Returning to practice during the coronavirus pandemic

How do practices look at returning to work and resuming face-to-face patient contact as a result of recent CDO guidance?

Following the government's updated guidance on its proposals for a return to work and changes in guidance from CDOs, the DDU has received a number of enquiries from members.

CDO advice

The recent advice from the UK's chief dental officers is focused on preparing to return to work:

Many DDU members have asked "Am I indemnified if…?" From the outset of the current pandemic, we have made it clear that our role is to assist our members in these difficult times. Our advice is that members should consider all relevant national and local guidance from authoritative sources and make a risk-assessed decision on how to proceed.

However they interpret the guidance, if they are criticised for doing so by the courts or any other body, members can look to us for our advice and support in the usual way.

GDC

The GDC's statement of 26 March 2020 includes the following:

"Practitioners providing NHS services will of course need to adhere to the directions given by their nation's chief dental officer; other practitioners will want to take that into account in making decisions.

"From a regulatory perspective, the central question is again whether an appropriate risk assessment has been made. If treatment is offered, it will be important to record the specific precautions in place to ensure that the risk is appropriately managed for the particular treatment envisaged."

DDU guidance

In order to practise in a way that is consistent with patients' best interests, and also acceptable to the courts and the GDC, it is generally necessary to demonstrate that if questioned, your actions would be found to be consistent with those of a responsible body of dental or medical opinion.

At any one time there may be more than one responsible body, but provided you comply with one such body - even if it is in the minority - it is difficult to see how any criticism could be justified.

The key question is not "Can I open?", but "Can I do so safely for patients and colleagues?" - that is, in accordance with a responsible body of opinion and in adherence to current law, including governmental instructions on restrictions on movement and social distancing.

Pathways to reopening

The CDO in England has said:

"Progression to resumption of services of the full range of routine dental care will be risk-managed by the individual practice and can include aerosol-generating procedures (AGPs), subject to following the necessary IPC and PPE requirements. Dental practices should also take steps to risk assess their workforce and take commensurate actions.

"Central to this is the acknowledged clinical judgement of practitioners and their ability to risk manage the delivery of dental care, as service provision is re-commenced."

The CDO in England has issued guidance dated 19 May 2020; A Prompt to Prepare and the associated statements.

The CDO in Scotland has set out a phased approach for the remobilisation of NHS dental services.

On 25 May 2020, the Scottish Clinical Effectiveness Programme (SCEP) produced a 'live document' toolkit entitled Resuming general dental services following COVID-19 shutdown: A guide and implementation tools for general dental practice.

Although developed for NHS Scotland dental services for Phase 2 of their dental services remobilisation, the advice provided is likely to relevant elsewhere.

The CDO in Wales has set out the move towards the next phase of the response to the COVID-19 virus. The plan includes:

In Northern Ireland:

The Department of Health published a letter from Michael Donaldson, acting chief dental officer, on the re-establishment of dental services (from 2 June 2020).

As well as this, the FGDP and College of General Dentistry have published guidance which can be found here.

If members follow the relevant advice, they should not be criticised if the way they are working is questioned.

This guidance was correct at publication 29/05/2020. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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