2nd November GG&C LDC Update

02 November 2020

Phase 4; SDR 148; New National SOP

    • PCA was sent out on 26th October which sets out the arrangements for the advancement to Phase 4 of the CDO’s remobilisation plan. This is a lengthy document that covers a great many bases. It is recommended that GDPs read it in its entirety before reading the following summary.
    • Phase 4 commenced on 1st November 2020.
    • The PCA stresses that this is not a return to business as usual and indicates a ‘public facing exercise’ will be undertaken to support this message.
    • There will be a blanket uplift of the FSM Covid Top-up payment up to 85% (of average item of service calculation for 2019/20) until February 28th 2021
    • From March 1st 2021 we will have a tiered top-up arrangement
      • This will based on the average IOS activity for the whole practice from 2019/20 financial year (what constitutes activity is tbc) and a committed maintenance of NHS  registration numbers (excluding VDP list data).
      • The tiers that will apply to the practice as a whole are:
        • 85% FSM top-up if 20% activity and 95%+ patients still registered
        • 80% FSM top-up if 10-20% activity and 90% patients still registered
        • 40% FSM top-up if less than 10% activity orregistrations dip below 90%
  3. PHASE 4 SDR 148
    • Statement of Dental Remuneration 148 is now available and is in effect as of November 1st 2020.
    • Patient charges have been reintroduced.
    • Discretionary fees have been reintroduced.
    • There has been a 2.8% fee uplift applied.
      • A backdated payment will be made in the November [paid December] schedule.
    • The Prior Approval limit has been increased to £430.
    • The triage codes are still in the SDR and may count towards activity in the future (tbc).
      • You must submit these to ensure non-clinical activity is recorded with the hope that FSM top-ups can be correctly applied in the following year.
      • The updated PSD covid website includes a guide to SDR 148which explains that triage codes should be included on the main claim’s submission.
    • Reduced caps/cons payment cut-offs have been extended from 3 years to 4 years.
    • The 3 month claims submission rule has been reinstated.
    • A National SOP based on the recommendations made in the SDCEP and NHSe Dental Annex was released on October 26th.
    • This can be adapted for your own general dental practice
    • It suggests Dental Triage and appointment planning should now include the following risk assessments (more detail follows):
      • Covid Service Level (see below)
      • Patient Covid Risk pathway (see below)
      • AGP Categorisation (see below)
      • Prioritisation of treatments (see below)
    • The NHS National SOP describes service levels for dentistry
    • This system would allow a Local or National directive to move general dental practices back into more restricted protocols (similar to the earlier Phases in the ‘Remobilisation Plan’)
    • For general dental practice the expected service provision at the various levels would be:
      • URGENT SERVICE – GDPs provide remote triage and AAA. Treat urgent dental care patients at UDCCs (tbc locally).
      • PRIORITY SERVICE – GDPs provide urgent and high priority dental care in practice for nonCovid patients. Treat Covid +ve/risk patients at UDCCs (tbc locally).
      • ROUTINE SERVICE –   GDPs can provide all dental care but with prioritisation as detailed below. Treat Covid +ve/risk patients at UDCCs (tbc locally).
    • In Phase 3b we were providing something close to Priority Service with a move towards Routine Service in Phase 4. However, with lockdowns looming,  we may yet receive direction to revert.
    • Urgent Service would only resume should there be wholesale shortages of PPE, which we are advised is much less likely this time around.
    • The NHS National SOP recommends that a patient’s COVID RISK is triaged, using the standard questions in the SOP. Based on their answers, they can then be put on one of three pathways:
        • Covid +ve test result in last 10 days
        • Covid symptoms (awaiting test results)
        • +ve contact (awaiting test results)
        • Asymptomatic, untested, with potential for contacts (most patients)
        • Asymptomatic, tested, with potential contacts since test
        • Asymptomatic and -ve test within 72 hours and isolated since test;
        • Asymptomatic and test -ve regularly (eg care home workers);
        • Have recovered from Covid, Asymptomatic for 3 days and have a  subsequent  -ve test result.
    • High risk patients should be AAA’d in the first instance.  They should only be appointed (at designated UDCCs) if AAA fails to control the patient’s condition through their isolation period.
    • Medium risk patients (which will be almost all patients in GDS until rapid testing, vaccines etc are available) will require enhanced PPE and fallow time for AGP Group A dental treatment (see below).
    • Low risk patients do not necessitate enhanced PPE or fallow time for AGPs. However, the likelihood of patients meeting these criteria is very low at present given the logistical difficulties in acquiring  a  test result and the subsequent isolation of their household.
    • Dental Procedures should be categorised as follows (full descriptions are in the SOP):
      • GROUP A – AEROSOL GENERATING PROCEDURE (eg High Speed, Cavitron) Fallow time and Enhanced PPE for high/medium covid risk patients (not necessary for low covid risk patients)
      • GROUP B – AEROSOL UNLIKELY WITH MITIGATION (eg sparing use of single stream 3in1, slow speed with high volume aspiration) Standard infection control procedures with mitigation
      • GROUP C – DROPLETS – LOW RISK OF AEROSOL (e.g. simple extraction, soft tissue exam) Standard infection control procedures.
    • The NHS National SOP (based on the SDCEP and NHSe Dental Annex documents) advises that AGPs should only be carried out in rooms with ventilation.
    • Fallow Time calculation charts are included in the SOP and will be specific to each surgery based on air changes
    • Social Distancing, fallow time and environmental cleaning will severely limit the number of treatment appointments available.
    • In order to give dentists a structured approach to deciding which patients should be seen first, the National SOP has described the following prioritisation system:
    • PRIORITY 1 – Emergency Dental Care
      • P1a SDCEP RED  – Emergency Problem (1 Hour)
      • P1b SDCEP AMBER  – Urgent Problem (48 Hours)
      • P1c SDCEP GREEN – Routine Problem (7 Days)
    • PRIORITY 2 – Priority Dental Treatment
      • P2 Definitive treatment of stabilised dental problems (patients who were patched up during the months since restrictions began and need definitive rx)
    • PRIORITY 3 – Treatment of uncontrolled disease
      • P3 Treatment of active caries and perio (e.g. patients who had planned treatment for asymptomatic disease but were postponed due to covid)
    • PRIORITY 4 – Routine 
      • P4 No known dental problems, routine dental care
    • PPE will continue to be provided by NHS NSS
      • Please note: Large quantities will now be delivered by courier direct from the central supply (some will still be dropped off by GG&C local teams)
      • There is an expectation that all practices will be able to receive deliveries during their contracted opening hours
    • NHS PPE will be provided free of charge until at least the end of the financial year.
    • Details of the new face fit programme for the Alpha Solway masks  will be communicated to generic practice inboxes in the coming weeks.
    • Secondary Care Hospital Dental Services (HDS) have issued interim guidance and revised criteria for referring in to GDH specialist departments.
    • The Public Dental Services (PDS) have also issued interim guidance and revised criteria for Paediatric (inc GA) and Special Care.
    • These can be accessed on our website here.
    • The need for volunteers remains low in most HSCPs.
    • A payment form is now available for those who have taken part so far, this is available from your LDC rep or Flu Vaccine Coordinator.
    • We are pushing the OHD for a solution to the barriers that seem to be preventing dental teams accessing flu vaccination. It is our understanding that we should have full access to occupational health services however many teams are meeting with resistance.