10th August GG&C LDC Update

10 August 2020

Fallow Time; SDR 147; PPE for AGPs; Contact Tracing

  1. PHASE 3b
    • A PCA Memorandum was sent out on Friday 7th August setting out how we will be able to deliver NHS AGPs (for those practices that are willing and able) during what is commonly being described as ‘Phase 3b’.
    • From 17th August 2020 NHS AGPs may be provided in practice for Urgent Dental Care.
    • Health Board notification/approval will be required before undertaking AGPs for NHS urgent care. As described in Friday’s Chief of Dentistry update, details of how to do this are being sent to GG&C practices’ generic mailbox. Please keep checking this regularly.
    • As described in the CDO letter of 30 July, dental practices can only provide AGPs in practice if they have surgical space with external ventilation.
    • If you wish to read the recent technical document on ventilation you can access it here. This is not guidance in itself, but will likely inform guidance in the future.
    • The PCA gives the following advice about fallow time:
      • ‘For a treatment room with more than 10 air changes per hour (ACH) and which can be evidenced to the NHS Board, a minimum of 20 minutes ‘fallow time’ (after which entrance to the room without PPE is allowed) before cleaning is recommended.’
      • For a treatment room with external ventilation (natural or mechanical) with less than 10 ACH or with no data on number of air changes per hour available, the fallow time would be 60 minutes.
      • For a treatment room with no external ventilation (natural or mechanical), the absence of air changes means that AGPs should not be undertaken.
    • Further guidance on ACH and mitigation is expected in the coming weeks.
    • The LDC advise caution in having ACH measured in the absence of the impending guidance. If it turns out your ACH is less than 10 on the day, you might inadvertently corner yourself into having to significantly increase your fallow time rather than reduce it.
    • The PCA describes an expectation that 1 surgery will be delivering 3 to 5 AGPs per day. More approved surgeries can be requested from the board.
  3. SDR 147
    • SDR 147 is now available on Scottish Dental.
    • The triage codes should still continue to be used.
    • The urgent care AGP treatment items (that were previously only available to the UDCCs) are now available to general practitioners in Section IX(b) on page 22, which include:
      • Difficult extractions (i.e. need to use a handpiece)
      • Extirpation and dress fillings
      • Splinting for trauma
      • Filling in a suitable material
    • Item 14(e)(2) – ‘filling in a suitable material’ lacks explanation as to what circumstances it should be used. However, this is all in the context of ‘urgent care’ so an example might be the treatment of reversible pulpitis in deep carious lesions.
    • These are all zero fees and no additional funding is being provided for opting in.
  4. PPE
    • Face Fit testing has begun for the 3mESPE1863 FFP3 masks in GG&C.
    • Details of how to arrange a test are being sent to practice generic inboxes.
    • NSS will be providing these free of charge (via GG&C PPE deliveries).
    • Dental practices will also receive adequate stocks of enhanced PPE  (gowns, additional disposable masks, etc) when supplies become available.
    • The Chief of Dentistry update highlights what would be considered a ‘contact’ with a covid-19 positive case requiring self-isolation, (referring to existing guidance):
      • Staff wearing appropriate PPE during exposure to COVID-19 cases, where there has been no breach in that PPE, should have no significant exposure risk so should not be classified as contacts.
      • Staff who have not been wearing appropriate PPE during exposures to COVID-19 case, who meet the contact definitions described above, should be excluded from work and self-isolate in line with advice for general members of the public.
      • Symptomatic staff must not report for duty, should self-isolate and arrange to be tested.
    • GG&C LDC are lucky to have several representatives on the Scottish Dental Practice Committee (SDPC), representing you at the national level.
    • The report from the 5th August meeting will give you an idea as to what is discussed and how the CDO responds to questions put to him.
    • This is one of the routes by which GG&C LDC (your local representatives) send your queries and concerns up the political chain.