COVID19 DENTIST CHARGING FOR PPE

superbigal

Interesting that Bupa with its particular high PPE Fallow premium did not Furlough any of their "employed" dental staff (Afaik). Seems a strange decision as they continued to pay most to sit on their !!!!!! for 3-4 months. 
I believe many were asked to work as cover in Bupa care homes etc, but were not penalised for declining.
The self employed Bupa Dental "staff" were dumped by contrast on day 1 of shutdown. 
They now seem to be making a complete mess of their reopening.

couriervanman

Just had a call today from my dental surgery for hygienist appointment.....last time £29 now £58 her offer was declined

brook2jack2

The difference is dentists are responsible for their own PPE and covid costs , so regulations can be set with no level of mitigation due to expense or practicality. We first saw that in CJD days where dentistry had to implement very onerous cross infection controls with little scientific evidence. 

Most dentists are somewhat shocked by the lax level of cross infection control displayed in many other areas of healthcare compared to what they have to comply with in the surgery. 

The difference is it's very easy to set rigid rules and regulations when you don't have to pay the price of that regulation. Similarly it's very easy to set aside cross infection standards if it requires significant investment in equipment and people by health authorities etc. 

Our practice alone has spent thousands on enhanced PPE , an ongoing expense, which will not be recouped as we are running at a loss seeing patients at less than 20% or capacity to allow for social distancing, disinfection , fallow time etc. 

The other difference is that dentists, at least , can refuse to see people who will not comply with cross infection protocols as the powers that be would be down on the surgery like a ton of bricks. Hospitals and medics quite often do not have that luxury. 

[Deleted User]

mosteth said:

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. 

I’m going to Bupa Lincoln, is the charge across all practices? Is braces aerosol producing?

superbigal

GabiB said:

mosteth said:

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. 

I’m going to Bupa Lincoln, is the charge across all practices? Is braces aerosol producing?

Yes and probably yes (You have not clarified exactly what)

couriervanman

brook2jack2 said:

In order to comply with covid precautions dentists have to take several steps
Enhanced PPE including masks that need fit testing by qualified fit testers and are much more substantial than ordinary masks. In addition ordinary PPE has massively increased in price eg a box of ordinary masks have increased from £3 a box to £25 a box , or from some suppliers £80 a box. Clinical waste costs around £5 a small bag to dispose of and the amount of waste has massively increased. 

Dentists were not eligible for a lot of financial help, they got less help than betting shops. 

Spacing of patients so no waiting rooms are used and patients do not cross over in the practice. 

Finally the most expensive problem is that for every aerosol generating procedure eg drilling , the room has to be left afterwards for an hour before disinfection can start. That means each dentist has to have two surgery rooms to use instead of one. A room in a surgery costs from £120 to over £200 an hour to run.
If a dentist sees 25 patients a day normally they can now only see 4 to 6 patients a day. 

The expenses are much,much more than pre covid , the number of patients a dentist can see much ,much less. Already one large chain of dentists has gone bust alongside many individual dentists , more will go bust soon as this covid style precautions that dentists legally must comply with make dental practice finanancially unsustainable. 

A covid PPE charge does not really touch the surface of how much loss the practice is making on providing dental treatment. 

Am i right/wrong in thinking that if my hygienist went back to "old school" scale and polish she wouldn't need as much PPE and cleaning time between patients

brook2jack2

Hand scaling and polishing is not an aerosol generating procedure so would not need one hour fallow time , but does need longer appointments as is much less efficient than ultrasonic and is very, very hard on the hands . There will be more PPE than normal but not the fp3 masks . 

Still will have less patients due to social distancing , no one in waiting rooms etc . Many hygienists have still not gone back to work as extra surgeries are needed for dentists to be able to drill and hand scaling is not as effective as using ultrasonics . 

mosteth

couriervanman said:

brook2jack2 said:

In order to comply with covid precautions dentists have to take several steps
Enhanced PPE including masks that need fit testing by qualified fit testers and are much more substantial than ordinary masks. In addition ordinary PPE has massively increased in price eg a box of ordinary masks have increased from £3 a box to £25 a box , or from some suppliers £80 a box. Clinical waste costs around £5 a small bag to dispose of and the amount of waste has massively increased. 

Dentists were not eligible for a lot of financial help, they got less help than betting shops. 

Spacing of patients so no waiting rooms are used and patients do not cross over in the practice. 

Finally the most expensive problem is that for every aerosol generating procedure eg drilling , the room has to be left afterwards for an hour before disinfection can start. That means each dentist has to have two surgery rooms to use instead of one. A room in a surgery costs from £120 to over £200 an hour to run.
If a dentist sees 25 patients a day normally they can now only see 4 to 6 patients a day. 

The expenses are much,much more than pre covid , the number of patients a dentist can see much ,much less. Already one large chain of dentists has gone bust alongside many individual dentists , more will go bust soon as this covid style precautions that dentists legally must comply with make dental practice finanancially unsustainable. 

A covid PPE charge does not really touch the surface of how much loss the practice is making on providing dental treatment. 

Am i right/wrong in thinking that if my hygienist went back to "old school" scale and polish she wouldn't need as much PPE and cleaning time between patients

The practice I attend (BUPA) are only offering hand scaling - 45 mins rather than the normal 30 mins. When I queried the effectiveness I was told by the receptionist that it was just as effective, only takes longer - as brook2jack2 says, this is not true! They are still doing the polish at the end though, my SIL says this is the best way of covering crap hygienist work as it leaves the patient with that lovely smooth tooth feeling...

Carolnee

On tooth Polishing;

The BSP (British Society of Periodontology)  guidance relates to prophylaxis as part of professional mechanical plaque removal (PMPR) in  people with periodontitis. The FGDP guidance relates to the more general term of tooth “polishing”,  which may not necessarily be undertaken for therapeutic reasons.   The international evidence‐based S3‐level treatment guidelines in periodontology strongly  recommend PMPR (highest evidence level: 100% consensus) in managing periodontitis. Clinical  harms may result in periodontitis patients if this is withheld.  

And on hand scaling exert taken from BSP in the standard operating procedures from the CDO (Chief dental officer of England)

Steps 1, 2 and 4 are sufficient to stabilise periodontal health in the majority of sites and in the majority of patients, and the evidence-based guidelines demonstrate that there is no difference in outcome from employing non-AGP instruments (hand scaling and root surface therapy using hand curettes) as opposed to AGP instruments such as sonic/ultrasonic scaling devices.

brook2jack2

Operator fatigue is the great difference. A hygienist doing hand scaling all day will tell you that. It takes longer and gets extremely uncomfortable for the hygienist and tough deposits can be impossible to remove. 

That being said in patients with gum disease home care is the number one important factor in keeping the disease under control, it is 95% of the solution . Where there is gum disease a handscale will do a great deal in helping to control it in conjunction with rigorous efforts from the patient.