Updates from week commencing 11 May 2020

Friday 15 May 2020

20:20

Weekly wrap-up

Here’s our weekly roundup of the top five things that happened this week in relation to the COVID-19 pandemic and UK dentistry. We hope you find it useful.

Useful links from the video:

Submit evidence on your business interuption policies via our online survey. 

​

18:10

Scotland: Dentistry in the coronavirus press conference

Watch National Clinical Director Jason Leitch as he discusses the dental situation in Scotland, and pays tribute to dental teams at the Scottish Government's daily briefing today. 

Wales: Roadmap on next steps imminent  

BDA Wales has been in consultation over the last few weeks with the Welsh CDO, Dr Colette Bridgman, regarding next steps and how general dentistry will begin to be restored to a new normal later in the summer. There is likely to be a road map published by the Welsh Government in the coming week and we will share this as soon as it becomes available. 

We have been very heartened by the consultation process to date and very much appreciate that Dr Bridgman is looking to the profession to develop the plans in more detail over the coming weeks.

16:30

DUP calls to safeguard future of dental surgeries

The DUP have called for further financial assistance from government to safeguard the future of dental surgeries.  

Sammy Wilson, the East Antrim MP, has joined with party colleagues and MPs from across the UK to support a call by Fleur Anderson MP. He stated: "Dentists are frontline health professionals who provide a vital service to the public. However, whilst surgeries have been forced to close, dentists are not appropriately provided for within the financial assistance packages and many will receive no support at all.  

Dental services are a necessity for a healthy society and when we are able to move out of the current restrictions it will be vital that patients can access services. 

The support given to this call from all corners of the UK and from every political viewpoint demonstrates the importance of this issue to everyone. I hope the Chancellor will act, but will also act quickly to offer reassurance to all those affected."

Associate NHS payments

NHS England's letter of preparedness dated 25^th March indicated that contract holders would continue to receive NHS income but that a number of conditions would be applied to payments. One of those was a requirement on practices to ensure that associates as well as other staff continued to be 'paid at previous levels'. This has resulted in some discussion about the interpretation of payment at previous levels. The BDA has expressed a view on the issue that the most obvious starting point is an estimate of the associate's net pensionable earnings.

We know that the vast majority of contract holders have taken a responsible approach to associate payments, but a number of queries to our contract resolution service indicate that some practice owners have adopted a position that is not consistent with the NHS England letter of preparedness. 

We have been in discussion with NHS England about how to resolve these matters and they are in the process of considering the introduction of regulatory change to ensure that contract holders pass on anticipated payments.

Members: We've made these tools for you
 
We've been producing a series of helpful tools to help members through some of the more complex areas of the current crisis. We hope you'll find them useful. You will need to be logged in to access them.

Furlough calculator for mixed practices
Mixed practices can use this new tool to calculate the amount of money you are entitled to claim from the Government if you were to furlough some of your staff for a given period of time. To make it easier we've always made a demo video on using the furlough calculator .

We have also drafted a letter for members with mixed practices to give to staff to explain the situation and seek their agreement to be furloughed workers. 

Videos on financial support
Our webinar  on financial packages, furloughing and retaining your staff, and paying associates in NHS and mixed practice is now available to watch in four edited videos.  We have also made available the slideshow that our expert advisors referred to  during the webinar.

Pay dispute resolution service for associates
Corporate bodies and practice owners with NHS contracts will continue to be paid on the condition (among others) that they pass on income due to associates. If you encounter issues, we will take them up on your behalf. See more about logging your pay dispute with us.

Remote consultation guide
We've put together guidance on how to conduct a remote consultation with your patients  and avoid some of the common pitfalls.

Risk assessment
We created a risk assessment to support members in providing urgent care . We've also updated it with guidance on record-keeping for NHS practices and triaging.

NHS Mail account for private practices
It's important that private practices 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. To set it up you need to answer 14 questions on data management and security. Here's our guide on how best to answer these questions .

We have also put together a document detailing key questions being asked by members .

13:10

Scotland: Dentistry included in NHS "mobilisation plans" for next phase  

 
The Scottish Government has written to NHS Boards asking them to develop "mobilisation plans" for the next phase of the NHS response to Covid-19. 

As part of these plans, Boards should increase the throughput in the 56 urgent dental centres across Scotland to manage acute and essential dental problems. This includes aerosol generating procedures (AGPs) as far as safety and quality allows. Boards should also plan for dental practices to reopen to see their registered patients for acute and essential care (again, as safety and quality allows). This will not involve AGPs, and practices should plan patient appointments to ensure physical distancing.

Boards have been asked to submit their draft mobilisation plans (to the end of July) by 25 May. The Chief Dental Officer will liaise with the profession to determine what is feasible.

Update on the Self-employment Income Support Scheme 
 
The Self-employment Income Support Scheme (SEISS) went live earlier this week. The launch has highlighted a potential difficulty for those self-employed associate dentists earning under £50k and therefore potentially eligible for the SEISS, but also in receipt of ongoing NHS income. Our campaign to lift the £50k limit on eligibility continues.

Under the various NHS schemes across the UK, self-employed associates are entitled to receive on-going NHS income. At the same time, associates working partly in NHS and partly in private practice will have seen their income reduced, potentially significantly if they rely heavily on private income.

These mixed practice associates earning less than £50k will be eligible to apply for the SEISS, but ultimately could actually make more money if the combination of their ongoing NHS income and SEISS support exceeds their likely normal earnings.

Unfortunately, there isn't a mechanism to make a part application under the SEISS. An application will be based on total previous earnings, all or nothing, with no ability in this context to split NHS and private earnings. So an associates needs to either apply to the scheme, or not.

We have approached HMRC to see if there is a way around this difficulty, for example by an associate making a claim under the SEISS being able to subsequently pay back any excess income once it becomes clear what their earnings have been for the period.

HMRC are considering the situation and we will keep you posted on developments. In the meantime, we would suggest dialogue between associates and practice owners on the issue.

NHS unions' blueprint for safe opening of healthcare

We are calling on the UK governments and employers to work with us to deliver our new nine-point blueprint for a safe return to work for NHS staff.

The blueprint has been agreed by 16 NHS trade unions - including UNISON, the Royal College of Nursing, the Royal College of Midwives, Unite, GMB and of course, the BDA - and calls for fast, comprehensive and accessible testing, ample supply of personal protective equipment (PPE) and for salaried staff to be paid properly for every hour worked.

We all want to avoid a repeat of the PPE supply problems experienced earlier in the pandemic which caused widespread anxiety. Access to readily available PPE is especially important as employers in other parts of the economy begin to open up their workplaces and source protective kit for staff.

Together we all represent more than a million staff working in the NHS across the UK, from dentists, porters and nurses to  radiographers, 999-call handlers, cleaners, and paramedics. Our aim is to ensure that, as out-patient clinics and operations resume, the NHS continues to operate a safety-first approach.

The Chair of our Central Committee for Hospital Dental Services (CCHDS) Peter Dyer has said: "We felt it was the right thing to do and are proud to have done so. This blueprint demonstrates what is important to dentists, ensuring safe working practices, full PPE and ensuring that a return to patient clinics means a safe return for all staff in hospital departments and their patients".

Chair of our England Community Dental Services Committee (ECDSC) Charlotte Waite said: "Community dentists have been at the forefront of setting up Urgent Dental Centres in England and have often gone the extra mile working long hours, to ensure patients in need have the care they require. This blueprint offers a firm foundation for many overstretched colleagues who have stepped up admirably to support the national effort."

NHS England and CDO on returning to work

Yesterday NHS England and the Office of the Chief Dental Officer hosted the first of a series of meetings to discuss the approach to expanding dental care in England. The BDA was well represented. The session also involved representatives from the Department of Health, General Dental Council, Care Quality Commission, Faculty of General Dental Practice, Faculty of Dental Surgery, Association of Dental Groups and Public Health England as well as patient input via Healthwatch. Health Minister Jo Churchill joined the meeting.

There was a recognition that care should be expanded as early as was safely possible, with a desire for a consistent approach towards the position of both NHS and private dentistry. The pace of movement looks likely to take into account conditions rather than be tied to specific dates. There was a wide ranging discussions about the different potential approaches to developing service provision. The group will meet again next week and we will continue to push for clear communication of the roadmap to enable practices to plan for expanding care.

 13:04

Survey on business interruption cover

We are taking urgent legal advice in respect to insurers not paying insurance claims made by dentists in regard to business interruption during the COVID-19 pandemic. That's why, we have invited members to submit evidence on your business interruptions policies via an online survey.

We ask that you do not send a full copy of your policy in to our advice teams. Instead, please fill out this survey. It's the best way of ensuring that all of our members' voices are heard on this complex topic.

NHS workforce feedback hub

NHS England and NHS Improvement have opened an online feedback hub so that its leaders can respond to the needs and experiences of the NHS workforce at this unprecedented time. 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 in England.

Scotland: Updated FAQs on NHS financial support

Following our discussion with Practitioner Services Division (PSD) earlier this week, PSD has updated its Frequently Asked Questions about NHS financial support for dentists during the COVID-19 outbreak.

Amendments to the previous version include information on: the time period used to calculate support payments; associates' contracts; cut-off dates for claims; and dentists returning from maternity leave.

The revised FAQs should help to answer some queries and we continue to seek clarity on a range of issues on your behalf.

Watch the Daily Briefing Q&A online

Yesterday, I spoke to Chris Barrow of the Extreme Business Academy on the Daily Briefing. Watch as I answer audience questions covering: associate pay, abatements, return to work and dental politics.

Wales: Lobbying continues

Commandeering the support of Westminster politicians continues this week, as we seek to secure a fairer solution for dentists in private practice in Wales. BDA Wales had written to all 40 MPs in Wales explaining the dire position that private practices face in being excluded from most of the COVID-19 financial support mechanisms, with the request they write to the Chancellor on behalf of their constituent dentists.

Sarah Atherton, MP for Wrexham went one better by also writing to Ken Skates, AM, Minister for Economy, Transport and North Wales. She had heard from many worried dentists in her constituency fearing for the prospects of their practices and their patients. Ms Atherton asked Mr Skates what financial assistance the Welsh Government would be offering private dental practices for their business continuity. A reply from Mr Skates explains that a new scheme recently launched should be available to many practices who need to access funds promptly.

However, we know these schemes do not go far enough and we had made it clear to Mr Skates in our letter that private self-employed dentists deserve equitable treatment. We will continue to press for action in Cardiff and in London on the issues that matter to you, and will update you on any progress made.

17:15

Dentists must not be pressured into overprescribing antibiotics

Susie Sanderson, leader of the task force on antibiotics in dentistry for the Council of European Dentists, has called for us not to lose sight of the importance of antimicrobial resistance.

Acknowledging the extraordinary pressures dentists are now under, she has said: "This pandemic has demonstrated the havoc a pathogen can unleash when we have no protection against it.

Inappropriate use of antibiotics at this time, even if motivated by the best of intentions, increases the likelihood that resistant bacteria will evolve. I'm sure you'll agree, that with a global viral pandemic underway, the last thing we need is to add to these risks."

Read this piece: Coronavirus: When to prescribe antibiotics. Or see the joint letter from Public Health England, the Royal College of Surgeons and the Faculty of General Dental Practice to support dentists in appropriate prescribing of antibiotics in urgent dental care.

Northern Ireland: Updated detail on Financial Support Scheme

The Department of Health have issued an updated FAQ on the Financial Support Scheme (FSS) for General Dental Services (GDS) in Northern Ireland. It provides an outline of how dentists in a range of situations can expect their payments to be calculated. We advise you to review this document, particularly if your circumstances changed during the 12 month period used to calculate the amount of support given.

England: No change to practice openings

This morning's changes to restriction regulations are causing confusion among dentists in England. It might appear that new regulations permit the reopening of dental practices in England, this is not the case.

Nothing has changed in relation to the guidance offered by the various UK administrations on the provision of dentistry.

The permitted dental care in the restrictions regulations refers to emergency-only care. The unfortunate lack of clarity in the restriction regulations is causing understandable confusion. We will keep you updated as things progress.

Northern Ireland: Post COVID-19 recovery group

The Chief Dental Officer (CDO) in Northern Ireland, Michael Donaldson, has set up a General Dental Services (GDS) committee on post-COVID-19 recovery. Four of our reps will join this committee to make sure your voice is heard in critical discussions around how the lockdown on dentistry will be eased in Northern Ireland. The committee will consider essential issues such as the provision of PPE and social distancing in the dental practice, and seek to provide preliminary operational guidance. Read its terms of reference.

Northern Ireland: Executive publishes plan for easing lockdown

Yesterday evening, a plan for easing lockdown in Northern Ireland was outlined by First Minister, Arlene Foster, and Deputy First Minister, Michelle O'Neill. The document, entitled Executive Approach to Decision-Making, does not include a timetable, but the First Minister has said that she hopes to have reached the final stage by December.

The government's message to the people of Northern Ireland remains "Stay home, Save lives" but they have outlined a phased lifting of restrictions. In the first phase, groups of four to six people would be allowed to meet outdoors while maintaining social distancing. Outdoor-based retailers, such as garden centres, will also be allowed to reopen soon. However, there is no sign of a return to routine dental care and we expect the present situation regarding urgent and routine care to continue for some time. We will update you when this situation changes.

Wales: Petition to pay funeral costs of NHS staff taken forward

A petition calling for funeral costs of NHS staff who die with coronavirus to be covered by the Welsh Government will be taken forward by the Senedd's petitions committee.

The 400-signature petition says refusing to pay modest funeral costs "undervalued the risk" for health workers.

Health Minister Vaughan Gething has said the £60,000 death-in-service benefit should help cover financial hardship. However, this money is not immediately available, leaving some families to rely on family and friends for financial support for funerals.

Further complicating the issue, is that many non-British NHS staff are prohibited from claiming public funds in the UK for either five or 10 years, depending on their visa, as Cardiff-based law firm Albany Solicitors have noted.

17:15

Scotland: Seeking clarity on NHS financial support

We had a useful videoconference with NHS Practitioner Services Division this afternoon to discuss the system they have developed to calculate the "average" Item of Service for NHS dentists over the 12 months to April 2020 as a basis for determining the level of financial support. PSD described the huge range of individual dentists' circumstances that they have been dealing with.

Scottish Dental Practice Committee representatives offered to peer review a sample of cases to verify PSD's calculations, and PSD will soon update its COVID-19 Frequently Asked Questions web page which should help to address dentists' queries.

Death of railworker highlights dangers of PPE shortage

The daily rising death toll of the COVID-19 outbreak is sobering. Today, we've seen that a railway ticket office worker has died with coronavirus after being spat at by a man who claimed he had COVID-19. This tragic circumstance reminds us of the importance of providing appropriate PPE to essential workers and why aerosol-generating procedures are particularly dangerous to patients, dentists and their staff.

We joined with the Society of Occupational Medicine early in the outbreak to call for better PPE, because we do not believe that work-related fatalities due to COVID-19 exposure are inevitable. A goal of zero work-caused fatalities is not impossible. However, the correct PPE must be available to all workers if this is to be achieved.

Why the BDA is more crucial now than ever

In our latest blog, Shareena Ilyas, a new member of the BDA Board, reflects on the role of the BDA during this time of crisis and beyond, saying: "Our work has already ensured that NHS and mixed practices will continue to receive funding. Associates who deliver NHS treatments will also receive financial support  – and have access to our new pay dispute resolution service should issues arise."

"We are very aware that the government has overlooked private practices and we have been relentlessly outspoken on this issue. Our campaign urging the government for a fair and equitable solution has already been supported by nearly 200 MPs."

"I believe the BDA is the only organisation that can stand up for us collectively. The more of us that take part, the stronger our voice will be."

Furlough scheme to be extended

Speaking in the House of Commons this afternoon, the Chancellor has said that the furlough scheme introduced to pay the wages of workers on leave because of coronavirus will be extended to October.

Mr Sunak confirmed that employees will continue to receive 80% of their monthly wages up to £2,500, but he said the government will ask companies to "start sharing" the cost of the scheme from August onwards. We are seeking clarity on what this means for dentistry and will provide you with more details when they become available.

The BDA is taking legal advice on dental insurers

Today we have announced that the BDA is taking urgent legal advice in respect to insurers not paying insurance claims made by dentists in regard to business interruption during the COVID-19 pandemic.

We have instructed law firm Brown Rudnick LLP to examine insurance policies affecting dental practices. It is now working with our members to gather relevant evidence on the full range of polices in the sector.

This legal advice will shape the guidance that we will be offering a profession that has been blindsided by a lack of effective insurance during a period that has seen routine care suspended and cash-flow for many practices fall to zero.

The Financial Conduct Authority (FCA), which stated on 15 April that most policies with basic cover would not respond to COVID-19 losses, now seeks "legal clarity" on business interruption insurance in an attempt to provide certainty for businesses and insurers.

We have acted following uncertainty over whether the FCA move will help or hinder practices given the breadth of policy wording covering the different sectors of the UK economy and the urgent cash crisis facing businesses. This has been made more acute in light of the indication that a court hearing will not take place until July.

Dentists leaders have also indicated they hope that instructing Brown Rudnick now will give them a better understanding of their legal position and allow them to consider representations to the FCA as part of the regulator's recently announced course of action. Following the conclusion of that process, an understanding of the legal position will give us a strong foundation upon which to engage with insurers and the FCA.

The government has remained unwilling to extend the Business Rates Retail Discount of 100% currently offered to leisure and hospitality sectors to dental practices, to ease potentially crippling losses in the sector. Our polling has indicated that over 70% of practices report they can only remain financially sustainable for the next three months.

18:10

This week: How dentistry fits into the new landscape

With the Prime Minister announcing last night a change in pandemic approach and advice (in England), thoughts are inevitably focusing this week on how dentistry fits into the revised landscape.

For the time being, the distinct existing advice for practices in the four UK countries still applies. This means practices are still to treat initially via advice, analgesics and antibiotics where appropriate, and to triage care into the various urgent care systems.

The Office of the CDO in England has reinforced the 'no change yet' message. Today they have stated: 'the temporary cessation of routine dentistry addresses the safety of patients and of dental teams as well as supporting the public health measures required to slow community transmission of COVID-19'.

However discussions are taking place across the UK about dentistry emerging from the lockdown. This morning BDA Chair Mick Armstrong and I met with Health Minister Jo Churchill and CDO Sara Hurley and discussed the general approach in England, both for NHS and private practices. On Thursday we have the first meeting of an NHS England group looking at this in more detail.

Wales is again perhaps at the forefront in terms of thinking about what adjustments will need to be made to NHS mechanisms in a new environment where traditional activity may be reduced for some time.

Discussions have also begun in Scotland and there will also be dialogue with the acting CDO in Northern Ireland tomorrow about the steps needed for movement towards reopening.

We will also be looking for your own views on the way ahead. We intend to share a short survey with you on post-lockdown practice, so please look out for that later in the week.

Prime Minister's announcement

We know that dentists and their teams will have questions regarding last night's announcement from the Prime Minister and his new advice to work from home if you can - but to go to work if you can't. Some have asked if dental practices should be re-opening on the back of this advice.

Firstly, we need to clarify that this government advice applies only to England. However, and more fundamentally, there have been no indications that the frameworks for the provision of dental care across the four UK countries has changed.

Discussions are taking place across the UK about how dentistry emerges from the lockdown however, until we are advised otherwise, we are working under the assumption that the existing advice for practices still applies. This means practices are still to treat initially via advice, analgesics and antibiotics where appropriate, and to triage care into the various urgent care systems.

We will update when we have more to share.