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Planning your business bou ceback PREPARING FOR REOPENING (UPDATED 8/6/20)

COVID - 19 WE’RE HERE TO HELP Henry Schein takes seriously its commitment to helping healthcare professionals manage the impact of the COVID-19 outbreak. We strive to be a valuable business partner that our customers can rely on to help operate efficiently and deliver quality patient care. We are always ready to stand by you during these challenging times. Please contact us or visit henryschein.co.uk for more information

Prepare to Reopen

Reconnect with Patients

Leverage Financial Solutions

Establish Opening Day Protocols

Acquire New Patients


COVID-19 fact sheet click here

Business Bounceback

It’s vital that practice owners and managers plan carefully for the return to normality post Covid-19. Dear customer, As dental practices start to reopen, this is going to be a very critical time for you, your practice, your team and of course, your patients. So it’s vital that you identify the strategies to allow your business to bounceback and recover profits lost during lockdown. Our bounceback suggestions will give you lots of ideas for how you can do this - including how to lead your team, how to communicate effectively with your patients, how to ensure your practice is ready to reopen, what the new normal might look like and how to look after the health of your business. This includes how to run virtual consultations, helpful marketing ideas, and a Youtube playlist to help you recommission your equipment and get it back up and running. Of course, our service team will also be on hand to help you with any difficulties you have. We have tried to address many of the concerns that have been raised around infection control and aerosol generating procedures, and how you can incorporate safer measures into your practice and your workflow. There is also a section on the official PPE recommendations and a mask explanation guide. There are many other ideas to help you prepare for what will become the new ‘normal’ in the world of dentistry. And it’s going to be quite different from how it was before. So please take a look inside, and if you have suggestions for anything else that will be of benefit to the dental community, please don’t hesitate to get in touch with me. Best wishes

Jane MacRae Marketing Manager e: jane.macrae@henryschein.co.uk m: 07771 920949

Watch my introductory video here

Contents Looking after your team Looking after your patients • Teledentistry • Marketing • EXACT Looking after your practice • Infection control • Aerosol generating procedures • PPE and masks • Gowns • Horton Consulting • Infection control other factors  • Waste management

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4 5 6 9 11 12 12 12 16 17 18 20 21

Water supply and specialist disinfection services The new normal • Useful global back to work toolkits • Patient screening • JSP Media Group • The CSR Coach • Protocols and SOPS • Contactless arrivals and departures • Diary management and appointment planning for reopening Equipment • Recommissioning

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21 22 24 25 26 27 28 30 31 32 32

• • • • •

Hygiene considerations 32 Going digital 33 Looking after your business 34 Finance and bounceback loans 34 Business growth coaching 35

Leadership  Have your say  Further reading and additional resources Your business is our priority

36 37 38 39


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The secret of change is to focus all of your energy, not on fighting the old, but on building the new.

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Practice Looking Owner’s after your Checklist team

Looking after your team Effective and strong leadership at this time is vital. You need to protect your team and communicate with them about your plans and priorities. Tell them how you will protect them and what impact the current crisis will have on the practice. Without leadership,your team will flounder and so will your business. For advice and help with this, visit Engage the Team. Henry Schein customers get 10% discount. Consider the following as part of your leadership plan:

•• Furloughing is an opportunity to protect your team and your business: it’s a positive government initiative to help businesses and •• Remote meetings are easy and effective, and individuals come through the crisis more there are many software applications, such strongly. It is designed to protect your team as Zoom, which are free and easy to use. against redundancy. It will hopefully allow you Keep your team informed about the business to retain your staff rather than having to impact of your actions, your current situation recruit new ones. and your recovery plans. Prepare to hit the •• If you do need to take on new staff, visit ground running on day one. MediCruit who will help you through the •• Focus on the mental health of your team – process - and give you a discount if you are a there are lots of free applications and guidance Henry Schein customer. on working from home. Stay in regular contact

•• Keep your team busy. You can use this time and be empathetic to their needs. Your to upskill your team. There is a plethora of mindset determines your experience of life webinars and CPD opportunities out there and yet few of us are consciously aware that including Software of Excellence’s Academy we can choose our mindsets, irrespective of of Excellence program designed to equip the what is happening around us. To help your practice team with knowledge and skills about team achieve this, they can run a short EXACT software that will help drive the exercise called The One Minute Mindset. It’s business, as well as providing formal super easy and obviously quick and yet it will certification and CPD hours. It’s also free empower you and your team to understand that during lock down. Register here. simple changes can have big effects. Click here for the free to use download. Keep smiling and •• Click here for more CPD webinars and links to enjoy the exercise. our suppliers and partners to access their •• When you do reopen your practice, re-induct online materials. We have tried to create a useful library across the whole industry of your team and celebrate the return. It’s a webinars focussing on COVID-19 information great opportunity to demonstrate leadership as well as clinical CPD for your team. and to bring the team back together again. •• Implement sick leave policies for your staff that are flexible, non-punitive, and consistent with public health guidance, allowing employees to stay home if they have symptoms of respiratory infection. Ask staff to stay home if they are sick and send staff home if they develop symptoms while at work.

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For more information on staff reinduction and training, click here


Looking after your patients Communicating with your patients has never been so important. So make sure your phones are diverted so that your patients can always communicate with you. The actions you take now will determine the success of your business in the coming months. Following the COVID-19 outbreak, patients will understandably be fearful of coming back to the dentist and may consider postponing non-essential appointments, such as check-ups and hygiene appointments. Therefore your strategy needs to really focus on continuing to educate patients about the importance of oral care and routine appointments as well as the importance of maintaining their dental finance plans to in order for to them avoid potentially hefty increases in future costs. Patient confidence needs to be restored and they need to understand that the risks of treatment have been minimised. Call your patients 24 hours before their appointment to assess their potential level of risk. For example, have they been self-isolating, or are they an NHS worker in daily contact with COVID-19 patients. •• Point of care diagnostic tests will almost certainly be available so you can also test your patients when they come into the practice. If you do not test them ensure that at least 3 days have passed since recovery (resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms such as cough or shortness of breath) and at least 7 days have passed since symptoms first occurred. •• It is important that you understand the risk profile of your patient demographic so that you can work out which groups are most likely to need encouragement to visit. (EXACT has this functionality). •• Consider patient financing for those who are in financial difficulty after the crisis. There are many different options available from a range of companies, including Finance4Patients who offer preferential rates for Henry Schein customers.

Looking after your patients

For more information on preparing your patients for reopening, click here

•• Pro-actively manage patient fear and demonstrate the ways in which you are minimising the possibility of infection and thinking about patient safety by reducing contact points and time spent in the waiting room: •• Reduce the number of patients in the practice at any one time. •• Stagger appointments. •• Ask patients to complete medical history and consent forms prior to arrival. •• Ask patients to wait outside or in the car until they are called. •• Consider having dedicated clinics for ‘vulnerable’ patients. •• Use automated messages direct from your dental software to communicate your plans to patients. •• How you are planning for contactless arrivals and departures (see page 20). Phone all your plan patients (using a script). They are the most loyal patients to you and your practice. Speak to your plan providers first to understand if they can offer payment holidays or other financial assistance, as there may be solutions available for patients who genuinely can’t afford to pay right now. Your patients will be very grateful for this and much more likely to remain with you. To prepare for this it will be helpful to segment your patient database and create different communication strategies for each group. Every patient will require significant amounts of targeted communication to persuade them of the importance of oral care and to convince them that you are open, safe and infection-free. You could even put on a webinar or online meeting (Zoom is ideal for this) for your patients to attend, in which you can present to them your new normal and what they can expect in terms of virtual consultations and physical appointments.

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Teledentirsty/Remote prescribing

Teledentistry The unprecedented global COVID-19 crisis is significantly impacting the dental industry, changing the way that we work and forcing dentists to leverage creativity to stay productive. This includes the adoption of new technologies to allow continued ongoing communication with patients. Unfortunately for dentists, remaining productive won’t happen by simply shifting morning huddles to Zoom calls. Clinicians have to interact with patients, simple as that. They need to stay in touch, be proactive and start marketing their new services. While your practice is closed, you can continue to offer advice and appointments via video conferencing or phone calls for urgent or emergency appointments. This gives early adopters of teledentistry a real chance to get ahead of the curve and our enforced ‘shutdown time’ presents an opportunity to explore these new possibilities for your practice. Click here for more information and advice on how to implement teledentistry. Check out 10 high level principles for good practice in remote consultations and prescribing from the GDC here.

Note from the BDA

Remote dental consultations with your patients are the new normal and we want to help you adapt to these new ways of working. That’s why we’re providing advice to members on how to conduct a remote consultation with patients and to avoid some of the common pitfalls. In this, we highlight technical issues to look out for, signpost clinical guidance to support your decision-making and also touch upon areas unique to remote consultations. We want to help you maximise the clinical time you spend with your patients. We hope this will give you a loose framework around which to structure your remote consultations whilst keeping you, 6

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your teams and your patients safe. Click here to find out more. When you launch your teledentistry business – and you can do it fast! - consider setting up a series of education group meetings online to which you can invite your patients and announce your new service. In these meetings you can run through: •• How to keep teeth healthy without visiting the dentist. •• Oral care at home: rinses, toothbrush advice, interdental brushes, flossing and tongue scrapers. •• How to minimise oral sensitivity. •• Share your health and infection control tips. •• Provide ortho or aligner tips. And much ortho work can continue with trays being posted to patients. The Invisalign website also has a virtual treatment connection. •• How to request a virtual consultation if patients have inflammation, bleeding or pain. •• Offer virtual consultations for any patients wanting to discuss treatments, for example aligner treatments or whitening.

Applications of teledentistry •• •• •• •• •• •• •• ••

Limited evaluations and triage Covid-19 urgent and nonurgent exams Hygiene only coverage Satellite office coverage Specialist consultations Outreach application Medical-dental integration Patient monitoring devices

To gain further understanding of how you can make teledentistry work for you and your practice, please view our recent webinar


Teledentirsty/Remote prescribing •• Remember you will need to offer a risk assessment for each patient and good advice can be found here and also in Dentinal Tubules’ ‘Risk assessment and protocol for going back to practice’. •• Check with your indemnifier that you are covered. Click here to see what the MPS/ Dental Protection Society has to say on teledentistry. •• Patients with urgent dental care needs should be referred to the local Urgent Dental Care centre. It is essential to minimise the number of patients referred to designated urgent dental care centres to reduce the risk of transmission of COVID-19 to healthcare workers and patients, and to lessen the pressure on these services. •• Appropriate records should be kept of all patient contacts, including care management and onward referrals. This will be essential for contract management calculations for 2020/21. •• If you have an intraoral scanner or camera, start taking scans of ALL your patients each time you see them. This way you can build up a bank of images of their teeth which will be of great help when you are practising teledentistry. You can also add xrays, and extraoral photographs to their notes. •• And remember to put a note on your website that you are now open for virtual consultations.

Teledentistry Support Products

You will also need a stock of products which you can send out to your patients to help relieve their symptoms and reduce their pain and inflammation. So we have compiled a list of all the teledentistry support products that might be useful for you to stock. And remember you can pop the items inside a sterilisation pouch to ensure no contamination occurs.

NHS payments for virtual consultations

There is no regulatory framework yet to claim for activity or apply patient charges for a triage via telephone; providers undertaking telephone triage are advised to keep a manual record of patients, with the view that this data collection will help support and inform development of contract management arrangements for 2020/21. Click here to view. Urgent treatments provided within UDC systems should adhere to the current regulatory framework for FP17 submission and applying patient charges. Triage advice For further information, the FGDP website is invaluable and offers nation-by-nation clear information and updates on urgent care arrangements. It also covers:

•• Telephone triage and assessment •• Remote prescribing and advice •• Reducing the risk to dental professionals and patients •• Definitions of routine, urgent and emergency care •• Aerosol generating procedures •• Record keeping For excellent triage advice from the British Endodontic Society click here For GDC information please click here

For triage advice from the Australian Dental Association click here

For General Medical Council information please click here

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Teledentirsty/Remote prescribing

Teledentistry It’s now more important than ever for private practices to have access to an NHS email account. Without one, it will make it much harder for you to be able to make referrals to UDCs and issue prescriptions.

Both NHS and private practices can sign up for NHS email accounts. For private practices, it’s now more useful than ever to have access to an NHS email account. Without one, it may be harder for you to make referrals to UDCs and issue prescriptions. To access an NHS.net account, private practices need to register and answer 14 questions on data management and security. The BDA has produced a guide for members in private practice on how best to answer these questions. NHS practices must follow a different pathway. Please see the BDA guide for members on completing the full Data Security and Protection Toolkit to sign up. According to NHS Digital, wait time to apply for and get an account is approx. 10 days at present. MEDPOD is a new teledentistry solution launched by Henry Schein to allow you to stay personally connected, 24/7, with your patients and to triage dental emergencies and perform post-procedure checks using video consultations. This simple video consultation tool can be used with any smartphone, tablet, or computer. It’s an on-demand, cloud-based, software that requires no downloads or installations.

Pricing

Pay-per-use: set up fee of £50 + £4 per visit Monthly unlimited subscription: £150 per user monthly Discounted rates available for 10+ users

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Click here for more information and to book a demo

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Key features include:

•• AES 256 Bit Encryption, double the standard 128k encryption •• Custom URL and branded virtual waiting room facility •• Patient can register or enter as a guest •• DHCP can view all patients in the waiting room and reason for visit •• 2 setups available to handle incoming patient calls •• Patient can select a specific dentist or wait for the next available •• Patient can view DCHP availability •• Chargeable to the patient via Worldpay (or using your own practice management system)


Marketing

Marketing At this critical time, it’s important not to reduce your marketing. In fact the very opposite. You need to communicate all your practice information, virtual consultations, reopening and infection control processes you are adopting. Let your patients know that you care and that you are here for them. Don’t forget that your website is your shop window and the best way for you to maintain communication with your patients. Keep it up-to-date, refresh the content and encourage your patients to visit regularly for help and support while you are closed. It’s essential that you have a clear message on your website homepage, that includes: •• Your updated opening hours - or if closed a statement to that effect •• Contact information for emergency cases •• Your Covid-19 hygiene update for when you reopen A nice way to make sure that everyone sees your message is to add a popup. If you have some extra downtime, there are 6 simple things you can do (without anyone’s help) to convert more online traffic into new patients. 1. Optimise your Google My Business (GMB) profile If you haven’t yet claimed your GMB listing - then you should do so immediately. To start the process, Google search for your own business. Go to Google maps and you should find your business. When you, do, click the listing and then click the “Own this business” link. When people search for a dentist on Google, most likely they’ll see your GMB profile first, before your website: •• Make sure the information section is completely filled out (including the services you offer and the region you serve) •• Upload more photos

•• Set-up messaging: a new feature that allows people to message you from GMB •• Manage and respond to reviews

2. Clean up directories •• If you’ve ever invested in SEO for your practice, the chances are the company listed your business on a variety of directories like yelp, yellowpages, hotfrog, canpages, etc. to improve your Google rankings. •• You should make sure that the business NAP (name, address, phone number) and hours are the same as your GMB profile because it’ll hurt your Google rankings if they aren’t (Google likes consistency).

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Marketing

Marketing 3. Optimise your social media pages •• Info on both platforms should be completely filled out, especially the ‘contact’ button. •• Writing your practice’s story on the ‘Our Story’ section of your Facebook page tells people what values your practice stands for and why you’re different from the rest. •• Same with your Instagram bio: add one or two lines about what makes you unique. •• Delete any ‘low-quality photos’. •• Delete any stock images, memes or any content that doesn’t create trust, affinity, and establish a connection with people, but was just put up for the sake of putting up content. •• Hootsuite is a great social media scheduling tool and has some good advice 4. When you are undertaking marketing to

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your patients consider whether under GDPR your message is of legitimate interest. If so, you can send communications to all patients instead of just those who have opted in. The Information Commissioner has clearly announced that data protection concerns should not stand in the way of appropriate information sharing. 5. Don’t forget to do some marketing campaigns around your teledentistry solution. This will help you attract new patients. You can also use time in the evenings and weekends to do it. Plus your hygienist and treatment coordinator can manage relevant patients. 6. Create posters to display on your front door and through the practice to advertise the measures you are taking to make your dentistry safe. 7. You can also text your customers with important messages and communications.


Marketing EXACT has excellent patient marketing functionality, so if you’re not already familiar with its capabilities, check out the Software of Excellence website Marketing Manager and Campaign+ allows you to create, automatically schedule and send marketing campaigns to targeted patient lists straight from EXACT, enabling you to target the right patients at the right time, and encouraging optimum treatment uptake. Responses are tracked automatically through EXACT’s intelligent software, and using Campaign+, you are able to instantly monitor your return on investment. With access to an array of campaign designs and templates, it’s easy to create personalised communications incorporating your own practice branding; including e-shots, direct mail, posters and flyers. Channel Track allows you to delve deeper into your marketing campaigns, helping you

to understand precisely which type of marketing works best for your practice. By adding unique phone numbers to each of your marketing channels, and dynamic phone numbers to your website, you can track the effectiveness of each communication and pinpoint exactly where your new patients are coming from. It also has the facility to record conversations with patients, enabling you to monitor how new patient enquiries are dealt with and introduce additional training where necessary, ensuring all queries are dealt with in the most effective manner. For 121 help and advice on marketing using EXACT, please contact 01634 266802 contactus@soeuk.com

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Infection control

Aerosol generating procedures SARS-CoV-2, the virus that causes COVID-19, is thought to be spread primarily through respiratory droplets. Airborne transmission from person-to-person over long distances is unlikely. However, the contribution of aerosols, or droplet nuclei, to close proximity transmission is currently uncertain. The virus has been shown to survive in aerosols for hours and on surfaces for days. However, it is unclear whether these particles actually are sufficient to cause an infection. There are also indications that patients may be able to spread the virus while pre-symptomatic or asymptomatic. The practice of dentistry involves the use of rotary dental and surgical instruments such as handpieces or ultrasonic scalers and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, DHCP, or the patient. The spray also might contain certain aerosols. Surgical masks protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of airborne infectious agents. Aerosol Generating Procedures (AGPs): •• Use of high speed handpieces for routine restorative procedures •• Use of Cavitron, Piezosonic or other mechanised scalers •• Polishing teeth •• High pressure 3:1 air syringe (NB Risk of aerosols could be reduced when using a 3:1 if only the irrigation function is used, followed by low pressure air flow from the 3:1 and all performed with directed high volume suction. Dry guards, cotton wool or gauze can also help with drying and moisture control) •• Opening teeth for drainage has now been added to this list.

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Non-AGPs •• Examinations •• Hand scaling with suction •• Non-surgical extractions (NB If this became a surgical extraction, a slow speed reducing handpiece could be used for bone removal, with cooling provided using saline dispensed via a syringe along with high speed suction. If this is not a suitable option, temporisation or referral would need to be considered) •• Removable denture stages •• Removal of caries using hand excavation or slow speed handpiece if necessary If it’s possible for you to reserve one of your surgeries for AGPs this may be a good solution. There is currently no data available to assess the risk of SARS-CoV-2 transmission during dental practice or to determine whether DHCPs are adequately protected when providing dental treatment using standard precautions. The evidence review will continue to be updated in light of emerging evidence for this new pathogen. Of course there is the risk, not only of infection for the whole dental team, but also patient to patient infection. Consequently there will be an even greater emphasis on hygiene, PPE, decontamination and infection control. Measures to reduce aerosol Consider purchasing medically certified air purifier units for your surgery/ies and waiting room, such as the Radic8 Viruskiller which is proven to destroy 99.9999% of certain viruses in a single pass. Air purifiers may reduce the time you need to leave between patients. For further information and prices, please check out our equipment website.


Viruskiller

™

Kills 99.9999% of viruses Leading the global fight against airborne and droplet viruses, and perfect for all areas of the dental practice, the Radic8 Viruskiller neutralises 99.9999%* of certain viruses in a single air pass. Protect your staff and your patients with this patented technology which neutralises all airborne pathogens and viruses through a combination of filters and air sterilisation. Even mercury vapour and other gases are neutralised. *

The patented, core technology has been tested against Coronavirus DF2 (not against SARS-CoV2), Adenovirus, Influenza virus and Poliovirus.

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The face of how we operate is going to change. The Radic8 Viruskiller is good. And it works. Andrew Parashchak

Click here

to find out more about the Radic8 technology

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Watch on YouTube

The face of how we operate is going to change. The Radic8 Viruskiller Dentistry After Covid-19: technologies is good.Clear And itair works.

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Webinar Hosted by Mark Cronshaw, Amery House Dental Practice, Andrew Parashchak Cowes and Director Dental Laser Training Academy Ltd

Watch on YouTube

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Infection control

Aerosol generating procedures The use of a 60 second pre-procedural mouth rinse along with the use of high volume suction apparatus significantly reduces the aerosol contamination and hence chances of cross-infection. Chlorhexidine, which is commonly used as a mouthrinse in dental practice, may not be effective to kill 2019-nCoV. Since 2019-nCoV is vulnerable to oxidation. A mouthrinse containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone is recommended, for the purpose of reducing the salivary load of oral microbes, including potential 2019nCoV carriage. A preprocedural mouthrinse would be most useful in cases when rubber dam cannot be used. Click here to see a study on the most effective mouthwash to reduce the potential concentration of Covid-19 in the oral cavity. And here for a useful white paper. Ventilation will also be very important. You will probably need to open the windows when AGPs are used. There are several other practical measures which can be taken to reduce aerosol splatter and these include: •• Use high volume intra-oral evacuation for treatments that involve an AGP (aerosol generating procedure). Click here to find out more about Isolite and Isovac which have been proven in 3 clinical trials to reduce by 90% the aerosol and moisture created during dental procedures. •• Use a high volume extraoral evacuator. Henry Schein have been researching and assessing the available and technology. •• Rubber dams also offer protection and should be incorporated for use within all aerosol-generating procedures. For routine hygiene procedures, a split dam technique may be an option. Consider using electric contra angle handpieces rather than high speed turbines. If you don’t have a chair motor, BA offer a plug and play motor to convert the chair for this purpose.

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Electric ones provide a consistent torque that does not decrease with resistance and higher load. Other advantages of electric handpieces include: •• They tend to produce a smoother and more precise cutting edge, due to the stable speed. The electric handpiece is more efficient at cutting various materials used in dentistry, especially machinable glass ceramic, silver amalgam, and high noble alloy, than the air-turbine handpiece. •• Smaller head diameter results in a better sight of the preparation area. Patients tend to prefer electric handpieces because they are quieter and don’t produce the same vibratory sensation. •• Most models are equipped with an LED light. •• Ultrasonic scaling generates significant aerosol. Hand scaling is a minimally invasive approach to periodontal care which reduces patient discomfort from the sensitivity linked with root surface instrumentation. It also appears to give the same long-term results in terms of treatment outcomes. Some US states are recommending hand scaling only. It may be prudent not to polish until further advice has been issued. Consider buying some new scalers with silicone, ergonomic handles. Good posture and the possibility of incorporating reinforced scaling techniques to reduce repetitive strain, carpal tunnel and tendonitis may further help with long-term use of hand instruments. View Imogen Fox’s article on COVID-19 and periodontal management with a response from Professor Iain Chapple. •• Consider using a laser where possible. For example, the Waterlase uses 80% less water compared to the ISO 14457 recommended flow rate for high-speed handpieces.


Aerosol generating procedures 90% of aerosols can be removed with proper high volume evacuation. Studies show that Isolite is more effective in reducing aerosols and spatter than using a rubber dam + HVE, or an HVE alone.

Not only that, but because Isolite provides continuous isolation, retraction, and suction, you will not require an assistant to evacuate liquid and debris. •• Sealant procedures can be done up to 25% faster •• Sealants are 95% intact at 12 months

•• You can increase patient satisfaction by 69%.

“With conscious sedation, it’s extremely important that we protect our airway. That’s one of the main reasons that I use the Isolite, not only because I am protecting that airway, but also it makes me be more efficient since I can be working on two quadrants at the same time.” Dr. Ana Vazquez

Click here for more information

“I’ve worked without an assistant, using an Isolite, not just for having it as an extra set of hands, but also for evacuating aerosols which is incredibly important at this time.” Dr. Laskin

•• You can reduce chair time by 48%

Dental devices and procedures known to produce airborne contamination Ultrasonic scalers

Considered the greatest source of aerosol contamination; use of a highvolume evacuator will reduce the airborne contamination by more than 90%

25 to 30 kHz High aerosol content

Air polishing

Airborne contamination is nearly equal to that of ultrasonic scalers; available HVE suction devices will reduce airborne contamination by more than 90%

High aerosol content

Water syringe

High volume flow of pressurised air and water is nearly equal to that of ultrasonic scalers; high volume evacuator will reduce contamination by nearly 99%

Predominantly splatter

Sonic scaler

Airborne contamination is somewhat less than ultrasonic scalers; use of a high volume evacuator will reduce the airborne contamination by more than 90%

6 to 8 kHz: air driven High aerosol content

Tooth preparation with high-speed handpiece

Minimal airborne contamination if a rubber dam is used

6 -7 kHz: air driven 3 kHz: electric 1:5 Combination of aerosol and splatter

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Infection Control

Check out our daily PPE availability here

PPE and Masks PPE and masks: FFP3 mask, eye screen, apron and gloves are essential for all patient contact for non-COVID-positive patients. This recommendation will remain in place until the current trajectory of COVID has flattened. For other direct patient care, a fluid-resistant (type IIR) surgical mask remains appropriate. Government advice for PPE to use with, and without, AGPs (including advice for donning and doffing) can be found here. There is a very helpful document from the European Centre for Disease prevention and Control here. And there is a useful video here. Perform hand hygiene before putting on PPE. The order for putting on PPE is apron or gown, surgical mask or respirator, eye protection and finally gloves. For removal, gloves are firstly removed, followed by the apron or gown, eye protection and finally mask or respirator. Hand hygiene should immediately follow removal of PPE. Check out the henry Schein guide to masks, types of masks and their properties here Click here to find out how much extra protection an FFP3 mask offers over FFP2 in the dental surgery. From the evidence presented, there would appear to be small

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additional protection (0.4%) offered by FFP3/ FFP2 masks compared to a surgical facemask during aerosol generating procedures in the dental environment if high volume suction and rubber dam are used in combination. In the absence of rubber dam this difference increases to 7%. If your FFP3 mask has an exhalation valve, you should consider using a surgical mask to cover it to protect the patient. Valved FFP3 masks may represent a risk by directing unfiltered exhaled breath toward a patient when asymptomatic clinicians can be COVID positive. Further advice on this from the BAOS and BAOMS can be found here. There is a lot of useful information from Public Health England and the FGDP including which PPE to use for different clinical settings. Explore your PPE options and ensure that you have an adequate supply of FFP3 masks (currently in short supply and unavailable from Henry Schein though we are working hard to source them). Unfortunately, it is no surprise that at this time, counterfeit and non-compliant PPE products are appearing on the market. Click here for more information on mask specifications and further contact details.


For more information on staff uniforms, click here

Gowns The NHS and Public Health England recommend the use of long-sleeved disposable fluid repellent gowns (covering the arms and body) or disposable fluid repellent long-sleeved coveralls/apron for aerosol generating procedures or when working in higher risk areas. Staff need to be trained in the safe removal of coveralls. If non-fluidresistant gowns are used, a disposable plastic apron should be worn underneath. Where an AGP is a single procedure, PPE is subject to single use with disposal after each patient contact or procedure as appropriate. If wearing an apron rather than a gown (bare below the elbows), and it is known or possible that forearms have been exposed to respiratory secretions (for example cough droplets) or other body fluids, hand washing should be extended to include both forearms. Wash the forearms first and then wash the hands. See article on What is the most appropriate gown/apron for preventing Covid-19 contaminated fluids transfer in dental practice? You may consider purchasing an industrial washing machine so that staff are not taking infected garments out of the practice.

For instructions on laundering re-usable gowns from the Health and Safety Executive click here. The US Centers for Disease Control and Prevention also recommend that procedures are established to routinely inspect, maintain (eg mend a small hole in a gown, replace missing fastening ties), and replace reusable gowns when needed (eg when they are thin or ripped). COVID-19

Quick guide – gown version

Putting on (donning) personal protective equipment (PPE) for aerosol generating procedures (AGPs) This is undertaken outside the patient’s room. Pre-donning instructions • ensure healthcare worker hydrated • tie hair back • remove jewellery • check PPE in the correct size is available

1

3

Perform hand hygiene before putting on PPE

2

Put on the long-sleeved fluid repellent disposable gown

4

Eye protection

Respirator Perform a fit check.

Gloves

Donning AGP PPE Guide

Click here COVID-19

Quick guide – gown version

Removal of (doffing) personal protective equipment (PPE) for aerosol generating procedures (AGPs) PPE should be removed in an order that minimises the potential for cross contamination.

1

The order of removal of PPE is as follows:

Gloves – the outsides of the gloves are contaminated Clean hands with alcohol gel

2

3

Gown – the front of the gown and sleeves will be contaminated

Eye protection the outside will be contaminated

4

Respirator

Clean hands with alcohol hand rub. Do not touch the front of the respirator as it will be contaminated

5

Doffing AGP PPE Guide

Wash hands with soap and water

Click here

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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HORTON CONSULTING'S VIRTUAL COMMUNICATION PROGRAMME This online training programme specially created by Horton Consulting will help you futureproof your dental practice for the new normal.

This course has been designed with the entire dental team in mind, to support effective communication in the current and post COVID-19 dental setting. WHAT WILL THIS COURSE PROVIDE YOU WITH?

Usual price: £1799

Intro price: £1499 This course contains 17 subject areas of training. Henry Schein We have broken the chapters into 5 phases and each customers price: £1399 phase will be released in blocks. (quote code HCVCS at checkout) Phases 1 and 2 are available now. Phases 3 - 5 are released weekly thereafter The training is backed up with resources such as manual, scripts, forms, email and letter templates, how to documents and much more!

Phase 1 • Introduction to implementing virtual and tele communication. • Preliminary phone calls. • Marketing and branding for a virtual communication. Phase 2 • Booking a virtual new patient consultation. • Preparation for a virtual consultation. • Virtual in treatment reviews. • Emergency triage system. Phase 3 • Virtual dental health review. • Virtual gum health review. • Handling plan patients.

Phase 4 • Virtual new patient assessment. • Virtual treatment options. • Virtual free consultation for new patients. Phase 5 • Post virtual communication feedback. • Post in practice appointment feedback. • KPIs / tracking. • Webinars for patients.

Book a free demo

Check out the videos for a full overview of the course and each chapter! 18

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COVID-19 Safe ways of working

A visual guide to safe PPE Aerosol Generating Procedures or High Risk Areas

Eye protection to be worn on risk assessment

Eye protection eye shield, goggles or visor

Fluid resistant surgical mask

Filtering facepiece respirator

Disposable apron

Long sleeved fluid repellent gown

Gloves

Gloves

Clean your hands before and after patient contact and after removing some or all of your PPE Clean all the equipment that you are using according to local policies Use the appropriate PPE for the situation you are working in (General / AGPs or High Risk Areas) Take off your PPE safely Take breaks and hydrate yourself regularly

For more information on infection prevention and control of COVID-19 please visit: www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

Š Crown copyright 2020. Public Health England Gateway Number 2019296. Version 1 April 2 2020

General contact with confirmed or possible COVID-19 cases

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Infection Control

Infection Control Other Factors Your team •• Consider testing your team for Covid-19 regularly. Screen them at the beginning of their shift for fever and respiratory symptoms. Document shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and leave the workplace. •• Provide masks and hand gels for your team to use outside the practice and at home. •• All team members should wear masks and goggles at all times in the practice. •• Consider double gloving: once treatment is finished take the second pair off, then doff remaining PPE with the first pair. If required use alcohol hand gel to disinfect the first pair of gloves as required during doffing. •• Create a disinfection protocol. For example, before staff leave the clinic encourage them to remove their clothes and apply disinfectant solution to all exposed skin including the face and the neck. All used clothing should be bagged and immediately laundered. Upon arriving at home all staff members should shower for a thorough full body wash of at least 15 minutes before changing into fresh clothing. •• Make sure you are familiar with all the latest infection control advice. Dentisan has lots of useful videos, education, infection control training and CPD (both online and inpractice). Their products are exclusively available from Henry Schein. If you are initially quiet when you re-open, it could be a good time to run an in-practice infection control refresher training course for your team. Click here to book. •• The ADA is recommending (interim guidance) that DHCPs may use extraoral dental radiographs such as panoramic radiographs or cone beam CT, as appropriate alternatives to intraoral dental radiographs during the outbreak of COVID-19, as the latter can stimulate saliva secretion and coughing. •• Use resorbable sutures to eliminate the need for a follow up appointment.

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•• Minimise your use of 3-in-1 syringe as this may create droplets due to forcible ejection of water/air. •• Stay on top of the new infection control products which are being launched to combat COVID-19 – for non-dental as well as dental equipment. •• Use wipe clean keyboards where possible. •• Consider a respiratory protection programme eg a medically certified air purifier unit, overhead uv-c decontamination or a negative pressure room in high risk settings, where patients with suspected or confirmed COVID-19 may be isolated). •• Think about the flow of movement within your clinic. There may be some recommendations for patients to enter one way and healthcare workers to enter another - at least for patients requiring isolation treatments (eg those with suspected COVID-19, discharged from hospital in the last 14 days or requiring an AGP). •• Whole room sterilisation will be required between patients. When an AGP has been undertaken, it is recommended that the room is left vacant with the door closed for 20 minutes in a negative pressure isolation room or one hour for a neutral pressure room prior to performing a terminal clean. •• You will also need a clean room where staff can get changed in and out of PPE. •• Hypochlorous acid is rapidly emerging as the new go-to sanitiser during the COVID-19 pandemic. HOCl is being widely used in South Korea in their battle against COVID-19, disinfecting everything from food to people to hospital wards and their mass transit systems. Looking at the way in which they have taken control of the spread of the virus it is clear to see that HOCl can also help the UK to gain the upper hand in this struggle. How does HOCl compare to other common disinfectants such as Bleach? They are actually from the same chlorine family. Research shows that both bleach and HOCl kill bacteria, fungus, spores, and viruses. However, bleach is highly irritating to the


Infection Control

Check out our daily PPE availability here

eyes, skin, and lungs—and inhalation over long periods could be carcinogenic. In contrast, HOCl has a mild, temporary chlorine-like smell that dissipates quickly, it is non-irritating, and it does not have poisonous side effects. •• When compared to alcohol-based sanitisers, HOCl fares even better. Whilst both are effective against viruses, fungi and bacteria, alcohol-based sanitisers do not kill bacterial spores. It can be used to treat dental unit water lines. Click here to see how it can be used in-practice. •• Consider purchasing a flag system for your surgeries to indicate which of them are clean and which are waiting for a clean. •• Following treatment, write notes in a different room. •• Use waiting room and operatory chairs that can be wiped down (no seams or cloth). •• The shoes of healthcare workers and the floor can be a hotspot for the virus so floors should be cleaned more frequently and disposable shoe covers or shoe sole disinfection may be incorporated into the contamination control measures. •• Consider purchasing more single use products and disposable items. Try to purchase environmentally-friendly products. Henry Schein will be introducing a range of products to help you manage infection control, such as door openers, screens to protect your receptionists and customers and social distancing stickers to display in your waiting room to indicate socially acceptable distances between patients. More information to follow.

Waste management

•• Initial Medical, part of the Rentokil Initial Group, delivers expertise in waste management. Their team can provide all the clinical and dental waste management services you may need, and can offer guidance on how to stay compliant. They also offer a range of specialist disinfection services and surface hygiene products which kill up to 99.9999% of pathogens and have proven efficacy against Coronavirus*. *Independently tested against feline Coronavirus, a

surrogate virus for Coronavirus. Source: Steri-7.

Their All-Purpose Disinfection service is suitable for all dental practices that protects against microbial infection and helps maintain a high level of hygiene. This service includes a specialist disinfection of all key areas and touchpoints, alongside a ULV disinfection fogging or spray, which uses extremely small droplets of disinfectant fog to enable the treatment of large areas in a short space of time. They can also provide a Specialist Disinfection service to assist with Coronavirus containment and control when there is a confirmed or suspected case of Coronavirus. Delivering a highly professional and legally compliant service in the most responsive way, when you need it. Dental practices who are customers of Initial Medical, also have access to their CPD-accredited online waste management training. For more information visit any of the above links or call 0870 850 4045. Henry Schein customers get a 10% discount across all contractual services and 5% discount across all consumable products.

Web Links •• Dental Practices •• Coronavirus Waste Management •• Coronavirus Containment and Control Assistance •• Surface Hygiene •• Free Compliance Auditing Survey

Disinfection services

•• Consider disinfecting your site’s water supply before you reopen. TWC (Services) Ltd – Water Specialist offer advice and may be able to assist with normal compliance whilst your practice is mothballed. Tel: 01869 323466. Additional reading •• Interesting article on ‘Emerging and Future Challenges for Dental and Oral Medicine’ can be found here

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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The new normal

The new normal As lockdown eases and dentists begin to resume their work, what will the new ‘normal’ look like for your dental practice? What’s changing? Here is a collection of all the things you will need to consider before finally opening your doors. See also our useful information, links and resources on page 31 Staff changing room

•• Provide an area for your team to don and doff their PPE •• Airtight laundry basket with bag for easy and safe removal •• Instructions for donning and doffing PPE clearly displayed on wall

•• Air purification system such as Radic8 Hextio for small spaces •• Hand gel and PPE dispenser for the team

•• Disinfectant solution to apply before they leave the clinic •• Tissue dispensers

Radic8 Hextio

Reception area

•• Clear screen to protect receptionist •• PPE for receptionist

•• Individual phone headsets for each staff member

•• All forms pre-filled in for fully contactless registration •• Contactless payments or provide branded pens for patients to keep •• Wipe clean keyboards •• Tissue dispensers

•• Minimal paperwork and clear surfaces Front door

•• Screen patients before they come for their appointment. Download sample screening form.

•• Write to them and ensure they know what to expect when they arrive and to come alone where possible •• Advise patients to wait in car or outside the practice until they are called

•• Electric doors for minimal contact, leave front door open (will also assist with ventilation ) or escort each patient into the practice •• Poster in window to show how are you are addressing COVID-19 to maximise patient confidence:

•• Advertise that you are a clean air practice with Radic8 virus killer certification •• Specify that you are now a fully contactless practice •• Display certificates for water treatments, COVID-19 decontamination treatments etc

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Waiting room

•• No magazines, drinking water unit

•• Chairs 2m apart and seamless wip

•• Social distancing stickers on the f

•• Air purification system such as Ra

•• 3-D printer for printing your own P •• Tissue dispensers

•• Shoe disinfection mat or provide

•• Add patient toilet facilities out of s


•• Correct PPE

•• Infection control SOPs

•• Air purification system such as Radic8 VK401 Window open for ventilation •• No air-conditioning

Radic8 VK401

The new normal

Surgery one (non-AGPS)

•• Chair with continuous sanitisation •• Disposable covers on headrest

•• Rubber dam – use for appropriate procedures to reduce aerosol •• High-volume evacuation such as Isolite/ Isovac to reduce aerosol

Zyris Isolite

•• Chemo mechanical caries removal (reduced drilling)

Surgery two (AGPS)

Surgery one (non-AGPS)

•• Extraoral evacuation e.g. VacStation •• Rubber dam

•• Single use items or disposable

3Shape Trios Move

•• Extraoral radiography where appropriate

•• Electric handpieces (generate less aerosol) •• Special water line cleaning

•• Consider digital solutions to reduce infection transmission •• Tissue dispensers

•• Minimal paperwork and clear surfaces Surgery two (AGPs)

•• If possible, undertake all aerosol generating procedures in a single surgery •• Air purification system such as Radic8 VK401 Window open for ventilation

•• Thorough cleaning process required in between patients including chairs, keyboards, curing lights, handpieces etc. •• Door sign to show where the surgery requires decontamination or is ready for use •• Tissue dispensers

•• Minimal paperwork and clear surfaces Hygiene area for patients

•• New PPE dispenser including shoe covers

•• Sink for patients to wash their hands with automatic tap and soap dispenser •• Hand sanitising gel for patients

•• Table for patients to bag their belongings next to PPE dispenser

ts, toys etc

•• Contactless thermometer for temperature screening

pe down material or cover them

floor

adic8 VK102

•• COVID-19 test with instantaneous results (when available) Radic8 VK102

PPE in addition to your usual dental products. protective shoe covers

service

•• Preprocedural mouth rinse with 1% hydrogen peroxide or 0.2% povidone •• Patient to don disposable masks and disposable gloves and advised not to touch anything •• Tissue dispensers

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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The new normal

The new normal Your back to practice protocol

The office of the Chief Dental Officer (CDO) for England has provided a Standard Operating Procedure (SOP) for the transition towards the resumption of the full range of dental provision. There are also earlier summary guidelines on how dentists in England should prepare for the resumption of routine care. For Wales, click here to view the document for the COVID-19 de-escalation plan. For Scotland, click here.

For Northern Ireland click here.

The Irish return to practice protocol can be found here.

The DDU have also made their position clearer.

Dental practitioners are encouraged to review and make the appropriate adjustments to protocols, procedures and practice infrastructure for the safe and effective resumption of routine dental care. Further guidance will follow, which will cover urgent dental care and alternative (non-AGP) evidence-based care planning. There are several other official toolkits available to help DHCPs plan for their postCOVID-19 world. These include proposals for communications, checklists, and strategies for keeping both patients and staff safe in the waiting room, chairside and the office. The American Dental Association toolkit can be found here. Advice from the New Zealand Dental Council can be found here. Guidance for resuming deferred and preventive dental care from the California Department of Public Health can be found here As part of the preparations for recommencing the provision of dental treatments, Dentinal Tubules have put together a playlist of recommended Tubules Talks that combine

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all these training aspects.

This will also help all practice staff approach their return in a safe and practical and sustainable way, in line with the CDO’s new SOP list of training requirements.

BDA

BDA members can also access the BDA’s new toolkit for returning to face-to-face care (login required). Before performing urgent care, the BDA strongly advises that you carry out a full risk assessment, including telephone triage, before agreeing to see any patient face-toface. They have developed risk assessment guidance to help members do this: click here for COVID-19 risk assessment guidance for members (login required). It has been updated with additional recommendations on record keeping. It is likely this guidance will change often so please keep an eye on this page for new versions. We urge you to read this guidance to support you in providing urgent care.

Victor Chan, the Chair of the BDA’s International Affairs Committee, has taken a look at how other countries are preparing to increase dental activity as lockdown restrictions are eased. He takes a look at what countries such as Australia, Norway, New Zealand and Canada are doing on important issues such as personal protective equipment (PPE) and aerosol-generating procedures (AGPs). These are unprecedented times. As the UK looks towards opening up dentistry again, there is a lot we can learn from what is being tried elsewhere. Read the SOPs for the Urgent Dental Care Centres for some ideas and planning.


The new normal This is a very helpful video that shows how Dr Rafi Romano in Israel manages his patients. Watch the Dentinal Tubules webinar on Back to practice and respiratory protection equipment. Here is the video that Portman Dental Care have developed to demonstrate the new patient journey for their practices. Here is an example video of the patient flow and practice set-up, developed by HEE Yorkshire & Humber Urgent Dental Care Centre. Here is the Dental Beauty video for patients to explain the new process

The new patient journey

Make sure your patients know what to expect before they come back in person. Send them detailed instructions on what measures you have implemented and what they will have to do when they arrive. Welcome back reassurance sample letters can be found here. •• Pre-appointment screening – call your patients 24 hours before their appointment and ask some screening questions. In-practice patient screening takes place when the patient arrives. Here is a useful screening form for you to use on both occasions. •• The first step is to identify suspected cases of COVID-19. Measure the temperature of the patient using a contactless forehead thermometer. Do you have a fever or have you experienced a fever within the past 14 days?

After the screening questionnaire: If the patient replies yes to any of the screening questions, and his or her body temperature is below 37.3°C, postpone the treatment until 14 days after the exposure event If the patient replies yes to any of the screening questions, and his or her body temperature is 37.3°C or higher, postpone treatment and follow advice on the current guidelines for isolation However, if the patient replies no to all the screening questions, and his or her body temperature is below 37.3°C, treatment should be permitted Finally, if the patient replies no to all the screening questions, but his or her body temperature is 37.3°C or higher, the patient should be directed for further medical care (Peng et al, 2020).

Other considerations

•• Consider team shift working one team in the morning one team in the afternoon. Applies to treatment staff cleaning staff and lab staff. •• Communicate the measures you’re taking to make your practice a safer environment by including details in your reminder messages. Prepare templates for your communication during this downtime. •• Consider installing a ‘hygiene check-in station’ where patients can wash their hands, sanitise and take their temperatures with a contactless forehead thermometer before their appointment. •• Encourage patients to useless contactless payment systems such as Apple Pay. However you can also purchase adhesive barrier film to put over the keys on your PDQ and remove after each patient has input their pin. •• Follow-up your patients after 14 days to check whether they have developed any symptoms post-appointment. •• Use social media channels to stay in touch with patients and also attract new ones.

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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JSP Media Group

NEW PATIENT

JOURNEY VIDEO With these changing times ahead, how are you telling your patients about the new patient journey? Your patients will need to get used to the ‘new normal’ in your practice and one of the best ways of communicating this is via an animated video.

Buy Now

£97 inc V AT

JSP Media Group have created 3 different colour variations of the same video, which contains a voice-over and accompanying music. The video itself is divided into 4 parts: • • • •

Before Your Arrival – this section explains to patients what to expect before they set foot into the practice On Appointment Day – this tells patients to arrive on time wearing a mask and the logistics once they come in

Inside The Practice – this informs them about their temperature being taken and that they will be required to sanitise their hands

Before Visiting Us – this advises patients not attend if they have any symptoms of COVID-19

The video is customised with your practice logo and can be featured on your social media channels, your website or even sent out as an e-mailed link to inform your patients of the changes you are making in practice.

3 different versions are available for you to choose from:

Multi-coloured version

Dark version

Light version

You can purchase by clicking here Once you have made the purchase, just email your logo to JSP Media Group at info@jspmediagroup.com and specify which version you want.

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The CSR Coach

Positioning your Business for Success in the Post-COVID World

After a long lockdown, face-to-face dentistry is returning. But the world has changed. Our teams, patients and the public continue to live through a situation that is unprecedented in our lifetime. And the expectations of business from our staff, patients and the public have come more sharply into focus. Even before lockdown, almost 90% of people said they expected us to ‘be responsible’: keeping our teams safe, well informed and cared for, looking after and communicating with our patients and doing what was possible to help our communities. The businesses that did this well have avoided many of the problems that those that didn’t are facing right now - departing patients, staff reluctant to return from furlough, or causing disruption with negative attitudes.

The key to post-Covid recovery The businesses that are doing the best coming out of lockdown are those who have continued to act responsibly and do the right things. There’s a reason for this. The future of successful business is holistic. And our communities are looking to us to show them we are doing the right thing. They are looking for Corporate Social Responsibility (CSR). The CSR Coach helps businesses to grow with purpose. We make sure their business covers all their social and environmental responsibilities effectively and builds a reputation as the kind of business that people want to work for and buy from.

What can CSR do for me? • Help you to attract and retain a more engaged team - increase productivity, reduce staff turnover • Fulfil your environmental responsibilities - allay your staff and patients’ concerns • Engage with and impact your community and good causes - make a difference and boost team morale • Demonstrate simply and clearly that you’re a responsible business - build your reputation and increase trust

If you’re like the many practices we talk to, you’re more and more aware of the need to think about how responsible your practice is. Demonstrating that you’re environmentally and socially responsible are now imperative if you want to reassure patients and staff that you’re a ‘good’ business to deal with - that you have a conscience, and that you care about your community.

CSR Coaching We understand that you’re busy and might need some help putting a plan in place. Perhaps you want an expert to handle everything for you, or some additional input to guide your team. Whatever stage you are at, we have a coaching solution to help you - from group webinars to face-to-face consultancy, and bespoke planning and supported implementation. We can take the thinking off your desk and get a simple and effective CSR plan in place that matches your business and team. Download our free 60 Minute CSR Plan at TheCSRCoach.uk

A business should never be considered complete until it has its own CSR, however big or small. Our CSR projects make us appreciate our current surroundings and have brought us together as a team, which is invaluable and something that money simply can’t buy. Prof Joe Bhat - Director - Moor Park Specialist Dental Centre

Schedule a complimentary call to discuss how certification can help you stand out AND build your business. Or email mark@marktopley.co.uk to find out more quoting code HSD-02021.

10% discount for Henry Schein customers

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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PROTOCOLS AND SOPS Protocols and SOPs The Office of the Chief Dental Officer (OCDO) for England has provided a Standard Operating Procedure (SOP) for the transition towards the resumption of the full range of dental provision.

The FGDP has produced its guidelines: Implications of COVID-19 for

the safe management of general dental practice: a practical guide The DDU have also made their position clearer, click HERE.

For Wales, click HERE

Association of Independent Dental Surgeons (UK & Eire) 31st May 2020

PANDORA Group: An Independent Think Tank Dear Colleague:

Pandora Dental represents many of the UK & Eire’s leading independent dental practices and was founded in recognition of the need for evidence-based best practice and guidance during the Covid-19 pandemic. They provide information and feedback from highly experienced primary care dental clinicians to support the key policy and decision makers in UK dentistry.

In conjunction with the IndepenDent Owners Group, they have recently launched their new Back to Work Protocol.

In anticipation of the reopening of private/independent dental practices closed since late March we offer here some templates for the required additional documentation following Covid-19 to supplement practice manuals in accordance with the requirements of the CQC and GDC. As the evidence base is in flux this can only be viewed as a living document. Consequent to the changing requirements adoption of this document must be the subject to continued and frequent review. Although every effort has been made to check the accuracy of the materials presented here within the context of the current evidence base it is an absolute requirement that ultimate ownership of the final template must by necessity rest with the individual practitioner. It is not a perfect document however we trust that it will prove of considerable help to you as you face the challenges of the post covid-19 era. We have endeavoured very hard indeed to produce this set of working documents and they represent many hundreds if not some thousands of hours of work by our dedicated team. My particular thanks are due to the following individuals who worked tirelessly to help colleagues such as yourself return safely to practice:

• • • • • • • •

Dr Tasleem Ahmed Dr Nicola Gore Dr Ashish Deved Dr Michelle Wyngaard Dr Petros Mapanda Dr Nadia Raitchev Dr Ivo Raitchev Dr Genevieve Edwards

Yours sincerely

• • • • • • •

Dr Mario Correia Dr Mark Becker Dr Maheshi De Silva Dr Jeremy Bliss Dr Cohan Rajan Dr Robin Horton Dr Raj Wadwhani

Dr Mark Cronshaw, BSc BDS LDSRCS (Eng) MSc Dental Surgeon President, Pandora Dental: Association of Independent Dental Surgeons (UK & Eire) Email: Drmarkcronshaw@outlook.com Web: Pandoradental.org.uk

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For Scotland, click HERE

For Northern Ireland, click HERE

For Ireland, click HERE

See how other countries are preparing to reopen

Documents from Pandora PANDORA CHECKLISTS • Personal protective checklist • Chairside checklist • Consent to dental treatment during COVID-19 • CSDG COVID-19 daily screening log • Face fit test certificate • Fit testing questionnaire and log • Tips on what your staff should say during COVID-19 • RPE policy with posters DENTAL UNIT WATERLINES • Background on dental waterlines with links • Legionella policy • Legionella risk assessment template • Waterline management EMOTIONAL AND HEALTH SUPPORT FOR STAFF • What are we doing to keep you and our team safe? • Contact list for wellbeing support • 10 tips to help manage anxiety - every mind matters

OTHER GUIDANCE DOCS • FGDP guidance on record keeping PATIENT CONSENT FORM • Patient consent form for COVID-19 RISK ASSESSMENTS • COVID-19 risk assessment for the surgery • COVID-19 risk assessment cleaning • COVID-19 risk assessment hand washing • COVID-19 risk assessment social distancing • COVID-19 risk assessment checklist SOPS AND BACK TO WORK PROTOCOL • Pandora dental and the independent practice owners UK - Protocol to get back to work • SOP version 5 • Appendix to the SOP • Front office protocols • CDO England Scotland Wales Ireland guidance letters • Glossary of terms

MARKETING TO PATIENTS • PPE training and marketing for patients (customisable) • Welcome back letter for Campaign+ • Welcome back letter

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Diary management

The new normal EXACT

As you prepare to return to work, there are some essential tasks you must complete within EXACT before re-opening. To guide you through these tasks we have compiled a collection of ‘how-to’ videos that are now available on SOE’s YouTube channel Topics covered include: Patient Communication •• Enable appointment reminders and editing SMS and email templates with new protocols •• Enable automatic recall reminders •• Create lists of patients to send mass communications to (email or SMS) about reopening and new protocols                       Patient Management •• Import Covid-19 custom screens •• Consider contactless arrivals and departure Diary management •• Prioritise patients with ongoing treatment using Care Manager •• Use the Short Notice List to increase diary utilisation •• NHS practices – tidy open UDA courses of treatment and rollover your NHS contract •• Creating a wait list for those patients waiting to book specific treatments

Contactless arrivals and departures

•• Prepare for contactless arrivals and departures – the fewer physical touchpoints there are in your practice the less risk there is of transmission. Sending forms direct to patients’ mobile devices prior to the appointment and encouraging self check-in via a QR code and kiosk in reception, combined with contactless payment options on departure, all help to minimise risk. •• Treatment plans can be emailed in advance having discussed them with the patient so by the time they come in you know exactly what they’re coming in for. Access to these services is free of charge from Software of Excellence until the 1st of September. Register your interest here 30

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Bounceback Review

•• Book a complimentary Bounceback review with SOE: during the call, we will consider both risk and fear and how you can navigate them. We will look into the increasing demand for a fully contactless service and the steps you can take to ensure you can provide this contactless experience. In this way, you, your patients and your team will be comfortable returning to work when you reopen your practice. The call will take a maximum of an hour, at a time of your choice. And during this time we will create a bespoke action plan around the following: ••   Financial                   Impact                  •• Patient Communications •• Team Engagement This plan will aim to get you and your practice team recuperating lost earnings and get you returning to a full diary in the safest way possible. To book your consultation simply complete the form and we’ll be in touch to confirm your appointment. •• Utilise your business data to understand how you can optimise your business recovery. •• Build a private income stream to fill the gap of patients not coming in for checkups and hygiene appointments etc. •• If you offer aligner treatments, consider using your downtime to build a pipeline of patients who are interested in orthodontic treatment. This may well also attract new patients to your practice which will help to replace those who don’t come back. •• Create a pipeline of whitening appointments by booking appointments for your patients (and taking payment) through a video consultation. •• And a last word, don’t forget to do a full stock check and make sure you use up short dated stock first.


Think about your diary zoning plans and sessions. Which patients do you want to come first thing, last thing and in between? Will you be using two surgeries? Can you limit one surgery (even for part of each day) to AGPs? Manage your appointment planning for reopening by calling and prioritising your patients. Don’t simply rebook patients that have missed appointments during lockdown because your days will be very different. You are likely to see far fewer patients and each will take a much longer time to include prescreening and hygiene measures. So leave a realistic amount of time for each appointment and also for deep cleaning the surgery in between. Your aim should be to retain your existing patients and to reopen in a structured way by prioritising existing patients in need of restorative work and using short notice lists to fill gaps with check-ups. If you end up with general appointments booked up when someone has an emergency, they may go somewhere else if they cannot be seen by you. So formulate your priority list as follows: 1. Existing patients who need urgent restorative work focusing on the most highly productive procedures first to start to rebuild your revenue stream. Don’t forget to train your team on this. 2. New patients. 3. Priority patients for check-ups. 4. Set aside clinics for vulnerable patients (those more likely to develop serious illness: older people, people with underlying medical problems, e.g. high blood pressure, heart problems, diabetes) at the beginning of the day.

Diary management

Diary management and appointment planning for reopening same time. •• Block sessions for patients requiring AGPs and for patients requiring non AGPs. •• Plan your AGP sessions at the end of the day. •• Allow longer time for hygiene appointments with hand scaling. •• Covid-19 positive patient emergency slots can be limited to the end of the day only or they may be referred to your local UDC. It’s likely that hot sites or urgent dental care centres will continue to operate and treat patients who need urgent treatment but have the symptoms of COVID-19. •• Manage your time very carefully and make sure nobody runs over. When are you going to start implementing recalls? Your low risk patients could be moved onto annual checkups. If they’re on a patient plan, explain your decision and offer them a double appointment when they next come in so they still have the same amount of time allocated. Most patients should be happy with that if you’re explaining it well. Don’t forget to book your complimentary Bounceback Review with Software of Excellence for more help on planning appointments for your return to practice.

Other factors

•• Stagger appointments to minimise the number of patients in the practice at the

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Equipment

Rewards members

10% discount off 2+ recommissioning packages

Equipment Technical Service

Before you reopen, recommission your equipment and ensure that it is in good working order. Recommission your treatment centres by cleaning and disinfecting Dental Unit Water Lines. Using a combination of Bioclear and DipSlides it’s possible to ensure that Dental Unit Water Lines are fully compliant with water quality guidelines prior to seeing your first patient. Henry Schein recommissioning playlists are available with detailed demonstrations of what to do with your treatment centre, autoclaves, plant room and handpieces. And if you require the services of our technical team, they can be contacted on 0292 044 2806 (equipment-servicedesk@ henryschein.co.uk). Book early to make sure you get your slot! Undertake any necessary preventative maintenance on your handpieces: for BA International’s handpiece repair service contact 01604 777 700 (info@ bainternational.com). You should have received one of their yellow repair bags through the door of your practice during closure. They can also offer a simple service on handpieces to make sure they are fully functional when you return. Click here for more information and offers.

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Equipment hygiene considerations

If you need a new treatment centre, or you would be interested in upgrading your current chair for continuous sanitisation, look into those which have the best hygiene options as this will be increasingly important for you and your patients. Some chairs (for example Anthos) offer cost-effective fully automated cleaning and sterilisation solutions for dental unit water lines and vacuum systems, as opposed to a manual cleaning process that requires tablets and or/the measuring out of cleaning solutions. View our dental chair comparison matrix for more information. And check out our ex showroom and equipment clearance site here.

Equipment training

Have you purchased equipment in the past but not got round to mastering it? Now would be a great time to brush up on training – there’s lots of information and tutorials available online, so you could spend this time getting familiar with it. Many companies have developed online learning programmes for you to do just this eg Dentsply Sirona, 3Shape, Acteon, Ivoclar, Formlabs. What better time than while you are out of the practice to think about your equipment? What new equipment do you need? Now is a good time to start putting together a business plan for your bank manager.


Equipment

Going digital

And if you are thinking of going digital or investing in an intra oral camera or scanner, research the options online. There are many videos and websites with information and ROI calculators including: •• Henry Schein •• Dentsply Sirona •• Acteon •• 3Shape •• UKdentech •• Ivoclar •• Formlabs

•• Remember intra-oral scanners are less likely to spread infection for both dental and lab teams due to reduced touch points. •• As well as reducing the work and time involved and they will give you more control. •• Hygiene options include autoclavable and single use disposable sleeve options. Plus of course the usual benefits of increased accuracy, consistency of fit, less remakes, less chair time and increased patient engagement and treatment uptake alongside easy patient monitoring. •• Is your lab digital, will they accept traditional impressions going forward?

•• If you already have a Trios scanner, email charlier@ukdentech.com for a free online tips and tricks session on how to get the most out of your equipment. Click here for what can be covered. •• Consider purchasing a 3D printer. Not only can you use it for printing temporaries, splints, mouth guards, surgical guides etc, but you can also print your own PPE. Check our 3D printing ebook to find out more. There is also a Formlabs guide on ‘How to Make Bellus3D’s Face Mask Fitter for COVID-19’ here •• And for the ultimate consider full chairside dentistry which not only offers swift turnaround and minimises infection risk, but speeds up treatment time, gives you maximum control and optimises your cashflow. •• Check out our helpful scanning ebook for everything you ever wanted to know about the subject. You can make use of the government’s Bounceback Loan Scheme to purchase new equipment. See page 34 for more information.

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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Looking after your business

Looking after your business Looking after your staff and patients during this crisis is important, but don’t forget about the needs of your business too. Use this period as an opportunity to take stock. Use the time to strategically plan how to increase your revenue stream, how to service more patients, how to implement new treatment procedures, how to take care of your team members. So prepare to ramp everything up and to focus on the things that can really help your business to grow. A great place to start is with the help of Software of Excellence’s Business Insight webinar series, Navigating COVID-19: how to manage risk and fear, and how to help your practice bounce back. This webinar series includes collated content and advice from the government, the BDA and other dental bodies, as well offering insights from global colleagues which will help you plan your next steps. There are also strategies on how to understand and minimise the impact of the pandemic on your business.

Finances

If you would like some help or advice on flexible payment options, please speak to our finance team on 01332 321702. We cannot promise a quick fix, but there may be some steps you can take.

Bounceback loan scheme

On Monday 27 April the Chancellor announced the new Bounce Back Loan Scheme (BBLS) to support loans of up to £50,000 to small businesses with a 100% government-backed guarantee for lenders. This letter to all accredited lenders under the Coronavirus Business Interruption Loan Scheme (CBILS) sets out the interest rate that Bounce Back Loans will be offered at, and outlines legislative and regulatory changes being made to support the delivery of the scheme. It also clarifies the interaction between lending under BBLS and CBILS.

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Other financial support

Coronavirus job retention scheme covering 80% of workers’ salaries

From 1 July 2020, businesses will be given the flexibility to bring furloughed employees back part time. Individual firms will decide the hours and shift patterns their employees will work on their return - and will be responsible for paying their wages while in work. From August 2020, the level of government grant provided will be slowly tapered and businesses will be asked to contribute a growing share. But crucially individuals will continue to receive 80% of salary while they are unable to work. June and July: government will pay 80% of wages up to a cap of £2,500 as well as ER NICS and pension contributions. Employers are not required to pay anything. August: government will pay 80% of wages up to a cap of £2,500. Employers will pay ER NICs and pension contributions. September: government will pay 70% of wages up to a cap of £2,187.50. Employers will pay ER NICs and pension contributions and 10% of wages to make up 80% total up to a cap of £2,500. October: government will pay 60% of wages up to a cap of £1,875. Employers will pay ER NICs and pension contributions and 20% of wages to make up 80% total up to a cap of £2,500.

Government-backed loans of £330 billion which have been made open to all businesses Business interruption loans, with no interest for 6 months, will be available Business support grant funds £10,000 extra cash grant for the smallest businesses.


•• Agree a mutual contractual variation e.g. reduced hours, longer hours and zero hours. •• LOST (Lay-off Or Short-Time working) •• Redundancy (voluntary, compulsory) •• You wish to introduce a shift pattern and split your dental team, particularly if you extend work hours. This will reduce the whole team’s risk exposure.

Looking after your business

Support for the self-employed currently excludes anyone earning over £50,000. This has an impact on dentists and those in private practice with no access to ongoing NHS earnings. The BDA is lobbying the Chancellor and the Health Minister to extend this financial support. VAT deferral scheme Tax bill deferral For more details click here.

And if you would like more in-depth support with improving your practice profitability and growing your bottom line, Andy McDougall from SpotOn Business Planning (management accountant and dental business coach) offers a mentoring program to create a dental business bounceback plan for your practice, help you consolidate your decisions and transform your financial results. See him in action with a series of informative webinars covering business survival and business revival. Click here to view.

Staff

Ensuring you manage your practice staffing levels against your appointment book will be one of the key challenges facing practices after lockdown. With salaries to pay and income streams diminished, making the right decisions at the right time will be crucial. It’s important to note that despite a wide range of interventions put in place by the Government, the principles of employment law have remained the same and therefore any decisions must be made with this in mind. Outside of any further Government support being available, some of the options that you could consider are: •• Use annual leave or agreed unpaid leave

Whichever option you are looking at, each will come with its own set of risks and procedures. Petaurum can support and advise you, so that any decisions you make about your workforce will not only be the right ones but also legally compliant. If you have an HR question that is keeping you up at night and want some free advice, or you are looking for longer-term HR support, then click here for more info. With all of your other worries about bringing your practice up to speed after lockdown, let Petaurum take HR off your hands. Henry Schein customers get a discounted rate. Watch Petaurum’s video for their top 5 tips to help your business come out of lockdown. The Society for Occupational Medicine has put together a very helpful Return to Work Toolkit.

Contact our service desk via email equipment-servicedesk@henryschein.co.uk

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Leadership

Leadership is about change and movement. Management is about order and consistency - and both are needed right now in equal proportions.

Leadership and management Never before will your leadership skills have been so thoroughly tested. You need to remain strong for your staff, lead by example and make sure that your whole leadership and management team does the same. You must be unified. You need to have a phased return to work plan. Knowledge of the plan should be limited to the management team until the way forward is clear and you are ready to communicate it more widely. You will need an outstanding clinical leader (which might be yourself) to be present in the clinic every day that you’re seeing patients. They will need to be able to read the guidelines and decide what you are doing and why, then design your systems and your training plans. A clinical system, minute by minute of what the patient experience will look like, allowing time to talk to the patient and to deep clean the surgery in between. This is a very responsible role and this person also needs to be a good leader. Also appoint a nurse lead to be available throughout the clinic. Their job will be to reassure, provide support and check systems.  36

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Reassure your team that their safety is a priority and communicate regularly: •• Have online weekly update meetings at a regular set time. •• Have 121 meetings with each member of the team every week when you can speak to them about how they feel, how it’s going and where they need help. •• 121s are needed for the leadership team. •• Have a huddle at the start and end of every session with the team involved.

Other leadership support

•• Create a pleasant break out room where the team can maintain social distancing. •• Have a changing area where the staff can don and doff PPE. •• Create a positive team culture - minimise negative communication within the team by encouraging them to go to their manager or team leader with any concerns. For advice on leadership and team engagement, click here or call 07702 111070 and quote your Henry Schein account number for a discount.


Have your say

Have your say NHS England and NHS Improvement have opened an online feedback hub so that its leaders can listen and respond to the needs and experiences of the NHS workforce at this unprecedented time. We have already received several important contributions from NHS dentists and are seeking to further boost

participation from the dental community. The hub is private and anonymous, and is being run by Ipsos MORI, the independent research organisation. It is open to anyone working in the NHS. Learn more and register.

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The Health & Safety Executive and the Health Protection Surveillance Centre’s ‘Guidance on Managing Infection Related Risks in Dental Services’.

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The Kois Center ‘COVID-19 Resources’.

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Click here

The FGDP’s ‘Implications of COVID-19 for the safe management of general dental practice: a practical guide’.

Click here

Click here

Click here

Denplan ‘Considerations for Re-Opening Denplan practices’

Click here

Pandora’s ‘Back to work protocol.’

The FGDP has a very useful resource library here.

Click here

Alpha Omega on ‘Returning to dental practice: realistic considerations, practical solutions’

Dentinal Tubules on ‘Back to practice and respiratory protection equipment’.

Click here

Click here

NHS England COVID-19 guidance and SOP for urgent dental care systems.

Click here

Dentinal Tubules ‘Risk assessment and protocol for going back to practice’.

Click here

Click here

Julian Perry on ‘How could I reopen my dental practice after COVID-19?’.

Click here

European Association of Periodontology ‘Suggestions for the management of a dental clinic during the Covid-19 pandemic’.

British Association of Private Dentists ‘Return to practice position paper’.

Click here

Click here

BSDHT’s ‘New dental protocol advocated to allow dental practices to reopen sooner’

American Dental Association ‘Return to work interim guidance toolkit’.

Click here

California Department of Public Health ‘Guidance for resuming deferred and preventive dental care’.

Dr. Markus Troeltzsch webinar on ‘Dealing with space infections’.

Click here

Click here Click here

American Dental Association ‘COVID-19 Safety and clinical resources and guidance’.

New Zealand Dental Council ‘Guidelines for oral health services at COVID-19 Alert Level 3’.

Click here

Nissit Patel on ‘How to protect ourselves and our patients post lockdown’.

Click here

COVID-19 Dental Services Evidence Review (CoDER) Working Group ‘Recommendations for the re-opening of dental services: a rapid review of international sources.

Click here

Further reading and additional resources


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A practical guide to help your business bounce back

Now that further guidance and a Standard Operating Procedure (SOP) has been released by the Office of the Chief Dental Officer (OCDO) for England, you will be preparing your staff, your practice, your equipment, your software and your patients for the new normal. This document offers lots of ideas and information to help you do just that. There are playlists to help you recommission your equipment and prepare EXACT for the new messaging, shopping lists for you to select the new everyday items and equipment you will need to ensure safety, recommence treatment, how you can adapt your practice for the new experience, communicate with your patients, make sure you are compliant, prepare your appointment book and give your Click here patients the reassurance they need.

to view online

Essentials for Practice Reopening Your essential guide to the products you will need when reopening your practice

As you return to practice and the start of the ‘new normal’, there is a range of products that you will find yourself needing more frequently, as well as lots of new ones that you didn’t need before. So we’ve tried to make the selection easier for you by filling this brochure with all the topline essential practice reopening products that you will need, to help take some of the strain. Everything is split into the relevant product categories for ease of reference, including PPE, cleaning and infection control products and aerosol reducing equipment. Each category is set up as a mini online shopping list for you Click here to simply add the quantity you want.

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39


What happens next? In the words of Stan Bergman, Chairman of the Board and Chief Executive Officer: “At Henry Schein, we have no doubt that the demand for dental and office-based medical services will rebound once the coronavirus passes.

Henry Schein intends to be there for you on that day and all the days leading up to the full resumption of care, now and in the future. We ask you to rely on us, and we are committed to living up to that promise during this pandemic. Thank you again for relying on Henry Schein.� To see our latest full updates from Stan, please click here

Click here to view the full video

Information and links There is lots more information on the Henry Schein website www.henryschein.co.uk and a Coronavirus resource centre with links, checklists, and useful contacts, updated daily. There is also a list of all the relevant COVID-19 and CPD webinars provided by our partners and suppliers here.

t 0800 028 4749 e info@henryschein.co.uk w henryschein.co.uk HenryScheinUK

Please visit http://www.henryschein.co.uk/gb-en/Dental-GB/LegalTerms.aspx for full terms and conditions. E & OE.

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Planning your Business Bounceback  

Dental Practice bounceback guide and return to work after Covid-19

Planning your Business Bounceback  

Dental Practice bounceback guide and return to work after Covid-19

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