coronavirus

Dental Protection calls for GDC leniency as third of dentists say fear of investigation is affecting mental wellbeing

Dental Protection has called for the GDC to take a lenient approach to complaints related to the treatment of patients during this Covid-19 crisis.

This comes as a Dental Protection survey of over 500 dentists – which was completed by dentists following their return to practise – shows that a third (33%) feel their mental wellbeing is worse than two weeks ago. 55% of dentists in the same survey said that working in unfamiliar ways is a key concern, with 33% also saying that fear of regulatory investigation is having the most impact on their mental wellbeing.

In a letter to the Professional Standards Authority (PSA), which oversees work of all professional regulators of healthcare in the UK, Dental Protection has stated that guidance for the GDC and other regulators is needed that would provide more reassurance on the issue of when an investigation would be conducted or not.

Raj Rattan, Dental Director at Dental Protection said: “Dental professionals have faced a range of challenges throughout this pandemic, and many have now returned to practise in equally in unsettling and challenges circumstances – working in different ways, worrying about their health and that of their patients, and facing a backlog of patients with problems potentially due to the delay in treatment.

“The GDC and other regulators proactively issued a joint statement in March confirming they will fully consider the context which dentists have been practising in during this time when reviewing any complaints they receive. While we welcomed this statement, we believe members would welcome clear guidance from the PSA which would demonstrate in more detail how the regulators will ensure a proportionate approach will be taken, especially as it will likely be a number of years before such complaints might be handled and at a point when memories of this time have faded. A more lenient and considered approach to investigations seems entirely appropriate given the unique circumstances.

“The pressure and stress involved with working in unfamiliar ways, and the prospect of a regulatory investigation down the line, is clearly taking its toll on dentists’ mental wellbeing. I know that more reassurance on this issue would be greatly valued by our members who are doing their very best for their patients.

“I would also like to remind members of our counselling service for those experiencing work-related stress. The service is provided through a third-party partner and is completely confidential.”

The survey was conducted by the independent market research organisation, Research By Design (www.researchbydesign.co.uk). It ran from 18th to 29th May and achieved 506 responses from dental members in the UK.

Video consultation services in Wales extended to dentistry

The Minister for Health and Social Services in Wales, Vaughan Gething, last week announced that video consultation services in the country were to be extended to dental practices, as well as opticians and community pharmacies. This follows on from the successful rollout of such services in primary, secondary, and community care during the Covid-19 pandemic.

Video consultation has rapidly expanded across Wales during the last few months, ensuring that the public retains access healthcare services during the Covid-19 response. More than 6,400 GP video consultations have been undertaken so far, along with 8,800 video consultations to support community and secondary care. The Welsh government states that 92% of patients have rated the service as excellent, really good or good.

Not only has video consultation allowed essential services to continue, but it also helped to protect patients and NHS employees from an increased risk of infection. The service has reportedly saved 36,000 miles of travel and 1,200 hours of travel time. It has also reduced Co2 emissions by an estimated nine tons.

A pilot will now take place during July to extend the services to dentistry, optometry and community pharmacies, all of which have experienced an increased demand for additional services. As social distancing has restricted some services, video consultation will help support the reintroduction of some.

In dentistry, video consultations will support pre-visit consultations to provide an understanding of the patient’s medical history and to facilitate a clinical assessment.

“Delivering care closer to home through the use of technology has always been a key part of ‘A Healthier Wales’, to deliver healthcare away from hospitals to communities, and where possible in people’s homes,” said Gething. “The coronavirus pandemic has meant that we have had to rapidly expand and adapt services. Video consultation has allowed us to overcome the challenges that social distancing brings. The delivery of video consultation has been fast tracked and is testament to the work of NHS Wales in delivering this service ahead of time  to support patients. Thousands of people have already received care via video consultation. I’m pleased to be able to extend this service to dentistry, optometry and community pharmacies which will see even more people benefit.”

BAPD seeks new guidance from government to help to screen for oral cancer

The British Association of Private Dentistry (BAPD) has advised the government that it needs to change its guidance in order to help dental practices successfully screen for oral cancer.

The Association recently conducted a straw poll of its members in order to find out whether dental professionals were encountering problems in referring patients who were suspected of having mouth cancer. The results found that 676 out of the 755 respondents had experienced referral problems when seeking secondary care.

The poll comes following research, which has suggested that more than 24,000 cases of cancer have gone undiagnosed due to the Covid-19 pandemic.

Jason Smithson, Co-founder of the BAPD, said: “The comments would suggest a multi-factorial problem; however, there would seem to be some common themes. Clearly, this is a serious problem for the profession. Therefore, we have compiled a survey that we hope to present to PHE and NHSE and may impact fallow and PPE.”

NHS England and CDO issue latest preparedness letter for primary dental care

Sara Hurley, Chief Dental Officer for England, and Matt Neligan, Director of Primary Care and System Transformation at NHS England, have issued the latest preparedness letter for primary dental care. This is the fifth in a series of regular updates to general dental practices and community dental services regarding the Covid-19 situation, all of which can be found here.

The latest instalment begins by expressing gratitude for the ongoing commitment to quality care provided by the industry as a whole, before making the following statement:

In light of the emerging evidence and recommendations for Infection prevention and Control, we continue to review the risk management measures for dental practices and will keep you informed of any developments. However, the potential for localised and regional resurgence of Covid-19 will endure. To this end, regions will retain their urgent dental care capability, and practices should be prepared to comply with any localised public health measures and restrictions.

Regional directors and public health leads will provide the necessary direction and practices are reminded to remain connected with their regional teams.

Hurley and Neligan go on to discuss various topics, including: the ongoing resumption of dental services, covering patient management and guidance and standard operating procedures; financial and contractual arrangements for dental services in England, covering contractual arrangements and further assistance; PPE and fit testing, including respirator fit testing and dental care provision PPE and IPC requirement; and workforce issues, such as risk assessments and the impact on dental training.

Read the letter in full here.

mydentist provides a look at what they did during lockdown

mydentist has released a short video on its YouTube channel, providing an update on what the company has been doing in lockdown to give support to local communities, both inside and outside of the practice. mydentist reportedly received more than half a million calls from patients needing advice.

Watch the video below.

DDU survey finds majority of dental professionals believe stress and anxiety levels have increased

New research published by the Dental Defence Union (DDU) has found that 68% of dental professionals surveyed feel that their stress and anxiety levels have increased since the pandemic. The DDU surveyed 224 members and also found that:

  • 67% feel stressed/anxious on a weekly basis
  • 52% feel they are unable to spend adequate time with patients
  • 47% often go to work when they don’t feel well
  • 49% feel they are unable to do their jobs effectively

Of those surveyed, the DDU discovered that 72% of respondents believe that they are making a positive difference to the lives of their patients. Also, the DDU found that members were most likely to raise concerns with their family members (88% of all respondents), colleagues (57% of all respondents) and/or their GP (42%).

This comes as the DDU launches a new health and wellbeing e-learning course which focuses on strategies for coping with adversity, the steps you can take to help yourself, and support a colleague who’s struggling.

Lesley Taylor, dento-legal adviser at the DDU, commented: “Most dental professionals are used to dealing with high pressure situations and stressful decisions but the COVID-19 pandemic has magnified these challenges to an unprecedented level. As many dental professionals prepare to return to work, they will now be faced with a ‘new normal’ and will need to adapt to new ways of working. This may elicit a wide range of emotions and the increased pressure may take its toll on their personal mental wellbeing. The DDU’s new health and wellbeing e-learning course aims to help you recognise the warning signs in yourself and others, as well as the steps you can take to seek support.”

To learn more about the DDU’s health and wellbeing e-learning course click here.

Dental Protection reassures members of support if unable to wear a fit-tested mask

Dental Protection has reassured its members that their membership and ability to request assistance is unaffected if they are unable to wear a fit-tested mask and that they can seek assistance from Dental Protection in the usual way. This reassurance follows several queries from dental professionals contacting Dental Protection in recent weeks concerned about their inability to wear a fit-tested mask for a number of reasons.

There may be legitimate reasons why it is not possible to wear a fit-tested mask, including for health reasons or because it is not possible to achieve an adequate seal when wearing a mask. Dental Protection recognises that for a variety of cultural and religious reasons, removal of facial hair and beards is not an option and in turn means passing a fit-test is not possible.  

The primary purpose of PPE, and in particular RPE masks, is for the dental professional’s own safety. For those who are employers, they would also need to consider the safety of their employees if they cannot pass a fit-test. Dental Protection recommends that members identify the overall risk to themselves, their team, and patients in situations where the fit-test has failed and ensure steps are taken to mitigate the risk.

Raj Rattan, Dental Director at Dental Protection, said: “We know our members are facing a number of challenges related to the reopening of practices and resuming of face-to-face care. We would like to reassure members that their membership and ability to request assistance will not be affected by the inability to wear a fit-tested FFP2 or FFP3 mask.

“The primary purpose of PPE and in particular RPE masks is for dentists’ own safety,” he continued. “We recommend that employers identify the overall risk in all situations where the fit test has failed and ensure steps are taken to mitigate the risk. These are challenging times, and as a profession, we may not know what the future looks like, but I can assure you that Dental Protection will be there our members.”

BSP, FGDP, CGDent issue joint statement on the provision of a dental prophylaxis under Level 4/3 Covid-19 alert status

The British Society of Periodontology and Implant Dentistry (BSP), Faculty of General Dental Practice UK (FGDP) and College of General Dentistry (CGDent), working with the Office of the Chief Dental Officer for England, have issued a joint statement to clarify and contextualise the differences in guidance issued relating to the provision of a dental prophylaxis under Level 4/3 Covid-19 alert status:

The BSP guidance relates to prophylaxis as part of professional mechanical plaque removal (PMPR) in  people with periodontitis. The FGDP guidance relates to the more general term of ‘tooth polishing’,  which may not necessarily be undertaken for therapeutic reasons.  

The international evidence‐based S3‐level treatment guidelines in periodontology strongly recommend PMPR (highest evidence level: 100% consensus) in managing periodontitis. Clinical  harms may result in periodontitis patients if this is withheld.  

A prophylaxis undertaken with a slow speed handpiece, with no water, reduced prophy paste and due diligence, is considered a Non‐Aerosol Generating Procedure (non‐AGP) as defined by emergent particle sizes (WHO 2007) and can be safely undertaken with level 2 PPE (R11 mask, gloves,  goggles/visor, plastic apron over scrubs). However, non‐AGP procedures are not without some risk and polishing teeth for cosmetic reasons is not recommended until Level 2 alert status is reached.  Prophylaxis does cause splatter which can travel in a ballistic manner between 15‐120cm from  patients’ mouths and which may contact the eyes, mouth and skin of the operator/assistant; hence the need for level 2 PPE. Teeth should be dried with gauze and high volume aspiration is recommended.  

The BSP guidance provides a risk categorisation based on procedure. The FGDP-CGDent guidance adopts a similar approach but uses the terms low and high‐risk Aerosol Generated Exposure (AGE), to ensure additional factors are taken into consideration when considering exposure to risk. These include length of procedural exposure to splatter, risk of exposure to naturally-generated aerosol (coughing, sneezing or breathing), and the potential to apply mitigation measures. These are different approaches and both have value and require professional judgement by clinicians on a case-by‐case basis, whilst accounting for the Covid‐19 risk of the operator and assistant.

Professor Nicola X West, Honorary Secretary, British Society of Periodontology and Implant Dentistry

Ian Mills, Dean, Faculty of General Dental Practice UK, and Trustee, College of General Dentistry

Sara J Hurley, Chief Dental Officer for England

BAPD composes rebuttal of CDO letter to government

The BAPD (British Association of Private Dentistry) has issued an open letter, primarily to the government, outlining a strong rebuttal of the letter sent by the CDO to parliament on 17th June. The letter reads as follows:

Dear Member of Parliament,

Re: OCDO Letter ‘Restarting dental services’

We feel that the recent letter you would have received from the OCDO (17th June 2020) requires urgent clarification with one that is less opaque, and endeavours to encompass the experience of the entire UK dental profession; perhaps highlighting some items not mentioned by the CDO but which have had a significant impact on patients and dentistry in the UK, and continue to affect the mental health of most dental professionals.

The British Association of Private Dentistry (BAPD) is an organisation established in April 2020, whose mandate is to support and represent all those operating in the private dental sector across the UK. We represent in excess of 10,000 members.

The BAPD tabled a Vote of No Confidence in the OCDO England on 15 May 2020; writing to the OCDO on 18 May 2020 with the results: an overwhelming vote from our membership in favour of no confidence. In reply, a brief rebuttal from Sara Hurley was published in the dental press on 20 May 2020 without the courtesy of a formal response, a “considered response” being promised “in due course”. To date, we continue to await that considered response despite sending a further open letter dated 20 May 2020, to rebut her initial comments and request transparency with regards to our previous unsuccessful attempts at OCDO liaison.

We are surprised by the content of this letter to all Members of Parliament (England), dated 17th June 2020, which takes a stance bearing scant resemblance to the reality experienced by patients and dental professionals during the COVID 19 Pandemic. Indeed, this letter appears to be little more than a ‘cut and paste’ of the letter to the profession received late in the evening of the 28th May 2020. Furthermore, we feel compelled to provide formal commentary on this letter; it would be remiss of us to continue to allow this misrepresentation of events that have fundamentally reduced the ability of the dental profession to safeguard the dental health of the general population of England.

We comment formally below:

QUOTE– ”On 25th March, in response to COVID-19, the CDO asked all dental practices in
England to close for face-to-face consultations and move to telephone triage for urgent dental
issues”.

COMMENT– The CDO stepped outside her remit in asking ‘all’ dental practices to close given
her authority is limited to practices with an NHS contract: whether this was knowingly or in
error remains open to clarification.

Local Area Teams apparently received formal notification from the OCDO in mid-February
2020 to prepare for centralised triage and face to face handling of dental emergencies.
Despite this, on the 25 March 2020, a whole month later, operational readiness was clearly
some distance away, with extremely limited access, regional inequalities and lack of
appropriate PPE, compounded with tardy, scant communications from the OCDO to dentists
which further reduced their abilities to provide timely care for their patients.

QUOTE– ”To meet the continuing need for urgent dental care, the dental profession stepped
forward in partnership with the NHS to deliver over five hundred urgent dental centres across
England, for face to face access to urgent dental treatment. This was an extraordinary feat.
Access to and support from these urgent dental care centres will remain available throughout
our next phase as we work with the profession to resume face to face care in all dental
practices”.

COMMENT– During the mishandled, poorly communicated and inexcusably slow rollout of
urgent dental centres, it was clear that many were initially unable to treat patients due to lack
of essential PPE and limitations in some skill sets to deal with more complex dental problems.
Throughout the staged rollout, inaccurate communications from the OCDO gave the
impression of a level of coverage and operational readiness at odds with the reality. This
factually incorrect stance was confirmed by members of the public, our members, in addition to
key workers within the UDC sites. A lack of ability to deal with all but the most basic dental
problems remains, and it is only with the reopening of practice-based dental services that
some of the more complex emergencies can now be addressed, albeit too late for many
patients. We refer you to the attached email ( Kelly Nizzer, Clinical Lead, London Region).

QUOTE– ”With this in mind I am writing to you to update on our progress with getting dental
services back up and running.On 28th May we confirmed the intent that from 8th June primary care dental services (general
dental practices and community dental services) may resume face-to-face care (both routine
and urgent) for appropriate patient groups. This announcement was preceded by the cascade
of a “prompt to prepare” guidance for all dental practices and followed by the publication of a
detailed standard operating procedure to support resumption of dental care in England”.

COMMENT– To clarify, the ‘cascade of a “prompt to prepare” guidance’ provided to dental
practices was a single letter, delivered approximately 8 hours prior to the actual call to resume
face-to-face dental provision. This letter was dated some nine days prior (19th May 2020) to its
eventual delivery on the 28th May 2020.

The second letter from Sara Hurley stating the intent for resumption of face-to-face care was
initially sent to Dentistry Magazine (an unofficial channel) and was actually released during the
morning of the 28 May 2020 as a minimally signposted link within an on-line article that was
“hidden within plain sight”. The formal letter to the profession was only released at 5pm that
day, giving a paltry 6 working days to recommission face-to-face dental care. The standard
operating procedure document was published on the 4th June, one working day before the
commissioning date, and the first release had non-functional hyperlinks to the essential linked
documents.

This catalogue of errors from the OCDO England, promulgates the almost universally held
perception amongst the profession that they have failed to provide timely, accurate and
detailed communication to dental professionals throughout this crisis. It is frankly unacceptable
and unforgivable that a caring patient-facing profession has been left hanging in the wind
when strong leadership would instinctively know that proper planning prevents poor
performance. This rings especially true for a department led by someone with a military
background. The consequent damage to patients oral health may never truly be known, but
can be laid squarely at the door of the OCDO.

QUOTE– ”Dental care will resume in a way that is safe and with flexibility for dental practices to
do what is best for their patients and their teams. This means there will be a gradual approach
to resumption of dental treatments based on clinical risk assessments, the availability of
personal protective equipment (PPE) and the ability to apply infection prevention control
measures”.

COMMENT- The lack of PPE continues to adversely affect the ability of dental practices to
reopen. In combination with the aforementioned incompetant communication was a wholly
mismanaged patient perception resulting from a lack of joined up and regular communication
to the profession, together with a culture of myth-weaving to spin a position of operational
readiness which was clearly pure fantasy.

The outcome has been a degree of panic, stress, and indeed, mental health issues within the
dental profession, the like of which has never been seen before. Most dental practices were
only made aware that they would be able to reopen via a singular report in the mainstream
media (specifically via a ‘ticker-tape’ message in the Daily Briefing on BBC1 on the 28th May).
Many dentists remained unaware of this until their patients began to contact them that
evening.

This has further skewed the public perception of the realities of patient-facing dental care at
the current time and has bolstered the fake news that dentists do not wish to see their
patients. Nothing could be further from the truth and we view this as a national scandal.
Furthermore, Public Health England then saw fit to make available stocks of PPE for sale to
dentists via dental suppliers – with strict instructions that these be made available for sale only
to NHS practices; an instruction that was only rescinded when private dentists voiced their
objection. Given that most practices that offer NHS dental services also provide treatment on a
private basis, and with no means to monitor whether this NHS-reserved PPE would be used
on patients treated privately in those practices, this was nothing short of discrimination against
dentists who only offer private dental services and patients who seek the same.

QUOTE- “We are still advising practices to minimise face-to-face care where possible and to
minimise the number of aerosol-generating procedures. Therefore, the range of dental
treatments that patients will be offered will be different to that which your constituents received
before 25th March. It is likely to be some months before general dental practitioners are able
to provide care in a way that your constituents will be used to and will depend in part on the
further easing of COVID-19 control measures”.

COMMENT– To continue the previous strategy of using the very weak evidence base to
conflate the precautionary principle with a scientifically illiterate and illogical position, will force
the profession to continue to use aerosol-generating-procedures as a proxy measure for risk,
whereas the alternative concept of aerosol-generated-exposure can provide a better proxy
measurement within the weak and partial evidence-base. No current accurate reporting of the
deterioration of dental public health is currently available, but anecdotal evidence based
around UDCs and our members reports, suggest that the illogical attempts to eliminate risk,
rather than the judicious mitigation of risk, will further impede attempts to right the wrongs of
the previous shameful and inadequate dental response.

QUOTE– ”If you have any questions regarding the delivery of dental services within your
constituency, your first port of call should be to your local NHS England and NHS
Improvement Regional Director of Primary Care Commissioning and Public Health. You can
make contact with them through your regional NHS team, the contact details of which are your
personalised MP’s guide to the NHS”.

COMMENT– We would urge you to instigate steps for a full and timely public enquiry to
evaluate the almost entirely avoidable deterioration in dental public health during the
COVID-19 crisis and to call those responsible to account, ensuring a forensic analysis of both
the poor quality leadership of the dental profession in England, and the lessons that must be
urgently learned to prevent a repeat of this catastrophe in the future.

QUOTE-”We continue to advise that shielded patients, those at the highest possible risk from
COVID- 19, should not currently attend dental settings unless absolutely necessary. If
face-to-face care is required, dental teams have been asked to align dental care provision with
the local arrangements for shielded patients or patients at increased risk. Often, that means
dental teams will consult the patient’s GP and/or other dedicated health and social care
professionals as necessary to arrange face-to-face care in a way that the patient needs.
In some cases, urgent dental care may be provided at home by a dedicated dental team. If
that is not possible or is clinically inappropriate, the provider must have appropriate measures
in place to separate shielded patients from possible COVID-19 cases.”

QUOTE– “Initially NHS England will maintain the current temporary contract arrangements to
make monthly payments in 2020-21 to all practices that are equal to 1/12th of their current
annual contract value, subject to abatement for lower variable costs. Work will continue with
the BDA on the mechanisms for the full 2020-21 contract year with the intention of
reintroducing a link to delivery of activity and outcomes.
As a dentist of over 30 years committed public service, my priority is to best serve the patient
by ensuring access to appropriate and timely dental care. However, given the precautions
necessary to minimise the COVID infection risk, I am sure you too recognise that dental
practice has to adapt the way that they offer and deliver care with changes in pace, proximity
and protection required for public and patient safety.”

COMMENT– The thinly disguised advancement of the plan to centralise and reduce the scope
of NHS primary care, has further disenfranchised the profession: this is frankly unforgivable. It
is clear that there is an agenda to change the provision of Dental Care within England without
consulting the profession; however to do it in such a sinister and underhand manner has not
gone unnoticed by the profession.

It is apparent that even the most basic working knowledge of general dental practice has not
been gained by the CDO, despite extolling her many years of public service.

QUOTE– ”I hope this update gives you the assurance of the ongoing commitment to the
nation’s oral health and that dental care continues to be a vital component of the NHS offer to
all patients”.

COMMENT- It is absolutely clear that dentistry was both forgotten by the government during
the initial lockdown, and mismanaged to a breathtaking degree by those leaders given the task
of steering the dental profession during these unique and challenging times.

This quoted letter is a gross manipulation of the truth, which should lead to the immediate
resignation or indeed dismissal of the Chief Dental Officer, Sara Hurley.

Yours sincerely,
The BAPD

Petition: Rates relief exclusion must end

With practices struggling to keep afloat the British Dental Association (BDA) has launched a petition calling on Government to extend the Covid-19 business rates relief to healthcare providers in England. 

To ease the financial burden on businesses forced to close temporarily as a result of the Coronavirus pandemic Chancellor Rishi Sunak offered business rates relief to businesses operating in the retail, hospitality, childcare, and leisure sectors. Healthcare providers remain excluded, and the BDA is working with professional bodies representing diverse groups from vets to therapists to address this gap. 

While dentists have resumed face to face care in England, most practices are now operating at a fraction of their pre-pandemic capacity. BDA Chair Mick Armstrong told the Commons Health and Social Care Committee that the combination of higher costs and lower patient numbers presented an ‘existential’ threat to the service. 

Only 8% of practices report they are confident in maintaining their financial sustainability under these conditions. The petition is available to sign here: https://petition.parliament.uk/petitions/318568

 
Armstrong said: “Dentists have returned to work in England, but the sky-high costs and low patient numbers leave the future of the service in doubt. Support that’s been missing during lockdown is needed now more than ever. With so many practitioners fearing for their futures, healthcare cannot remain excluded from rates relief.

“Rishi Sunak said he’d do ‘whatever it takes’ to protect the economy. Well, that has to include dentistry. We are not looking for special treatment. We just need the same support that’s been given to our neighbours on the high street. The government expanded relief to include betting shops. It’s ludicrous that dedicated health professionals are still not getting the help they need.”

Meanwhile Daniella Dos Santos, British Veterinary Association President, said: “Veterinary practices have remained open throughout this challenging period to provide 24/7 essential care and fulfil their duty to maintain animal health and welfare, and public health. However, many have been hit by dramatic reductions in turnover as they scale back their schedules and staffing rotas in order to prioritise the safety of colleagues and clients. It’s a huge concern that vets are still being overlooked when many other high street businesses have been offered an economic lifeline. 

“Restrictions may now be easing, but business is by no means back to normal as practices adjust to new and unpredictable realities. The sad fact is that some of the practices that have been hit hardest financially may not survive, and that could mean gaps in the provision of veterinary care for pet owners and the farming industry.”