The chief dental officer for England has issued a number of changes to the delivery of dental services as the UK heads into lockdown.
Sara Hurley has said all non-urgent treatment, including orthodontics, should be stopped and deferred until told otherwise.
Additionally, she advised the following changes to primary dental care services:
- All practices should establish a remote urgent care service, either independently or by collaboration with others.
- Telephone assistance should be provided for patients with urgent needs during the usual working hours. Where possible, they should be treated with advice, analgesia or antimicrobial means where appropriate
- If the patient’s conditions cannot be managed by these means, they should be referred to the local urgent dental care system
- All community outreach activities should be stopped until otherwise advised
- Practices should update their websites and inform their regional commissioner of any change in practice availability hours due to staffing levels, and the arrangements for cover
Funding and contracts
Dr Hurley confirmed NHS England will take immediate steps to revise the 2020-21 contract to reflect service disruption for those participating in the COVID-19 response.
As a result, the following steps will be taken:
- Continued monthly payments in 2020-21 to all practices that are equal to 1/12th of their current annual contract value
- Progress work with the BDA to finalise an approach to contract value and reconciliation
This approach will aim to achieve the following:
- Maintaining cash flow to provide stability for dental practices
- Protecting the availability of staff to provide essential services during the response to COVID-19
- Enabling staff to be diverted to support service areas with additional activity pressures due to COVID-19
- Maintaining business stability to allow a rapid return to pre-incident activity levels and service model once the changes cease
- Fairly recompensing practices for costs incurred
Workforce
Dental staff are also being urged to contribute to the wider COVID-19 response.
Alongside providing remote dental support, Dr Hurley is asking for the freed-up workforce to help:
- Urgent dental care services
- NHS colleagues working in wider primary care
- NHS colleagues working in the acute COVID-19 response
- Local authority and voluntary services COVID-19 response
As part of the funding support, the NHS expects dental practices to support the redeployment of staff to support the wider effort.
This includes helping to staff the new Nightingale Hospital that is being established in London.
Urgent dental care systems
The creation of local urgent dental care systems should meet the needs of the following groups:
- Patients who are possible or confirmed COVID-19 patients – including patients with symptoms, or those living in their household
- Patients who are shielded – those who are most at risk from COVID-19
- Patients who are vulnerable or at an increased risk from COVID-19
- Patients who do not fit one of the above categories
Each system should provide provision at a number of different sites to allow for appropriate separation and treatment.
The range of conditions likely to appear are not limited, but are likely to be:
- Life threatening emergencies such as airway restriction or breathing
- Trauma including facia and oral laceration and/or dentoalveolar injuries
- Oro-facial swelling that is significant and worsening
- Post-extraction bleeding that the patient is not able to control with local measures
- Dental conditions that have resulted in acute and severe systemic illness
- Severe dental and facial pain: this is pain that cannot be controlled by the patient following self-help advice
- Fractured teeth or tooth with pulpal exposure
- Dental and soft tissue infections without a systemic effect
- Oro-dental conditions that are likely to exacerbate systemic medical conditions
