Your NHS dentistry and oral health update

Thursday 10th December 2020

An update from Sara Hurley, Chief Dental Officer England 

Dear colleague,

As you will have seen on the news, the NHS has planned extensively to deliver the largest vaccination programme in our history, and it began on Tuesday. It’s important to say that while we are moving fast, this will be a marathon, not a sprint. I will keep you updated on timelines and progress and what this means for dental teams and more information is in this update.

I'm delighted to announce that Professor Rebecca Harris, Professor of Dental Public Health at Liverpool University has been appointed as our new Deputy Chief Dental Officer. Rebecca will join myself, Jason Wong and the team at the end of January, when our long serving and incredibly talented friend Eric Rooney will retire. Although he's not escaping just yet, I'm sure you will all join me in thanking Eric for his dedication to the profession.

As you may know, the minister has also confirmed to parliament the Government's decision that from Monday 14th December dental charges in England will be increased. The new charges are detailed below. 

Yesterday Healthwatch England published their quarterly report with a focus on dentistry. We are reading this report carefully as we continue to restore dental services and do our best by patients.

I've also included updates from the General Dental Council on CPD cycles and the impact of the end of the EU Exit transition period on registration arrangements. The NHS and Health Education England have also launched an important new programme to support dental teams deliver sensory health services to children with a learning disability or autism and I encourage you to register.

Today's "By Word of Mouth" shout out goes to Christian, one of our dental nurses at Barts Health NHS Trust. Christian was redeployed earlier this year and shares with us his perspective. I am always on the look out to promote the achievements of our profession, so please do email me  at england.cdoexecutive@nhs.net with any suggestions.

Mouth cancer action month came to an end in November, but its message is relevant every month. Myself and Deputy Chief Dental Officers Eric Rooney and Jason Wong each completed our 10k just in time before 1st December. I know how many of you promoted mouth cancer action over the last month, and I am looking at ways to promote the signs to the public and support the profession on this important issue. If you have any ideas, concerns or points please do drop me a line at the email above.

Jason has also taken to NHS England's twitter and can be spotted on NHS England's Instagram with his lovely tribute to our profession - "I would like to take this opportunity to thank the whole dental family for delivering excellent patient care in extremely difficult circumstances. We're immensely proud of the work and effort of the whole dental family" 

Sara

Further information on the NHS' plan for COVID-19 vaccinations 

What is happening now to deliver the Pfizer vaccine?

The NHS has planned extensively to deliver the largest vaccination programme in our history. Now that we have the first vaccine that has been rigorously tested and confirmed as safe and highly effective by the expert Medicines and Healthcare products Regulatory Agency (MHRA), we have been able to adjust and finalise the plans in the light of the particular properties of the first vaccine. We can begin to roll it out to those groups who the independent Joint Committee on Vaccination and Immunisation (JCVI) have decided need it most.

When it is the right time people will receive an invitation to come forward.  For most people this will be a letter, either from their GP or the national NHS.  This letter will include all the information a person will need to book appointments, including their NHS number. We are asking the public not to contact the NHS to get an appointment until they get this letter. We would be grateful if you would help us to share this message over the coming weeks.

Although the Pfizer vaccine is typically delivered by a simple injection in the shoulder it is complex to move, store and prepare. It needs to be stored at -70C before being thawed out and can only be moved four times within that cold chain beginning in Belgium before being used. So, from this week, we started delivering it from “Hospital Hubs”.

What will happen next?

A small number of GP-led Local Vaccination Services will begin vaccinations during the week beginning 14 December with more practices in more parts of the country joining in on a phased basis during December and in the coming months as vaccine supply allows.

The NHS will offer the vaccine to more groups of people and in more ways, like local vaccination services:

• We will keep expanding the programme as we get more vaccines.
• So we can go as fast as supply allows, we have been recruiting and training more vaccinators and support staff from across the NHS and outside of it.
• All of these will be trained, assessed and supervised, just like regular NHS vaccinators.

Who is being vaccinated first and when will dental teams be vaccinated?

Phased vaccine supply means the bulk of vaccination for high risk groups will inevitably take place between January and April. So great vigilance is required before then to prevent a third wave of Covid.

Patients aged 80 and above who are already attending hospital as an outpatient, and those who are being discharged home after a hospital stay, will be among the first to receive the life-saving jab. Hospitals have already begun inviting over 80s in for a jab and working with care home providers to book their staff in to vaccination clinics.

We are doing everything we can to make sure we can overcome significant challenges to vaccinate care home residents as soon as possible, and expect to begin well before Christmas. As the care minister Helen Whately has said, getting the Pfizer-BioNTech vaccine to care home residents is challenging because of the requirements for transporting it and the temperature at which it is stored.

The JCVI have put patient-facing health and social care staff into the top two priority groups because of their heightened risk of exposure to the virus. So, any appointments not used for the initial groups will be used for healthcare workers who are at highest risk of serious illness from covid. The details of how dental professionals would be vaccinated, along with other healthcare professionals such as GPs and pharmacists, will be confirmed as soon as possible.

How can dental professionals help deliver the vaccine?

Further guidance on recruitment into the COVID-19 vaccination programme is available at Join the Vaccine Team

What are the indemnity arrangements if dental professionals do help? 

We know that many dental practitioners and dental healthcare staff want to support the COVID-19 Vaccination Programme. To help clarify how indemnity arrangements will work, NHSE/I have prepared an FAQ document. In summary, the Clinical Negligence Scheme for General Practice (CNSGP) cover extends to additional staff being brought in to help with administering vaccines under the national protocol, provided they are engaged by the Trust or practice, for example via a secondment agreement, honorary contract or volunteer agreement. It is under these arrangements that dental professionals would most likely help the vaccination programme. These indemnity arrangements will also apply to the administration of any temporarily authorised COVID-19 vaccines.

Dental charges increase from Monday 14th December 

The Government has announced that the National Health Service dental patient charges in England will increase from Monday 14th December 2020. Details are in the table below.

About Rebecca Harris, our incoming Deputy Chief Dental Officer 

In 2020 Rebecca was awarded the International Association for Dental Research 2020 Distinguished Scientist Award for Behavioural, Epidemiologic and Health Services Research. 

Rebecca's professional roles have included 2017-2018 President of the British Association for the Study of Community Dentistry (BASCD) which is the UK’s professional association for the science, philosophy and practice of promoting the oral health of populations and groups in society; and Oral Health topic expert on NICE Public Health Advisory Committees 2014-2017.

Message from the Department of Health and Social Care: Adrenaline for anaphylaxis kits 

You will be aware of the MHRA patient level recalls of Emerade 150microgram, 300microgram and 500microgram devices on 4 March, 7 April and 18 May 2020, respectively. The advice remains to conserve supplies of adrenaline auto-injectors (AAIs) for patients who truly need them. Some dental practices may be holding EpiPen or Jext devices, in preference to adrenaline ampoules, to treat anaphylactic reactions; this should not be necessary. All healthcare professionals providing services where anaphylaxis treatment may be required should have the competency to draw up and administer adrenaline from ampoules with a normal syringe and needle. We ask that when you renew the adrenaline in your anaphylaxis kits, you alert all your staff to please stock ampoules (ensuring you also include dosing charts, needles and syringes) and not AAIs. This will reduce the reliance on AAIs and therefore preserve essential supplies for patients, parents, carers, teachers, etc. who, as lay persons, cannot be expected to administer adrenaline via a needle and syringe.

The Green Book and Resus Council guidance provides additional advice to healthcare professionals on the use of adrenaline in response to anaphylaxis. Supplies of adrenaline ampoules are currently available and there is an expectation that dental practices should use these in preference to AAIs.

All enquiries relating to this issue should be sent to the DHSC Medicine Supply Team at DHSCmedicinesupplyteam@dhsc.gov.uk. 

The original message can be found on the NHSBSA website.

Sharing the message that dental practices are open

Many of you are continuing to promote the fact that dentists and their teams are open for business. Next week, we will publish a patient information leaflet on what to expect from NHS dental services and how to access them. The NHS has produced some handy "social media assets" that you can download and use, along with some recommended posts.

These are available on the coronavirus resources government web page, click "download", a file will come up and you will find them in the "Dental - social" section.

End of the EU Exit transition period: important information from the General Dental Council

The General Dental Council have updated their guidance about how the end of the EU Exit transition period at 11pm on 31 December will affect registration arrangements for dental professionals with non-UK qualifications. The rules for EEA-qualified dentists and dental care professionals will work differently from 1 January 2021. More information is on the GDC website.

New programme to support delivering dental care to children with learning disabilities and autism

Some children and young people with learning disabilities and autism can have difficulties understanding, receiving, and responding to information and may experience sensory processing difficulties.  People with these issues may have an adverse reaction to anything that under or overstimulates their senses, such as light, sound, touch, taste, or smell. This can affect their behaviour and ability to interact with other people making it more difficult for them to access health checks.

The Delivering sensory health services e-learning programme is designed to support dentists and their teams who carry out these sensory health checks. The programme outlines:

• What to consider when communicating with children and young people and their families in these schools or colleges.
• How to work with other professionals to help support whilst in situ and provide this support
• To help prepare beforehand in order to understand how a particular school or college works.
• Specific topics on autism and behaviours that can be a challenge and what sensory impairment means to the patient.
• How to reduce/avoid this sensory overload whilst caring for the individual.

More information, including how to register for the programme is on the e-learning for Healthcare website.

UK Resuscitation Council life support courses 

In our last update, we mentioned that the GDC and the CQC recognised that COVID-19 social distancing has made accessing accredited Life Support training difficult but encouraged practices to make every effort to ensure training in line with the UK Resuscitation Council's quality standards for primary dental care. This statement has been welcomed by the Council and the it recommends that those practitioners wanting to access Immediate Life Support courses take advantage of many of the Council's accredited ILS Course Centres have continued to successfully run socially distant courses throughout the pandemic in line with Government Guidelines. For non-clinical dental staff, eLifesaver offers an affordable option for practices to ensure their non-clinical team have the skills to save a life.

A quick reminder on the details of Regulation 11 from NHSBSA

NHS Business Services Authority (NHSBA) have published a quick reminder on the details of Regulation 11. The regulation is the treatment band that applies to replacement NHS dental appliances, when the original was lost or broken, due to an act or omission by a patient. This also applies to stolen appliances. The only appliances that are covered by Regulation 11 are dentures, obturators, bridges and orthodontic appliances (for orthodontic contract holders only). More information, including patient charges and activity, can be found on the NHSBSA website.

Updated model contract for salaried dentists

NHS Employers has worked with the British Dental Association to update the model contract for salaried dentists and bring them in line with changes made to employment law under the Employment Rights Act, which came into effect in 2020. NHS Employers have more detail on their website.

New toolkit on adult oral health in care homes

Public Health England has produced a toolkit to support care homes and commissioners to implement the NICE guideline (NG48): Oral health for adults in care homes. The toolkit also contains useful links for care home staff, residents, their families and friends to support good oral health and reduce oral health inequalities.

Minimum CPD hours: an update from the General Dental Council 

If you’re coming to the end of your CPD cycle and are concerned that you will not be able to meet the minimum CPD hours for exceptional reasons, please consider applying for a grace period. Applications for grace must be made in writing and received by 31 December. More information is on the GDC's website. 

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

Signing up to this bulletin

Have you been sent this email by someone else? 

This bulletin is a round up of all the latest news and important resources for anyone working in NHS dental services. We'll send it out as and when important news needs to come your way. If you've already signed up but didn't receive the update, then check your junk folder for the confirmation email and make sure you've followed the instructions to complete sign up.

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 

NHS updates to the profession 

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

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 

Changes to the previous SOP are in yellow. It was updated on Tuesday 27 October and is online here.