Sara Hurley confirms NHS dental services will continue during new lockdown

Sara Hurley, Chief Dental Officer for England, has issued her latest NHS dentistry and oral health update, covering recent announcements and links to current guidance and relevant publications. 

The update has been sent out “in light of the Prime Minister’s announcement that from Thursday [5th November] England will enter a period of further national restrictions until 2 December.”

The bulletin includes confirmation from Chief Dental Officer for England that during the period of tighter restrictions dental services will remain open for face-to-face care. This includes delivery of both aerosol generating procedures (AGPs) and non-aerosol generating procedures. Dental care is to be delivered in line with the principles set out Transition to Recovery SOP published 27 Oct 2020 and with regard to the recently updated national infection prevention control and the accompanying dental appendix. Priority remains focussed on patients who require access to urgent care, patients at higher risk of oral disease, and patients with outstanding treatment needs that cannot be delayed. All dental practices should continue to provide remote consultations with triage and advice as necessary options. Dental practices will be asked to maintain their support to their local UDC system (face to face as well as remote).  Co-ordination of the local UDC system lies with the NHS Local Area Team and all practices are encouraged to remain in close contact with their area teams.  The principles for UDC systems and provision of urgent dental care are set out in the revised UDC SOP published 27 Oct 2020

The CDO explains: “The government’s guidance states that “a number of public services will also stay open and you will be able to leave home to visit them. These include […] the NHS and medical services like GPs

“I can confirm that this includes NHS dental services. Therefore, during the period of tighter restrictions practices should remain open to treat patients in line with the standard operating procedure and with regard to the recently updated national infection prevention control dental appendix. Detail on both of these were shared in last week’s update and are repeated below.”

Read more here.

NHS England: Contract uplifts confirmed

Following consultation with the BDA, the Department of Health and Social Care has confirmed that contracts will be uplifted by 2.5% in England. The uplift will be paid in November and backdated to 1 April.

The BDA stressed, when the Chancellor announced his deal back in July, that an above inflation award represents a bare minimum any government can offer NHS workers’, adding that the ‘uplift does not begin to cover the huge increases in expenses practices have faced with PPE and meeting new cross-infection guidelines’.

Foundation Dentist salaries will be updated by 2.8%, as will Educational Supervisors’ grants. FD service costs have been frozen, which the BDA has strongly objected to.

This is the second consecutive year of above-inflation pay awards for dentists. The BDA remains clear that this must now be built on, as part of wider plans to maintain the long-term integrity of the service.

The BDA continues to campaign on behalf of NHS dentists.

NHS England updates Urgent Dental Care Guidance and Standard Operating Procedure

NHS England and NHS Improvement have issued updates to the Urgent dental care guidance and standard operating procedure and Dental standard operating procedure: Transition to recovery documents, along with a letter from Chief Dental Officer Sara Hurley.

“It is 12 weeks since dental practices in England were able to resume face to face dental care,” Sara Hurley begins in her latest communication. “Thank you for all your efforts in broadening access to dental care and supporting the collective NHS focus on a return to full operating capability across the whole of healthcare.”

To support practices as they continue to expand the range of treatments offered, the latest Covid-19 dental guidance update incorporates validated evidence and expert consensus. These publications serve as a framework for identifying and mitigating the risks to dental staff and patients.

“Updates include: Covid-19 screening questions to be asked in line with the case definition for possible Covid-19 and isolation requirements including quarantine advice for those entering or returning to the UK,” says Hurley.

To read Sara Hurley’s letter in full, click here.

The Urgent dental care guidance and standard operating procedure can be accessed here.

The Dental standard operating procedure: Transition to recovery document can be found here.

NHS England releases GP Patient Survey Dental Statistics – January to March 2020

Between January and March 2020, 2.3 million adults were asked for their views on NHS dentistry as part of the GP Patient Survey. Participants were asked if they had tried to obtain an appointment with an NHS dentist and, if so, whether it was with a practice they had been to before and if they had been successful. They were also asked what their overall experience was of NHS dentistry.  Patients who hadn’t tried to obtain an NHS dentist in the previous two years were asked to select the main reason for not trying.

The GP Patient Survey (GPPS) was significantly re-developed in 2018 in order to keep pace with changes in frontline general practice. This included updating the terminology on some of the existing questions, including additional questions and removing questions deemed to be of limited use. The format and layout of the questionnaire was also re-designed in places and, for the first time, 16- and 17-year olds have been included in the survey. There have not been changes for 2020 meaning comparisons can be made between the most recent three publications, but not completely with years prior to this.

There have also been changes with regards to geographies. A number of CCGs were merged, and boundaries were changed so that the number of CCGs was reduced from 195 in previous years to 135 this year.

The results from the survey responses are presented here at national (England), regional and Clinical Commissioning Group (CCG) level.

Main results

  • 3 million GP Patients age 16 and over were contacted, 740,000 replies were received, with a response rate of 32%.
  • Of all respondents asked, just under three fifths (57.9%) tried to get an NHS dental appointment in the last two years.
  • Of the group of respondents who had tried to get an appointment in the last two years;
  • 84.3% rated their NHS dental experience as positive (50.8% very good and 33.4% fairly good);
  • 91.6% were successful in getting an appointment, a success rate of 93.8% when excluding the ‘can’t remember’ category.
  • Respondents who had not been to the practice before were less successful in getting an NHS dental appointment. Younger adults and ethnic minorities also reported a lower success rate. A lower proportion of younger adults and respondents from ethnic minorities had been to the practice before, compared to other respondents.
  • The remaining two fifths (42.1%) did not try to get an appointment with an NHS dentist in the last two years, 26.0% had never tried to get an NHS appointment and 16.1% had tried but over two years ago.
  • Of those who had not tried to get an appointment:
  • 37.4% mentioned private dentistry as the reason for not trying to get an NHS appointment; 25.9% prefer private dentistry and 11.5% stayed when their dentist moved from NHS to private.
  • A fifth (20.5%) of those patients who did not try stated they had “not needed to visit the dentist” as the reason for not attending.
  • 13.4% of the respondents who didn’t try to get an NHS dental appointment gave their reason as “I didn’t think I could get an NHS dental appointment”.

The full summary of the Dental Results from the GP Patient Survey can be found here.

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.

Appointment of Deputy Chief Dental Officer

NHS England and NHS Improvement and the Chief Dental Officer for England are pleased to announce the appointment of Jason Wong MBE as Deputy Chief Dental Officer for England. Jason will work alongside Sara Hurley and Eric Rooney (Deputy CDO) in collaboration with local and regional teams to deliver improved outcomes for patients, and champion the role of dentists and dentistry within the health system.

Jason is a general dental practitioner who qualified from the University of Birmingham in 1995 and also holds a Diploma in Postgraduate Dental Studies from the University of Bristol. He is a partner at the Maltings Dental practice in Grantham. He was awarded an MBE for services to Dentistry and Oral Health in 2020.

Chief Dental Officer, Sara Hurley said ”Jason has a track record for outstanding delivery as a Local Dental Network Chair. He is a respected practitioner and trainer and a notable champion of children’s oral health. His experience and diverse portfolio will be invaluable as we navigate the ongoing challenges of COVID-19 and build on the integrated team approach alongside our colleagues in the wider health and social care sector.”

Wong commented: “It is a privilege to be appointed as Deputy Chief Dental Officer for England. I am very much looking forward to joining the Office of the Chief Dental Officer and working with the entire dental family”

Jason will share the role with Deputy Chief Dental Officer Eric Rooney MBE.

Tooth decay in five-year-olds now increasing in some parts of England

Survey figures published by Public Health England (PHE) show the state of oral health of five-year-olds in the North West, Yorkshire and The Humber and the West Midlands has worsened since the last survey in 2014-2015, bucking a previous improving trend. Overall, in 2016-2017, 23.3 per cent of five-year-olds in England experienced tooth decay, improving from 24.7 per cent in 2014-2015.

More than a third (33.9 per cent) of five-year-olds in the North West have tooth decay, according to PHE’s data. The proportion of five-year-olds with tooth decay is also very high in Yorkshire and The Humber, where 30.4 per cent have rotting teeth. In the West Midlands more than a quarter (25.7 per cent) of five-year-olds are suffering decay.

The Faculty of Dental Surgery has said that although an overall drop in the percentage of 5-year-olds is welcome and reflects the work that has gone into educating families about oral health in recent years, including through NHS England’s new Starting Well programme, more needs to be done to stop deterioration in the worst affected areas of England.

Stephen Fayle, Board Member of the Faculty of Dental Surgery at The Royal College of Surgeons, said: “We are very disappointed the proportion of young children with tooth decay has increased in some areas of England, especially as this deterioration has occurred in parts of the country where decay levels are already high. This growing inequality is despite efforts to educate children, parents and carers. It is even more concerning when you consider that approximately ninety per cent of dental decay is preventable.

“More work must be done to understand why the message isn’t getting through in these areas, or if it is, why it isn’t leading to the decrease in tooth decay, seen in other parts of the country. With so many children still suffering from decay, we also need to make sure children can easily access NHS dental services, which are free for under-18s.

“We are pleased the overall number of five-year-olds in England with tooth decay continues to decrease. Many, including the Faculty of Dental Surgery, have worked hard in recent years to make people aware of the awful state of our children’s teeth.

“We can’t let children’s oral health fall off the Government’s agenda. We need to be constantly pushing for public health initiatives that remind families to brush teeth regularly with fluoride toothpaste, reduce sugar consumption and visit the dentist routinely.

“We would also like to see the promising ‘Starting Well’ initiative rolled out more widely across the country – for example, there are currently no programmes in the West Midlands even though this region has seen a rise in levels of tooth decay.”

The full results of the oral health survey of five-year-old children 2017 published by Public Health England are available here: www.gov.uk/government/statistics/oral-health-survey-of-5-year-old-children-2017

Financial solvency – tests fundamentally flawed

The Financial Capability & Capacity (FC&C) tests that are required when tendering or retendering for contracts with NHSE (NHS England) under the “Dynamic Purchasing System” are ‘fundamentally flawed’. That is according to NASDAL (The National Association of Specialist Dental Accountants and Lawyers) and Alan Suggett, specialist dental accountant and partner in UNW LLP.

“The solvency tests are flawed in their application to unincorporated businesses and most owner managed limited companies,” said Suggett. “NHSE don’t (want to?) understand this and their stance is that they are just standard accounting tests that are easily calculated so where is the problem? The problem is that from our initial testing, around 90 per cent of dental practices would fail the tests! As dental practices are regarded as one of the least risky sectors for business lending this is clearly ridiculous.

“The tests are appropriate for larger entities such as the larger corporate groups. However, it would be a cynic that might suggest this is by design rather than accident. As the tests are of a technical accounting nature, it seems that nobody involved (dentists and NHS employees including public sector accountants) understands the issues – they are only apparent to accountants who act for owner managed dental practices.”

Suggett continued: “NASDAL are working with the BDA to persuade NHSE that a cashflow forecast, supported if necessary by proof of deficit funding, is sufficient evidence of financial viability.”