A dentist is calling on dental teams to offer treatment at their own pace as practices across England start to open their doors for face-to-face care.
Dr Nishma Sharma, a practising dentist in Hertfordshire, is urging practices not to succumb to pressure to open for in-person appointments if they feel underprepared or lack the appropriate PPE.
Following advice from the CDO for England, Sara Hurley, practices have been able to resume both non-AGPs and AGPs from Monday 8 June.
But Dr Sharma, who works for the OCDO, is reminding teams that the inability to offer these treatments from this date will not lead to penalties – particularly as many are struggling to source the correct PPE.
‘The problem with the lack of PPE stems from high demand as we all try to access limited stocks,’ she said.
‘We are up against other healthcare providers and now the public. Face coverings are compulsory on public transport as well as when entering hospital and community services.
‘There has been a sudden surge over the last week as we all try to access the various PPE required. Before the release of guidance, it was difficult to know exactly what was required for AGP/non-AGPs.
‘There have also been many practice teams who donated various PPE to their local community nurses, hospitals, GP practices and hospices who required it during the peak of the pandemic.
‘These dental teams should be highlighted and congratulated for the local heroes they are.’
‘We should pace ourselves’
Last week, England’s CDO released the new standard operating procedure for primary dental care.
For AGPs to be carried out, team members must wear a disposable, fluid-repellent gown or approved equivalent, as well as gloves and eye or face protection. An FFP3 respirator should also be worn by all staff involved in the procedure. A fit-tested FFP2 can be worn as an alternative.
‘Dental professionals were told they can open from 8th June. We need to remember that if dentists don’t see a patient face-to-face from this date onwards, they are not going to be penalised,’ Dr Sharma said.
‘On balance, there would be far more serious consequences should a practice open up for face to face when it has not been risk assessed as safe to do so for both themselves and their patients. I feel the consequences of this could be dire; GDC Standard 7.1 really is important to bear in mind here.
‘This is not a competition or race. Opening up due to a type of peer pressure is not worth the risk. We should pace ourselves, the fact we ‘can’ does not mean we ‘should’.’
She added: ‘We’ve also got to remember that we were never closed. We have always been open to triage patients and give A,A,A, throughout lockdown. And there were also those hardworking team members manning the UDCs, again, to be grateful for.
‘June 8th just allows all practices to commence seeing patients face to face again if it has been risk assessed and judged safe to do so.’
For many practices, fit-testing troubles and PPE access issues have been a key factor in slowing down progress when it comes to offering treatment.
Although dental professionals can train to become fit testers themselves, Dr Sharma argues it is not that simple.
‘You can train to become a fit tester but again, there is a high demand on these courses and equipment. Everybody is trying to access them for the same reasons as discussed previously,’ she said.
‘The area of fit testing is a complicated one, with reports of some indemnity providers not happy to cover fit-testers.
‘This possibly leaves them exposed to a risk of litigation. Is this covered under crown indemnity or not? Who indemnifies and protects the fit testers?’
Dr Barry Oulton is a practising dentist in Haslemere, Surrey, and the owner of The Confident Dentist.
His practice is part of Portman Dental Care and is only offering non-AGPs until the appropriate PPE comes through.
‘We don’t have screens or visors yet and have no date for when we will resume AGPs,’ he said.
‘We don’t know when there will be fit testing for us or when we will receive the PPE. There’s two people fit testing in the south east for Portman – and that’s for a corporate.’
Although many practices may not be ready to offer AGPs, Dr Oulton believes dental teams can still keep themselves busy.
‘My advice to other practices depends on PPE levels,’ he said.
‘If they’ve got the PPE required for non-AGPs they should be triaging and thinking about increasing their income, producing non-AGP procedures such as clear aligner orthodontics.
‘They can upskill their training in patient communication. This can increase the amount of dentistry provided on fewer patients.
‘They can keep look after their patients, staying in contact and nurturing those relationships and train themselves in virtual consultations.
‘But I’m aware that this may be more in the mindset of private practices where income is dependent on happy patients.’
He added: ‘I do think we were given short notice but we’re all incredibly resourceful.
‘There’s a lot of good opportunities here to change the way we deliver dental care. Communicating clearly is key – it’s only going to work if we communicate well.’
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