Your NHS dentistry and oral health update

Tuesday 31 August 2021 (Issue 24)

An update from Ed Waller and Jason Wong

Dear colleague,

Last week saw the NHS Dental Statistics for England 2020-21 Annual Report published. We know that during a year like no other, NHS dental teams have worked hard to see patients as quickly and safely as possible. We are encouraged that the statistics show that responsible clinical prioritisation has been taking place during this difficult period.

The temporary exemption for patients to sign dental forms ends from tomorrow. Also as of tomorrow, as previously communicated to you, all clinical dental records must be stored using SNOMED-CT.

A number of colleagues have reached out to ask about whether patients should be seen if they are asymptomatic with COVID-19 contact or exposure identified. As detailed in dentistry's IPC guidance, patients should be treated on the medium risk pathway and in line with our Standard Operating Procedure. 

Do read on for further detail and other updates and helpful information.

We hope you have enjoyed the summer and we will be in touch again soon.

Best wishes and thanks,

Ed and Jason

SNOMED CT in practice management software: Wednesday 1 September

As of 1 September 2021, all clinical dental records must be stored using SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms). SNOMED CT is a standardised terminology that allows collaboration across all healthcare platforms.  The capture of this richer data set should not make the patient charting more onerous. SNOMED CT is a system that is essential to speed up referrals for oral cancer and enable dental practices to receive crucial information on issues such as child safeguarding

As dental practitioners contract directly with dental software suppliers, it is incumbent on practitioners to ensure that their practice management software is compliant with SNOMED CT.

Please see this blog entry, published on the GDC website, for further details

End of signature suspension on dental forms: Wednesday 1 September

This is an announcement on behalf of the Department of Health and Social Care (DHSC):

Since 1 November 2020 to 31 August 2021 the requirement for patient (or their representatives) signatures on NHS prescription, dental and eye care forms was temporarily suspended. The requirement for community pharmacies to submit certain EPS tokens was also suspended.

From 1 September 2021 patients (or their representatives) will again be required to sign the reverse of NHS prescription, dental and eye care forms or tokens for all prescriptions presented at the pharmacy on or after 1 September 2021.

NHS Dental Statistics for England 2020-21 Annual Report

During a year like no other, NHS dental teams have worked hard to see patients as quickly and safely as possible. It’s inevitable that the upheaval caused by Covid has disrupted some people’s dental care but dentists have been prioritising treatment for patients in urgent need, in part through the rapid establishment of 600 urgent dental centres - with millions still getting care through the pandemic. Provision of urgent care has been at pre-pandemic levels since December. 

The evidence shows that in 2020/2021, dental teams prioritised urgent and more complex work over the least complex treatments:

• Urgent courses of treatment share of activity increased from 9.5% in 2019/20 to 29.9% in 2020/21.
• Complex and urgent work, such as fillings and extractions (band 2 courses of treatment) and crowns and dentures (band 3 courses of treatment) stayed at similar levels in 2020/2021 to previous years, at 24.6% and 4.8% respectively. 
• The proportion of the least complex treatments such as a check-up or scale and polish (band 1 courses of treatment) decreased from 60% share of activity in 2019/20 to 40.8%, reflecting dentists prioritising the sickest patients. 

A reminder of COVID-19 dental care pathways

According to dentistry's infection prevention control guidance, the COVID-19 care pathways are:

1. High risk COVID-19 pathway:

• a) Untriaged individuals present for assessment or treatment (symptoms unknown), or; 
• b) Confirmed SARS-CoV-2 PCR positive individuals are cared for, or;
• c) Symptomatic or suspected COVID-19 individuals including those with a history of contact with a COVID-19 case, who have been triaged/clinically assessed and are awaiting test results, or;
• d) Symptomatic individuals who decline testing.

2. Medium risk COVID-19 pathway: 

• a) Triaged/clinically assessed individuals are asymptomatic and are awaiting a SARS-CoV-2 PCR test result, or;
• b) Triaged/clinically assessed individuals are asymptomatic with COVID-19 contact or exposure identified, or; 
• c) Testing is not required or feasible on asymptomatic individuals and infectious status is unknown, or;
• d) Asymptomatic individuals who decline testing.

3. Low risk COVID-19 pathway: 

• a) Triaged/clinically assessed individuals with no symptoms or known recent COVID-19 contact/exposure and have a negative SARS-CoV-2 PCR test within 72 hours of treatment and, for planned admissions, have self-isolated for the required period or from the test date, or;
• b) Individuals who have recovered (14 days) from COVID-19 and have had at least 48 hours without fever or respiratory symptoms, or;
• c) Patients or individuals are part of a regular formal NHS testing plan and remain negative and asymptomatic.

Currently, and until ‘point of care’ testing is available, patients requiring routine dental care will predominantly fall into the medium risk pathway. If a patient has evidence of a recent (72 hours) negative SARS-CoV-2 PCR test and no screening or triaging risks are identified, then the low risk pathway can be followed.

Please see page 4 of the Standard Operating Procedure for further information on planning for the delivery of care for patients in each pathway.

Vaccinations for all staff entering a care home

From 11 November 2021, all staff entering a care home need to be vaccinated, unless exempt.

Following the publication of DHSC operational guidance, we have written to the NHS and published FAQs on how this new regulation will be delivered operationally. All relevant providers of NHS funded services will need to actively support staff to have their first COVID-19 vaccine by 16 September 2021 (as eight weeks is required between the two doses) and carry out proactive workforce planning to ensure:

• only staff who are vaccinated, or exempt, are deployed to a care home from 11 November
• service provision is not disrupted once this regulation comes into force;
• ensure that relevant staff can demonstrate to care home staff, via the NHS COVID Pass service, that they have either had two doses or are exempt

The FAQs will be updated on a regular basis, to support systems and providers to implement this new regulation.

Staff Mental Health and Wellbeing Hubs

In response to the pandemic, mental health and wellbeing hubs have been set up to provide staff rapid access to evidence-based mental health support where needed. The hub offer is confidential and is free for all health and social care staff in England to access.

The hubs can offer a clinical assessment and referral to local services, such as talking therapy or counselling. You can self-refer or refer a colleague (with their consent).

For further details go to the  Mental Health and Wellbeing Hubs webpage. Dentists can also self-refer to the Practitioner Health service.

NHS Business Services Authority August bulletin

The NHSBSA has published it's August dentist bulletin, containing:

• Annual Reconciliation Report process
• Your Annual Pensionable Earnings and Contribution Statement (SD86C)
• Friends and Family Test submissions
• Suspension of some Compass functions
• Orthodontic PAR score submissions
• Reminder: Your year-end reconciliation letter is in Compass
• Reminder: Submitting patient data
• Compass video tutorials
• Access eDEN using your mobile or tablet
• NHS Pension Scheme guidance

You can find the bulletin online here. 

Pride in the NHS Week – Tickets Now Live  

Pride in the NHS Week is a week-long focus at the end of Pride Season 2021 (June – September) to provide rest, relaxation and recovery for NHS colleagues from our LGBT+ communities. It is by the community for the community.

The theme for 2021 is Elevate, Educate, Celebrate. We know that working towards equality is everyone's business and building awareness through Pride, bring us together to educate, elevate and celebrate.

This Pride in the NHS Week, culminating in the NHS Virtual Pride finale, will take place as an always-on virtual festival.

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Previous NHS dentistry and oral health bulletins 

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. 

COVID-19 advice, guidance and resources

Communications resources for NHS dental practices

Click on the links below to view and download useful communication resources:

• Click here for social media image cards and patient leaflets
• Click here for social media assets and posters explaining IPC requirements
• Click here to download website/social media copy and scripts for answer machine message, text message and emails.

NHS updates to the profession 

Key letters from the Chief Dental Officer and the NHS dentistry and oral health team are online here. 

Transition to Recovery: Dentistry's standard operating procedure

The latest version was published on Friday 16 July 2021. Changes to the previous SOP are in yellow. You can read the SOP 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.

Avoidance of doubt note: provision of phased treatments

This document is to support dental professionals, and to clarify where it might be appropriate to provide phased treatment spanning over several courses of treatment (CoT). You can read it online here.

Health and wellbeing support