Charlotte Waite outlines her experience securing essential PPE when setting up urgent dental centres.
"Teams have been working... to get the new systems in place so we can continue to treat those who need us most."
The dedication and devotion I have witnessed in the emerging network of Urgent Dental Centres (UDCs) is inspiring and overwhelming.
Dental teams across the UK have been working frantically to get the new systems in place so we can continue to treat those who need us most. Teams have quickly learned to work in a different way from triaging to providing remote consultations to delivering analgesics, antimicrobials and of course, for those who absolutely need it, face to face dental procedures. It's an on-going challenge that I have witnessed the dental profession rise to and for that I am grateful and proud.
We are aware of the risk which coronavirus poses, not to just ourselves as healthcare workers, but to our patients, their families and the wider community.
NHS England recently updated its Standard Operating Procedures: “We must deliver care differently now and plan for how we will best deliver care in the future. Local systems will need to determine how they can best work collaboratively, informed by key principles to protect the public, patients and staff.”
"Promises are starting to ring hollow with reports that our level 3 PPE... are being taken back from UDCs and redistributed within the NHS."
We are all aware that there is a shortage of PPE. There is increasing evidence that supply isn't keeping up with demand. Promises from Government are starting to ring hollow with reports that our level 3 PPE, which has only just been provided, are being taken back from UDCs and redistributed within the NHS.
I know we are down the pecking order when it comes to urgency and level of need, and I accept that. However, I can't help being deeply concerned for the safety of our teams and of our patients.
In times like this it feels inappropriate to throw the blame upon anyone. We are in a situation that no-one could have imagined or prepared for. All we ask is that a sensible and realistic approach is taken - one that is transparent and clear from NHS England, Public Health England and the Government.
The guidance from NHS England makes it clear that aerosol-generating procedures (AGP) should be "avoided unless absolutely necessary”. It also states that "each patient should be assessed and managed on their own merit, taking into account the patient’s best interests... and the prioritisation of the most urgent care needs".
NHS England is endeavouring to set up UDCs that only provide certain procedures. For example, some centres will only perform non-AGP procedures with Level 2 PPE. Other centres will carry out AGPs and thus will need Level 3 PPE. There are also centres that will need both Level 2 and Level 3.
"Let’s be clear - we can’t maintain the two metre social distancing recommendation with our patients."
The difficulty arises in trying to accurately predict the need for AGP. My colleagues and I continue to report concerns about the lack of evidence on which dental procedures may generate an aerosol. Let’s be clear - we can’t maintain the two metre social distancing recommendation with our patients. We work within two feet of a patient's mouth with level 2 PPE (unless delivering AGP). This applies to all patients, including those presenting coronavirus symptoms.
The guidance may sound sensible on paper, but the reality of the situation is really quite different.
Charlotte Waite, Chair
England Community Dental Services Committee