Dentists to return to work post COVID-19

Following the chief dental officer’s announcement last week that dental practices can recommence routine appointments from 8 June 2020, dental practitioners are looking ahead to the policies and procedures they will need to put in place in light of COVID-19. 

Our article published just last week set out an overview of both clinical and non-clinical factors that dental practitioners will need to consider when they return to work. 

Comprehensive clinical guidelines have now been issued jointly by the Faculty of General Dental Practice & College of General Dentistry for the safe return to general dental practice. Separate guidance has also been published by The Office for Chief Dental Officer England. 

These are recommended reading and clearly set out the clinical considerations when reopening a practice. Of course there are numerous other resources available and we are finding that corporate clients are beginning to create their own libraries of those clinical resources. 

Given how much is being published on a near daily basis, we understand that some dentists may begin to feel overwhelmed with prospect of finding, reading, digesting and implementing the information and guidance to reopen their practice. To try to help and support our clients, we have created a COVID-19 hub of information. 

Last week we considered other (non-clinical) measures required to comply with COVID-19 specific guidance. For instance, employers must, as a minimum, complete a risk assessment. In doing so, dental practice owners must: 

• identify activities or situations (including particular treatments and procedures) that might lead to transmission of the virus;
• consider which individuals (including patients and staff) could be at risk;
• identify how likely it is that someone could be exposed; and
• act to remove the activity or situation. If this is not possible, all reasonable steps must be taken to control the risk identified. 

If the practice employs five or more people, the risk assessment must be completed in writing. Even if there are fewer than five employees, it may be beneficial to maintain a written record. 

The issue of what measures are reasonable in these unusual circumstances is key. It is not clear how that will impact on a practice’s ability to undertake the volume of care expected under NHS contracts, other than there is little likelihood of practices being able to deliver the requisite number of UDAs. How that will play out for the current contract year and how that will impact on the new NHS contract that was due to be rolled out next year, remains to be seen. 

When considering the reasonable steps which must be taken, reference must be made both to current Government and professional guidance. However, at the present time, the steps will include obtaining necessary PPE and enforcing social distancing (both in the treatment room and reception and waiting areas).  

Examples of measures that practice owners might consider once routine dental care resumes include:

• Taking steps to limit the number of people in the practice or in a surgery at any given time, including limiting the risk for those entering and exiting the premises (one way in and one way out, for example).
• Ensuring that people do not congregate in waiting areas, and putting procedures in place to facilitate people passing through waiting areas, rather than spending significant time there.
• Providing hand washing facilities and/or hand sanitiser for those visiting the premises.
• Completing a patient risk assessment as part of dental triage (and in advance of any on-site appointment), including confirming that patients have not suffered any COVID-19 symptoms within the past 14 days.
• Allocating appointments based on need and assessing whether a telephone or video appointment may be more appropriate.
• Ensuring that adequate additional steps are taken for aerosol generating procedures (such as high-power suction and rubber dams).
• Scheduling breaks between patients allow for deep-cleaning of the treatment room.
• Instructing and training staff on how and when to use PPE, explaining why it must be used and any limitations.
• Making sure that, if PPE is required, there are no exemptions for wearing the equipment for tasks that only take a few minutes.
• Checking with insurance providers to make sure any planned reopening will be covered.
• Updating or creating relevant health and safety policies both generally, and in light of government guidance on infection and control generally and the dental sector specifically 

In addition to ensuring that they meet their legal obligations, dental practice owners should keep a written record of the steps they have taken to fulfil their legal health and safety obligations. These records could then be provided as evidence in the event of any future challenge on a dental practice’s health and safety record. 

Practices that have been used as UDCs must also keep complete, accurate and extensive records of emergency treatment from all stages from triage through to actual provision of the treatment. Non-UDC practices must update patient records where they have been treated at an off-site UDC. 

Jonathan Steele is a Senior Associate in the specialist dental healthcare and regulatory team at Charles Russell Speechlys LLP.