Since the UK-wide suspension of all routine dental care (and most urgent dental care) in March 2020, many dentists and dental care professionals in England have called for greater guidance from their Chief Dental Officer. Today, the Chief Dental Officer for England ("CDO") has published A Prompt To Prepare, which is described as a “handrail designed by dental practitioners for use in primary care settings” to prepare for the resumption of routine dental care.
COVID-19 presents a particular risk of transmission to dental staff and patients in light of both the clinical proximity of dentists and DCPs to their patients and the aerosol generating procedures involved in dentistry. However, with reports of "DIY Dentistry" escalating, the CDO has noted that dental care cannot be postponed indefinitely. All general dental practitioners are therefore advised to implement the guidance set out within A Prompt To Prepare without delay. Many will nevertheless be disappointed that the CDO's guidance does not include any hint of a timetable for routine dental care to resume (and indeed that, although the document is dated 19 May, it was only circulated today, 28 May).
The suggested pathway set out within A Prompt To Prepare comprises eleven steps, which can be briefly summarised as:
1. Patient flow/practice layout
Patient flow and practice layout should be considered in order to comply with social distancing measures e.g. limited number of patients in the practice at any time, single entry and exit points.
2. Communal areas
Consider fitting physical barriers, ensure availability of products for cleaning and disinfection, display handwashing signs and remove all unnecessary items from waiting areas.
Check stock inventory and order advance supplies of equipment such as PPE.
Review and adhere to manufacturers' guidance, CQC guidance and the Faculty of General Dental Practice (UK) guidance on closing and re-opening dental practices.
Consider additional training for staff on topics including donning and doffing of PPE, infection prevention and control and rubber dam replacement.
6. Staff screening
Screen all staff, both on their return to work and on a daily basis thereafter, conduct risk assessments and maintain ongoing screening records.
7. Health and wellbeing
Review Public Health England and Health & Safety Executive guidance on planning for a return to the workplace, signpost staff to health and wellbeing resources and provide staff with adequate information regarding the measures being taken to reduce risk of transmission.
8. Work scheduling
Assess staff availability, which may be impacted by other issues such as childcare, living with vulnerable adults or redeployment into urgent dental care.
9. Patient communications
Consider how the changed ways of working will be communicated to patients, for example by issuing a welcome back bulletin.
10. Patient and care plan identification and prioritisation
It is anticipated that there will be a need to prioritise patients and practices are advised to allocate patients and care plans into priority groups ranging from shielded patients through to patients with routine dental care needs.
11. Patient journey
Review options for appointment scheduling (e.g. allowing sufficient time between appointments to allow for decontamination), review options for teledentistry and configure Reception so as to minimise interactions.
The full guidance can be accessed here. Please don't hesitate to contact Andrea James or Nicola Lomas of Brabners' Healthcare Team should you need assistance in relation to any COVID-19 or return to work issues in dentistry.
A sustained reduction in COVID-19 transmission risk will provide an opportunity to safely resume some elements of dental care. However, safety standards, personal protective equipment (PPE) and infection prevention and control (IPC) will affect the tempo of transition as well as capacity and prioritisation for dental care.