Your NHS dentistry and oral health update

 Wednesday 1 June 2022 (Issue 48)

An update from Sara Hurley and Lisa Ritchie

Dear colleague,

The UKHSA guidance on Infection prevention and control (IPC) for seasonal respiratory infections in health and care settings (including SARS-CoV-2) for winter 2021 to 2022 and the accompanying dental appendix has been archived.

This is part of healthcare's continuing transition back to pre-pandemic IPC measures.

NHS England has written to systems today.

The NHS England Infection Prevention and Control Manual gives dental practices the principles to which your practice should now deliver care which is safe for your patients, your staff and in particular your vulnerable groups.

Accompanying the manual is a dental framework for identifying hazards and risks with guidance on measures that should be maintained as we move to new, improved and safer ways of working. This may be found online.

In making a safe transition and balancing risks appropriately the framework follows the now familiar hierarchy of controls format.  It provides a consistent handrail applicable to the generic dental practice environment in the management of respiratory pathogens.  

Practices will be very familiar with the Standard Infection Prevention and Control measures detailed in the manual and should note the on-going additional transmission based precautions which should be adopted for the management of higher risk.

For ease of understanding key points for practices to note on IPC from this point onwards are set out below. 

Of course, we must remain vigilant to the risks and impacts of existing and emerging pathogens and consider the associated measures for their management in dental practice settings. However, practices may also wish to take local advice from Regional IPC leads and their Regional Public Health Team.

The change in IPC guidance represents another step back towards pre-pandemic ways of working.

Thank you for your ongoing efforts to give our patients the high quality care during these challenging times. 

With best wishes,

Sara and Lisa

Infection prevention control as we live with COVID-19

Throughout the pandemic IPC guidance has continued to evolve to meet the challenges of COVID and risk management to protect your patients, your staff and yourself.  The UK Health Security Agency (UKHSA) have replaced their previous UK IPC Guidance with new COVID-19 pathogen specific advice for health and care professionals. This new advice should be used alongside the National Infection Prevention and Control Manual (NIPCM) for England and applies to all NHS settings or settings where NHS services are delivered. The NIPCM also contains guidance on the application of the hierarchy of controls in dental setting. This is designed to be complementary to your clinical and professional judgment in managing risk in your practice. 

With the archiving of the UKHSA Dental Appendix, key changes for dental teams to note as set out in the NIPCM are:

• Protecting your patents, your staff and your self: Risk assessment via the dental framework and application of the hierarchy of controls, as detailed in NHS IPC Manual.
• Patient Screening: Screening questions are no longer required prior to attendance. 
• Public Messaging: Practice information for patients should encourage patients with any respiratory signs and symptoms to telephone for advice. Patients should not visit if unwell/infectious without telephoning the practice for advice.
• Physical Distance: No longer required unless suspected /confirmed case attending.  In these cases 1 metre social distancing required, ideally look for timeslots at the end of sessions to minimise contact with other patients/staff.
• Cleaning: Practices are to return to the well-established pre-pandemic cleaning routines.  Enhanced cleaning only required after known infectious patients have attended
• Staff testing: No change – all staff should continue to test twice a week with LFDs.

Monkeypox CAS alert

UKHSA has advised that cases of monkeypox have increased recently but the risk to the UK population remains low. UKHSA has confirmed that community transmission is occurring in the UK with multiple generations of spread. Illness appears to be generally mild, consistent with other information about the West African clade.

Anyone can get monkeypox. Currently most cases have been in men who are gay, bisexual or have sex with men, so it's particularly important for these people to be aware of the symptoms.

Patients should contact a sexual health clinic if they have a rash with blisters and either:

• have been in close contact, including sexual contact, with someone who has or might have monkeypox (even if they've not been tested yet) in the past 3 weeks
• have been to west or central Africa in the past 3 weeks

Patients who meet these criteria should be assessed and tested in line with UKHSA guidance.

If patients are not able to contact a sexual health clinic they should call 111. Additional information for patients is available on nhs.uk

Further guidance is in development by the national IPC team with support from regional and dental public health colleagues.  This is drawing on information that you can currently find on the government website including:

• guidance for primary care
• guidance for environmental cleaning and decontamination

and information on:

• case definitions
• contact tracing
• vaccination.

For any immediate concerns your Regional IPC teams are your primary point of contact.

Flexibility in Dental Specialty Training

The recent Advancing Dental Care Review revealed that lifestyles and career expectations have changed radically in recent years. It demonstrated an increasing need for current training pathways to reflect this, by developing newer flexible training opportunities to meet the changing needs of our current and future dental trainee workforces.

We would welcome insight and feedback into current challenges and barriers you have experienced in the delivery of Less Than Full Time (LTFT) and Out of Programme (OOP) training options if you're an educator, or if you're a postgraduate dentist in training, to understand your awareness of flexible working opportunities available to you.

We invite you to complete the following surveys to share your experiences:

Flexibility in Dental Specialty Training (Survey for Educators)

Flexibility in Dental Specialty Training (Survey for Postgraduate Dentists in Training)

This feedback is vital in helping to inform how we develop and improve training opportunities and experience for current and future postgraduate dentists in training.

Please note the closing date is Monday 6 June.

Next Steps for Integrating Primary Care

Dr Claire Fuller’s Next Steps for Integrating Primary Care, published last Thursday, sets out a welcome vision that focuses on improving the access, experience and outcomes of primary care services for our communities.

The stocktake report, which was commissioned by NHS England, assesses how newly formed Integrated Care Systems and primary care could work together to improve care for people, ensuring services are joined up and as convenient as possible so that everyone can get the right care for their needs at the right time.

Thank you to all those working in dentistry who took the time to share their feedback with Dr Fuller.

Help develop the new Booking and Referral Standard

We wish to speak to members of the dental profession about the new Booking and Referral Standard (BaRS) to ensure it supports the needs of you and your patients.

The BaRS is an interoperability standard for healthcare IT systems which will enable bookings and/or referral information to be sent between NHS 111 and urgent dental care services quickly, safely and in a format that is useful to clinicians.

If you would like to take part or have any questions, please contact bookingandreferralstandard@nhs.net

Health and Social Care Panel - Virtual Honours Festival 

As part of a week of virtual festivities that coincides with the Queen’s Platinum Jubilee celebrations, an event is being held for the Health and Social Care sectors on 15^th June from 1-2pm. During the session you’ll hear from a variety of inspirational honours recipients, while taking the opportunity to learn more about the UK honours system and how you can make your own nomination for someone amazing. Full details on all of the week’s events and registration can be found here.

Free and rapid coaching available for primary care dental colleagues

Thank you to everyone who attended last Thursday evening’s webinar on how Looking After You coaching can support you and your dental team.

We had a great response to the webinar and hope that the free and confidential coaching services will be helpful to you. Slides and a recording are now available on our FutureNHS workspace. Please note, you will need an NHS or similar professional email address to register.

If you feel like you want to talk to someone impartial about your wellbeing, the team you lead or your career, our ‘Looking After You’ coaching offers are available right now. Appointments are available at a date and time that suits you, and you won’t be waiting more than 48 hours to get access to an experienced coach.

Thousands of colleagues from across primary care have booked sessions and given positive feedback on their experience.

One dentist who accessed one of the services said:

“My coach was amazing. The subject matter was difficult. She was so sympathetic and empathetic and very supportive. I found that speaking objectively to someone like my coach can only help , even if a solution is not found. A massive thank you.”

All coaching is free and confidential at a date and time that suits you. Please take some time to look after yourself and your colleagues as you continue to look after others. Do share this service with any colleagues you feel may benefit from support.

Ukrainian Citizens Arriving in the UK

UKHSA has published information for primary care professionals on how to meet the health needs of patients from Ukraine. This guide is available here. 

This resource is intended to help primary care professionals assess and address the health needs of patients ordinarily resident in Ukraine who have arrived in the UK in response to the conflict between Ukraine and Russia. Individuals may be eligible for reduced charges or free care for dental services and information about this is available in other languages. 

Families and individuals arriving in England supported by UK Visas and Immigration  (UKV&I) under section 95, are usually issued with HC2  certificates within 2 weeks of their arrival. If the patient has not yet received their HC2 certificate and is unable to provide evidence of exemption, then you will need to include the clarification on access to dental care and the agreed approach to dental charge exemptions process:

• Do not refuse treatment
• Put an X against the ‘No’ option in the Evidence of remission seen’ box on the FP17 PR form and Dental Activity claim
•  Ask the patient to sign the declaration on the FP17 PR form

Checklists can be used to aid in assessing new migrant patients oral and dental health, 

The UK Health Security Agency (UKHSA) has produced advice for primary care professionals and Doctors of the World have translated a number of their resources for patients into Ukrainian and Russian.

We would like to remind colleagues that to be most effective for the people who need it, these support efforts must be properly co-ordinated, as part of the overall UK Government-led response. As such, we ask that, rather than trying to contact Ukrainian or neighbouring authorities directly with offers of support, NHS organisations direct their contributions to England.incident14@nhs.net. 

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Recent dentistry and oral health bulletins 

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

Special focus bulletins 

Chief Dental Officer Sara Hurley and the NHS team regularly produce 'special focus bulletins' on clinical priorities and key aspects of patient care. These bulletins summarise the key information dental teams need to know and act as a refresher, combining best practice, expert opinion and useful resources. If you would like to suggest a topic for a future special focus bulletin please email the CDO's team at England.CDOExecutive@nhs.net 

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. 

Key advice, guidance and resources for NHS dental teams

NHS updates to the profession 

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

Infection prevention control (IPC) 

NHS practices should refer to the NHS England Infection Prevention and Control Manual which details the principles NHS dental practices should now follow to deliver care. The accompanying dental framework identifies hazards and risks with guidance on measures that should be maintained as we move to new, improved and safer ways of working. 

Dental recall priorities for children: implementation tool

Children are a clinical priority group for all NHS dental teams. Practices are encouraged to use the NHS implementation tool which assists dental professionals in the recall of children for a dental appointment, in line with NICE guidelines. You can view the tool online.

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