It is Tuesday 24th March and I have just spent the morning seeing emergency patients at my practice. Fortunately, I managed to deal with all patients effectively, I think, without the need to expose my staff to the potential risk of an aerosol generating procedure (AGP). This was entirely down to good fortune and not because of planning from myself, my staff or NHS England.
Between patients, I was triaging phone calls, meeting with my practice manager and scouring the internet for updated guidance from NHS England. It is a bit like waiting for Father Christmas, except he generally turns up on time and has rarely let me down over the years. I can only imagine the pressure the NHS England team are under, and I have no doubt they are working tirelessly to overcome what appears to be an insurmountable problem. But I find that colleagues around the country find it hard to be forgiving, when they have so much at stake.
I appreciate the situation is constantly changing and guidance and advice must be accurate, robust and evidence based wherever possible. In this rapidly changing environment, the timeliness of information is absolutely key and our members have expressed growing frustration and anxiety over the delays in guidance being updated. The dental teams up and down the country are committed to putting their patient’s best interest first, but it is inappropriate to ask them to do so while placing their colleagues and loved ones at risk. We need clear, timely and succinct guidance for us to support our patients, staff and the wider population. The FGDP (UK) would therefore highlight the importance of taking this into consideration with more frequent and clear advice being made available to reflect changing evidence and expert opinion.
This is particularly relevant in relation to the safety of front-line staff in treating dental patients. Current advice is clear in relation to the avoidance of aerosol generating procedures (AGPs), wherever possible.
However, this still leaves significant confusion on whether to carry out some elective procedures or not. The general advice from the Prime Minister is clear, which is in stark contrast to the conflicting clinical advice within the UK ( 23rd March 2020). The Prime Minister made recurrent and explicit references on social distancing and its power at reducing unnecessary transmission of the virus. We fully expect that NHS England will follow the lead of the other devolved Nations and explicitly state that all elective procedures within dentistry must cease immediately; we can only advise colleagues to take their own decisions accordingly.
I was fortunate this morning that I did not have to pick up an air rotor to open a tooth. If this had been clinically indicated, it would have been necessary for me to undertake a potentially dangerous procedure without appropriate PPE for myself and my nurse. A significant number of specialist societies have recommended the use of FFP3 respirators for all AGPs and I believe this to be an eminently sensible approach. Public Health England’s guidance on infection prevention and control for COVID-19 states that FFP3s should be worn for all AGPs on patients with known or suspected COVID-19, and in view of the low levels of testing for the disease and its long incubation period, every patient represents a potential infection risk to dental teams, even if asymptomatic.
Many experts are now recommending that any dental care professional exposed to AGPs should be supplied with the appropriate equipment: failure to do so, exposes individuals to an unacceptable risk of contamination. I can barely get hold of a surgical mask, visor and gloves from our usual supplier, what chance have I got of getting an FFPR respirator? Having said that, I fully appreciate that as long as FFP3 face masks remain in short supply, those that are available should be prioritised for emergency medical care. As that is currently the case, it makes a lot of sense to follow the model in Scotland and establish dedicated emergency centres to provide urgent care in a safe environment with the appropriate facilities, equipment and personal protection.
Discontinuation of routine dental services will impact on patient care and the maintenance of oral health for some; however, at this stage patient and public safety is of much greater importance and needs to take precedence. Such measures will have a significant impact on the financial viability of dental practices across the UK, and everything must be done to ensure that we are able to retain the premises, equipment and staff to allow a return to normal provision in due course.
The financial support package for employed staff announced by the Chancellor on 20th March is to be welcomed and will be of considerable benefit to the many dental care professionals who are employed within dental practices. Unfortunately, this will not provide any support for those who are self-employed, and this must surely be taken into consideration for both NHS and independent providers of dentistry. Financial packages for NHS Providers have been announced by all of the devolved nations, and my inbox has been bombarded by irate dentists who are vexed by delays in England, which is causing severe anxiety, distress and hardship.
At the FDGP (UK) our role is to promote and support the delivery of high standards of patient care, but for this to be achieved we are very clear that the workforce needs to be supported. At this time of crisis, we believe this is of particular importance and we will do our best to contribute to sensible, well-timed and supportive action – protecting people today, and protecting the future for a vital healthcare service for our nation. In my previous blogs I spoke of the need for strong leadership and effective communication, and it seems that need is becoming ever more acute.
Read more posts by Ian at www.fgdp.org.uk/deans-blog