A Resumption of Dental Services?
In late March, dentistry was reorganised, along with other NHS primary care services, to minimise face-to-face care to contain the spread of COVID-19 during the peak of the pandemic. Dentists were asked to suspend all routine treatment and instead offer urgent advice and remotely prescribe antibiotics as required. Urgent treatment was made available through regional NHS urgent dental centres – around 550 were open in late May. Triaging patients into these centres through NHS 111 or through the patients’ own dentist became the default approach to delivering care, and indeed was the only route for patients to seek face-to-face treatment before the resumption of routine services began.
We wanted to establish how far that resumption had gone including whether our members and fellows are back to delivering the full range of dental provision, how many patients are they seeing, and whether they feel safe at work. Key recommendations and findings from the full report of our survey are listed below.
Key recommendations in brief
- Keep dental care services open throughout the remaining ‘stages’ of the COVID-19 pandemic, using PPE and IPC to mitigate risk and keep patients safe, to prevent an insurmountable backlog building up.
Assuming that outbreaks of COVID-19 and associated outbreak control (including lockdown) measures will continue to occur, dentistry should not be shut down again: it is an essential part of the health care system. Practices should remain open for the delivery of face to face care, whilst triaging patients remotely in advance, and using remote consultations where appropriate. Routine care along with urgent and emergency care is vital for oral health care including early detection of cancers.
- Ensure adequate PPE across regions and settings.
Dental surgeons across specialties remain reliant on PPE to be able to resume all types of care. General practice needs parity with NHS hospital practice in terms of PPE supply to ensure patients have access to safe treatment. Ensuring the dental service has adequate PPE is vital to delivering urgent and routine dental care in a COVID-secure way that will safely provide care for patients and support the long term survival of the service.
- Focus on barriers to resumption, specifically fallow time, by promoting and monitoring the use of ventilation systems to increase the ACH rates.
Tackling the barriers to resumption, including fallow times, will ensure a consistent throughput to work on the backlog of care. To achieve this, new guidance on fallow times should be more widely promoted, and the use of ventilation systems to achieve higher ACH rates should be monitored by NHS England. We acknowledge the guidance changed part way through our survey and we would welcome further research in this area.
Summary of findings
- Most members (93%) said that since resumption they had been seeing ten patients or fewer per session, and less than 1% are seeing more than 20 patients per session. In contrast, before the pandemic the nearly half (46%) of members were seeing more than 10 patients per session.
- A third (34%) of respondents did not know when they would fully resume services, with a further 36% saying they did not expect to resume full pre-pandemic services until 2021.
- Only 4% of respondents had not resumed any services since 8 June. Nearly two thirds (60%) had already begun routine procedures that involved AGPs. However, private practice respondents were considerably more likely to have provided routine AGP procedures with 83% having done so. In NHS hospital practice this fell to 62%, and to 40% in NHS general practice. NHS general practice respondents noted lower service range in all categories aside from emergency procedures (non-AGP).
- When asked about the principal barrier to resuming services, significant numbers of respondents proactively raised the issue of fallow time following AGPs. Social distancing was also cited as a barrier to patient throughout.
- While confidence in PPE supply was high,it was notable that those in NHS hospital practice felt much more secure compared to those in private practice or NHS general practice.