England's urgent dental care hubs facing PPE shortages and fit testing delays with some dentists resorting to scuba masks

Following the suspension of routine care,​ the network was meant to provide urgent care for dental patients during the COVID-19 pandemic. But a British Dental Association (BDA) poll has found:​

• Over half (54%) of dentists responding in England report PPE shortages are impacting on the​ operational status of sites. Only 1 in 5 dentists in Scotland are reporting the same issues.
• Nearly two thirds of dentists at sites in England report shortages of FFP3 masks and gowns.
• 32% of dentists at sites in England designated to use FFP3 masks for Aerosol Generating Procedures have yet to be fit-tested. 52% report shortages of the vital testing spray required to ensure the safe operation of these masks.  
• Some 62% of respondents in England report their sites as active. This rises to over 98% in devolved nations.
• 58% of dentists report they do not feel fully protected at the sites they are working at. Official guidance continues to state even COVID-19 positive should be treated using basic PPE.
  
  

The slow roll-out in England has seen millions left without access to urgent care across whole regions. Yorkshire and Humber, one of the last regions to start getting a service up and running in recent days, is now reportedly already struggling to manage demand for urgent care, which includes cases of broken teeth and abscesses, which can be life threatening if left untreated.

Despite progress on bringing sites live, chronic shortages of PPE, together with a lack of training and fit testing, continues to leave many teams unable to treat patients.

Sites in the East Midlands have reported kit being requisitioned for use elsewhere in the health service. The BDA understands the scale of these shortages has led some dentists in the South East to actively explore alternative sources of PPE, including non-medical equipment, such as scuba masks.

NHS England had previously operated a distinction between ‘hot’ sites for COVID-19 symptomatic patients and ‘cold’ sites for treatment of other patients, including vulnerable populations. While that approach has now been dropped, it has left limited supplies of key PPE concentrated in a relatively small number of hot sites.

Active centres also appear to be operating at significantly lower than expected capacity given the need to follow stringent decontamination procedures and social distancing guidelines, with reported patient volumes falling from forty patients per surgery per day pre-pandemic, to eight.

Where Aerosol Generating Procedures are used, there is need to leave surgeries fallow for an hour post treatment to minimise the risk of cross-infection.

Dentist leaders have accused NHS England of basing PPE guidance for staff not on risk, but on the limitations placed by the current shortage across the NHS, and urged a national effort to up production and distribution for all NHS frontline staff. 

BDA Chair Mick Armstrong said: 'Many dentists have been redeployed, only to find their hands tied by a critical shortage of kit, and delays in training and fit-testing. The depth of these problems will fatally undermine any progress on getting this network up and running.

'Patients are taking matters into their own hands, while desperate colleagues shop around for scuba gear in a bid to keep themselves safe. It is time for a genuinely national effort to get PPE to the NHS frontline.

'No health professional should have to risk becoming a super spreader simply to eke out supplies. The authorities should not be putting dentists, their families or patients in harm’s way.'

PPE in Urgent Care Centres

A poll by the British Dental Association, fieldwork 17-19 April, 1010 respondents identifying as dentists working in urgent care centres,                                       
705 in England, 75 in Wales, 151 in Scotland, 79 in Northern Ireland