Professional Topic: NHS Organisations

COVID-19 infection prevention and control – Dental Appendix

This guidance is issued jointly by the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS), Public Health Scotland, Public Health England and NHS England as official guidance.

This Guidance was first published on the 20th October 2020 and updated on 21st January 2021 .

The guidance:

  • seeks to ensure a consistent and resilient UK wide approach, though some differences in operational details and organisational responsibilities may apply in Northern Ireland, England, Wales and Scotland
  • applies to all clinical dental services in all settings, including those provided on a private or independent basis Academic evidence has been considered in the development of this guidance, and in particular, relevant sections of published reports from 2 UK dental expert working groups, which include:

SDR Amendment 144

Amendment 144 of the Statement for Dental Remuneration was published on 22nd June 2020.

 

Remobilisation of dental services

This is a series of letters from the Chief Dental Officer to all dental health professionals in Scotland.  The most recent letter is linked above. The correspondence outlines the first steps for the remobilisation of NHS dental services in Scotland.

8th June 2020

Preparations to step up to Phase 2

Cabinet Secretary for Health and Sport, Jeanne Freeman announced in Parliament on 2 June, as part of the Scottish Government preparations for the remobilisation of NHS services, that we are intending to reintroduce dental services on a phased basis over the course of this month. This means dental practices will be able to see NHS patients for face-to-face consultation who are in need of urgent care, using non-aerosol generating procedures. The precise date will be confirmed following the next 3-weekly review of lockdown regulations on 18 June. I am aware that not all dental practices will be able to open at the same time as some practices may take longer to prepare. The start date is not to be considered a target – practices must be certain they can safely open before they do. I am also taking the opportunity to update the naming of the dental phases, as per my letter of 20 May, to align with wider route map framework. This will ensure clarity going forward and is attached in the annex to this letter.

Preparations and Next Steps

Dental practices should prepare a single surgery in anticipation of opening to patients. SDCEP has developed a ‘practice recovery toolkit’, available at the following link:
https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/
Practices are encouraged to work with their NHS Board and Dental Practice Adviser throughout the preparation process; practices will be required to certify to their NHS Board that they are fully compliant with current guidance during the COVID-19 pandemic. In some circumstances the NHS Board may wish to visit the practice before opening. NHS Services Scotland have ensured adequate stocks of appropriate PPE through a central distribution system of PPE that dental practices may access via their NHS Board. Practices should contact the NHS Boards to discuss the local arrangements for the supply of PPE. Directors of Dentistry in each NHS Board have been advised to ensure a person from the dental team is available to provide a contact point and on-going support to practices. In the meantime practices should continue to telephone triage patients according to the revised guidance included in my letter of 20 May. On opening, dental practices should refer all patients who require an urgent AGP to their local urgent dental care centre. The intention is to publish a revised Statement of Dental Remuneration (SDR) shortly. This will include the list of treatments that dental contractors providing NHS dental services can provide under Phase 2 of the remobilisation plan. The purpose of this interim SDR is to record activity against the appropriate items of treatment. The NHS financial support measures that were provided to NHS dental contractors and NHS committed practices, as described in Memorandum to NHS: PCA(D)(2020)7, will remain in place during Phase 2 and that these measures are not dependent on the date of opening. Finally, I need to impress on dentists and dental teams, not only the absolute necessity to ensure patient and staff safety as we move forward but also public health more generally. Transition to later recovery phases will be determined by taking a graduated risk-based approach to the type of care and treatment to be made available, the risk and level of transmission within the community as determined by the reproduction number “R” and other factors including the number of cases and wider control measures in place.

20th May 2020

There are two phases:

1) Increasing capacity of Urgent Dental Care Centres (UDCCs)

During phase 1 dental practices will remain closed to face-to-face patient consultation. Dental practices should now work with their NHS Boards to prepare for the practice receiving patients under phase 2(a) (for further details see below). Presently patients with an urgent dental care need can be seen at UDCCs in their NHS Board area. However there are an increasing number of patients with on-going dental health issues that need to be seen. We are now expanding capacity in these centres to increase the scope of treatments available to patients. UDCCs will move as soon as possible towards dealing with red, amber and green care set down in the SDCEP guidance on urgent dental care (see below) to provide an expanded list of treatment for acute and essential care.

Action for Dental Practices

  • Dentists should follow the SDCEP guidance when triaging patients to UDCCs, taking account of the COVID guidance on advice, analgesics and antimicrobials.
  • Where following triage there is a requirement for a patient to have a face to face appointment at a UDCC the referral by the dentist should be accompanied by a differential or definitive diagnosis. This will allow the UDCC to determine and prepare for the appropriate treatment. The guiding principle for this is that UDCCs will provide a single episode of care, avoiding AGPs where possible.

Information to Patients

Dental practices may wish to disseminate these links (with covering text message in italics) to their patients so they are aware of these changes:
Dear Patient, It was initially necessary to restrict the range of treatments available in urgent dental care centres and we are now able to expand the scope of this service to deal with a wider range of acute and urgent dental problems. Further information may be found at: https://www.scottishdental.nhs.scot/public/dental-services-during-the-covid-19-pandemic-informationfor-patients-in-scotland/ or, https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid19/healthy-living/coronavirus-covid-19-accessing-dental-services You should continue to contact your dental practice in the first instance to discuss your treatment need.

2) Restarting dental practices

During phase 2 we envisage restarting NHS dental services in practice. There are two identifiable steps within this phase:
  • Phase 2(a): All dental practices to open for face-to-face consultation for patients in need of urgent care that can be provided using non-aerosol generating procedures;
  • Phase 2(b): Face-to-face consultation to be expanded for patients that can be seen for routine care, including examination,and treatment that can also be provided using nonaerosol generating procedures.
UDCCs will continue to see patients on referral for treatments involving aerosol generating procedures. We are developing a ‘practice recovery toolkit’ that will provide further guidance to dental practices on how to prepare for providing care in anticipation of phase 2.

Action for Dental Practices

In anticipation of the start of phase 2, dental practices should prepare a single surgery to provide urgent care on their premises with appropriate social distancing measures for waiting patients (with your Board’s agreement there may be an opportunity to have more than one surgery for seeing patients). We do not have a precise timeline for phase 2, however we anticipate having made some progress by 31 July 2020, with a minimum 2(a) in place in every practice. Phase 2(b) is dependent on the availability and supply of appropriate PPE (see below), and the wider picture around the relaxation of lockdown across Scotland.

3) Introducing AGPs to Dental Practices

Phase 3 envisages a limited introduction of AGPs to dental practices, this will be dependent on evidence of risk and possible mitigation. The main focus at present is on a staged recovery and phases 2(a) and 2(b).

Other Issues

Supply of PPE to support the Remobilisation of NHS Dental Services

We are very much aware that the supply of appropriate PPE is an essential pre-requisite to support the phased remobilisation of NHS dental services. Which is why we are working very closely with National Services Scotland to ensure that dental teams have an adequate supply of appropriate PPE during each phase of the remobilisation plan. We will keep dental practices briefed on the supply of PPE. The intention is to match any phased remobilisation to the levels of PPE at the time.

Testing for COVID-19

As you will be aware the Scottish Government is currently looking at how we develop an effective community testing programme as we emerge from lockdown. This is a key element in the strategy for controlling COVID-19. We are liaising with our colleagues leading on these programmes and it may be the case that as part of the phased remobilisation of NHS dental services, practices will be asked to support these programmes.

Financial Support and Statement of Dental Remuneration

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.

Pay and conditions of service

This circular sets out for 2019-20:

  1. increases to national salary scales and post-specific salaries
  2. uplifts to fees and allowances

affecting:

  • hospital medical and dental staff
  • doctors and dentists in public health medicine and the community health service
  • public dental service staff
  • dental training grades
  • associate advisors and assistant directors
  • directors of postgraduate general and dental practice education (CRUMP)
  • GP specialty registrars in general practice.

Statement of Dental Remuneration: Amendment No. 139

This letter advises NHS Boards and Practitioner Services of the publication of an amendment to the Statement of Dental Remuneration (SDR), Amendment No 139.
It also advises of the maximum patient charge for a single course of NHS dental treatment.

Pay and conditions of service: addendum

Re:

  • Hospital Medical and Dental staff
  • Doctors and Dentists in Public Health Medicine and the Community Health Service
  • Public Dental Service staff
  • Dental training grades
  • Associate Advisers / Assistant Directors
  • Directors of Postgraduate General and Dental Practice Education (CRUMP)
  • GP Specialty Registrars in General Practice

NHS Circular PCS(DD)2018/2 detailed the increases to national salary scales and uplifts to fees and allowances in 2018-19 for the above staff groups.

This Appendix to the circular stated that the following tables would be provided under separate cover. This addendum now provides these tables.

Table 1

Total Salaries for Full-time Training Posts from 1 April 2018, updating Appendix 1 to the terms and conditions of service for hospital medical and dental staff and doctors and dentists in public health medicine and the community health service (Scotland) (2007).

Table 2

Total Salaries for Flexible Trainees Working Less than 40 hours per
week (Pre-June 2005 pay arrangements) from 1 April 2018, updating Appendix 1 to the terms and conditions of service for hospital medical and dental staff and doctors and dentists in public health medicine and the community health service (Scotland) (2007).

Table 3
Doctors and Dentists in Training – Flexible Trainees: (Post June 2005 Pay Arrangements) from 1 April 2018, updating Appendix 1 to the terms and conditions of service for hospital medical and dental staff and doctors and dentists in public health medicine and the community health service (Scotland) (2007).

Table 4

Guidance relating to GP Specialty Registrars (GPStR) from April 2018, updating Banding Supplements from Section E of NHS Circular: PCS(GPR)2009/1.

Table 5

Payment to GP Specialty Registrars

Table 6
Locum Tenens Appointments – banding supplements, hourly and weekly rates.

Pay and conditions of service: remuneration of hospital dental staff, dentists in public health medicine and the community health service.

This circular authorises changes in the pay and national terms and conditions of service of all NHS employed staff detailed in the heading above.

The Scottish Government has agreed the following uplifts to basic pay for the above mentioned staff groups in order to balance
the Recommendations from the Doctors’ and Dentists’ Review Body (DDRB), Scottish Public Sector Pay Policy (SPSPP) and the recently  agreed Agenda for Change (AfC) pay deal for 2018-21. All pay points up to £80,000 FTE will increase by 3% and all pay points at or above £80,000 FTE will be increased by £1,600, or the pro-rata equivalent for part-time workers.

The value of distinction awards and discretionary points for consultants remain unchanged.

Results of practice premises revaluation exercise: 2018

This letter advises NHS Boards and Practitioner Services of the completion of the revaluation exercise of practice premises undertaken by the Valuation Office Agency (VOA) on behalf of the  Scottish Government.
It advises of dissemination arrangements, on the use of the information now available, the arrangements for valuations following the national exercise and arrangements for reviews of valuations.

Phasing down of dental amalgam and Amendment no. 138 to the SDR

This letter advises NHS Boards and Practitioner Services of the new arrangements relating to the phasing down of dental amalgam. This includes guidance regarding alternatives to dental amalgam, when they should be used and the exceptions to this.

This letter also advises of Amendment No. 138 to the Statement of Dental Remuneration (SDR), which takes effect from 1 July 2018.

Revised Scottish Dental Access Initiative

This letter advises NHS Boards of a further revision of the Scottish Dental Access Initiative (SDAI) capital scheme which will take effect from 1 December 2016.

From 1 December 2016 further revisions are being made to the SDAI capital scheme to reflect the continued improvements in access to general dental services (GDS) in most areas.

From 1 December 2016 offers of financial assistance, under the SDAI to establish new or expand or purchase existing NHS dental practices will be available only in the following designated areas where access to GDS availability is poor, i.e. in order to meet unmet patient demand:

  • Grantown, Invergordon, Nairn, and Wick within NHS Highland
  • NHS Shetland;
  • Isle of Lewis within NHS Western Isles.

Download the full text from the Download link above.

National Dental Inspection Programme (NDIP) Report 2016

The data shows that while oral health in P1 pupils is continuing to improve, the rate of improvement is slowing.   The proportion of P1 children with no obvious decay now stands at 69% overall, with the average number of decayed missing and filled teeth (dmft) now standing at 1.21.

Across Scotland, socio-economic inequalities in the oral health of P1 children remain, with percentages with no obvious decay experience ranging from 55% for children in the most deprived quintile, (SIMD 1) to 82% for those in least deprived quintile, (SIMD 5).

Further details are available in the summary  and full reports.

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