By Alex O’Neill CODE’s Head of Compliance
We are currently living in both unprecedented and extremely fast-moving times. What began as a seemingly extremely clear instruction from all sides for the profession to cease all routine treatment, offer AAA only and refer to NHS UDCs where the three As had failed has evolved into a vote of no confidence against the Office of the Chief Dental Officer in England, legal challenges against the CQC, barristers being instructed and statements being published by different authorities, on almost a daily basis.
So where are we now?
In Scotland and England we seem to have reached a consensus that private practices are not governed by instruction from CDOs and our regulators have stated that at no point did they tell private dentists to stop operating.
So what does this mean?
It means that private practices could operate as emergency hubs and that regulators such as the CQC would check, amongst other things (more later), to see that they had created an SOP that complies with the NHS UDC guidance for their country.
But if CDO instructions don’t apply to me why can’t I open fully right now?
In short, because there is currently no authoritative guidance on how to perform routine dentistry on patients during this pandemic that you could demonstrate you are complying with. Currently the FGDP, BDA, BAPD and others are working on this guidance and we hope it will be published in the next 2 weeks (we have contacted them for comment and will update you when we have more information). You can operate the UDC model because essentially there is a piece of recognized guidance that a regulator can check you are complying with and it has been designed to minimize risk in the current pandemic climate.
If this is all the case then why are a number of my colleagues preparing to open on June 1st?
Some tabloid newspapers erroneously published that dental practices could reopen on the 1st of June. This is false, but it seems that some members of the profession have interpreted this as a green light to reopen.
Additionally, some larger corporates appear to have put significant resources behind aligning their operating procedures to published position papers/a growing evidence base and are taking a calculated risk to reopen, most likely with a lot of evidence they have collated to support their decisions. As there is currently no published authoritative guidance CODE cannot advocate that our members do the same, though it is an option.
The current situation is that NHS practices have instruction from the CDO to not offer any face to face appointments. Private practices could open, but the only guidance they can follow is the UDC guidance and therefore returning to private routine right now would risk the wrath of regulators.
Where can I read more about this?
Taylor Defence Services instructed a barrister to look into the legalities and possibilities on this topic and have published a letter which explains a lot of what I have outlined above, but in far greater detail. I would advise anyone thinking of reopening to read it thoroughly.
I want to open as a private emergency hub, what should I do?
I will cover the key points here, but please do not take this as a definitive guide and I’d encourage our members to call us for advice if they are seriously considering this option. It does seem likely that guidance will be published shortly to enable private dentistry to reopen fully in the not too distant future and therefore practices putting efforts into opening in this way now may be sacrificing their ability to reopen fully as quickly as they could due to what will almost certainly be differing requirements.
Your first step would be to download the UDC SOP, read it thoroughly and then adapt it to your circumstances. You will want to consider whether it is financially viable to operate such a hub as the reality of the situation is that you would most likely see very few patients.
You will need to make sure you have adequate stocks of the correct PPE (including FFP3 masks) and will need to be able to provide fit test certificates to the CQC if they investigate your case.
You will need to make sure you have updated your risk assessment to meet all relevant guidance (see section below), have implemented all necessary control measures, have trained your team on the risk assessment/control measures and SOP, including performing ‘dummy runs’ and have documented all training.
Will CODE be producing an SOP template and risk assessment for reopening as a private UDC in England?
At this stage it seems highly likely that we will have different guidance, SOPs and risk assessment requirements for private and NHS dental practices to reopen in England, with the NHS taking a staged approach, whilst continuing to fund contracts to some level, and guidance for private practices being aimed at full reopening as soon as is possible, potentially with evidence based PPE etc.
Currently we are focused on digesting the position papers that are influencing the conversation around the full reopening of private dental practices and drafting procedures and risk assessments ready for editing when this guidance, and any NHS guidance, is published. We believe that some of these documents are due in this next week and therefore due to this reason, plus the difficulty of sourcing UDC PPE right now, it would not be in the best interests of our members to reallocate resources to producing UDC documents at this point.
Will CODE be producing templates for NHS phased reopening and private practice reopening in England?
Absolutely, we are focused on this task right now, but cannot publish until there is official guidance
When do you think practices will be able to reopen in England?
As mentioned above I think that we’ll see a different approach and potentially date for services for private patients and NHS practices. If the FGDP guidance is published in the next couple of weeks then technically as soon as people can implement it they could start seeing private patients. If NHS England follows the other CDOs then we’re most likely looking at 1st July at the earliest for the first ‘phase’ of relaxations.
Realistically it seems 1st July might be the target date for both, but in the absence of guidance this is very difficult to comment on.
I’d like to get a head start on preparing to fully reopen, what should I read?
The British Association of Private Dentistry have published a position paper that appears to be influencing the conversation. The information within that paper is very similar to the paper published by Pandora dental. Consensus seems to be growing around what control measures we will need to fully reopen and I would suggest reading both of these papers and then potentially making some purchases, thinking about patient journey etc. However, you would need to bear in mind that the FGDP, BAPD, BDA etc. guidance that is coming may differ from this, but it doesn’t seem likely when we consider that the Portman Group have just published their new patient journey which seems to align very closely with these papers.
If I want to reopen as a UDC what additional guidance should I be adhering to?
Here is a non-exhaustive list:
- CQC – https://www.cqc.org.uk/guidance-providers/dentists/current-position-dental-care-services-regarding-covid-19-updates
- Public Health England – https://www.gov.uk/government/collections/wuhan-novel-coronavirus
- Government Guidance for Workplaces (including social distancing guidance)
- Health and Safely – Guidance from HSE (including how to undertake a risk assessment)
- Health Protection (Coronavirus) (Restrictions) (England) Regulations 2020