Friday 20 August 2021
Wales: Recovery of Services
The Deputy Chief Dental Officers in Wales have today written to all GDPs to offer further detail and clarity on a number of outstanding issues.
The letter addresses any misunderstanding over the fluoride application metric within NHS and mixed practices, while also providing an update to the Standard Operating Procedures. We are pleased to also see details in an annex for the assessment of routine and urgent cases that are seen under the NHS contract.
We welcome the news that financial support and suspension of UDAs will continue until the end of March 2022 and anticipate that measures from April 2022 onwards will be confirmed in quarter four.
This is good progress and we will continue to work with the deputy CDOs for better support for dentists during this time.
Scotland: Dentists given 24 hours' notice to prepare for rollout
We have warned the Scottish Government that it must improve communication and manage patient expectations after today's announcement that 18-25 year olds will receive free NHS dental care. The policy is to take effect on Tuesday next week, providing dentists with one working day's notice.
The policy was a centrepiece of the SNP's May election bid, and plans to abolish dental charges for this age group were introduced over two months ago. Today's communication is the first formal instruction on how practices should implement the policy.
We are very concerned that many practices will simply be unable to introduce the required changes at such short notice. The eleventh-hour timing has all but ruled out the possibility of delivering necessary staff training for the new arrangements, and the opportunity and introduce appropriate practice management systems.
As our Chair of Scottish Dental Practice Committee, David McColl has said: "Ministers risk creating demand for care that simply cannot be met, and must communicate clearly what is and isn't available. Failure to do so will only leave hard-pressed colleagues bearing the brunt of patients' frustrations.
"The Scottish Government hasn't fully understood the operation of dental practice throughout this pandemic".
Advice on COVID-19: Updates to our FAQs
Designed to give you and your practice the advice you need, our
COVID FAQs are frequently updated with the latest information. Members' most frequently asked questions currently include:
- Should I use the NHS COVID-19 app?
- Must patients wear face coverings?
- If I'm vaccinated, is full PPE essential?
- Is the COVID-19 vaccination mandatory?
- What if a staff member is told to self-isolate?
England: Must NHS staff self-isolate if a household member has COVID-19?
NHS England and the Office of the CDO have confirmed that those working in NHS dentistry will be asked not to come to work if they are living directly (in the same household) with a positive COVID-19 case.
Confusion arose recently, when on Monday individuals in England who are double vaccinated were no longer required to self-isolate if they are a close contact of a positive COVID-19 case, but there was a lack of clarity around what should happen in relation to household contacts. This update should help to clarify the situation for dentists and their teams.
Thursday 19 August 2021
Associates: What you need to know about vicarious liability
James Goldman, Associate Director of Advisory Services, tells associates what you need to know about the recent High Court decision on vicarious liability and its possible impacts. This includes: cover for vicarious liability, indemnity clauses in your associate agreement, clinical audits and dealing with complaints.
“It is reasonable for a practice owner to require an associate to agree in the associate agreement to pay for losses caused by the associate through negligent treatment or bad conduct. Such terms are often in what lawyers call 'indemnity clauses.' However, you should look very carefully at any such indemnity clauses.”
Dental politics: Why get involved?
Ahead of this year’s
BDA elections, Rajdeep Singh, a young dentist in Derby, tells us why he got involved in dental politics and gives us an insight into what it involves:
“After graduating I had a great foundation year, but when I moved to another practice for my first associate role, I had an unpleasant experience. This is unfortunately quite a common problem among young associates. [This] made me keen to get involved in BDA committee work… I wanted to help my peers who were struggling and to be a voice for young dentists within the association, so I joined the BDA Young Dentist Committee (YDC).”
“Looking back at the last four years, I’m pleased to say that I’ve learned a lot and am more confident than ever that getting involved in dental politics – either by voting or nominating yourself for a committee – you can make a huge difference for yourself and the profession.”
40% drop in dentists’ incomes over a decade
Since 2008/9 dentists working in the NHS have experienced cuts in real incomes of up to 40%.
New figures reveal an historic squeeze without precedent in the UK public sector, which has had a real impact on associates and practice owners.
The estimated earnings for the average associate in England in 2008/09 was £67,800. By 2019/20 new estimates show that figure had fallen to £58,100. When factoring in inflation that figure was the equivalent of just £42,942, a 37% fall.
It is a similar picture for owners and associates in every UK nation that followed the financial crash, including in Northern Ireland where
the future of Health Service dentistry is under threat.
Northern Ireland: FSS3 start date confirmed
The third phase of the Financial Support Scheme (FSS3) will commence on 8 September 2021, the Department of Health has confirmed. Related payment will take place in October 2021.
An MDS will provide more detail on claiming for the new PPE Item of Service (IOS) code.
We will keep you updated as soon as we have more information.
Wednesday 18 August 2021
England: Household contacts and self-isolation
NHS England and the Office of the CDO have today confirmed that those working in NHS dentistry will be asked not to come to work if they are living directly (in the same household) with a positive COVID-19 case. This should help to clarify the situation for dentists and their teams.
Confusion arose recently, when on Monday individuals in England who are double vaccinated were no longer required to self-isolate if they are a close contact of a positive COVID-19 case. This allowed healthcare workers who had been notified by test and trace that they were a close contact of a positive COVID-19 case to return to work, subject to certain conditions being met. However, there was a lack of clarity around what should happen in relation to household contacts.
NHS England letter issued last week indicated that individuals living directly (in the same household) with a positive COVID-19 case would be asked not to come to work. It said that this advice would be kept under review and that there may be times when it was appropriate for the individual living with a positive COVID-19 case to return to work, in a risk-assessed way, but that this should be agreed with a senior decision maker, such as a director of public health.
Public Health England guidance for healthcare settings, also updated on 12th August, made no mention of the different treatment relating to household contacts when it comes to exemptions. Hence, there has been some confusion about the position.
We welcome the clarity provided by NHS England and the Office of the CDO and we will update you on any further developments.
Scotland: Increased PPE for trainee dental nurses and trainers
allocation of free PPE is now available to NHS practices who have taken on dental nurse trainees, NHS National Services Scotland has advised.
Eligible practices will have the extra allowance added to their allocation through Pecos, the online ordering platform. The number of dental nurses reportedly leaving the profession rose during the pandemic and adverts for recruitment are on the rise. It is hoped that this may go some way to supporting NHS practices to re-establish dental nurse training.
Dental careers podcast: Kids, community and prisons
Have you thought about treating children? Or perhaps you’re pondering the prison service or CDS? On our podcast, Chairside: Conversations about careers in dentistry, Andrea Ogden speaks to two dentists about their careers in these areas, giving you an insight into their experience and motivations.
Jinesh Thakrar, ex-prison dentist and current CDS dentist: “Prison dentistry really helped me keep up my speed, helped with my diagnosing, as you can imagine there’s a high dental need there… I really got involved in doing a lot of endos, extirpations, extractions, lots of restoration work too, which I really enjoyed.”
David Drysdale, paediatric specialty registrar at GOSH and former CDS dentist: “The problem I had with the community was that you don’t receive much formal training. That’s why, I decided to do the masters in paediatric dentistry, it wasn’t to help me specialise, it was to do my job… it was on the back of doing the masters, and doing quite well that I decided to specialise…and I would go back [to work as a specialist in the community] in a heartbeat.”
Spotify or search “Chairside” on your chosen podcast platform.
Answering your questions on self-isolation
Our advice team is receiving a large number of queries from members about staff and patient self-isolation requirements.
Many of these centre around whether
the latest rules apply if the close contact is a household member and also how to manage patients who have been identified as close contacts of someone who has tested positive for COVID. The
lack of clarity in guidance available has led to this confusion.
We’re working hard to clarify the exact position, so that we can inform members of how they ought to proceed. We hope to be able to clarify the situation shortly and will keep you updated.
Confidential counselling and emotional support
We provide all members with access to Health Assured, a comprehensive confidential service designed to help you deal with personal and professional problems that could be affecting your home life or work life, health, and general wellbeing. Members can access the helpline 24/7, 365 days a year. Support includes:
- Life support: Unlimited access to counselling for emotional problems and a pathway to structured telephone counselling for you or your dependents and for you face-to-face counselling sessions at your convenience.
- Legal information: Advice for you on any issues that cause anxiety or distress including debt management, accountancy, lawsuits, consumer disputes, property or neighbour disputes.
- Bereavement support: Health Assured offers qualified and experienced counsellors who can help with grief and related stress plus a team of legal advisors to help with legal issues.
- Medical information: Qualified nurses are on hand to offer advice on a range of medical or health related issues. They can't diagnose but can offer a sympathetic ear and practical information and advice.
- CBT online: We recognise the value of self-help tools in dealing with a range of issues, which is why we have a range of CBT self-help modules, informative factsheets and invaluable advice videos from leading qualified counsellors.
Tuesday 17 August 2021
BDA Museum: Telling the story of dentistry
Our museum is still closed to the public due to the pandemic. However a piece from Rachel Bairsto, BDA Museum Head, gives us
an insight into the museum’s excellent collection of dental artefacts.
This blog reflects some of the highlights of the collection, including Mayan jewelled teeth and hippo ivory dentures:
“The oldest piece we have in our collection at the BDA Museum is a Mayan tooth, from around the 9th century AD, which demonstrates the advanced cosmetic dental skills of this ancient civilization. Most likely, a bow drill was used to prepare holes for semi-precious stones in front teeth. The stone was then shaped to fit the hole and cemented into place. Drilling as accurately and effectively as this challenged dentists for centuries in the Western world.
“It wasn't until the 1870s, when foot operated drills were developed, that western dentists mastered this technique. So, it is quite incredible to learn that in Mayan times some smiled with teeth containing different gemstones!”
Northern Ireland: Resources for challenging and abusive patients
BDA Northern Ireland know that some dental teams have been experiencing abuse from patients at present. Abuse of any kind towards dental staff cannot be tolerated and ensuring that all dental staff remain safe is vital. That's why we have produced new resources to support you in dealing with abusive patients and tough access conversations.
These helpful posters, which you can customise, print and put up in your practice, will help make clear to patients that abuse is never acceptable. We are also working with the Health and Social Care Board to put out a series of patient-facing messages about the pressures practices continue to face. These are a reminder to the public to be patient and respectful to dentists and their teams as they continue to deliver care in difficult circumstances.
We have partnered with local practitioner Ciara Gallagher to produce a video to explain access restrictions to your patients. Download this video to share it on your practice's social media platforms.
Clinical topic of the month: Composites
In response to the EU 2017/852 directive to regulate the use of mercury, the use of amalgam is being phased-down for UK dentistry and restricted from use in under 16s and pregnant women.
Amalgam use has been increasingly replaced by composite which, although more aesthetic, is very technique-sensitive.
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England: Update to IPC guidance
Sara Hurley, Chief Dental Officer England, confirmed last week that there has been a minor change to dentistry's infection prevention control guidance. Post-AGP fallow time is no longer considered necessary for successive appointments between members of the same household. Please read
the IPC guidance in full online.
This guidance should be read in conjunction with
dentistry's standard operating procedure. Primary dental care providers may carry out both non-AGP and AGP care, subject to availability of the appropriate PPE and in line with infection prevention and control guidance, including post-AGP downtime requirements.
Monday 16 August 2021
Are your NHS practice details up to date?
It is important for patients that NHS dental practices have accurate information on the NHS website. This should include opening times and whether the practice is taking on new patients.
Check if your practice’s details are up to date. If they are not, the
NHS' online visual guide explains how to gain editing rights and update your profile.
Wales: Stopping in-year clawback
Several practices in Swansea Bay University Health Board (SBUHB) had monies removed from their contract payments last month, without prior consultation, based on an assessment of their performance in Q1 regarding fluoride varnish applications. Last week, we sent a letter of complaint to the Head of Primary Care, copied to the CEO of SBUHB, and the Office of the CDO, making plain our disappointment in this behaviour.
This goes against the spirit of everything the previous CDO Dr Bridgman was trying to engender in contract reform and GDS contractual conditions. It is a breach of contract and we have made clear that we expect immediate reimbursement to affected practices. We have asked the Head of Primary Care to ensure that contract managers work constructively with affected practices to clarify the reasons for the apparent under performance, whether these were for clinical reasons, data capture reasons, staffing reasons or any other mitigating factors.
A supportive approach is needed in future to ensure the successful outcome of trialling these new contract measures. If there are valid reasons for clawback of monies against a practice’s contract value, then this should not be done until a full consultation process has been exhausted. Monies should not be removed until the end of the financial year when practice performance over the 12 months can be fully assessed against all the new measures and done in a joined-up fashion.
If your practice is under any such threat of in-year clawback, please tell us at
Scotland: Government response to practice finance issues
The Scottish Government has
responded to our concerns regarding practice finance issues, saying they are reluctant to introduce ad-hoc amendments while the sector is still under the COVID “emergency” payment system. However, they have said that they will keep the situation under review.
There is general agreement that the emergency payment system that was introduced at short notice at the start of the pandemic is not sustainable, and more pitfalls are emerging which are causing difficulties for many practices. Following a meeting with Scottish Government in June, we collated a number of “real-life” examples from practice owners about the problems they were facing in paying new associates and attracting locums.
We will continue to push for a more robust intermediate funding model to ensure the sustainability of NHS dentistry, and that will allow practices to plan their finances, until a long-term funding model is developed.
England: Self-isolation removed for double jabbed close contacts
From today, those who are
double jabbed and under 18 will not be legally required to self-isolate if they are a close contact of a positive COVID-19 case. This means that healthcare workers who have been notified by test and trace that they are a close contact of a positive COVID-19 case are allowed to return to work, subject to the following conditions:
- they have been double vaccinated
- they have had a negative PCR test after being contacted and before returning to work
- they take daily LFD tests for ten days from being contacted and those tests are negative.
Staff, who may now return to work under these new rules, are still advised that they may be infectious, and they should consider precautions such as wearing a face mask and avoiding unnecessary contact. If staff are working with clinically extremely vulnerable patients (such as where patients are predominantly people with serious medical conditions who are isolating), there should be a risk assessment carried out in the workplace before they return.