Case study summary
As part of the COVID-19 response, Kent Community NHS Foundation Trust (KCHFT) has adapted the way it delivers dental care to vulnerable patients, to ensure they receive urgent treatment as safely as possible.
The community dental services usually provide routine dental care for patients with additional needs which mean they would find it difficult to visit a high street dentist. For example this may include those with high anxiety, very young children, those with complex medical histories, dementia and learning disabilities
When the Chief Dental Officer paused all routine dentistry nationally and outlined how to deliver urgent care through hubs, NHS England and NHS Improvement South East set up a working group to deliver on the guidance locally.
Mark Johnstone, Dental Director with Kent Community NHS Foundation Trust and chair of the Kent, Surrey and Sussex Local Dental Network, was included in the group and focused on setting the standard operating procedures for the hubs.
The local response
“It took us around two weeks to set up the new urgent dental care hubs,” said Mark. “There are a number throughout Kent, Surrey and Sussex being run from general dental practices. , Our trust is running two dedicated hubs in Kent for patients who are shielded and people at risk of severe illness if they were to catch COVID-19.
“These hubs are referral only and are based in Canterbury and Ramsgate and we only take patients who are high risk and vulnerable as we’re set up for that level of care. Other patients can be seen in different hubs which are located across the county.”
Accessible support for all urgent care patients
Mark says that while there has been a complete change to the dentistry on offer and how it’s delivered, the route in to access care remains the same – calling a local dental practice.
Under the new system patients call their local dentist. They will usually speak initially to a receptionist who explains why only urgent care is available. The patient will then either speak to a dentist straight away or receive a call back. The dentist will triage them using an electronic referral system which also checks on their COVID-19 status, and then they are offered advice and/or a prescription for pain relief or antibiotics, or are referred on to one of the hubs for urgent care.
This initial triage identifies high risk patients and those with complex medical needs who are referred to one of the KCHFT specialist hubs. These hub teams may then engage with the patient’s GP and with their carers in order to gain consent to treatment. They may also link with hospital teams, for example if someone is undergoing cancer treatment.
Mark said: “The system is designed so that anyone with a dental problem can call any dentist to access treatment. It’s important that people use the system we’ve set up by calling their local dentist, not by going to their GP or A&E, which takes up time and increases the risk of transmission.”
Delivering safe care
The standard operating procedure Mark helped to develop with NHS England and NHS Improvement South East covers the whole pathway, from the initial triage to what the dental team will wear and the cleaning requirements in between patients.
The two KCHFT urgent dental care hubs operate five days a week, seeing on average five to six patients a day, which is about a third of their usual throughput.
Local dental teams are closely monitoring capacity and demand at the hubs and are working to put in place additional hubs or extended hours where this is needed.
“We need to spend more time on triage, the safe use of Personal Protective Equipment (PPE) and cleaning between patient visits,” explained Mark. “In total, it can take up to two hours from a patient arriving in the car park until they leave and then we can prep for the next patient.
“It’s much more intense for staff – despite the lower footfall there are higher risks and social distancing with patients is not possible. We’ve done a lot of training on PPE and planning and practising patient flow through the buildings, from patients parking up and someone going out to the car to collect them, to getting them into the building, providing treatment and then them leaving.”
Positive feedback from staff and patients
Mark said: “It’s important to keep staff on board, and patient and staff safety is our top priority – we can only run the service because we have the right levels of PPE. Feedback from staff has been really positive, with people volunteering to work.”
The staff phone patients after their appointments to get feedback. “We’ve had extremely good feedback; patients are relieved and happy once they have had their treatment,” added Mark. “Early on there were lots of questions but patients understand why we are being so cautious. We haven’t had anyone not turn up for their appointment and they have all known what to expect.
“It’s crucial for health and wellbeing that patients know how to access the dental care and support that is available, and that even the most vulnerable of people can safely access urgent dental care.”