Your NHS dentistry and oral health update

You can find the revised standard operating procedure online here. Changes are in yellow. You are encouraged to read the document in full.

The NHS contractual expectation is that all NHS funded capacity is used to deliver the maximum possible volume of safe care for patients, that practices ensure that face-to-face urgent dental care is available for all attenders via direct contact or referral via 111, and that efforts are directed towards patients at highest clinical risk and to addressing health inequalities.

The standard operating procedure has been updated to support practices in meeting the needs of their patients and their NHS contractual obligations.

The changes include clarification that: 

All patients may be offered face-to-face care with the dental practice: 

• Dental teams should continue to undertake remote risk assessment and triage of all patients, prior to patients attending the practice, to inform care planning and optimise scheduling.
• Clinically extremely vulnerable patients may continue to be seen for dental care in the same way as other patients. Where possible, without compromising the requirement for access to care in an appropriate timescale, additional efforts should be made to minimise their exposure to risk.
• There is no requirement to avoid or minimise AGPs. AGPs may be undertaken for any patient, in line with government IPC guidance and PPE protocols.

Regarding Urgent Dental Care (UDC):

• The principles of care delivery are the same for routine and urgent dental care.

• The UDC SOP is now redundant and UDC guidance is contained in the Transition to Recovery standard operating procedure.
• Local UDC arrangements will vary and practices should ensure they are complying with local contractual expectation and/or pathways.
• All practices should be prepared to provide additional support to the local UDC system if necessary (e.g. in the event of a local outbreak).

Dental practices should have business continuity plans to ensure arrangements are in place to minimise the impact of a local incident on services. Arrangements should recognise opportunities to maintain patient services through remote working, collaboration with other local dental providers, and integration with the local UDC system. In the event of COVID-19 impacting service delivery, practices should:

• Inform their local commissioner in line with local reporting/escalation processes.
• Be aware of, and follow, any local containment plans or additional precautions instituted by national direction or local systems (e.g. Local Authorities; Regional NHS England commissioning teams; Local Health Protection/PHE).
• Communicate service changes to patients.

Domiciliary dental care (e.g. in residential care home, patient’s own home) may resume where the COVID-19 risk assessment for the care setting deems it appropriate:

• Care must be delivered in line with IPC guidance, risk assessment requirements, COVID-19 testing requirements, relevant local/national guidance and other measures and considerations as set out in the ‘Domiciliary dental services (including delivery in residential care settings)’ section in the SOP (please see SOP for full details).
• Where possible AGPs should be carried out in the dental surgery. In domiciliary settings, AGPs should only be undertaken for patients identified as being on the low risk COVID-19 care pathway (care pathways as defined in the IPC Dental Appendix). Patients on the medium/high risk COVID-19 care pathway, who require care involving an AGP, should be supported to receive that care in an appropriate clinical dental setting. 
• Practices should continue to prioritise patients with the greatest care needs. This includes promoting access for vulnerable patient groups (for example people experiencing homelessness, Looked After Children and asylum seekers/refugees); this will support efforts to reduce health inequalities which may have been compounded by the pandemic.

As a helpful reminder, the useful flowchart below can be found on page 18 of the national dental infection prevention control appendix. This is an important tool you can use in calculating the correct post-AGP downtime.

We have produced a handy document with key messaging for patients which explains why restrictions are still in place for NHS dental services.This includes suggested website/social media copy, answer machine message, text message and an email script following patient query of public health measures, all of which you can copy and paste. You can access the document by clicking on the button below. If this does not work please email the Chief Dental Officer's team at england.cdoexecutive@nhs.net

This graphic is available as an official NHS poster to display in your practice and as a card for you to use on social media and on your website. They are available for download from Public Health England's website. 

Chief Dental Officer Sara Hurley has published an updated note on the use of phased treatments. The purpose of this document is to support dental professionals, and to clarify where it might be appropriate to provide phased courses of treatment to deliver optimal restorative and periodontal care under the existing General Dental Services (GDS) contract. It ensures dental professionals can focus their resources on prevention and support patients who engage in behaviour change, risk factor control, and improved oral hygiene to the point of oral health stability, ensuring patient engagement, before proceeding to more complex clinical interventions.

This should improve access to high quality NHS dentistry to meet the needs of patients who will not usually have accessed and completed routine dental care in the previous 24 months. This cohort of patients would generally be those with high dental needs and as such are more likely to be adults from a vulnerable background with additional health or social needs.

You can read the note online here.

As part of our work for the next stage of dental system reform, we want to hear from dental professionals and commissioners. If you'd like to participate in a dental system reform focus group as a provider, you will need to complete the expression of interest form by 11:59pm on Sunday 18 July. The expression of interest online survey has to be completed in one sitting. To read a copy of the questions in advance, see the expression of interest survey PDF.

The way that NHS staff across all primary care contractor groups (medical, dental, optometry and community pharmacy) order lateral flow device (LFD) tests is changing. From 5 July 2021, all NHS staff have been be able to order tests directly through the government lateral flow ordering portal and have these delivered to their home addresses.

A supporting LFD standard operating procedure and frequently asked questions have been published on the NHS England and NHS Improvement website. More information about the change is available in the letter issued to system leaders on Tuesday.

Providers and performers who are members of the NHS Pension Scheme are required to confirm that the estimate of their net pensionable earnings (NPE) is correct by completing the annual reconciliation report process (ARR) in Compass.

The deadline for completion of this process has been extended until 6pm on Wednesday 18 August 2021.

The pandemic has shown how vital Freedom to Speak Up (FTSU) is in healthcare.  As the sector rebuilds following the pressures of the last year, supporting workers to continue to deliver their best for patients, service users and colleagues has never been more important.  

We are asking for your assistance in providing us with information that will shape our offer of support to every organisation, helping them embed and develop their FTSU arrangements.

The survey is open until Friday 23 July. Please fill in the survey online

The Care Quality Commission (CQC) has stated that "it consider orthodontic treatments provided to patients following an intra oral scan or when a patient has taken impressions themselves to be regulated activity." Providers cannot legally carry out regulated activities without registering with the CQC. It is an offence under Section 10 of the Health and Social Care Act to provide regulated activities without being registered with CQC. CQC can use our regulatory powers to prosecute such offences. CQC will work with the GDC, dental professionals, service providers and people who use services to understand the developments in how services are delivering care.

The CQC's statement can be read in full online.

Her Majesty The Queen has awarded the George Cross to the NHS as we marked the service's 73rd anniversary last week. The George Cross was instituted in 1940 by King George VI for “acts of the greatest heroism or of the most courage in circumstances of extreme danger”. It is the UK's highest award for non-military courage.

"It is with great pleasure on behalf of a grateful nation, that I award the George Cross to the National Health Services of the United Kingdom [...] You have the enduring thanks and heartfelt appreciation of us all."

Her Majesty The Queen

This award recognises all NHS staff, past and present. This award is made to recognise the collective courage and dedication of all of those working in  healthcare systems across the United Kingdom, in all capacities, who have accepted and faced into the danger and stress the pandemic has brought to them and their families.

Read The Queen's letter to the NHS on the Royal Family's twitter.

NHS Chief Executive Simon Stevens described the whole NHS team as "'an inspiring example for our own generation of how out of adversity can come strength". You can read Simon's address to the ceremony online.