COVID-19 Information Sharing

By Dhru Shah
Tuesday March 17th 2020

Hi everyone

This is a page where we will share as much information as  about the questions you have regarding COVID-19 and the uncertainty.  There is very little in terms of advice out there and slowly aspects are coming along. We have created this COVID-19 Page to help each other. This page is listing all the questions, we need answering and will respond with either

A. links to guidelines

B . Advice from experts

C. Our thoughts if none of the above are available (or "no answer available yet")

 

First a word from the CEO of Tubules

Part 1. Questions from Practice Owners

1.1 What do we do as staff  if we have to close OR if there are no patients?

Please inform the relevant bodies, see Q1.7 below

If your practice needs to close, we suggest asking staff to undertake some tasks from home such as completing CPD courses.

Depending on the employment contract, this will either be done at full pay or lay-off guarantee pay, see our model employment contract for more information. Staff who are sick or in self-isolation, during the closure, will continue to be entitled to receive the standard sick pay.

Both associates and practice owners will lose income if the practice closes. Associates should check their associate agreement carefully to see what terms may be applicable, and discuss with practice owners what measures both parties can take to mitigate any losses.

1.2 What do we tell our staff about the future?

A Tubulite kindly shared this letter with his staff

"I appreciate you are all worried about the current crisis and how we as front line care workers should react to the latest government advice. The BDA have yet to put out anything and it was expected today but they are waiting on the Department of Health to give clarity to dentistry and let’s be honest no one cares about dentists.
We must act in the best interests of our patients and we will do that absolutely.  Your financial security is of utmost importance to me and I shall do everything in my power to maintain this; but if we are to close this is likely to mean that there will have to be some reduction in everyone's pay.  So we have to be cautious and balance working and seeing patients and making sure the practices are viable and not increasing our own risk.
So at the moment and it is a rapidly changing Landscape, I want to remain open and working as I believe prevention and treatment of pain and disease of our patients is essential.
This being said we should text and or call our over 70s and Medically compromised patients who are coming in for treatment and give them the option of attending.  Sarah and I will work on the precise wording. They may still choose to attend given we could be closed any time now, and would rather risk the attendance than suffer with dental pain and not be able to access us. Let’s be honest 111 is appalling for dental emergencies even at the best of times.
I will not be upset or annoyed if you feel you don’t want to work and want to take unpaid leave or holiday or if you are sick and want to get sick leave. All I ask is if this is the case you give us some prior warning of your intentions where possible so we can arrange cover and continue to provide services to our patients.
As with everything going on at the moment these are unprecedented times and if I can help any of you with anything even on a personal level  I will do my best to make sure you are ok.
Try not to worry. These times are going to be very strange indeed and it is essential we don’t all stress and make ourselves ill.  Eat well, exercise if you can,  maybe we all need this time to reflect what is truly important to us and make contingencies for our elderly loved ones.

I hope this clarifies my thoughts today and of course I will update you as events unfold.

1.3 What do we do for long term planning?

At the moment there is no answer

 
1.4 What about the plan subs for patients?

At the moment there is no answer

1.5 What happens if someone in our practice (patient or staff) is found to have COVID-19?

Contact your local health protection team for advice . Find your local team at https://www.gov.uk/health-protection-team .  They will discuss the case, identify people who had been in contact with the affected person, conduct a risk assessment and advise on any actions or precautions to take.

If a staff member is found to have a continuous cough or high temperature, they must be asked to self isolate for 14 days

1.6 What if my practice cannot meet the UDA obligations and targets?

Q10 on the BDA advice page is useful . Read it at https://www.bda.org/advice/Coronavirus/Pages/faqs.aspx?utm_source=linked...

1.7 Who needs to know if we close the practice?

Q11 on the BDA advice page is useful . Read it at https://www.bda.org/advice/Coronavirus/Pages/faqs.aspx?utm_source=linked...

1.8 What happens if a staff member needs to self isolate as they confirm they have the symptoms or they have a confirmed diagnosis?

Q2  at https://www.bda.org/advice/Coronavirus/Pages/faqs.aspx?utm_source=linked...

has the answer

They state "If a staff member is told by a medical professional or NHS 111 to self-isolate, they should be treated as if they are on sick leave. The government has said that statutory sick pay should be payable from the first day of the sickness period.

Employers with fewer than 250 employees will be eligible to reclaim two weeks' SSP for each employee who has been affected by COVID-19. This has not yet been formalised in emergency legislation, but it may include a clause allowing it to be backdated. Ensure you keep records of any absence due to COVID-19 to be able to claim this back from the government."

1.9. What if a staff member is pregnant and wishes to stay away due to the risk?

Q3 at this link has a comprehensive answer. https://www.bda.org/advice/Coronavirus/Pages/faqs.aspx?utm_source=linked...

2.0 What if a staff member has a pregnant partner and wishes to stay away due to the risk?

 

2. Questions for Practice Owners and Managers about running the practice day to day

2.1. What messages do we give patients before arrival ?

This is taken from the Welsh CDO report today "Dental teams need to establish if a patient who has a booked appointment is a potentially infective case prior to any visit by phone or by text or on arrival. Use clearly visible or binlingual instructions at the entrance.

2.2. Who do we cancel and who do we not?

Any non essential treatment especially in vulnerable groups (elderly , asthmatic patients and pregnant patients) that can be delayed should be delayed

2.3 What measures do we put in place for those patients who do arrive for treatment at the practice?

You can view guidance published for COVID-19 in primary care settings at https://www.england.nhs.uk/wp-content/uploads/2020/02/20200305-COVID-19-...
Please note this is an ever changing situation

Many practices are also:
- Asking patients about any symptoms of COVID-19 to assess risk (see Q 2.1)
- Taking patient temperatures
- ASking patients to wash hands or clean with antibacterial gel prior to entering

2.4 What are the protocols for elderly (Over 70s) patients who are vulnerable

Currently, there is no guidance on this issue. You can decide in your own practice the policy you wish to follow. The tubules practices we have spoken to, are trying to complete treatment if possible to avoid any teeth related emergencies and if non-urgent are deferring treatment. If you do so, please communicate this clearly to staff and patients.Regardless of age, if the patient has a “new, continuous” cough OR a temperature of 37.8 degrees or higher, you should cancel any scheduled treatment and advise them to look at NHS 111 online, or if they cannot do that, call NHS 111.

2.5 What are the protocols for pregnant patients

3. Questions from  Associates and Clinical Dental Workers (Hygienists/Therapists/Dentists/Nurses)

3.1 What happens to our pay and patients 

The Welsh CDO statement said "Practices will be supported and continue to receive practice monthly income. Monitoring and UDA targets will be relaxed or suspended as confirmed. Details of how this will operate will be confirmed later this week. Continue to submit FP17W and collect PCR as appropriate for the patients you do see"

Nothing on England report as yet

3.2  What constitutes essential and emergency work and what constitutes an emergency?

Advice from our team states that emergency work is patients needing to be relieved from pain, swelling, unstoppable bleeding or any other emergency that is life threatening. There is not further advice. However the Welsh CDO report today has said that "Reduce the number of routine check-ups by cancelling patients from vulnerable groups (and offer cancellation to anyone else who wishes to do so) to reduce the need to travel and have close contact with others in waiting rooms and surgeries. This will also conserve supplies of PPE for urgent care and free up capacity for urgent and necessary care that cannot be delayed. "

Nothing from the English CDO yet, We await updates

3.3 When do we stop doing essential work?

The Welsh CDO statement has said that "Given the potential risk of asymptomatic cases attending in this delay phase it seems sensible and necessary at this time to reduce exposure of staff and patients to infection by avoiding all aerosol generating procedures wherever possible. "

Nothing from the English CDO yet, We await updates

3.4 What Decontamination procedures can we use?

The Welsh CDO statement has said that "Use robust IC procedures, wiping down surfaces between patients with extra vigilance to include door handles etc. and use standard PPE – you can use full face visors which also provide eye protection or masks"

Nothing from the English CDO yet, We await updates

3.5 Do we need to wear FFP3 masks?

The Welsh CDO statement states that "We have interpreted the first bullet point of this advice to be relevant to dental teams providing care (that cannot be delayed) to infected cases in the designated Urgent/Emergency Centres. It would not be practicable or necessary for all dental practices and services to have FFP3 masks" 
NB: This was referring to the first point from the CMO report that had stated that "Healthcare workers should wear the appropriate personal protective equipment (aprons, gloves and a fluid repellent mask whilst assessing and treating patients; gowns, gloves, FFP3 masks and eye protection whilst performing aerosol generating procedures)."

Nothing from the English CDO yet, We await updates

3.6 What happens in a lockdown, do we need to keep antibiotics on site?

There is no guidance on this

3.7  We have a patient who has COVID-19 confirmed and a dental emergency

This patient should contact the Health Protection Team

Questions from Staff

To be added here

Advice and video blogs from our team

 

"As a practice owner, this is a tough leadership time. What should I do"

Kevin Rose answers.....video to follow

12 Comments

17/03/2020

Great idea, Dhru - I've added your page to my own communication resources which I'm using to stay in touch with clients, although it is also publicly accessible. https://www.markoborn.com/blog/communication/covid-19-dental-practice-ad...

17/03/2020

I have recently had an update through my workplace regarding precautionary measures to take whilst treating patients during the COVID-19 outbreak. I thought I would forward on this journal if it is any use to anyone else.

https://www.nature.com/articles/s41368-020-0075-9

17/03/2020

Amazing . Thank you Mark and Nicola

17/03/2020

Brilliant - leadership - thank you Dhru

17/03/2020

Thank you Chris. Please ask anyone with informationto share it here . We need united efforts and we need a central place as best as possible

17/03/2020

I am a Private Associate.If I don't work I don't have any income .Obviously the welfare of patients comes first but it appears that I am on my own with no support from anyone.I feel very isolated and anxious about my health and my ability to support my familly .Not expecting answers or sympathy because I expect there are millions of other people in a similar or worse position.

17/03/2020

Fantastic Leadership in these testing times Well done Dhru

17/03/2020

Hi Andrew. You are not alone. There is a log of people in the same position and difficulty. Please connect with me to join our WhatsApp groups

17/03/2020

Thanks Harish. We have to rally the troops let's keep doing it

18/03/2020

just starting first day of self isolation. Desolated!
I'm fine (probably; no symptoms) but my wife is definitely symptomatic.
Is it fair to reduce staffing according during the next two weeks on a prorata basis - so not just my nurse is affected. Everyone can take a turn covering reception, everyone can take a turn on lay off pay rates.

18/03/2020

And do our practice insurance policies through tower gate etc not cover epidemic/pandemic outbreaks

18/03/2020

This is really great - well done.
As a community dental officer, we have been given guidance from our Director to only see vulnerable groups as an emergency and to reduce aerosols as much as possible (so no fills or Ultrasonic scaling). This means delaying treatment if we can. If we do see people as an emergency - it's PPE and as little as possible. A lot of our patients are in the vulnerable group so we are not doing a lot of treatment at all and many are cancelling.
It's a trying time for everyone but I feel particularly sorry for those of you in general practice.
Take care everyone.

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