23 Jun 2020  •  Blog, Covid-19, Practice Management  •  6min read By  • Kris Leeson

How I set up a private Urgent Dental Centre during lockdown

In the midst of the COVID-19 lockdown, Kris Leeson, Principal Dentist at Thorpe Dental Group, set up a private Urgent Dental Centre (UDC).

Here, he talks to Suki Singh about the experience, the challenges and the reactions of patients…

Suki: What were the reasons behind setting up the private UDC, which I believe was the first in the region?

Kris: We set up a cluster of a number of practices together to have a bit of strength in numbers. But the main reason was to reduce patient-to-patient contact during the lockdown and help to reduce the spread of COVID-19.

The other concern was the potential for PPE issues. Obviously, if we all opened individually, we’d be using a lot more PPE. So we did try and come together and help each other with some parts of the PPE.

Suki: I believe the cluster was looking after almost 12,000 patients who were then directed to your practice, in case any urgent dental care was required?

Kris: We had 15 practices in total and we opened the UDC on 11th May, the number of patients we’ve been covering increased to around 28,000. We told the cluster that it will run for as long as they need us to run it because I do know that some dentists can’t get PPE, so they can’t do the aerosol generating procedures (AGPs).

It’s a significant number of patients, but even with those numbers, we still don’t have huge amounts of emergencies. We were still only seeing about five or six patients a day. In the run up to practices reopening we doubled up to about ten to try and get used to what would be coming down the line.

I was planning to open all three of my sites but we decided to just open one, the main reason for that is because we did a little bit of a test to confirm patients’ attendance and half of them didn’t want to attend the practice for anything routine.

Suki: What was the reason for patients not wanting to attend, was there a bit of a fear factor?

Kris: They just want to limit face-to-face contact as much as possible and don’t want to come in just for a check-up, obviously the emergency cases are different. But when we looked at the group, a lot of private practices were experiencing the same thing.

Our demographic is generally the older ages; 30% of our list is probably aged over 70 and therefore they’re in the shielded groups. So really, we shouldn’t be bringing them in unless it’s an emergency anyway. Which means that straight away you can just wipe all of those check-ups and hygiene visits out of the appointment book, so you ended up thinking, ‘Well, what’s the point of opening?’.

Suki: That’s certainly a challenge, and you mentioned PPE earlier as another one. What other challenges have you faced?

Kris: Much of it was just around trying to work out what the best options were. At the beginning, I saw some FFP3 masks which cost £17 a mask. That works out at £816 for 48 masks, it’s just absolutely bonkers.

After talking to colleagues, we started looking at the reusables which, at the time, were slightly easier to get. Especially, P3 filters, but they’re really difficult to find now. I think Amazon have come up to the plate a little bit because they seem to be selling PPE. We saw loads of rubber dams on Amazon and yet you can’t get rubber dams from any of the usual specialist suppliers.

Suki: How have patients reacted to the services you’ve been able to provide?

Kris: It’s been massively rewarding, Suki. I think going forwards, people are going to realise how important dentistry is and the importance of looking after yourself, because nobody expects healthcare to be taken away from you, and it has been for a lot of people.

We’ve been running the UDC for four or five weeks now, and every single patient has been massively appreciative. And that really makes it worthwhile.

At the beginning, I was a bit concerned that all the PPE we have to wear would scare patients. But it’s probably been the total opposite. All the testimonials we have had have been about how well equipped we are and how safe they feel coming into the practice, because we are dressed like we are.

Suki: What are your intentions since lockdown restrictions started easing?

Kris: Anybody who’s been working in this situation knows that the guidance is changing daily. I was a little bit disappointed with the Standard Operating Protocols (SOP), from the NHS because I think it’s very restricted. The original letter basically said ‘go back to doing everything’ but then the SOP wasn’t saying that.

The SOP says we should still be doing minimal patient contact, we should be doing AAA and triage remotely, which is not what the letter said.

We are following the FGDP guidance and operating with four dentists from one of our sites.

If we’re doing AGP, we’ve left half an hour between each patient because we have got mitigating factors, which hopefully will reduce that fallow time. There’s no evidence out there for anything that we’re doing so we’re doing the best we can and doing what, I think, is sensible and safe. That’s what the main priority is, keeping our patients safe.

We’re going to have a morning of non-AGP procedures and an afternoon of AGP, per surgery. Initially, we’re just working through our emergencies, which is a list of about 100 patients with broken teeth. Then we’ll start to bring back the three-monthly cleans, which the dentist will be doing initially rather than the hygienist, and we’ll also be looking after our patients with outstanding treatment. I think the longer we leave things, the more of a ticking time bomb it becomes.

I think it’s going to be extra important to try and keep in contact with your fellow professionals. We all just need to work together. Our cluster has set up a WhatsApp group that we post any updates on when they come out, so we’re not missing things.

It’s been said before, but we do need to use our common sense. Even the CDO guidance said ‘60-minute fallow time is recommended.’ It doesn’t say, ‘It’s a must’. It’s a recommendation. So, again, we can do what we think is safe.

Suki: Kris, thanks for sharing what you’ve been up to. Hopefully we’ll be able to meet in person soon, stay safe.

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