Red Dental Alert letter to all dentists from CDO Wales

Please download the Red Dental Alert letter from the Welsh Government - Directorate of Primary Care and Health Service or if more convenient, please read the full letter below

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All Primary Care Dental Teams in Wales

Dear Colleagues,

Thank you all for your understanding and professionalism at this difficult time.
Further to my letter of 17
March 2020 and given the continued spread of COVID-19 infections, there is a need to ensure dental teams are being protected from risk of infection, complying with social distancing measures and helping others to do so, to help reduce the transmission.

Hence, we have decided to declare that we are now in ‘COVID19 Red Dental Alert Level’ which means dental services need to contribute to the national effort to reduce the spread of COVID19 and its impact on the population.

Provision of routine dentistry has been scaled back considerably in Wales over the past week. It is strongly advised, that people aged 70 or over, people with underlying medical conditions and pregnant women stay at home. Schools and hospitality businesses have been closed across the country.

This is a period of rapid change. Practice rotas and urgent dental care centres are being established in each health board. Dental teams need to communicate and work with local Health Board teams, be contactable to advise, direct and assess patients who have urgent needs.

To support dental teams and communities in Wales, adhere to advice on staying at home and support social distancing, from today the action required is:
  • Routine scheduled dentistry needs to cease for the time being. 
  • Aerosol generating procedures (AGP), that are being avoided, should now stop.
  • Dental team members who are pregnant or otherwise immunosuppressed should not provide or assist in the direct care or assessment of patients.
  • Practices and services can remain open (via a local rota and skeleton staff) and should make every effort to triage, advise and reassure patients who have a dental problem by telephone. This will avoid patients travelling and presenting at the practice or clinic, to minimise contact with people with symptoms or with those who are infected but asymptomatic.
  • Dentists can offer remote prescription, analgesics and antimicrobials, by contacting local pharmacists. The pharmacist can supply a medicine provided the dentist undertakes to provide a physical prescription within 72 hours of making the request (Human Medicines Regulations).
  • All dental treatment that can be should be delayed at present.
If assessment in person is required, use robust standard PPE procedures, only see patients who are asymptomatic and try to keep face to face assessments and (non-AGP) dental treatment to a minimum and only to meet urgent treatment need.

Patients identified through telephone consultation, who have an urgent or emergency need that cannot be delayed and requires AGPs, will have to be directed to your health board designated emergency/urgent dental care centre via a local booking system for assessment and care - but only if absolutely necessary. No patient should attend the practice or urgent centre in person without a pre-agreed assessment/treatment slot.

Health boards will work with local practices to ensure they have the details of booking systems and to link those team members from practices who are willing and able to contribute to the staff rota at the centre. Dental teams at the health board centres will receive training in the use of FFP3, and have FFP3 available to them.

FFP3 is a limited resource and it is not practical or desirable to train, fit test and supply to every dental practice team in Wales. However, it will be available at the centres where patients, positive or asymptomatic, are being assessed and treated.

The centres will follow emergency/urgency criteria, and wherever possible delay providing treatment to ensure the most severe cases receive priority and to preserve FFP3 stocks.

Clinical judgement decisions will be required – see attached RED alert guidance to support this.

The situation is evolving rapidly. Specialist societies and the BDA support stopping routine dentistry, and they also want to ensure teams providing care that includes AGPs, are trained, fit tested and have access to FFP3. Given the escalation of social distancing measures announced late last week, it is necessary to move dental services in Wales to RED alert of the COVID-19 dental plan from today.

In terms of contract delivery in 2019/20, flexibility has been offered for up to 4% of the contract if needed. This means up to 4% (of UDA activity) can be credited where this flexibility is needed toward meeting the 100% contract target. This flexibility acknowledges practices may struggle to meet 100% activity due to the current Covid-19 pandemic through staff absences, cancelled appointments etc. and to help ensure contractual payments take this into account.

I wanted to ensure details on payments April to June 2020 could be included with the next CDO communication. However, it is important we moved to RED alert today and these details will follow as soon as possible.
Thank you all for your continuing and collaborative team work across practices, services, health boards and organisations in Wales. My thoughts are with you and I hope you and your families remain well. I trust this advice will support all of you to adhere to social distancing and self-isolation advice.

Yours sincerely,

Colette Bridgman
Prif Swyddog Deintyddol
Chief Dental Officer
Cc: Heads of Primary Care all Health Boards
Welsh Dental Committee (including LDCs)
CDS Clinical Directors
BDA Wales

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