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Coronavirus: De-escalation plans and private practice in Wales

Blog Author Paul Jones

Blog Date 04/06/2020

Paul Jones tells us how de-escalation plans impact private practices in Wales and highlights members’ voices at this critical time.


Coronavirus: De-escalation plans and private practice in Wales

Many dentists in private practice have questions about how the Welsh Government’s framework for de-escalation will affect them. Very little is set in stone, but we are pushing for clarity on your behalf. As the Welsh representative on the BDA’s Private Practice Working Group, I’d like to share with you what we know so far.


National guidance and how it compares 

Our Chief Dental Officer recently published the roadmap, SOP and guidance for the staged resumption of full dental care in Wales. Shortly afterwards, came the surprise announcement from the CDO in England about the return to full general dentistry from 8 June.


This has caused much debate about what that might mean for the timetable in Wales. However, we know that the return to full dentistry will not happen overnight in England and will be incremental for most practices, as acknowledged in the new BDA toolkit.


Does de-escalation framework apply to private dentistry?

The Welsh Government has said they have tried to balance the public heath needs of the pandemic conditions with what is permissible for dentistry within the UK legislation. The current red alert directive permits practices to continue offering a certain amount of direct patient care, but within a restricted scope and for urgent care only.


"Welsh CDO, Dr Bridgman, has been clear that the de-escalation phases apply equally to NHS and private patient treatment"

Welsh CDO, Dr Bridgman, has been clear that the de-escalation phases apply equally to NHS and private patient treatment, because they are first and foremost based on public health measures. The current plan is that from 1 July there could be a greater scope of treatment.


The GDC have given their view, stating that dentists should “[have] regard to relevant guidance issued by professional bodies, the government, other statutory bodies and the NHS.”


Where are we now? 

We are still in the red alert phase, which means urgent care only and no aerosol-generating procedures (AGPs) in general dental services (GDS). Any AGPs performed in the GDS in the future must follow the de-escalation phases and any SOPs as communicated by the CDO.


Private practices are registered with Healthcare Improvement Wales (HIW) and it is HIW that is communicating with private practices about the measures needed during the various stages of the pandemic. HIW has been contacting practices directly, making clear what is permissible for private practices.


Looking ahead 

None of us underestimates the challenges we’re facing. As shown by our latest member survey of the views of dentists in Wales on the reinstatement of dentistry:


  • Over 75% said they would be content to return to work next week providing non-AGP care to patients not suspected of being COVID-19 positive with routine PPE
  • Just over half of respondents said they would be content providing AGP care to patients not suspected of being COVID-19 positive with higher end PPE - fluid filtration mask (FFP3)
  • But almost half of dentists said they would not be content to provide non-AGP care to patients confirmed as being COVID-19 positive
  • And over half of respondents would also not be content providing AGP care to patients confirmed as being COVID-19 positive
  • Overall, dentists in Wales have concerns around the sustainability of both NHS and private dentistry. They believe that the pandemic will affect dentistry in the medium and long term, including a reduction in oral health, financial effects, such as the value of businesses being lost and loss of earnings are feared; as are impacts on staff, including a risk to jobs.

We know that it will be difficult to restore a dental service for patients in a new normal setting. Not least, patients may be cautious or even fearful about ongoing infection risks, which may be in addition to their dental phobia, so practices need to proactively ally such concerns.


It’s clear that the need for sophisticated SOPs, reliable supplies of enhanced PPE, and modifications to the practice site are just a few of the many changes necessary. The BDA has a new page on returning to work with lots of practical guidance – be sure to check for updates regularly as you make preparations.


Paul Jones

Welsh Representative on BDA’s Private Practice Working Group



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