Your NHS dentistry and oral health update

 Thursday 7 January 2021

An update from Sara Hurley, Chief Dental Officer England and Eric Rooney and Jason Wong, Deputy Chief Dental Officers

Dental professionals who work for a NHS trust will fall within the vaccination programme co-ordinated through their trust.​ Locum clinical staff employed by the practice and non-clinical ancillary staff who may have social contact with patients but are not directly involved in patient care (e.g. receptionists and cleaners) are also included. 

The coronavirus vaccination programme, the largest in the health service’s history, is off to a strong start having already vaccinated more people than anywhere else in Europe, and it is expanding geographically each week as vaccine supplies increase.

As frontline health professionals, it is important that when you are called to be vaccinated you attend. Private practices are advised to ensure their contact details with the CQC are up to date as a matter of urgency. More detail is in this bulletin.

We have the PPE, we have access to testing, we are sharing the message loud and clear that practices are open and now we have access to the vaccine, too. Dentistry is an essential medical service, not an optional extra. Patients need to and deserve to see their dental teams and the vaccine roll out is another important next step in the fight against COVID-19 and restoring NHS dentistry.

More widely, commissioners are able to issue those who work in NHS dental practices with documentation that prove critical worker status. More detail is below.

We are also very proud of Satyesh Parmar, Asha Thomson and Heather Pope who were honoured by the Queen in the New Year's Honours List. As I am sure you will agree, they are three shining examples of how our profession improves lives. 

Sara, Eric and Jason

How you will receive the COVID-19 vaccine if you work in NHS primary care dentistry 

The NHS will contact you, you do not need to contact the NHS, such as a GP surgery. First, the NHS will contact the email address your practice is registered with the NHS on to understand the number of people eligible for the vaccine. Once we know the demand, hospitals, and in some cases local vaccination centres, will then begin contacting you to come forward for the vaccine. This vaccine will in all likelihood be administered at your local hospital.

As more information becomes available we will keep you updated.

How you will receive the COVID-19 vaccine if you work in secondary care dentistry

If you work in a NHS trust then your trust will organise your vaccine as your employer. Please speak to your line manager if you have any questions.

How you will receive the COVID-19 vaccine if you work in private dentistry

*Please forward this bulletin to any colleagues in the private sector*

The NHS request providers update their contact records with the Care Quality Commission (CQC) as a matter of urgency.

This is because if you work in private sector dentistry and the practice you work in or you personally do not have a NHS contract, then the NHS does not hold any contact details for you. This means we need to get hold of your contact details, or that of your practice, from the regulator the CQC. It is therefore essential that private practice owners ensure the contact details for their practice with the CQC are up to date, especially with an up to date email address. The NHS can then begin the process of vaccinating staff.

If you are a locum clinical staff not currently clinically active or between employment we will update you as soon as possible.

Volunteering to help deliver the vaccine 

We encourage you to volunteer to support the vaccination programme, if you have capacity after fulfilling clinical responsibilities. Our profession's focus is quite rightly on tackling the backlog in dental care and expanding access, in line with the standard operating procedure. 

We are delighted that former members of NHS staff, including dental professionals, have applied to support the vaccination programme and actually tens of thousands of people have already completed their online training - these are being processed as quickly as possible and volunteers will be deployed as and when they are required.

Infection prevention control response to new variant strains 

A peer review has been undertaken by an expert group of clinicians to assess the new variant strains (SARS-CoV-2 VOC-202012/01 and UK VOC122020/02). The evidence review has not identified a change in the mode of transmission between the variants and previous circulating strains of COVID-19, and therefore a consensus agreed that there are no changes to the recommendations set out in the IPC guidance at this stage. The Scientific Advisory Group for Emergencies (SAGE) has also advised that there is currently no evidence of any association between the new variant and increases in transmission in particular settings and that there is no evidence for differences in routes of transmission or different survival on surfaces.

A CAS alert was issued on 24 December outlining actions for the NHS to take in response to the variants. All NHS organisations should ensure thorough application of current IPC recommendations and assurance on adherence, PPE is available and in supply, and that all staff training is up to date. For dental teams, the COVID-19 dental appendix is the key source of guidance.

PPE should continue to be worn as per current IPC guidance, with FFP3s to continue to be worn for AGPs. This position is being kept under close review. COVID-19 measures in the workplace should be robustly implemented and adhered to, including reinforcing physical distancing, optimising ventilation, greater patient mask use and enhanced decontamination/cleaning (especially frequently touched surfaces). 

Emerging evidence and data on variant strains will be continually monitored and reviewed, and the guidance amended accordingly if needed.

Dosing schedules of COVID-19 vaccinations: the safe course of action 

The four UK Chief Medical Officers have written an open letter laying out the scientific and public health rationale for the dosing schedule for the AZ vaccine and the change to the dosing schedule for the second dose of the Pfizer vaccine. As with all decisions during this pandemic it is about balance of risks and benefits. The key points of that letter are:

1. "We have to ensure that we maximise the number of eligible people who receive the vaccine. Currently the main barrier to this is vaccine availability, a global issue, and this will remain the case for several months and, importantly, through the critical winter period. The availability of the AZ vaccine reduces, but does not remove, this major problem. Vaccine shortage is a reality that cannot be wished away.

2. We are confident that based on publicly available data as well as data available to the JCVI, the statutory independent body, that the first dose of either Pfizer or AZ vaccine provides substantial protection within 2-3 weeks of vaccination for clinical disease, and in particular severe COVID disease. The JCVI has issued a new evidence statement today.

3. The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy. In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine.

4. In terms of protecting priority groups, a model where we can vaccinate twice the number of people in the next 2 to 3 months is obviously much more preferable in public health terms than one where we vaccinate half the number but with only slightly greater protection.
5. This is why the JCVI has recommended that first doses of vaccine are prioritised for as many people as possible on the Phase 1 JCVI priority list, in advance of second doses which will subsequently provide more assured longer-term protection. It is a classic public health approach centred on doing as much good for as many people in the shortest possible time frame, within the available vaccine supplies, against a background of immediate disease activity and still high population sero-susceptibility (despite the disease burden seen).
6. The JCVI is confident 12 weeks is a reasonable dosing interval to achieve good longer-term protection.
7. The position is strongly supported by the UK Chief Medical Officers on public health grounds of maximising benefit."

The letter can be read in full online.

Proving you are a critical worker when part of a NHS dental team

Dental professionals and their teams are defined by the Government as critical workers. The Government website says "This includes, but is not limited to, doctors, nurses, midwives, paramedics, social workers, care workers, and other frontline health and social care staff including volunteers". Front line health staff includes dental professionals and their teams.

If you need further evidence of this, email your NHS commissioner who can provide a letter from NHS England explaining that you are a critical worker. 

The British Dental Association has advised the Chief Dental Officer that they will support private practices with a template letter as required.

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

This year's New Years Honours List had a strong showing from the dental profession, with three members in England being awarded the MBE.

Heather Pope, the Clinical Director for Dental Services at East Cheshire NHS Trust for services to dental treatment for the vulnerable. 

Asha Thomson, a Speciality Dentist in Oral and Maxillofacial Surgery and Senior Clinical Leadership Fellow East Anglia NHS England and Senior Clinical Teacher in Oral Surgery, Kings College Hospital London for services to the NHS, particularly during the Covid-19 Response. A 

And Satyesh Parmar, Consultant Surgeon Queen Elizabeth Hospital Birmingham for services to Oral and Maxillofacial cancer surgery. 

Big congratulations also go to our friends and colleagues in Wales and Scotland, with Professor Barbara Chadwick, Honorary Senior Lecturer & Consultant in Paediatric Dentistry at Cardiff University and Kenneth Neil Macdonald, a retired dentist who trained dentists in Cambodia, also honoured for their hard work.

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Previous NHS dentistry and oral health updates 

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

• Issue 1: 27 October
• Issue 2: 2 November
• Issue 3: 27 November 
• Issue 4: 10 December 
• Issue 5: 22 December 
• Issue 6: 30 December 
• Issue 7: 4 January

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 Tuesday 27 October. 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 Tuesday 27 October and is online here.