Resumption of dental services in England



Publications approval reference: 001559 / C0562

To: Dental practices

Cc: Regional dental commissioning leads

28 May 2020

Dear colleagues

Thank you for your contribution through the peak pandemic period and your continued commitment to supporting the national response.

On 25 March 2020 we wrote to NHS dental practices setting out immediate changes to services due to the overriding need to limit transmission of COVID-19. These included:

  • deferring routine, non-urgent dental care including orthodontics
  • establishing remote urgent care services, providing telephone triage for patients with urgent needs and
  • setting up networks of urgent dental care (UDC) sites for face-to-face care where clinically necessary

We are incredibly grateful to the clinicians and professionals who have risen to this challenge in providing remote services and in rapidly establishing over 550 urgent dental care sites from existing practices, acute and community facilities across the country to meet patients’ urgent dental care needs.

This letter now sets out next steps for delivery of NHS dental services in England, as the NHS moves into the second phase of the COVID-19 response.

Resumption of services

The goal for patients and professionals is to resume the safe and effective provision of the full range of care in all practices, as rapidly as practicable.

Working with the British Dental Association, wider professional representative groups and the dental industry, we have consensus on the commencement of reopening services.

We support the full resumption of routine dental care, in a way that is safe, operationally deliverable and allows dental practices flexibility to do what is best for patients and their teams. 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.

In developing this approach, we recognise:

  • clear safety standards, including personal protective equipment (PPE) and infection prevention and control (IPC) protocols are required to safely deliver dental care, as recommended by Public Health England (PHE)
  • that given the dual impacts of IPC requirements and changed patient behaviour during the pandemic, previous operating volumes will inevitably phase back in
  • that remote consultations will continue as part of a practice’s revised operating model

Today, we are asking that all dental practices commence opening from Monday 8 June for all face to face care, where practices assess that they have the necessary IPC and PPE requirements in place.

Our advice is that the sequencing and scheduling of patients for treatment as services resume should take into account:

  • the urgency of needs
  • the particular unmet needs of vulnerable groups
  • available capacity to undertake activity

Progression to resumption 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.

There also remains a need to be able to respond to any local or national re-imposition of public health measures should they arise.

NHS England and NHS Improvement regional teams will work with local providers to agree which UDC sites remain operational and for what period. This will include support for the provision of AGP during the early stages of resumption of services and assist with any local dental access issues.

Financial and contractual arrangements

Initially we will maintain the current temporary contract arrangements to make monthly payments in 2020-21 to all practices that are equal to 1/12th of their current annual contract value, subject to abatement for lower costs. We continue to work with the BDA on the mechanisms for the full 2020-21 contract year with the intention of reintroducing a link to delivery of activity and outcomes.

A number of dentists have been asking if the advice to NHS dental providers also applies to the private dental sector. We recommend a single approach to the safe and effective resumption of dental care.

Thank you for your commitment and understanding of the complex challenges we have collectively navigated in meeting the COVID-19 public health requirements, maintaining safety and access to care for patients, and the safety of the dental workforce. Your co-operation throughout this difficult period continues to be recognised and appreciated.

Sara Hurley | Chief Dental Officer

Matt Neligan | Director of Primary Care and System Transformation