Your NHS dentistry and oral health update

Thursday 25th February 2021

An update from Sara Hurley, Chief Dental Officer England 

An important Central Alert System notification has been issued on FFP3 masks - you should have received this from your NHS regional commissioners or directly from the alert system. Its really important you read this alert and take action to review your stocks.

The Never Events list has been updated and wrong tooth extraction should now be singularly reported as a patient safety incident. In my view, wrong tooth extraction is unacceptable and patients have every right to demand that every measure is taken to avoid it. It must never be noramalised. But it is, sadly, not completely unavoidable. I am confident the patient safety incident arrangements both reflect the clinical situation on tooth extraction and respect the patient's right to protection from such an incident. My deputy Jason Wong and NHS England's Deputy Director of Patient Safety Dr. Matthew Fogarty have written a piece for today's bulletin explaining this decision. 

The NHS Business Services Authority has published a helpful article about misconceptions around NHS dental treatment in England, which I encourage you to read. 

The NHS is also reminding practices to update their NHS profiles. This is so important, its essential for patient care that the public can find a NHS dentist quickly. And the NHS' website being up to date is one of the easiest ways to do that.

Today's By Word of Mouth shout out goes to something a little bizarre but special. A koala - nicknamed Triumph - was born without a foot, meaning he had difficulty walking and climbing freely. Well, that was until Triumph went to see the dentist. Koala feet weren't covered in my studies at Bristol and doubt they are in Brisbane, but it goes to show....

Nothing can stop a dental team....

Sara

Important Notice – Immediate Action Required: FFP3 masks

The Chief Medical Officer and the Department of Health and Social Care (DHSC) have issued a Central Alerting System (CAS) on the below product:

Manufacturer: Fang Tian FT-045A FFP3 masks 
Supplier: Polyco Healthline 
Product Code: BWM541

DHSC has received information that suggests this item may not meet DHSC’s essential technical specification for FFP3 masks. Action is required of dental teams to review stocks.

To understand this and required actions it is important you read the CAS Alert in full and its attached letter which can be found online here. 

All healthcare providers can sign up to receive safety alerts by contacting the CAS Helpdesk on safetyalerts@mhra.gov.uk .

If you have any queries about the Central Alerting System:

Telephone the CAS helpdesk: 020 3080 6747
Email: safetyalerts@mhra.gov.uk 
CAS website: https://www.cas.mhra.gov.uk

We recommend that all dental practices confirm that they are signed up for CAS Alerts.  Practices may also wish to consider using a generic nhs.net email address for their CAS alerts. Generic accounts can be used by more than one person, to maintain continuity of service. Access to the generic account can also be transferred when post holders change to minimise the risk of delays in communication.

Book yourself a COVID-19 vaccination appointment 

To support healthcare workers and community based social care workers to receive their Covid-19 vaccination, they now have the option to book their vaccination appointments in a vaccination centre or community pharmacy through the NHS Covid-19 Vaccination Booking Service.

Staff can book online here.

Staff should try online booking first but if this is not possible, they can phone 119 free of charge, 7am to 11pm, 7 days a week. 

As part of the booking process, eligible staff need to self-declare that they are a health or social care worker.

At their appointment, staff will be asked to verbally declare that they are a health or social care worker, the type of role/work they do and the name of their employer. The member of staff should also bring ID/proof of employment such as a staff ID badge, a recent payslip or recent letter/email from their employer (dated within the last 3 months).

Arrangements for locum staff

Locum staff who are patient facing are eligible for the COVID-19 vaccination. Staff should follow the above process, but verbally declare they are a locum healthcare worker.

In place of the name of their employer they should provide details of their locum agency.

In place of a staff ID badge, locum staff should provide proof of General Dental Council registration. 

In place of a recent payslip or letter from their employer, they should provide a letter of confirmation of locum status from their locum agency (dated within the last 3 months).

All staff will be able to book this way for a limited period, until Sunday 28 February so do not delay and please pass this important message onto your colleagues.

Reporting processes for wrong tooth extraction: an update from Jason Wong and Matthew Fogarty 

Wrong tooth extraction is a patient safety incident. That's why the NHS has strong processes in place such as patient safety incident reporting, to ensure that when it happens there is proper accountability and regard for patient welfare.

As you know, Never Events are serious incidents that are wholly preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers.

The NHS has reviewed its list of "Never Events". Wrong tooth removal was originally included on the Never Events list as part of a broad category of wrong site surgery Never Events.  As part of the current review of sub types of Never Events, it was concluded that despite wrong tooth extraction being an unacceptable incident, the available barriers to prevent the removal of wrong teeth are not strong enough to prevent this type of incident from occurring in all cases.

For example, the review found patients often had different numbers and locations of teeth, for example as a result of previous dental work or due to their individual dental anatomy. This was compounded by a lack of standardisation in types of tooth notation and difficulties with site marking.

Removal of the wrong tooth will not be classed as a Never Event from 1 April 2021.

However, even though there may be understandable reasons when it may occur, this does not mean that wrong tooth extraction is "just one of those things". It is still a patient safety incident. 

Wrong tooth extraction incidents must be reported as a patient safety incident and managed according to local risk management policies.

Along with the Office of the Chief Dental Officer, many stakeholders took part in the review which worked closely with partners including the Faculty of Dental Surgery, the British Dental Association, the Faculty of General Dental Practice, the Association of Dental Hospitals, the Association of Perioperative Practice, the College of Operating Department Practitioners and the Healthcare Safety Investigation Branch.

Based on the broad clinical input into this decision and the robust safety processes and reporting mechanisms in place, we are confident this is a safe and considered way to move forward.

This clarification presents an opportunity for a renewed focus on the importance of existing measures to prevent wrong tooth extraction.  These include the use of Local Safety Standards for Invasive Procedures (LocSSIPs). There are some excellent resources from the Royal College of Surgeons England, including guidance on mechanisms to prevent Never Events and examples of good practice including dental extraction toolkits and checklists to be used in primary care settings. 

We look forward to progressing this work with you all in the future.

Tackling misconceptions in the profession around NHS dental treatment 

The NHS Business Services Authority (NHS BSA) produce a number of "in the spotlight" articles. These articles contain good practice guidelines which have been developed from feedback and questions raised by clinicians and the NHS BSA’s review of dentists’ clinical records.

The latest article is about misconceptions around NHS dental treatment in England, and highlights some of the misconceptions of current regulations and professional standards when providing NHS and private options for dental care. 

Some of the misconceptions the article clarifies are:

• If you have capacity to accept new NHS patients for dental care, it is not appropriate to provide the initial examination on a private basis in order to assess the extent of treatment required prior to accepting the patient for a course of NHS treatment.
• Similarly, you cannot charge a registration or administration fee to patients who have requested NHS treatment before seeing them.
• You cannot charge an NHS patient for a missed appointment.
• If the patient is accepted as an NHS patient, then following the examination, all treatment that is available under the NHS and identified as clinically necessary should be offered as an NHS option for that course of treatment. You must not charge an additional private fee on top of the NHS fee, regardless of the justification for the clinical techniques or materials used in the patient’s treatment: for example, faster laboratory turnaround or tooth-coloured clasps on dentures.
• You must not charge an additional private fee on top of the NHS fee to cover the cost of additional PPE or providing NHS treatment outside the practice’s NHS contracted hours.

All articles can found online here. 

Reminder to update your NHS website profile

The Covid-19 pandemic has had an impact on access to dental care. The NHS website allows users to find local dentists and access useful information such as opening times, contact details and whether the practice is currently taking on new patients.

It is important for dental contractors to review this information regularly to ensure it is correct and up to date. This may help your business run more efficiently, reducing calls from patients enquiring if you are accepting new patients and freeing up your call lines for patients wanting to book appointments. This is also a good way to demonstrate that you have made attempts to reduce the quantity of unfilled appointments.

As such we are asking all practices to review their NHS website profile and update it, if necessary. Instructions on how to do this are online here.

PPE: update on complaints and enquiries 

A new complaints email address and phone number are now being managed centrally by the national PPE allocation team to provide a central log of all PPE related complaints and enquiries.

If any providers have a Clipper delivery issue such as late, non-delivery or the wrong product delivered, please continue to call the Unipart line and get the reference number, as this is how Unipart manage and resolve any Clipper delivery issues: 0800 876 6802.

Please also copy in the new central email address and they will make sure they collate these issues across the whole country: ppe.complaintsandenquiries@nhs.net.

If any providers have a question or query about a particular product, such as what are the specifications, is it latex free or what are the washing instructions etc, please contact the national PPE allocations team on ppe.complaintsandenquiries@nhs.net (0203 747 0900) and they will assist.​

Consultation on changes to the data on written complaints in the NHS – Primary Care (GP and Dental) KO41b collection

The NHS complaints procedure is the statutorily based mechanism for dealing with complaints about NHS care and treatment. NHS Digital currently collects data on complaints regarding NHS primary care services collected annually via the KO41b return from GP and Dental practices.

NHS Digital are carrying out a consultation to ensure that collections and future publications deliver maximum value for the minimum burden on NHS organisations and that all the items collected remain relevant. This consultation covers the primary care (KO41b) complaints collection.

Please find below a link to the K041b consultation which will stay open until the 26th March 2021.

Please do share the link with any parties you may feel would like to respond to the consultation:

Consultation on changes to the Data on Written Complaints in the NHS – Primary Care (GP and Dental) KO41b collection - NHS Digital - Citizen Space

By word of mouth ... the colleagues we're all talking about!

The Chief Dental Officer is happy for dental professionals to assist koalas (before rapidly handing over to our veterinary colleagues).

Signing up to this bulletin

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Previous NHS dentistry and oral health updates 

Previous bulletins can be accessed by clicking on the links below:

NHS primary care bulletin

The NHS primary care bulletin provides resources on health policy and practice and we encourage you to sign up for this, too. It is aimed at teams across general practice, dentistry, community pharmacy and optometry. 

A reminder of the latest COVID-19 advice and guidance 

Letters of preparedness to the profession 

During the course of the pandemic, we have regularly written formal letters to the NHS dental profession with important updates and information. They are online here. 

Transition to Recovery: Dentistry's standard operating procedure

This document is the essential guidance for all dental teams in England. In it, we detail all the key things dental teams need to know about how to run their services safely, for patients and themselves. The latest version was published on Wednesday 3 February 2021. Changes to the previous SOP are in yellow. You can read the SOP online here. 

Urgent Dental Centres: Standard Operating Procedure 

If you work in an urgent dental centre or are responsible for one as a provider, or as a commissioner, then the Urgent Dental Centre SOP should be your guide. Changes to the previous SOP are in yellow. It was updated on Wednesday 3 February 2021 and is online here.

COVID-19: infection prevention and control dental guidance

The guidance is an appendix to and should be read in conjunction with the national guidance on infection prevention and control for COVID-19 . You can read the general guidance and the specialist dental appendix online here.