Dental regulation in the shadow of COVID-19
First published in Dentistry 2 April 2020.
Stephen Hooper assesses the latest regulations to explain what is expected of the dental team during the coronavirus pandemic
The coronavirus pandemic has thrown the dental profession (indeed, the whole world) into a state of disarray and confusion. Each day, we are glued to our TVs and computers, awaiting news of the latest developments, both in terms of the spread of the disease and what is expected of us.
The government is urging people around the country to work from home unless it is impossible not to, and businesses have closed their doors in the most dramatic lockdown on normal life in living memory. The exception has been in frontline healthcare (particularly NHS) services, which have gone into overdrive – but what of the dental team? This article attempts to pull together the guidance so far.
The General Dental Council
The General Dental Council’s (GDC) position has remained rather vague. In a joint statement issued by the regulators of all health and care professionals on 3 March, practitioners were encouraged ‘to use their professional judgement to assess risk to deliver safe care informed by any relevant guidance, and the values and principles set out in their professional standards’, while acknowledging that ‘professionals may need to depart from established procedures in order to care for patients and people using health and social care services’.
The difficulty with such guidance (which was no doubt intended to be reassuring) is it allows room for interpretation. Will one dentist’s professional judgement be criticised if it is out of sync with another’s? In its updated guidance on 23 March, the GDC explained it does not ‘expect any dental professional to provide treatment unless, in their professional opinion, it is safe to do so for both patients and the dental team’.
The question then follows: what if one dentist’s notion of ‘safe’ is diametrically opposed to another’s? Those concerned at the scope for misinterpretation might be reassured to read that the GDC ‘won’t be looking to second guess judgements made on that basis’. That said, practitioners should still exercise caution, given the GDC’s statement that there ‘is still a vital role for regulation’.
Fitness to practise hearings diarised will be postponed unless there is a perceived immediate risk to patients. As for new complaints, the GDC will ‘continue to record and make a risk assessment of new fitness to practise concerns and we will continue to progress new and existing cases as far as we can’. Practitioners should not assume that, in this time of crisis, they will be immune from investigation – the GDC will still investigate complaints if deemed serious enough, so it is wise to ensure current guidance is followed and standards maintained.
The GDC is not in the same position as the General Medical Council, which has exercised its power given to it in the Coronavirus Bill to ask countless retired and/ or de-registered doctors to rejoin the workforce. No such power has been afforded to the GDC, so dental professionals not in practice will remain so, at least for the moment. There is also no indication that practitioners currently subject to restrictions – either conditional registration or suspension – will see their status change.
Local guidance
Although they have not all moved at the same pace (England having lagged behind Wales, Scotland and Northern Ireland in issuing guidance), some definitive rules appear to be materialising at a local level, which will assist practitioners in meeting the GDC’s expectations.
Practitioners are encouraged to read the local guidance in full (it is all widely available on the relevant websites), but the key features are as follows:
NHS England
As of 25 March:
- All routine, non-urgent dental care (including orthodontics) should be stopped and deferred until advised otherwise
- All practices should establish a remote ‘urgent care service’, providing telephone triage for patients with urgent needs in terms of advice, analgesia and antimicrobial means where appropriate. Any conditions that cannot be managed by these means will be referred to a ‘local urgent dental care system’
- Community outreach activities, such as oral health improvement programmes and dental surveys, should cease.
Directorate of Primary Health Science (Wales)
As of 23 March:
- Routine schedule dentistry should cease for the time being
- Aerosol generating procedures (AGPs) should cease
- While practices can remain open, patients should be triaged by telephone, with dentists permitted to offer remote prescriptions, analgesics and antimicrobials via local pharmacists
- All dental treatment that can be delayed, should be.
Population Health Directorate (Scotland)
As of 23 March:
- All routine dentistry should cease
- AGPs should cease
- Patients should be triaged with advice given by telephone, if possible
- No patients should attend an urgent care centre in person without a pre-agreed appointment.
Health and Social Care Board (Northern Ireland)
As of 23 March:
- AGPs should cease
- Routine dental treatment is to be deferred until the conclusion of the outbreak
- No patients are to be seen without a prearranged appointment
- Urgent treatment can still be provided to patients who do not have symptoms of COVID-19, but advice should be provided by phone if clinically appropriate.
‘Flexible’ regulation
It is clear that the dental team is no longer expected to provide routine treatment to patients, so will not be penalised for closing their doors to all but those with urgent needs.
There is still scope for interpretation; for example, in terms of what would constitute ‘urgent’ treatment, but the regulators appear sympathetic to the need/right of dental practitioners to protect themselves and their staff during the pandemic.
The GDC intends to be ‘flexible’ in its regulation, but what that means in practice is unclear. One would expect that dentists making genuine clinical decisions based on managing the risks of the coronavirus will be looked at sympathetically, but those who use the situation to simply abrogate their professional duties might not be. Ultimately, until we see some examples of what the GDC is investigating, we will not know.
The local advice relates to the delivery of NHS dentistry, but it can be expected that those in private practice would not be criticised if they adopt the same measures in exercising their clinical judgement.
That the GDC will not look to ‘second guess’ clinical judgement is a reassuring sign, but wherever uncertainty remains, advice should be sought from defence organisations, the BDA and lawyers before acting.
When it comes to regulation, prevention will always remain better than cure, even in such unprecedented circumstances, so do all you can to minimise the risk of concerns being raised.
THE CORONAVIRUS PANDEMIC is a fast-developing crisis, with guidance changing daily. The comments in this article are current as at 25 March, and practitioners are encouraged to keep abreast of changes.
Hempsons’ COVID-19 Portal tracks the latest developments, and we remain available to provide advice and assistance to any practitioner looking for a helping hand in these troubled times. Visit our portal HERE.