Routine dental care in Wales to resume in 2021, new plans suggest

The CDO for Wales, Colette Bridgman, has published plans to get dentistry back up and running over the next 12 months as lockdown begins to ease.

The Welsh Government released guidance for a phased return to practice, including ‘de-escalation SOPs’, in a bid to restart primary care services.

In the transition plan, the profession will see a gradual reintroduction of non-AGPs and limited routine care – with UDCs continuing to play a key role in the delivery of treatment.

From 23 March to 10 May 2020, more than 68,000 dental-related calls were taken in Wales, resulting in more than 15,000 prescriptions and 750 referrals to UDCs.

According to the de-escalation framework, it currently suggests routine assessment and care will be completely reintroduced in January 2021.

However, de-escalation decisions will be based on emerging evidence – with local variation a possible requirement.

Criteria for the delivery of dental care in general dental practice include a low risk of transmission, safe systems of work to include PPE, and risk-based procedures.

Red

This is the current status in Wales. Only emergency and urgent dental care should be delivered, with dental practices open for telephone contact and assessment.

High Amber

As lockdown begins to ease, this is the first part of the de-escalation plan and is set to be rolled out from July 2020.

Dental practices will be able to see patients face-to-face but only those displaying no symptoms of COVID-19.

They will only provide necessary treatment with low risk of aerosol generation, such as dental examination, radiographs and simple extractions.

Patients with COVID-19 symptoms and all patients who require AGPs will continue to attend UDCs. This includes restorative procedures and those involving 3 in 1s.

All non-urgent routine dental care using the following should be delayed for patients with or without COVID-19 symptoms:

  • High speed hand pieces
  • Ultrasonic scalers
  • Surgical hand pieces
  • 3 in 1

Low Amber

In this phase, dental practices will continue to carry out urgent non-AGP treatments and limited routine care for patients with no symptoms of coronavirus.

As above, patients with COVID-19 symptoms and all patients who require AGPs will be referred to UDCs.

All non-urgent routine dental care using the following should be delayed for patients with or without COVID-19 symptoms:

  • High speed hand pieces
  • Ultrasonic scalers
  • Surgical hand pieces
  • 3 in 1

Green

Finally, the ‘green’ de-escalation phase will see the return of all routine dental care in practices.

However, patients with symptoms of COVID-19 will still be treated in UDCs for both AGPs and non-AGPs.

Additionally, all non-urgent routine care for those displaying signs of the virus should be delayed.

Financial support

From 1 July to 30 September 2020, practices with NHS contracts will be handed 90% of their annual contract value (ACV).

This is to reflect the reduced material and laboratory expenses. However, the additional cost of PPE means it has been brought up from the current level of 80%.

This support will be given in return for the following:

  • All practices with NHS contracts being open for more than remote telephone contact from July 1
  • Practices and staff to observe the COVID-19 SOPs
  • Patients to receive any necessary non-AGPs
  • Urgent and non-urgent AGPs will be referred to UDCs or designated dental practices for treatment
  • All NHS patients in the ‘practice population’ will receive an Assessment of Clinical Oral Risk and Need (ACORN) before 31 March 2021
  • All staff who deliver NHS care will be retained. Their pay will be protected at previous levels to reflect their NHS work.

The Welsh Government will also shift away from the Units of Dental Activity (UDA) targets during this time.

The letter from CDO Colette Bridgman states: ‘Monitoring ‘cure-based’ activity rather than needs-based care would not be appropriate for the de-escalation phase, given its focus on courses of treatment and AGP treatment delivery.

‘Effectively, the UDAs will become a Unit of Dental Assessment (UDAS) and will link directly to individual patients – the number of unique patients in a practice population.’

She adds: ‘This is a time for the dental community to come together and collectively care for the population’s oral health needs in this exceptional context.’

Scotland has also released its ‘back to work’ plans, with CDO Tom Ferris taking a three-phase approach. 

He also emphasises the continued use of UDCs as the country starts to focus on the return of NHS dental services.

GSK

 

Find out more about Dentistry’s Back to Practice campaign. 

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