CDO announces ‘remobilisation’ of NHS dental services in Scotland
All practices could be open by 31 July, but only for for patients in need of urgent care
The first steps in the “remobilisation” of NHS dental services in Scotland have been announced by Tom Ferris, Scotland’s Chief Dental Officer.
In a letter to NHS dentists, the CDO said: “As you will be aware this is an extremely complex process. We need to be mindful of the oral health needs of patients balanced against the wider situation with COVID-19, and the essential requirement that we reduce the risk of community transmission and protect both patients and dental teams.
“We need to take into consideration the added risk of aerosol generating
procedures on COVID-19 transmission; the availability of appropriate PPE is also a major consideration in how we shape the recovery and remobilise NHS dental services.”
Ferris said that three key phases of remobilisation had been identified. Phase one involves increasing the capacity of Urgent Dental Care Centres (UDCCs), while dental practices remain closed for face-to-face-consultation but begin work with NHS Boards to prepare for receiving patients during phase two.
The UDCCs will move “as soon as possible” towards dealing with ‘red, amber and green’ care set out in the SDCEP guidance on urgent dental care to provide an expanded list of treatment for acute and essential care. Ferris said dentists should follow the SDCEP guidance when triaging patients to UDCCs, taking account of the COVID guidance on advice, analgesics and antimicrobials.
Phase two of the remobilisation would involve all dental practices opening by 31 July – initially only for face-to-face consultation with patients in need of urgent care that can be provided using non-aerosol generating procedures.
Depending on the availability of PPE and the status of lockdown generally in Scotland, practices would then open to patients who can be seen for routine care – including examination and treatment that can also be provided using non-aerosol generating procedures.
UDCCs would continue to see patients on referral for treatments involving aerosol generating procedures (AGPs).
The CDO said that a ‘practice recovery toolkit’, providing further guidance to dental practices, is being developed in anticipation of phase two. Ahead of the second phase, he said dental practices should prepare a single surgery to provide urgent care – with appropriate social distancing measures for waiting patients.
Phase three envisages a limited introduction of AGPs to dental practices, dependent on evidence of risk and possible mitigation. But the CDO said the focus now was on a “staged recovery” and the distinct elements of phase two.
Work is ongoing with National Services Scotland to ensure that dental teams have an adequate supply of appropriate PPE during each phase of the remobilisation plan, he said.
In a response to the CDO’s letter, Lee Savarrio, Chief of Dentistry at NHS Greater Glasgow and Clyde, commented: “The advice to practices holding a list number with NHS GG&C that have combined practice inspections carried out is to follow the Chief Dental Officer guidance and remain closed at this time other than for telephone triage. Wholly private practices should take advice from Health Improvement Scotland in consideration of moving towards phase two re-opening.”
On the issue of funding, the CDO said that “an item of service model is not the most appropriate vehicle of financial remuneration during this period of reduced activity.
“We are therefore looking at alternative models of funding that will provide a more sustainable income level during this unusual period.
“In the meantime we will look at appropriate NHS financial support measures for each phase of recovery. We will be advising dental practices about the precise financial arrangements.”
In his letter, the CDO added that dental practices may be asked to become involved in Scottish Government plans for a community-based COVID-19 testing programme “as we emerge from lockdown”.