March 23rd COVID-19 Update (CDO and Local Updates; Increased restrictions ; Furloughing staff)

23 March 2020

Please find attached the most recent official covid-19 guidance relevant to GDPs in GG&C . Much of the information is not new however there are further changes to the advice on what treatment can and cannot be provided in general practice. There is also a table for practices to complete which asks for the details of staff that would be available for redeployment and also for PPE/Materials that could be redeployed to the PDS when practices inevitably close.

  1. The March 23rd CDO letter (link below) has now advised we cease all ROUTINE care in effect from start of play tomorrow (March 24th). NO exams, NO hand scales, NO denture stages, NO crown fits etc.
    • We are still expected to open practices for at least a few hours a day to answer phones and treat what emergencies we still can.
    • The expectation is that most patients should be given telephone advice in line with guidance in SDCEP ‘Managing Acute Dental Problems’ wherever possible. It would be prudent for receptionists to divert calls specifically requesting urgent care to the dentist (or arrange call-backs). The dentist would be best placed to triage, give advice and make a clinical record of the advice that was given. This will also free up receptionists to manage cancellations.
    • We are no longer to drain/extirpate teeth (a previous exception to the  ‘NO Aerosol Generating Procedures’ advice). If the urgent problem cannot be solved with a SIMPLE extraction, or the patient refuses extraction, then prescribe and refer in to the PDS Urgent Care Pathway where dentists with appropriate PPE can undertake drainage/extirpation. The patient should not expect to be seen quickly as this service is likely to be quickly overloaded.
    • Although not explicitly mentioned in the advice, we understand that patch-filling broken teeth should only be undertaken if you can do it without an aerosol (excavating>>cotton wool swab>>GI patch) and only if the tooth is causing urgent and acute symptoms (e.g. sharp edge traumatising soft tissue to the point where eating/swallowing affected).
    • COVID19 patients should be triaged, given advice and if appropriate, referred into the PDS Urgent Care Pathway.
    • In GG&C the PDS Special Care Hub phone number is 0141 314 6669
  2. The March 23rd EVENING letter from the GG&C Chief of Dentistry mirrors much of what the CDO letter states in terms of further restrictions in what treatment to undertake. It also asks:
    • GDPs liaise more closely with buddy practices and consider contacting other local practices to make a local network (no doubt with the expectation that some practices may inevitably have to close completely)
    • Where patients are to be seen in general practice, the letter describes the measures that should be taken to maintain the principle of ‘social distancing’ (telephone triage, limit patients in waiting room etc)
  3. GG&C have also sent out the attached weekly activity sheet, which has been modified to capture information about general dental practice staff who might be available to be redeployed. It also asks what PPE and material stock practices have that could be redeployed into the urgent care hubs (for when the service inevitably condenses following practice closures).
  4. We would encourage Practice Owners to take a breath before making significant decisions about laying off or furloughing employees, or making significant cuts to associates. The fine detail of how the government furlough scheme might apply to NHS dentistry is far from clear, especially if the NHS are providing us with bespoke funding packages that may be contingent on having an availability of staff to be redeployed. The CDO has indicated in his letter that further financial support may yet be forthcoming for GDPs and the government are expected to announce a support package for the self-employed in the coming days. Remember…  we are all in this together, we will get through it together and your LDC is trying extremely hard to help!

 

CDO Letter – Cessation of Routine Dental Care – Further Advice – 23 March 2020

Chief of Dentistry Update 23-3-2020 at 4.30pm

Weekly activity sheet and declaration of availabe staff, PPE and Materials