Your NHS dentistry and oral health update

Thursday 25th November 2021 (Issue 34)

An update from Sara Hurley and Ed Waller

Dear colleague,

The UK infection prevention control (IPC) requirements for healthcare have changed, including the guidance for the UK dental sector. In line with the changes we have revised NHS England’s standard operating procedure (SOP) to reflect the new reality.

Importantly, with the introduction of a two pathway approach, the post aerosol generating procedure (AGP) down time requirement has been removed for a significant proportion of dental patients. The risk-based return to Standard Infection Control Precautions (SICPs) measures for many more clinical scenarios, together with other changes to infection prevention control, creates greater opportunity to address the backlog of care and meet the demand for urgent dental care.

Our aim is to withdraw the SOP and return to business as usual as soon as possible. However, we have judged it necessary to continue with a SOP for the time being.

Contractual requirements for the next financial quarter (January - March 2022) are being put together and we will inform you of them as soon as possible. As a reminder, where they can safely do so, contractors are expected to deliver beyond the 65% UDA threshold for clawback. With the changes to IPC requirements we anticipate that to be the case for many more practices.

Other important updates in this bulletin include information on the Government's decision to introduce compulsory vaccination for healthcare workers from April 2022, advice on how to keep your directory of service up to date and patient safety training.

Today's changes are an important, and significant, step in restoring NHS dentistry for our patients. They will help us see more patients and deliver care more quickly to those in need.

Thank you for your continued hard work.

Best wishes,

Sara and Ed

Significant changes to infection prevention control guidance and the dentistry's standard operating procedure

Summary of the main infection prevention control (IPC) changes

Th UK Government has now published revised IPC guidance for the dental setting. The main changes from the previous version of this guidance include the removal of the 3 distinct COVID-19 care pathways (high, medium and low) and now the introduction of a screening tool to place patients on either a non-respiratory or a respiratory pathway:

• For patients on the non-respiratory pathway standard infection control precautions (SICPs) apply. Testing for patients on the non-respiratory pathway should be in line with country specific requirements - in England there are no requirements. 
• For patients on the respiratory pathway, transmission-based precautions (TBPs) apply in addition to SICPs.
• For patients on the respiratory pathway undergoing aerosol generating procedures (AGPs), post AGP downtime applies.
• For the non-respiratory pathway, the guidance states that physical distancing should be at least 1 metre in all areas where possible, for example when not providing direct clinical care. This should be increased to 2 metres whenever feasible.

Sample screening questions can be found online.

Many parts of the guidance have not changed, including all patients being screened for COVID-19, universal masking/face coverings and more.

All practices must follow the IPC guidance in full.

You are strongly recommended to read the IPC guidance in full and it can be found online.

Summary of the changes to NHS primary care dentistry's standard operating procedure

Now that the IPC guidance has changed, we have amended the standard operating procedure. The main changes and key points are:

• Clinical prioritisation of patients remains in place, with practices required to prioritise urgent care and priority groups such as children. A key component of urgent care is the provision of follow on care to further stabilise disease, treat and prevent. 
• In order to maximise access when care may need to be deferred at short notice, practices should run a short notice cancellation list to minimise any lost clinical activity.
• For patients on the respiratory pathway, a further clinical assessment (i.e. triage by a dental professional) is required to determine whether routine care may be deferred until any respiratory symptoms resolve and when any COVID-19 isolation/quarantine periods has been completed.
• Individuals who have not yet received the COVID-19 vaccination should be supported and encouraged to take up the offer of the 1st and 2nd doses.
• Limiting transmission of infection in health and care setting requires a range of IPC measures. The national IPC guidance contains a ‘hierarchy of controls’ which, if applied in order, are used to identify the appropriate controls. The SOP adapts these controls for the dental setting and can be found in appendix A (page 16).

The SOP can be read online here and you are strongly encouraged to read the document in full.

Advice for dental teams in secondary care

Hospital dental services (secondary care) should liaise with their trust or organisation to determine whether this appendix or the IPC guidance for health and care settings is most appropriate for their services. 

Next Wednesday's webinar with the Chief Dental Officer on the latest IPC guidance and SOP changes 

Sara Hurley, Chief Dental Officer England, is hosting a webinar for all dental care professionals and practice team members on what the changes for mean for the delivery of primary care dentistry. 

Date: Wednesday 01 December 2021
Time: 19:00 - 20:00
Click here to register for the webinar 

Please take the time to read both the IPC guidance and the SOP. Although on the webinar we will take questions through the chat box, we would appreciate it if you send questions in advance so we can make sure as many as possible are answered as part of the presentation. 

Email the Chief Dental Officer at england.cdoexecutive@nhs.net 

Please note the webinar will not cover contractual issues.

Compulsory vaccination against COVID-19 for NHS staff and contractor groups

On 10th November, we wrote to all NHS dental contract holders to inform them that the Department of Health and Social Care (DHSC) has formally announced (9 November) that individuals undertaking CQC regulated activities in England must be fully vaccinated against COVID-19 no later than 1 April 2022 to protect patients, regardless of their employer, including secondary and primary care. 

The government regulations are expected to come into effect from 1 April 2022, subject
to parliamentary process. This means that unvaccinated individuals will need to
have had their first dose by 3 February 2022, in order to have received their second
dose by the 1 April 2022 deadline.

Please do read the letter of 10 November in full which has details on support for staff and next steps for the service.

How to get your COVID-19 vaccine 

Staff vaccination is an essential step in preparing for winter. More than three million eligible health and care workers had a COVID-19 booster in the first month of roll out in September, and we know the coverage continues to climb.

Ahead of winter please do keep encouraging colleagues to have their COVID booster vaccine – frontline colleagues can book their COVID booster, for six months after completion of the primary vaccine course, on the National Booking Service.

Important action to keep your Directory of Service (DOS) up to date

Providers have requested advice on ways to manage the impact on their practice if a patient cancels an appointment. One key way of ensuring your book is filled quickly is to update the DoS with the relevant contact details, this will enable NHS 111 to refer patients in urgent need to your practice. It’s essential to include in your profile when the last referral from NHS 111 would allow for sufficient treatment time.

Using the updated DoS NHS 111 can signpost or refer callers to dental practices: 

• Signposting involves giving the caller the address and telephone number, so that they can make contact themselves either by phone or attending in person 
• Referral involves sending the case details electronically to a specific dental service, which means that the caller will expect a call back to arrange a timeframe for advice or treatment.

Providers are strongly encouraged to update the DOS if they haven’t already done so in order to meet their contractual obligations and to prioritise urgent care by maintaining access for patients, in accordance with the Standard Operating Procedures (SOP) and Infection Prevention Control (IPC) guidance, focusing on face to face care where clinically appropriate.

Under the General Dental Services Contract and Personal Dental Services agreement, providers must provide urgent treatment that is necessary to meet the reasonable needs of its patients during normal surgery hours. Additionally, as we have stated previously, practices are reminded that, as a condition of income protection, they should not prioritise patients of lower clinical need over those in higher clinical need, such as urgent care or a member of a priority group such as children. As there is no patient registration within NHS dentistry patients must be prioritised against clinical need and priority groups regardless of whether the member of public is on a practice’s business list or not.

If you require a manual update to the Directory of Services (DoS) that informs NHS 111, including your capacity status, you should contact your local dental commissioning team or your DoS Lead so the change can be agreed prior to the system being updated.

If you do not know your DoS lead you can contact the DoS Provider and Commissioner Helpline on 0300 0200 363. In addition NHS Digital has also provided guidance to help you ensure that your NHS website profiles are kept up to date.  

The NHSBSA March 2021 bulletin provided advice on how technology can support the management of appointment time being lost to cancellations .

NHS pension scheme consultation

Government has launched a consultation on proposed changes to member contributions to the NHS pension scheme from 1 April 2022. Find out about the proposed changes and respond to the consultation here. This consultation closes on 7 January 2022.

Patient safety training

New online patient safety training, developed with Health Education England and the Academy of Medical Royal Colleges and aligned with the patient safety syllabus, is now available via the eLearning for healthcare hub. All staff, including those in non patient-facing roles, are encouraged to complete Level 1: Essentials for patient safety.

Latest news from the GDC and the NHSBSA

The General Dental Council's latest newsletter includes:

• A view from the GDC’s new Chair
• Annual Renewal for dentists opens 8 November
• VAT changes for the import of dental prostheses

The NHSBSA November dentist bulletin contains updates on: 

• Quarter 3 reports available in Compass
• Mid-year review letters in Compass
• Post Annual Reconciliation Report process
• New data items on FP17s
• Replacement form submissions
• Opening more than one Compass window
• Your contact details in Compass
• Inactive users on eDEN
• Compass upgrade
• Dental Assurance Framework

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Previous NHS dentistry and oral health bulletins 

Previous bulletins from 2021 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

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 Thursday 25th November. 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