13th July GG&C LDC Update

13 July 2020

Phase 3 Implementation; Routine Care; Glasgow Fair Monday

    • On 9th July the CDO confirmed that from Monday 13th July  Phase 3 of the re-mobilisation plan will begin. On the same day we received an update from the GG&C Chief of Dentistry  hinting at some of the preparations GG&C were making in anticipation of this.
    • On 10th July a PCA from Scottish Government detailed how Phase 3 is expected to be implemented. This was released alongside a new phase 3 interim SDR detailing the NHS treatments that can be carried out.
    • Phase 3 permits dental practices to begin seeing patients for nonAGP ‘routine’ dental care when they are able to do so.
    • Practices will be also able to open more surgeries to see more patients if the board are satisfied that appropriate social distancing measures are in place.
    • AGPs must still be carried out at UDCCs for NHS treatment.
    • The SDR remains zero fee to the patient.
    • The CDO made two important points in his letter:
      • ‘The message I wish to convey is that I am enabling the framework for phase 3 to happen from 13 July. There is no expectation that all practices should be seeing routine patients from this date, but some will want to start as soon as possible.’
      • ‘This is not business as usual, rather this is about providing reassurance for patients that are not in need of urgent dental care, we are not expecting a substantial increase in activity.’
    • Much like the conflation of the term ‘Urgent’ in various dental contexts, the use of the term ‘Routine’ has become a point of confusion for dentists and patients alike
    • In Phase 2, ‘Routine’ was used to describe SDCEP ‘green’ level emergency dental care (to be managed with self-care or appointed for nonAGP recements, dressings etc within 7 days)
    • In Phase 3, ‘Routine’ appears to mean everything you would normally do in NHS practice that doesn’t involve an AGP.
    • The Phase 3 interim SDR details in sections I to XI the nonAGP routine care that can be provided for NHS patients in practice, which include (in addition to the urgent care treatments in the Phase 2 interim SDR):
      • Examinations
      • Hand Scalings
      • Dentures
      • Stabilisation fillings (nonAGP)
      • Other less common nonAGP treatments
    • The CDO has made it very clear that there is no expectation that practices should be rushing to fill their diaries with examinations and denture stages at this time.
    • The only ‘deadline’ that is very clear that is that all practices should be open and delivering at least the Phase 2 Urgent Care model by no later than 31st July.
    • The LDC are seeking clarification as to the base expectations of GDPs in phase 3 given that:
      • It is clear that there is limited benefit to the majority of patients in performing examinations where treatment is not yet possible.
      • It is questionable how effective any examination would be without use of a 3in1.
      • Lab fees will still inversely affect practitioners’ income as the revised funding package is designed to benefit the practice and not the claiming dentist.
      • There is an increasing disparity in what dentists can offer patients who can afford private treatment and patients who cannot.
    • The Covid Financial Support Measure payments remain in place during phase 3 (Cons/Caps/Allowances + 80% Items of Service inclusive of patient contribution).
    • A 30% increase in General Dental Practice Allowance payments was announced in the CDO letter last week. The GDPA Cap will also be increased and the payments will now be paid quarterly.
    • The CDO states in the PCA that  ‘The intention here is to help NHS dental practices with fixed costs and other charges including additional laboratory fees.
      • The LDC recognise that this statement by the CDO demonstrates a fundamental lack of understanding as to how lab expenses are split between practice and practitioner in the majority of cases. We will once again be asking our national representatives to address this with the CDO.
    • Commitment payments will continue to be paid at the pre-covid levels.
    • SDR amendment 145 is now available detailing the Phase 3 range of NHS treatment items
    • Sections I to XI detail the Items of Service that are available to dentists in general practice when treating registered patients
      • There is now a ‘nonAGP stabilisation restoration’ code to be used when placing a temporary/dress filling
    • Section XIIa details nonAGP occasional treatment codes for patients who are not registered (practice and UDCC).
    • Section XIIb details the AGP codes for UDCCs to use.
    • Section XV details the triage codes (still to be recorded during phase 3 to monitor activity). There have been some additions to the list:
      • Use of an interpreter
      • ‘Other types of referral’
      • Multiple UDCC visits
      • Visor Disposal
  5. PHASE 3 PPE
    • The CDO has indicated that NSS are preparing to increase the amount of PPE made available to practices for nonAGP treatment during phase 3
    • This will continue to be at no charge to the practice during phase 3
    • GG&C will be sending out a new webropol survey asking about PPE requirements so that they can plan collections/deliveries.
    • The PCA details the procedures for handling open courses of treatment (the detail needs to be read before attempting to manage these). Below is a brief summary:
      • Courses started pre-lockdown that can be completed without AGPs should be continued to completion where possible and submitted in the usual way. The patient fees will remain.
      • Courses started pre-lockdown that require AGPs to complete the plan should be PFTR’d dated as their last attendance, noting the amount the patient has already paid in the observations.
      • No specific direction is given for cases that were Prior Approval. Further clarification has been requested from PSD.
    • Practice Management Software suppliers have been given all the necessary information to update systems with the new SDR Codes.
    • Information on the progress in updating these can be found at the NSS update page on their website.
  8. UDCCs in Phase 3
    • Most practices in GG&C are now open to see all of their own nonAGP urgent care patients.
    • The CoD was clear in his 9th July letter that currently openpractices should be seeing all of their own red, amber and green urgent care patients and only referring those patients who need AGPs after triage and assessment at the practice.
    • Where extractions may become surgical, it is expected that an attempt to remove the tooth should be made before referral to the UDCC for an AGP surgical.
    • The UDCCs are working on the assumption that nonAGP referrals will cease by 31st July, with their focus shifting to the sole provision of AGPs administered by the nominated GDPs at the sites.
    • The few practices who are not open can still refer their nonAGP urgent care patients into the UDCCs until this date. However, all practices should be working towards opening ASAP and the DPAs are available to provide support and guidance.
    • NHS 24 will be covering dental practices for patient telephone triage on Monday 20th July and the board have ensured appropriate cover is in place for emergency dental care.
    • Practices who have chosen to take this as a holiday can advise patients to contact 111 for urgent care on this day.
    • There is a regulatory requirement for all dentists and dental care professionals to behave professionally (GDC Standard 9.1)
    • We understand that this is an extremely frustrating and stressful time but that is not an excuse for aggressive or abusive language and behaviour.
    • Please help us ensure Greater Glasgow and Clyde GDPs are represented well in the community by:
      • Interacting with other healthcare professionals and organisations with the same courtesy and respect you would expect yourself.
      • Being mindful of the language you use (whether it be in person, by phone, in writing or on social media).
      • Raising concerns through appropriate channels.
    • The LDC are here to support you and are happy to take up any concerns you might have with the relevant parties on your behalf.