The COVID-19 Journey

S3 Dental Eltham is pleased to announce our plans to reopen, having finally been able to fulfil and in some areas exceed all the requirements made necessary by Public Health England & the NHS to reopening dental services. 

COVID-19 CLOSURE AND PPE RESPONSE

As many of you will have been aware, the requirements that needed to be met to reopen the practice were far and wide, and unfortunately in some circumstances without evidence. The UK has experienced an incredibly high mortality rate with COVID-19 and as such the precautions being taken by the government has reflected this to ensure we remain as safe as possible. Given that dentistry involves working in close proximity to the mouth, the risk of infection for dental procedures has been deemed extremely high and so the dental team and patients needed to be protected from the risk of COVID-19 transmission. 

The risk of transmission was not only through direct transmission but also via aerosol generated by the treatments we provide. The aerosol was deemed to potentially carry the COVID-19 virus and could potentially be inhaled by the dental team or other patients. Therefore the Chief Dental Officer of England suspended dental care across the country and we were required to close. 

During the peak of the pandemic and with the shortage of PPE, there was no clear guidance on how we should reopen and as such, we had to wait for official guidance before purchasing any PPE items. Dental practices found out about our ability to reopen at the same time as everyone else on a national address by Boris Johnson, and had to the wait a further 10 days before being provided with official guidance on how we were supposed to be operating and what the requirements were - in fact, we only actually had 1 working day before the proposed June 8th reopening. 

Given the incredibly short notice, the vague guidance provided, we started to place orders for the necessary items, and like every other dental practice in England attempted to purchase these items at the same time. All our dental suppliers had during this time been diverting their PPE supplies to hospitals and other necessary organisations, and as such had nothing in stock to supply. 

Over the last few weeks, the necessary PPE items have been delivered, but we were hindered from reopening due to the requirement to have the enhanced masks (respirators) we wear to be fit tested. Fit testing kits which ensure our masks keep the dental team safe are in short supply and like everyone else in the country in high demand. We received our fit testing kit, and began to ensure our dental teams can wear the necessary face masks. Unfortunately not every mask fits every face, and every time we change brand and model of the mask (due to the supply available), we are required to fit test again. Furthermore, not all masks being supplied to the UK are legally compliant with UK healthy and safety law.  S3 Dental does appreciate that some patients have been frustrated by our lack of face to face appointments, or any previous clear timeline for reopening, but we had placed orders for the items with multiple suppliers as soon as possible, but unfortunately they had been on back order which meant we were operating on a day to day basis.

We were unable to see patients prior to this, as our legal cover was suspended during this time and would only be reinstated when the above measures were fully met. This was the first hurdle we needed to overcome.

THE PATIENT JOURNEY

The second challenge we have faced in ensuring the practice was appropriately safe for our teams and patients. We needed to ensure appropriate social distancing measures could be achieved such as a suitable one way system to limit patient interaction, suitable spacing between colleagues, air quality control and how we could make our patient journey as paperless and contactless as possible.

To that end, we have introduced the new patient journey through the practice where you will be directed towards separate entry and exit points. We have installed air purifiers in common spaces to reduce any pathogen population in the air we breathe and repurposed office and surgery space to allow the clinical team to work to social distancing requirements. We are working on upgrading our telecom systems to supply these areas and you may find your next telephone call to the surgery a little different to accommodate these changes.

Our biggest change to the patient journey will be the “patient portal”. This online portal involves patients being emailed a link which allows them to update their contact details, fill in necessary medical history forms and a COVID-19 symptom declaration to allow us to triage patients prior to their appointment. We are not able to see patients who have an active COVID-19 infection and any patients with symptoms of COVID-19 requiring dental treatment will need to be referred to specific treatment hubs.

It will be a necessary requirement during COVID-19 level 3 risk status for patients to complete these forms, as there will not be any face to face interaction between the reception team and patients when they visit the practice.

NHS England has currently suspended routine dental care, and we have been instructed to provide urgent dental care only on the NHS whilst the risk to COVID-19 remains high. This remit by the Chief Dental Officer of England only applies to NHS dental care, and as such, there will be a difference in the services we are able to offer to patients.

The next challenge for us on returning to work is something referred to as “fallow time”. As mentioned the use of dental equipment such as the high speed drill has been deemed to generate aerosol, which could potentially contain COVID-19 droplets from asymptomatic patients. Therefore we are required to wait approximately 1 hour after treatment of each patient to allow for the aerosol to settle. After this fallow time has elapsed we can then clean the surgery as we normal do, sterilising work surfaces and equipment but now also mopping the floors after every patient.

With the introduction of fallow time, we are therefore facing a very restrictive covenant where each dentist can only physically see 4 patients in an 8 hour working day. We will now need to be very selective with the patients we see to ensure we treat those with the severest need first, before attending to routine dental care.

Therefore we are facing a very difficult period for the business. With the reduced number of staff allowed in the building, the small number of patients being seen, the significant increase in basic material costs such as our PPE we are unable to unfurlough our dental team fully. We have also needed to increase our patient charges during this time to compensate for the high costs associated with operating the service.

PATIENT APPOINTMENTS

During COVID-19 level 3 risk periods, we will be operating a closed door appointment policy, and if you require dental assistance, you will first be remotely triaged by a dentist. Advised if any dental problems you may have require an appointment, and if so how much it will cost to attend and be treated.

Our reception team will subsequently then contact you to arrange an appointment where we will take payment in advance of the appointment. After booking your appointment you will be sent an appointment confirmation that will contain a link to your patient portal. You will be required to complete these forms at least 1 day before your appointment. Once completed you will then be able to fast track your arrival by using our automated patient check in service.

During this time, you will be asked to attend at the specific time of your appointment, be asked to wait outside, and will be allowed to enter the building when it is your appointment. We ask you attend with minimal baggage and items. Once you arrive at the practice, you will be able to use the patient portal to check in for your appointment and notify us that you have arrived. We will then open the door and allow you to enter. We will require you to place all your belongings such as mobile phones, coats and shopping items into bags provided which will then be sealed and kept safe during your appointment.

We may check your temperature, ask you to sanitise your hands and then direct you towards the clinical room you will be seen in. Your treating dentist, nurse or hygienist may be wearing enhanced personal protective equipment, that may make verbal and non verbal communication more difficult. Some PPE items require us to place them on before the patient enters the room and not to be removed until the end of the clinical day.

After your appointment, you will have your personal items returned to you, and escorted out of the practice via a different route. If you require any follow up appointments, they will be need to be made remotely.

PERSONAL CHANGES AND THE CLINICAL TEAM

The COVID-19 pandemic has had short term and long term implications for everyone, and our clinical team unfortunately has not been spared these. Due to a number of factors such as personal or family member medical conditions, BAME risk status, financial implications as well child care related problems, we have needed to restructure our teams.

We have therefore needed to change the clinical team available to us. At your next dental visit you may find that your dentist has changed and in some circumstances no longer working at S3 Dental. The sudden change in personnel may be jarring for some patients, and we apologise for the lack of notice, but some of our team needed to make very important decisions based on their circumstances and needed to do them on short notice. During this time of national crisis you may not see your regular dentist and may see the on-call dentist to deal with your dental emergency.

We will be providing updates to our working hours and clinicians over the coming weeks as we embark on our recruitment processes and we hope to operate at full strength once we get to national covid risk levels 2 or 1. We would like to thank patients for their continued support and patience during this time, and look forward to offering a new and improved service when lockdown restrictions have been sufficiently eased and the Chief Dental Officer of England has confirmed that routine dental services can resume.

DENTAL CHARGES

NHS Dental charges were due to increase on the 1st April 2020, but as the pandemic hit, the government reversed its decision to increase charges and has deferred the increase until September, when the charges will be reviewed again. The current cost of PPE and materials has made the provision of widespread routine dentistry on the NHS unaffordable currently and so we will only be offering urgent dental care and limited routine care options.

Our Private and Denplan schemes are able to provide a wider range of treatments and options currently, but as a result of the increased cost of materials and our operating costs we have needed to increase our dental charges to allow the continued provision of these services.

SUMMARY OF CHANGES

We are operating a strictly appointment only service with our doors being closed to walk in appointments.

Routine NHS Dentistry has been suspended by NHS England and we are only offering urgent dental care on the NHS. Some treatments may need to be referred to specific NHS urgent dental hubs.

We will currently be offering limited examinations and treatments privately to patients.

Patients will be required to complete medical information and details via a patient portal and required to pay for dental treatment in advance of their appointment as we currently have no face to face contact for patients with non clinical staff. Our waiting room area is currently restricted.

Patients will need to attend for their appointments alone, unless they require a carer or guardian and we will need to separate appointments that generate aerosol from those that don’t so that we can perform air quality checks.

Our clinical team will be wearing enhanced PPE equipment which may make the appointment seem very different but we endeavour to reassure and comfort patients.

Patients will have no access to the reception team initially, so any paperwork will need to be completely online. Please make every effort to complete your paperwork online and appreciate we need to keep everyone safe.

Given the rules associated with self isolating and track and trace we need to ensure our staff remain safe and ask patients to assist us by accommodating our new protocols, so we can get back to providing the service as efficiently as possible.

We are expecting a very high call volume and we ask patients to contact us if they have a dental emergency or problem, but wait for us to contact them regarding outstanding treatments and rescheduled examinations.

Yours sincerely

Dr Sami Butt - Principal Dentist & Co-Founder of S3 Dental