Clinical Update – COVID-19

Dear All,

Thank you for your ongoing patience and commitment over the last few days. So many of you have demonstrated loyalty, kindness and strength during these testing times.

Further to our last correspondence, the BDA have published guidance on management of patients in primary care. The BAOS have also published their guidance in Oral Surgery in light of this global pandemic. I attach them both for you to examine.

What we do also know is that London is at the epicentre of this growing outbreak and, by virtue of its unique transport system, population density and size, we have seen exponential growth in the number of cases in the capital city.

Furthermore, we have attempted to locate supplies of FFP3 masks but also acknowledge that these are critical for the ICU teams who are treating COVID-19 patients in hospitals. In addition, the Health & Safety Executive has stated that these require rigorous testing and should be professionally fitted, or they simply will not serve their purpose – https://www.hse.gov.uk/respiratory-protective-equipment/fit-testing-basics.htm

Currently, there are no “fitting/testing” appointments available as these have been reserved for secondary care.

The BDA have advised that no aerosol generating procedures (AGPs) should be carried out without an appropriately fitting FFP3 mask. The BAOS have advised that no IMOS services/consultations in primary care should be carried out without an appropriately fitting FFP3 mask.

As a Company, once again, I reiterate, that no decision is taken lightly and our senior management team have spent today deliberating for a number of hours over video conference. Together Dental’s position is as follows:-

Greater London Practices (Broxbourne, Whitechapel, Clapham, Tottenham, Hamsey Green and Wandsworth)

London Practices, in light of their proximity to the centre of this epidemic outbreak will move to not be seeing patients for routine or emergency appointments, as soon as practically possible. The door will be locked with a notice which has our telephone number. Reception staff will be present in practice to answer telephones and can redirect patients to the London acute dental units. All staff within the practice will be expected to be socially distant for the entire duration that they are in the premise.

Practices Outside of London Region

All other practices outside of this region will be open for true emergency appointments only. These are strictly limited to:-

 Trauma including facial/oral laceration and/or dentoalveolar injuries, for example avulsion of a permanent tooth
 Oro-facial swelling that is significant and worsening
 Post-extraction bleeding that the patient is not able to control with local measures
 Dental conditions that have resulted in acute systemic illness or raised temperature as a result of dental infection
 Severe trismus
 Oro-dental conditions that are likely to exacerbate systemic medical conditions such as diabetes (that is lead to acute decompensation of medical conditions such as diabetes)
 Pain which is disturbing sleep, cannot be managed by analgesics and is disturbing sleep

NO AGPs are permitted, even for emergencies

These practices will also have their doors locked. A notice will be placed on the door stating that we are only providing emergency appointments only and patients will be required to call the practice to be asked a series of questions:-

  1. Do you currently have a new continuous cough and/or temperature (>37.8 degrees)?
  2. Please can you explain what the emergency is?
  3. Just to inform you that we are unable to carry out any aerosol generating procedures in practice and therefore can only conduct a brief assessment and advice.

Before booking appointments

 Every patient (including, any other chaperone who will be attending) must be asked if they have developed a new cough or fever
 If a patient says they have developed a cough, fever the patient must contact 111

Booking appointments

 When booking patient appointments each emergency appointment must be made for 20 minutes
 A 10 min space must be left between each patient booked to allow time for the surgery to clean the surgeries adequately between patients.
 Patients appointments must not be ‘squeezed’ in,
 No more than 1 patients can be in the practice at any one time (excluding carer/translator or parent)
 Patient must be advised at the time of booking that they must attend the appointment alone, or with one other person if a carer or translator is required. Equally if a child requires an appointment only 1 parent who has parental guardianship over the child can attend – under 16 years old.

Patient arriving for appointment

 The door sign must be used daily to inform patients of the intercom for appointments or call if no appointment.
 The main entrance door must be kept on the locked latch during opening hours
 Patients must use the intercom to gain entry to the premises.
 When the patient enters the premises they must be asked to wash their hands for 20 seconds with soap and water.
 Medical History Form will be filled in verbally and the PR form on the patient’s behalf and they need not sign either form.
 All MH and PR forms must be scanned at reception, no paper should travel with the patient.
 If a patient pays for their treatment, payment must be taken by card upfront

Patient during their appointment

 Reception / Admin staff are not to enter treatment rooms throughout the day, unless there is an emergency and they require assistance.
 Use of high speed handpieces is prohibited
 Use of Cavitron, Piezosonic or other mechanised scalers is prohibited
 High pressure 3:1 air syringe is prohibited

Patient after appointment

  1. Patient is to leave surgery without any paper/documentation to take to our reception team.
  2. Patient is escorted out of the building by the reception team/nursing team whilst maintaining social distancing.

Throughout the day regular cleaning and disinfection of all waiting rooms, patient contact areas must be maintained, including surfaces, pens, iPads, PQD machines, clipboards, light switches and door handles.

Best Regards

Mayur N Pandya
Chief Clinical Officer
23rd March 2020