Your NHS dentistry and oral health update

Friday 27th November 2020

An update from Sara Hurley, Chief Dental Officer England 

As you will have seen, since my last update, the NHS has moved to incident Level 4 and the government has announced the tiers communities in England will be in after the period of national restrictions ends on 2nd December. Our clinical priority remains the provision of urgent dental care. As we continue the transition to recovery of services and where practice capacity allows, we would increasingly expect practices to be actively recalling patients to resume interrupted care pathways and seeking to offer appointments to patients who normally attend the practice for care in terms of their risk. 

I recognise that there is a delicate balance in meeting patients’ needs against the restrictions of COVID. However, the statistics demonstrate the great efforts of the majority of practices in providing access and addressing a wide range of patients’ dental care concerns.

November is mouth cancer awareness month so it is a good opportunity for me to remind everyone that a patient with suspected mouth cancer is in urgent need and should be prioritised for a face to face consultation.

Sandra White, Public Health England's lead for dental health has also written an important update on the use of antibiotics. Dental professionals have done sterling work in reducing the use of unnecessary antibiotics in the last few years and we must continue to do our bit to avoid the development of antibiotic resistance.

I'm also delighted that the amazing Peninsula Dental Social Enterprise has been named the South West Regional Winner in the Health Equalities Award category of the NHS Parliamentary Awards 2020. Their local MP nominated them after seeing the excellent work the practice has done to support those who are homeless in Plymouth. More detail on their achievement is below. In these updates to you, I want to share just some of the stories which show why we should be proud of what we're doing. If you know of a colleague who deserves a shout out (and you all will) then please do drop me a line at ocdo-cdo-exec@nhs.net

Sara

Government guidance on those clinically extremely vulnerable

The Government has published updated guidance for those defined as clinically vulnerable. For dental teams, it is important to remember that the clinically extremely vulnerable are still entitled to dental care. Practices should ensure that they continue to undertake a risk assessment when co-coordinating care for clinically extremely vulnerable patients who have been shielding. The relevant advice on appointment scheduling, along with the necessity for close liaison with the patient and their GP to ensure shared decision making remains in place. 

Update on the use of antibiotics from Public Health England

The move to providing emergency dental care through local triage led urgent dental care pathways where patients were managed remotely as much as possible with advice, analgesia or antimicrobials was a vital element during the initial phase of the national response to the COVID-19 pandemic . It is not surprising that the reduced access to curative dental services resulted in an increase in the dispensing of antibiotics to treat dental infections. A total of 799,282 prescriptions for antibiotics were dispensed from Apr – June 2020 compared with 645,332 during the same period in 2019. There was also a statistically significant increase in enquiries about analgesics from dental patients to the National Poisons Information Service.

It may be tempting to look back and suggest how antimicrobial prescribing could have been improved, but pathways and remote care were in their infancy and dental teams were doing their best to care for their patients in unprecedented times while navigating new PPE and decontamination requirements.

Significant strides towards optimising prescribing have been made over the last five years with the number of NHS antibiotic prescriptions reducing by around 25%. As services get re-established it is time to return to good practice.

Dental teams have shown over the last few months that they can be flexible, take on new guidance and provide a safe environment for their patients and all who work at the practice. The whole of the dental team have a part to play in re-establishing our profession’s antimicrobial credentials. Antibiotics should be reserved for the treatment for people with severe and spreading bacterial infections to avoid the development of antibiotic resistance. ‘Incision and drainage’ is still the mainstay of dealing with dental infection and effective analgesia is important to manage dental pain.

When antibiotics need to be given, or pain relief advised for patients, a number of resources, and links to guidance can be found in the Dental Antimicrobial Stewardship Toolkit"

Sandra White, National Lead for Dental Public Health (Public Health England)

The Oral Health Foundation's campaign to raise awareness of mouth cancer 

The Oral Health Foundation has produced a useful suite of materials for dental teams to help raise awareness amongst patients and the public of the symptoms of mouth cancer, as part of Mouth Cancer Action Month. The message is clear: if in doubt, get checked out.

A patient with suspected mouth cancer is in urgent need and should be prioritised for a face to face consultation. The NHS encourages patients to contact their dentist or GP if they suspect mouth cancer. More information is on the campaign's dedicated website.

Complaints data collection on hold

The information obtained from the KO41B collection monitors written complaints received by NHS primary care providers (GP and dental practices) by service area and type. Following the suspension of the collection and publication of the 2019-20 annual KO41B data from GP and Dental practices, NHS Digital has confirmed that that this collection will not take place for 2019-20. This means there will be no collection or publication of 2019-20 data. NHS Digital’s intention is to use this as an opportunity to streamline the data collection for 2020-21. NHS Digital intend to collect this in May/June 2021. This will ensure that the approach and information requested is proportionate and removes unnecessary administrative burdens from the collection. However, while the data collection is changing, the expectations about responding to individual complaints are unchanged.

NHS Digital would like to enlist the help of practice managers and staff to help with developing the content and approach. If you are interested in being involved please contact: nhs.comp@nhs.net

Life support training for dental professionals 

The Care Quality Commission and the General Dental Council have recognised that COVID-19 social distancing has made accessing accredited Life Support training difficult. In a joint statement the CQC and GDC have said "Providers and individual dental professionals should continue to make every effort to complete accredited BLS/ILS training annually. However, if this training is unavailable due to current COVID-19 restrictions, appropriate alternative provisions, in accordance with relevant government guidance, should be made".

The Chief Dental Officer encourages you to read the statement in full on the GDC's website here.

Open letter to dental professionals from the four UK chief dental officers

The Chief Dental Officers for Scotland, Northern Ireland, Wales and England have issued a joint letter to all dental professionals thanking you for your hard work. As said in the letter, this second wave will require healthcare professionals to be flexible in what they do and the joint statement issued by the healthcare regulators in March 2020 remains in place. The CDOs also reiterated their determination that the long-term prospects of dental professionals in training are not compromised by this prolonged health crisis. The General Dental Council, together with the education bodies in the four nations, and Dental Schools Council are working on this. We will keep you updated. 

NHS staff testing: the process for primary care dental teams 

The Government have made it a priority to provide testing for NHS front line staff, including dentists and dental health staff, when symptomatic. A number of tests are reserved for essential workers and all symptomatic frontline staff can request a test as an essential worker via GOV.UK. Essential workers can order five test kits for themselves and other symptomatic members of their households via the process below. However, for households of more than five, 119 can raise an order on their behalf.

Employer referral for essential workers

Employers can refer essential workers for testing if they are self-isolating because either they or member(s) of their household have coronavirus symptoms. They can do this by uploading the names and contact details of self-isolating essential workers to the secure employer referral portal. Referred essential workers will then receive a text message with a unique invitation code to book a test for themselves (if symptomatic) or their symptomatic household member(s) at a regional testing site.

To get a login to the employer referral portal, employers of essential workers should email portalservicedesk@dhsc.gov.uk with the following information: organisation name,  nature of the organisation’s business, region and names (where possible) and email addresses of the 2 users who will load essential worker contact details. Once employer details have been verified, 2 login credentials will be provided for the employer referral portal.

Dental teams and COVID-19 vaccines

Role in administering the vaccine 

We know that many dental practitioners and dental healthcare staff want to support the COVID-19 Vaccination Programme. A variety of roles are available to both registered and non-registered professionals in either the administration or supervision of the vaccine. You do not need to be a current NHS healthcare professional and full vaccine and administration training can be provided. Please do discuss with your manager and colleagues if this is something you can undertake. More information on how to help the programme is available on the NHS Professionals website.

Access to receiving the vaccine

The Joint Committee on Vaccination and Immunisation (JCVI) are the independent experts who advise Government on which vaccine/s the UK should use and provide advice on prioritisation at a population level. The JCVI published interim advice on 25 September 2020.

The JCVI has prioritised healthcare workers and care workers in the initial recommendations and the minister Jo Churchill has confirmed this includes dentists.The final recommendations will be based on a detailed analysis of benefit-risk.

Primary care dental teams and access to flu vaccinations

We are asking all healthcare workers to make sure they have had their flu vaccination as soon as possible. Taking this easy but important step will help protect yourself, your family and our patients from flu this winter. Responsibility for offering a free flu vaccination to frontline health care workers rests with the employer, as part of their occupational health responsibility. It is recommended that NHS independent contractors, which include dental teams, general practice, pharmacists and optometrists, offer vaccination to their employed staff. A dental professional who is employed by a NHS trust would have their flu vaccine provided by that NHS trust. Dentists and dental staff who are in a ‘at-risk’ group will be eligible for a free flu vaccine under the flu programme.

Government proposals to ban online adverts for foods high in fat, sugar and salt

The Department for Health and Social Care has launched a new consultation on proposals to ban online adverts for foods high in fat, sugar and salt in the UK to tackle the obesity crisis and get the nation fit and healthy. And of course, in dentistry we all know too well the impact on oral health. As clinicians and those with a valuable insight into the health consequences of obesity, we encourage you to submit your views to the consultation. More information is on the government's website.

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

We're delighted that Peninsula Dental Social Enterprise (PDSE) has been named the South West Regional Winner in The Health Equalities Award category of the NHS Parliamentary Awards 2020. Local MP Luke Pollard nominated PDSE for their Community Clinic, which supports vulnerable patients who are experiencing homelessness in Plymouth.

PDSE are now through to the final round where the winner will be announced at a ceremony at the Palace of Westminster in July 2021. Every year MPs nominate NHS organisations in their constituencies for outstanding achievements, and this year we are proud that dental teams have reached the final.

Dental treatment is provided by a dentist and referrals for this service are made through local residential homeless centres and GP outreach services.  As a committed social enterprise PDSE currently provide this service as a pro bono contribution to the local community.

Since the start of the Community Clinic, the team have treated 89 vulnerable individuals providing a range of extensive treatments. Initially, the clinic treated people experiencing homelessness, expanding within the last year to include individuals using drug and alcohol services, as well as vulnerable women who risk of having multiple children removed from their care. They carefully control the number of people being treated at any one time to ensure we have sufficient flexibility to complete an individual's course of treatment and short waiting times between appointments are key to achieving this.

With the attendance rate for the service at 82%, the service plays a vital role in supporting the NHS by reducing the need for unscheduled dental appointments, attendance at the GP for dental pain and sepsis, inappropriate presentations at A&E and repeat prescriptions of antibiotics and analgesia by GP outreach services.

Congratulations to the team at Peninsula - you have done us all proud!

"PDSE’s Community Clinic is absolutely brilliant. Its focus on oral health inequalities and its creativity has undoubtedly changed the lives of vulnerable people excluded from mainstream dentistry"  Luke Pollard MP

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A reminder of the latest COVID-19 advice and guidance 

NHS updates to the profession 

During the course of the pandemic, we have regularly written to the NHS dental profession with important updates and information. This, and previous updates from the Chief Dental Officer and the NHS dentistry and oral health team are all 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.