Pre-screening
Unlike some chronic conditions which represent an ongoing cross infection risk (such as HIV or Hepatitis B/C/D which we are very well practised at managing), Covid-19 represents an infection risk for a few weeks only (akin to influenza but unfortunately rather more vicious to some of the population). We will therefore be screening each patient by telephone several days before an appointment and again on the day before a scheduled visit. I would ask that you engage fully with this and bear with us even if it feels annoying. It is not a desire to fill in forms for the sake of it but the best way to protect you, other patients and our lovely team from possible and avoidable infection. The information you give will be kept strictly confidential as always. We will require a fully updated medical history and Covid-19 symptom/contact history. If we perceive a risk to other patients or team members we will simply ask you to delay your visit by 3 weeks.
No-touch (a polite approach)
We will take your temperature on arrival at the practice, with a no-touch infrared thermometer.
We will unfortunately have to (temporarily) refrain from handshaking or hugging. The coffee machine and newspapers have been removed from the waiting room and we recommend you bring your own water rather than use the water fountain in the hallway.
Where possible, please use elbows/shoulder to open the front door, you will need to touch the button and (lovely new) brass handle to exit but these will be wiped constantly throughout the day. If you are able to climb the stairs without holding the handrail, please do. Please avoid using the bathroom unless absolutely necessary. There will be alcohol hand gel around the building for your convenience and safety and we would encourage you use it as often as possible.
Please bring a minimum of belongings with you as these represent a greater risk to others. Please bring a cardigan or sweater to wear in the surgery if your appointment is likely to be lengthy as we may be sweltering under PPE and the air conditioning will be on (our air conditioning is individual to each room, not a central system).
We will ask you to settle your account on the day of your appointment, preferably by bank transfer but if you need to pay by credit card, the machine will be wiped after each transaction. We would prefer not to handle cash.
We will give you a surgical mask to wear whilst in the common parts of the building. Please don’t forget to smile and maintain warmth. Eyes smile even if nose and mouth are covered. Let’s maintain a sense of good humour.
Social distancing
Please keep your distance from other patients whilst in the building, do not cross on the stairs (I always wondered why that was considered unlucky – I now know). Please limit your time in the common parts of the building to a bare minimum (just for now).
Please come unaccompanied if at all possible. We do understand that some patients need to attend with parents or carers, and this is perfectly acceptable.
On time
We will be giving precise times for appointments and we will ask that you attend on time, neither early nor late – if early, we will ask you to stay outside or in your car. If too late, we may not have time to do the treatment planned and appointments will be in short supply initially. If we are running late, we will notify you and ask that you remain outside until we are ready – we hope this will be rare but please be understanding as ever. There will be longer time allocated to each appointment to allow for a further increased clean down of all surfaces of the surgeries between patients and for PPE changes.
Because appointments will be very limited in the first few weeks, please ensure that you let us know in good time if you are unable to attend. We will charge in full for failed appointments without adequate notice (the notice period for cancellation will be reduced to 24 hours during this period) – we fully understand and request that you cancel if you or anyone in your household develop Covid-like symptoms and have decided to self-isolate and in this circumstance we will not charge.
Air quality
We have recruited (purchased) an army of air purification units for the surgeries. We hope to benefit from these long after Covid-19 has receded and will continue to enjoy an ongoing reduced risk of seasonal colds etc along with a filtering of the rather polluted London air and pollen in the summer.
Clean teeth and mouths
This may seem obvious, but please could we ask that you prepare for your visit by being very thorough with your toothbrushing and oral hygiene in the days before your appointment and most definitely in the hours just before you attend. There will be no facility for toothbrushing in the practice ahead of your appointment as it would represent an increased infection risk to others. We do understand that you may well be overdue to see the hygienist and that will be reflected in the condition of your mouth. Please do not eat after you have cleaned your teeth or on the way to the practice (unless for medical reason such as diabetes).
We will ask you to pre-rinse for a minute with a disinfecting mouthwash prior to any examination or treatment.
Personal Protective Equipment (PPE)
If you were in any doubt about what PPE was prior to the pandemic, you will not be now. At 38 we have always worn PPE routinely (gloves, masks, eye-wear and uniforms) but we are required to increase the level of this for a while. You will have seen images on the news of PPE ranging from gowns and hats to full hazmat suits. We will all be dressed like dinner ladies – it is fairly un-becoming but we hope to wear it with style and good humour and gradually as time goes by, we will be working on obtaining a more sustainable and environmentally friendly version.
Throughout the pandemic, we have been mindful of the pressures on the supply of PPE to frontline NHS staff and so have not felt it right to stockpile. For the last few weeks we have been ordering PPE in a responsible way and providing outline training for our team in anticipation of our return to work. Many items remain on back order and this is one of our bigger challenges. Disappointingly the price of all PPE has gone through the roof, we will need to add a PPE charge to each appointment as this cannot be absorbed as a cost and is essential for all our safety and a legal requirement at present.
We require as usual that you wear eye-protection during your appointment. Our goggles will be disinfected between patients, but you may prefer to wear your own glasses or sunglasses, if so, please remember to bring them.
Shortage of appointments
We will not be able to accommodate the normal number of patients each day. There is much pent up demand after 10 weeks of closure which we must patiently work through rather than rushing to see too many patients. We will be prioritising those with the most urgent needs initially and moving to more routine care and preventative treatment over the coming few weeks. We are hopeful that Covid-19 cases will reduce still further over the summer, but we must be ready to respond appropriately should this not happen.
Testing
We are researching in great detail the available tests both for antibodies (representing past or recent infection and therefore some possible immunity) and the virus itself. We have some reliable antibody tests which take approximately 15 minutes to see a result currently which we can offer to patients if wished. These give an idea of past infection and some possible immunity or recent infection and possible early infectivity. I would be grateful if you would indicate when you book your appointment if you wish to be tested in this way. It is interesting to know and although it is not certain at present whether past infection gives long or robust immunity, it will nonetheless be of interest to many of you. There will be a fee for testing (tbc).
Ultimately, we hope to have a real time, rapid test for the active virus that we could carry out for everyone just before their appointment and daily for the team – this is the optimal way to be secure and navigate a return to normal. This seems to me to be the key to safely and confidently opening up all aspects of life that have been locked down: whether offices, schools, theatre, shops, restaurants, airports, trains, tubes the list is endless and testing represents the key to consigning Covid-19 to the history books. There is an extraordinary, very exciting and innovative race for this technology going on worldwide. The technological resourcefulness and creativity is wonderful to observe. More work has been done on understanding and treating viruses in the past 3 months than in the past 10 years it seems and this will be a lasting legacy. Watch this space!
And Finally….
Let me apologise if this reads like an endless list of rules. I remember some years ago moving into a temporary rented flat with my four kids and finding ourselves in a block where the residents association had an unfortunate monthly newsletter…..every sentence on two sides of A4 paper began with the words “DO NOT” (in capitals and bold)….. I really hope I have managed to convey this information to you without that sense?
Please be patient with us. We want nothing more than to continue where we left off with the highest standard of comprehensive, need based and preventative care delivered to last and keep you out of pain and trouble. We may not be at liberty to deliver our full menu for a short while. We can assure you that at all times we will do what is best for your safety, that of your family and our lovely team and we will balance this with what is best for your teeth and their long term preservation.
Kind regards
Dr Gaynor Langley
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