an appointment and the NHS slots for that day have been taken, owing to demand from the backlog of cases accumulated in lockdown. The patient could then be offered the next NHS slot, which may be days away or the next private slot which may be sooner.
We have been clear that no patients should ever feel coerced into private options when NHS care is available, and we have
written to members reminding them of their obligations. Please take the time to explain this difficult situation to your patients.
While the Government has provided needed support for the NHS activity, they’ve failed us on the private side which has been effectively subsidising NHS care for many years. Since lockdown we’ve achieved
high levels of media coverage highlighting the plight of the profession. We will continue to push for support for private dentists.
Wales: Seasonal flu vaccinations for dental teams
Following enquiries by BDA Wales, the Welsh Government has confirmed that dentists and dental teams providing any volume of NHS dental care in Wales will be able to access
free flu vaccinations in the usual way via their local occupational health services.
We asked whether wholly private colleagues would be able to access this service but at present they are not eligible and must pay for their flu vaccine provided elsewhere. The paucity of support for private dentistry in Wales and across the UK remains a major obstacle to the ongoing sustainability of dentistry, and one which BDA representatives will continue to raise.
Thursday 24 September 2020
Wales: PPE extended expiry dates - quality assured by Welsh Government
The CDO for Wales has replied to the Chair of WGDPC regarding the provision and validation of PPE during this Amber phase.
Dr Bridgman stated that there are sufficient quality checks of FFP3 masks with extended expiry dates. The CDO said that “Health Board primary care teams have been informed and provided with the necessary audit trail regarding assurance over their safety”.
We have asked for sight of these documents. Any practice queries can be directed to their Health Board primary care teams. The Welsh Government advised they are also holding regular meetings with Health Boards and NHS Wales Shared Services Partnership to help ensure supplies.
More public health funding is needed
We have issued a
joint statement and joined forces with Cancer Research UK, the British Medical Association and over 50 other leading bodies to call on the Treasury to increase spending on public health in the forthcoming Comprehensive Spending Review.
The public health grant, which funds local authorities in England to deliver functions and services that promote health and prevent ill-health, has been cut by more than a fifth (22%) since 2015/16 despite a growing and urgent need for investment in public health and prevention.
Deep inequalities in children’s dental health remain persistent and stark, with the latest Public Health England survey of five-year-olds showing almost a three-fold difference in prevalence and a more than ten-fold difference in severity of dental decay between those in more and less deprived local authority areas.
This picture is expected to have worsened during the pandemic, particularly for the most deprived, due to poor diets, lack of access to dental care and suspension of public health programmes such as school-based supervised toothbrushing. That's why, we're calling on the government to provide funding where it's needed in the up-coming review.
Wales: CDO responds to local lockdown in Rhondda Cynon Taf
The CDO for Wales, Dr Colette Bridgman, has advised that the
latest Standard Operating Procedures for Wales remain as guidance for those working in areas under
new lockdown measures.
Dr Bridgman reiterated the message that as long as practices are following the SOPs, then the dental team, the patient and subsequent patients are safe. There will be no need to return to red alert, or even heightened amber, unless staff in the practice are in higher risk groups.
Local lockdowns have generated discussion on three key areas:
While some health boards may ask dentists not to see patients for routine checks to reduce travel in or out of area, Dr Bridgman is clear she has built clinical judgment and flexibility into the SOP as it is important that the recovery in dentistry continues.
The Welsh Government have said that justification for travel in local lockdown would include ‘to attend healthcare appointments’ – no reference was made to whether that is for essential or routine.
2. Urgent vs routine care
The CDO is still asking NHS providers to ensure urgent needs are met first before resuming routine checks etc. It is assumed all practitioners will exercise similar caution as we all need to contribute to supressing this virus in communities.
It is also necessary to resume dental care, so it is a balance between direct and indirect harm from COVID-19. Routine dental treatment to address back log of delayed care and routine check and assessment of patients who are at risk is essential to healthcare delivery in dentistry.
3. Social distancing
It appears that a lack of social distancing in staff rooms, car sharing and not wearing masks in healthcare team settings (including in dental practices) could be the reason that some staff are testing positive.
The SOP does make reference to keeping up to date with local circumstances and the fact that the amber phase is and can be dynamic. Dr Bridgman is clear that clinical judgement and flexibility are needed here, particularly for private elements of practice which are not receiving the same financial support as NHS providers.
New Job Support Scheme and end of furlough announced
Today the Chancellor set out his Winter Economy Plan. We will be poring over the detail and providing members with the guidance they need going forward. But here’s what we know so far.
The new ‘Job Support Scheme’ has been announced to allow employers to reduce an employee’s hours, while keeping them in post, with the Treasury covering some of the lost wages. So far, we know:
- Employees will be required to perform at least a third of their contracted hours. The government, together with employers, will cover two thirds of the pay they lose by reducing those hours. Employees will receive 77% of their monthly wage in total.
- The scheme will kick off in November and run for six months
- All small and medium sized businesses will be eligible.
The Coronavirus Job Retention (or furlough) scheme, which has enjoyed strong uptake among dental practices, will end in October. At this point, practices and labs will still be hugely vulnerable given low levels of capacity. That’s why, we’d pressed the Chancellor earlier to deliver a targeted extension to one of the few lifelines extended to private practices that hasn’t involved taking on additional debt.
The government guarantee on loans has also been extended to ten years, and the deadline for applications is extended to the end of the year.
The existing SEISS grant for the self-employed is being extended on similar terms to the Jobs Support Scheme, and will be worth 20% of earnings, compared to 80% at the outset of lockdown. However, the £50k cap remains in place.
Unfortunately, we're not seeing any movement on business rates support or help for thousands of self-employed dentists who’ve so far been excluded from financial support. We will continue to campaign on your behalf and update you when more information is available.
COVID-19 and Community Dental Services: the challenges ahead
Next month we're hosting a webinar outlining the current COVID-19 related challenges facing the community dental services and the implications on vulnerable groups.
Participants will get the chance to ask each speaker questions.
The webinar, on Thursday 8 October, counts for one hour's CPD and is free to members or £50 to non-members.
Book a place on COVID-19 and Community Dental Services: challenges ahead webinar now.
NHS Test and Trace QR codes do not apply to dentistry
Our advice team has received many queries regarding the NHS Test and Trace QR codes that are now a requirement for venues in hospitality, tourism and leisure. We can confirm that the QR codes do not apply to dentistry.
Dentists do not have to display QR codes in their practice as dentistry is not activity listed in
the schedule of the regulations.
We will of course keep you updated should any of this advice change.
Wednesday 23 September 2020
England: Current arrangements continue despite rise in alert level
Following the increase of the UK’s COVID alert level to four, and yesterday’s announcement by the Prime Minister about additional restrictions in England, members have understandably been asking whether there is any impact on the provision of dental care.
Our understanding is that the current approach to care
remains as outlined in the existing SOP of 28 August. There is no indication at present that the changes in the wider government position will result in changes to oral health provision. This afternoon, Chief Dental Officer Sara Hurley confirmed this. That may change of course where any specific local restrictions implemented.
It is now almost two months since NHS England set out the current contractual arrangements for general dental practice in England. Further work is underway, involving the BDA, to develop the contractual framework for the rest of this financial year. There has been some anticipation that any revised arrangements would begin halfway through the current financial year (i.e. from the beginning of October) and we have had queries as to when there would be clarification about changes.
Discussions between us and NHS England are ongoing. We know that practices and dentists will want to have reasonable notice and clear advice about any changes and we will seek to ensure that practices get time to prepare. We will update further when there is more to share. In the meantime, the current arrangements continue.
Chair of the BDA board has been elected
Eddie Crouch has been
elected as the new chair of our board. Taking office, he said: "My responsibility is to listen and to lead. I intend to work with staff and representatives from across the profession in all four nations to set a direction that improves on the benefits our members enjoy."
Peter Crooks (Northern Ireland) has also been elected as the new deputy chair, with Shareena Ilyas (Greater London) to serve as chair of the Education, Ethics and the Dental Team Working Group.
Tuesday 22 September 2020
Updated advice for pregnant healthcare workers
The Royal College of Obstetricians and Gynaecologists recently updated the advice for healthcare workers who are pregnant. The updated advice states that an individual who is pregnant can continue working with patients at any stage of pregnancy as long as they have completed a pregnancy risk assessment and an individual risk assessment.
These assessments must be regularly reviewed with their employer and followed by the guidance promoted by the risk assessment.
Questionnaire on AGPs
The Scottish Dental Clinical Effectiveness Programme (SDCEP) is leading a rapid review of the evidence related to the generation and mitigation of aerosols in dentistry and the associated risk of coronavirus transmission. The findings will likely inform government policy. We are still expecting a comprehensive report covering fallow time to be published imminently.
SDCEP are currently looking for responses to their
survey to better understand the current provision of AGPs in dentistry. Please complete the questionnaire today, it should take 10-15 minutes.
Monday 21 September 2020
Tackling antibiotics resistance in the context of the pandemic
Dentists can access a new
free online course on antimicrobial resistance (AMR).
The course features Dr Wendy Thompson, a member of our Health and science Committee and was developed to identify ways in which those involved in dental practice can do their bit to tackle antibiotic resistance (ABR). It is a collaboration between the FDI and the British Society for Antimicrobial Chemotherapy.
Further information can be found on our page which includes a prescribing self-audit tool developed jointly by BDA, FGDP and PHE to help dentists ensure they are prescribing in line with guidance.
Scotland: Financial implications for practice owners of reducing NHS staff
We have been receiving a number of queries from practice owners about the possible financial consequences of reducing their NHS staff. The Scottish Government has confirmed the conditions set out in
PCA(D)(2020)7 that “there must be no consequential loss of workforce” in practices receiving NHS financial support.
Such staff reductions would be viewed by the Scottish Government as a breach of the conditions of support and could mean a reduction or loss of NHS financial support payments. The Scottish Government has also advised practices in this situation to notify their NHS Board and advise Practitioner Services in the first instance.
New NHS dentistry and oral health bulletin
Next month NHS England will be launching a new NHS dentistry and oral health bulletin, which will include a roundup of all the latest news and important resources for anyone working in NHS dental services.
Sign up to the
NHS Dentistry and oral health update.