COVID19 DENTIST CHARGING FOR PPE

Niv

brook2jack2 said:

The masks dentists have to wear now have to be fp3 which are in very , very short supply , and have to be individually fit tested By a qualified fit tester on each member of staff. When supplies run out then you need to fit test on another type of mask .
Even ordinary surgical masks have gone up in price from £3 a box to £30 or more a box. 

Dentists now need to wear surgical gowns , aprons on top of scrubs for aerosol procedures along with hats, shoe covers etc 
Screens are fitted at reception, no touch thermometers provided to staff to scan patients. 

Many practices have bought foggers or air sanitisers to help with keeping aerosol down . 

After each aerosol procedure the surgery needs to be left for an hour before decontamination can be done, so a surgery is seeing less than 20% of the patients it would normally see but with increased overheads. 

For information here is what almost £300 of disposable fp3 masks looks like 

Just to clarify, this is not a legal requirement. You are able to buy a kit to undertake the face fit test 'in house'. If it is NHS policy, that is another matter.

brook2jack2

No it is a legal requirement for a suitably qualified person to fit test each and every pf3 mask https://www.dentalprotection.org/uk/articles/fit-testing-of-masks-dental-protection-position-statement
I have qualified in mask fit testing and can say you cannot source the kits or chemical as there is a world wide shortage at the moment. Many dentists have done the training but cannot test their staff as they can't get hold of the kit . 

Powered respirators eg Papr do not require fit testing and because the of extreme difficulties in doing microsurgery in pf3 masks many dentists are investing in these , although they cost £500 to £1000 and are getting difficult to source as well. 

The employers will not be insured if their staff are not fit tested by a qualified fit tester and HSE could bring a prosecution . 

This is but a tiny part of the legal and ethical considerations in running a dental practice in covid times .

Niv

brook2jack2 said:

No it is a legal requirement for a suitably qualified person to fit test each and every pf3 mask https://www.dentalprotection.org/uk/articles/fit-testing-of-masks-dental-protection-position-statement
I have qualified in mask fit testing and can say you cannot source the kits or chemical as there is a world wide shortage at the moment. Many dentists have done the training but cannot test their staff as they can't get hold of the kit . 

Powered respirators eg Papr do not require fit testing and because the of extreme difficulties in doing microsurgery in pf3 masks many dentists are investing in these , although they cost £500 to £1000 and are getting difficult to source as well. 

The employers will not be insured if their staff are not fit tested by a qualified fit tester and HSE could bring a prosecution . 

This is but a tiny part of the legal and ethical considerations in running a dental practice in covid times .

Apologies, I had read your original as meaning externally qualified. You can train in house staff  to be competent. 
Many companies do not read 'should' as 'must'.
https://www.hse.gov.uk/respiratory-protective-equipment/fit-testing-basics.htm

mosteth

brook2jack2 said:

Dentists have no choice. The PPE , fallow times , distancing of patients ,equipment changes etc are all detailed in hundreds of pages of documents from our regulatory bodies. If dentists do not comply they will be shut down , struck off and prosecuted.

The NHS has already recognised that dentistry ,in covid era , is financially unsustainable and is drastically reducing targets to try to keep dentists afloat. 

Private dentists have less financial support than betting shops . They will have to increase charges to cover the dramatic downturn in patients they can see a day and the dramatic upturn in costs to remain covid compliant. In my part of the world , which is definitely not well off, 50% of all dentistry is carried out privately , most dentists subsidise NHS treatment with private. For these mixed practices NHS fees alone will not keep them going.

How are dentists going to stay open on vastly reduced patient numbers and vastly increased costs, if not by defraying some of those costs?

Thanks for the informed posting! I am currently debating whether to pay the COVID-tariff and go to my scheduled hygienist appointment in a couple of weeks. My dentist sold to BUPA last year and BUPA have introduced a £7 Covid-tariff for non-aerosol appointments and £40 for aerosol-using appointments. I have been told that ‘my’ hygienist has taken a sabbatical, otherwise I would be more inclined to go to keep her books open.
Thrown into the mix is my sister-in-law is a dental hygienist and she (and the dental nurses) have been treated horrendously over this period by one of the practises in which she works and this is apparently not an uncommon experience. I am not too sure how accurate your comment re ‘if dentists don’t comply with the regulatory bodies’ is: from what I hear, there is variability in interpretation of the guidance and the 1 hour wait after aerosol is not apparently sacrosanct. Patients (or are we clients?) don’t know what to expect so surely the only way the bad ones will be found out is if they get a COVID spike as a result of their poor practice, or if there are whistle blowers. If my SIL wasn’t so worried about the medium and long-term prospects, there would be some serious whistle-blowing going on. 

brook2jack2

The problem with the one hour fallow time is it can be mitigated , possibly, by introducing negative pressure ventilation, or increasing air exchanges by use of extraction units. Other dentists have bought air purifiers and scrubbers at a couple of thousand pounds per room or external dental suction units  but the exact mitigation effect of these is difficult to quantify. A research group is due to report in around five weeks on fallow time and another on aerosol reduction. There is a lot of scepticism over , what some would say , excessive measures UK dentists are expected to take compared to the rest of the world where eg fallow times are either non existent or much shorter , fp3 masks are not deemed necessary and do not need fit testing Etc etc . 

The facts are that dental practices despite being , in theory , the highest risk for staff and transmission of covid , are actually having lower rates than more or less anywhere else , even pre extra precautions. The theory is that dental practices are so good at cross infection control ordinarily that they have not been hubs for transmission the way that other health and care related places have been. 

The GDC puts an onus on the individual to whistle blow if they see bad or dangerous practice . Their registration is at risk if they do not do something about it. These are very difficult times and most of us are having to work longer and more hours , not take holidays , etc this is what is necessary to try to keep afloat and much of this will be unpaid. If your sister in law is employed this is just how it is , if she is self employed , particularly working in a corporate, some of the financial burdens placed are intolerable eg practitioner charges for ppe which means the dentist/hygienist virtually pays to work. Many dentists and hygienists I know have decided to leave dentistry as the stress etc is not worth it.  But if your sister in law is witnessing dangerous practice she must do something about it. 

silvercar

The facts are that dental practices despite being , in theory , the highest risk for staff and transmission of covid , are actually having lower rates than more or less anywhere else , even pre extra precautions. The theory is that dental practices are so good at cross infection control ordinarily that they have not been hubs for transmission the way that other health and care related places have been.

It does make you wonder. If the dental staff are PPE'd then the risk is patient to patient. With good hygiene the question goes to fallow time. I have seen local public halls use fogging machines that can be bought for ~£400 that clean the air in 10 minutes. You do wonder why there is a need for long fallow times.

brook2jack2

We have a fogging machine but the scientific evidence for it reducing fallow time With covid 19  is not there, ditto using uv air sanitisers , so whilst it is good to have it has not been authorised to reduce fallow time. 

 There is currently a scientific committee investigating the science behind fallow times but their report is not due out for another five weeks at least. 

Re patient to patient transmission , dentists have to stage appointments so waiting rooms are not used , patients are screened for covid , they wear masks, sanitise hands , have temperatures checked, are escorted to and from surgeries , everything is wiped down, door handles,bannisters etc before and after visit , moving them in and out of surgeries is co ordinated so they do not come across another patient , the door is locked and entry is gained by phoning practice up so public cannot access. 

Patients cannot bring anyone else into practice , they cannot bring coats, bags into surgery , payment and future appointments are arranged over the phone. 

These and many other measures are to ensure there is no patient to patient contact. 

mosteth

brook2jack2 said:

The problem with the one hour fallow time is it can be mitigated , possibly, by introducing negative pressure ventilation, or increasing air exchanges by use of extraction units. Other dentists have bought air purifiers and scrubbers at a couple of thousand pounds per room or external dental suction units  but the exact mitigation effect of these is difficult to quantify. A research group is due to report in around five weeks on fallow time and another on aerosol reduction. There is a lot of scepticism over , what some would say , excessive measures UK dentists are expected to take compared to the rest of the world where eg fallow times are either non existent or much shorter , fp3 masks are not deemed necessary and do not need fit testing Etc etc . 

The facts are that dental practices despite being , in theory , the highest risk for staff and transmission of covid , are actually having lower rates than more or less anywhere else , even pre extra precautions. The theory is that dental practices are so good at cross infection control ordinarily that they have not been hubs for transmission the way that other health and care related places have been. 

The GDC puts an onus on the individual to whistle blow if they see bad or dangerous practice . Their registration is at risk if they do not do something about it. These are very difficult times and most of us are having to work longer and more hours , not take holidays , etc this is what is necessary to try to keep afloat and much of this will be unpaid. If your sister in law is employed this is just how it is , if she is self employed , particularly working in a corporate, some of the financial burdens placed are intolerable eg practitioner charges for ppe which means the dentist/hygienist virtually pays to work. Many dentists and hygienists I know have decided to leave dentistry as the stress etc is not worth it.  But if your sister in law is witnessing dangerous practice she must do something about it. 

Thanks! At one of my SIL’s practices she has take a pay cut from £40 to £23 per hour, and she has been told she will not get a nurse. Rather than put herself at risk without one she is paying for one out of her pay, so will now be working for £13 per hour. It is absolutely disgusting treatment but she feels she has no choice - the practice owner has done a ‘divide and conquer’ job and there is unfortunately no united front amongst the staff. He has even recruited a couple of additional hygienists during lockdown so she knows they will be given her slots if she doesn’t comply.

brook2jack2

One of the big corporates is charging its nhs dentists £43 for agp appointment PPE etc. Considering that the average course of band two dentistry earns , in total , £75 of which the dentist will earn around £25 it means that the dentists are paying to treat patients at the moment. 

Dentistry private or NHS is financially unsustainable at the moment The pay your sister in law will earn will still be more than many others who will lose money by remaining working. In private practice there is virtually no help at all. 

At the moment I am working two other jobs , on the times I am not in the practice , a dentist I know who is a practice owner has been working in amazon selecting goods .

we can hope that fallow times become shorter and the group reports in their five week timescale and it's good news. Otherwise a lot more dentists will go bust.

Dr_Crypto

The precautions in dentistry seem much more onerous than in hospitals. For example we hardly clean consulting cubicles at all between patients (although no AGPs are performed there) and patients still troop in with their possessions. There is a waiting room with social distancing and relatives are discouraged but some do still sit in the waiting room (they aren't allowed into clinical areas). I personally don't agree with this lax infection control but it seems that the pressure to get patients seen has trumped that. The "get checked outs" seem to have returned as well so A+E numbers are approaching pre-COVID which is difficult with the requirements for social distancing. General out patients is still mostly virtual and that seems set to continue.