Sunday 22 March 2020
BDA issues urgent advice to dentists
In all four nations of the UK, governments and officials have issued recent advice in relation to the provision of primary care dentistry. This clinical advice has reflected the UK Government's developing position in relation to increasing social isolation, reduction in use of public transport and use of health services, and also growing unease, as infection levels grow, about the potential for spread of COVID-19 from asymptomatic patients.
Official advice across the UK is not exactly the same, but there is a consistency in guidance that there should be a reduction in the amount of routine dental activity, particularly in respect of vulnerable groups and importantly that staff and patient exposure to potential infection should be reduced by avoiding all aerosol generating procedures wherever possible.
Appropriately, all dentists should exercise their own clinical judgement, taking into account their own practising circumstances. However, given the high proportion of patient interaction in dentistry that has the potential to involve aerosol generation, the BDA believes that for most practices it is likely that compliance with the guidance of the various UK administrations will mean a significant reduction in routine clinical activity. Indeed, for many practices, the practical consequences of the guidance will mean ceasing routine care entirely, given the difficulties of identifying in advance patients who will not need aerosol generating procedures. The BDA supports dentists and practices choosing to stop regular patient treatment.
We believe that current guidance should be more explicit given the continuing spread of the virus and uncertainty around asymptomatic transmission and the associated risks. Given this uncertainty, the BDA recommends that no aerosol generating procedures are undertaken on any patient without appropriately fitting FFP3 masks, other required protection equipment and protocols.
Further, given the uncertainty and reflecting the practical consequences of the current official advice, we recommend that practices cease routine dentistry and operate an advice and emergency service only. Consistent with Government advice to limit social contact, face to face contact should be kept to a minimum but telephone advice should remain available during normal hours. This service will be important for patients, particularly until fully fledged emergency provision is in place. Each practice should make its own risk assessment of what is safe and what can be delivered by way of an ongoing emergency only service.
The situation is changing rapidly and it may well be that as the pandemic evolves emergency only treatment and patient contact will only be deemed appropriate in particular setting and temporary practice closure may become mandatory.
As things stand, the chance of advanced PPE equipment, protocols and training being widely available to avoid this seems unlikely, with resources appropriately being directed to intensive care. In any case, the development of Government advice around social isolation has the potential to further limit the availability of routine care.
The purpose of this advice is to give maximum protection to dentists and staff but it remains an individual practice decision as to what level of service continues to be provided on the basis of rigorous risk assessment.
Again there will be variation across and within UK countries, but local discussion should be taking place around the provision of NHS urgent dental care, particularly as the amount of routine care decreases. Arrangements for the provision of emergency care will become increasingly important if and when the country moves towards further social isolation and further lockdown of normal activities. Dentists involved in urgent care in specialist centres will require full personal protective equipment including FFP3 face masks.
Clearly, a reduction in clinical activity will have financial consequences for practices and for associates. The BDA is acutely aware of this and we continue to make the case forcefully to all administrations that support is offered to protect dentists' NHS income and that this protection extends to associates. We are also conscious of the impact on private dentistry and are arguing to government that private practices should have appropriate access to the range of wider financial support being made available to business across other sectors.
Saturday 21 March 2020
New advice for pregnant women working in the NHS and other settings has been published
Women who are less than 28 weeks pregnant should practise social distancing but can continue working in a patient-facing role, provided the necessary precautions are taken.
Women who are more than 28 weeks pregnant, or have underlying health conditions, should avoid direct patient contact.
Read the Royal College of Obstetricians and Gynaecologists' advice.
Support from BDA Benevolent Fund
The BDA Benevolent Fund recognises that the coronavirus (COVID-19) outbreak is causing disruption and uncertainty for dentists and dental students. We know that sickness, self-isolation and practice closures will have impact on earnings and on mental health.
If you are worried that you cannot meet your essential household expenditure, you can find further information about how to apply for financial support on our website. You can also access a free budget planner to help you assess your finances and make plans for the future.
We also provide support towards medical, legal and life and wellbeing issues. This includes access to counselling sessions via our partnership with Health Assured and their 24/7 helpline.
Friday 20 March 2020
Wales will waive 4% of practice UDA target - further explained
We have been assured that the last two weeks in March are covered by a 4% waiver of practice UDA target. This means if you have completed the requisite UDAs up to mid-March you will not be subject to k. The Welsh Government has today given further guidance on how the calculation works. See our updated FAQ for further details.
Routine dental treatment significantly reduced
We have responded to new guidelines on the Coronavirus outbreak which probably spells the end of most routine care in England, lamenting the absence of any current safety net to support services through this crisis.
Read our complete response to the new guidelines.
Role for employed NHS dentists in COVID-19 response
We have sent a letter to NHS England to discuss the valuable role employed NHS dentists could undertake in the response to COVID-19.
We are aware that it is likely that efforts to deal with the Coronavirus pandemic will ultimately include wider NHS staff than doctors and nurses. We welcome the opportunity to discuss the transferrable skills held by academic, community and hospital dentists. These are highly trained experts in cross-infection control and hospital-based MDT working.
We believe that the dentists we represent could provide a valuable service to the wider NHS in this challenging time.
BDA meets Health Minister
Mick Armstrong and I had a (virtual) meeting this afternoon with Health Minister Jo Churchill, alongside general medical practice and pharmacy colleagues. The Minister wanted to hear our concerns around the impact of the COVID-19 pandemic.
We highlighted ongoing uncertainty around clinical advice; concern around airborne aerosols and adequacy of protective equipment; planning for the treatment of urgent care as the pandemic develops; the part that dentists and teams can play in the wider healthcare effort; and the crucial need for financial support for both NHS and private practices. All points seemed to be well received and the Minister committed to weekly discussions.
We will continue to update you with outcomes from these discussion.
Government announces wage subsidy
The government will pay 80% of wages for employees not working, up to £2,500 a month, Chancellor Rishi k has pledged this evening. We are seeking clarity if this policy will apply to the self-employed.
Financial scheme secured for NI practices
We welcome the announcement of a financial support scheme designed to help dental practices in Northern Ireland remain financially sustainable through the disruption caused by COVID-19. The new scheme from the Department of Health hopes to provide the assurance practice owners, practitioners and staff require at this difficult time. Read more about the new financial deal for Northern Ireland.
Communicating with you
We're working hard to get you answers and keep you informed during this stressful time. Here are our recent communications to our members in Northern Ireland and Scotland:
Our advice team have also extended their hours and are answering members' calls from 08.30-18.00.
Dental practices need business rates relief
We have urged government to extend the Business Rates Retail Discount of 100% to include dental practises to ease potentially crippling losses from the Coronavirus pandemic.
The relief is currently offered to the leisure and hospitality sectors which includes shops, restaurants, cafes and cinemas, live music venues and hotels. Premises that are used by dentists, doctors and others are excluded.
While NHS practices currently receive some help with rates, private practices receive no support. In an open letter to Secretary of State for Housing, Communities and Local Government, Robert Jenrick, we have called for a full extension of relief to all practices.
England CDO sends ‘preparedness’ letter
NHS England and Office of the Chief Dental Officer have issued an up-to-date ‘preparedness letter’ for primary care dentistry. Of particular note it advises practices to ‘consider the potential risk of asymptomatic cases attending in this delay phase and reduce exposure of staff and patients to infection by avoiding all aerosol generating procedures wherever possible’.
This is the second in a series of regular updates to general dental practices and community dental services regarding the emerging COVID-19 situation.
Wales will waive 4% of practice UDA target
Funding models for practices with NHS contracts are being developed in consultation with us. We have been assured that the last two weeks in March are covered by a 4% waiver of practice UDA target. This means if you have completed the requisite UDAs up to mid-March you will not be subject to clawback. Read Director of BDA Wales, Dr Caroline Seddon's blog for further details. Members in Wales were emailed at 5:05pm on Thursday 19 March 2020.
Dentists and their staff are key workers
We have received clear confirmation that dentists and their staff will be designated as key workers during the pandemic.
Officials have confirmed that team members meet the criteria set out by the Department for Education earlier this morning.
The move follows recent discussions between the BDA and NHS England. With schools and nurseries facing shut down UK-wide this move should enable all team members with children to remain in practice, with provisions in place for childcare.
We believe this should apply to teams operating in private practice, and are seeking urgent clarity.
Dentists to be redeployed to support NHS
As the pandemic develops, it is possible that our profession will be asked to redeploy across the health service to provide extra-ordinary support to an already depleted NHS workforce. There would clearly need to be careful consideration about what roles dentists and their teams might take. The government website provides more on that notion. There is no further detail available yet, but we will be involved in any discussions.
"Medical practitioners and other healthcare workers from a range of disciplines and settings are likely to be required to help deal with a coronavirus outbreak. For example, dentists and GP practice nurses may be asked to assist staff in NHS hospitals in administering injections and medication that would normally only be administered by hospital medics." Published 19 March 2020.
Thursday 19 March 2020
National data opt out delayed until 30 Sep 2020
The National data opt out policy which was due to be implemented in England from 30 March 2020 has been delayed six months until 30 September 2020.
The National data opt out is a service that allows patients to opt out of their confidential patient information being used for research and planning - not direct patient care. Organisations which were already part of the policy will still need to remain compliant, however, new organisations, which includes NHS dentistry across primary and secondary care, do not now need to comply until September. At that point the decision will be reviewed.
For more on this read the letter from NHS Digital and NHSX.
Guidance from NHS England
We understand that, once again, the updated NHS England guidance on coronavirus (the single operating procedure) has been delayed and will not be published this evening. We are anticipating publication tomorrow morning, Friday. But we have been anticipating publication every day this week. We continue to make representations that this is simply unacceptable.
Letter from CDO for Scotland
CDO for Scotland Tom Ferris has sent a letter to the NHS boards to distribute to dentists, further clarifying the financial support measures that he previously set out in a letter on 17 March 2020. The recent correspondence covers some of the points that we raised in our feedback and also includes specific guidance around the use of aerosol generating procedures. We will continue to liaise with the Scottish Government on financial support and guidance for dentists.
Supporting dental students, trainees and recent graduates
The Dental Schools Council (DSC), the Joint Committee on Postgraduate Training in Dentistry (JCPTD) and the General Dental Council met yesterday, to discuss arrangements to support dental students, trainees and recent graduates across the UK in the context of COVID-19.
They've told us that a joint statement will be issued tomorrow, Friday 20 March. This will cover students on undergraduate BDS courses, those undertaking training to be a dental care professional, dental professionals in foundation or vocational training and in postgraduate specialty training. We are hoping this statement will also offer more clarity on the situation with dental exams, following news today that GCSE and A-levels exams have been cancelled in England, Scotland and Wales.
In addition, the four statutory postgraduate education bodies, HEE, NES, HEIW and NIMDTA have issued guidance to employers of dentists in training with regard to the impact of COVID-19 on postgraduate training programmes. This includes dental foundation training, dental core training and specialist training.
They've assured us that they're working closely with other education stakeholders to mitigate against any negative impact on trainee progression through their programmes. They realise that the limitations in place due to COVID-19 may compromise the ability to gain required competencies. The situation is under daily review and updates will be on-going.
Foundation dentists and other dental trainees should raise any concerns about personal circumstances with their educational supervisors, training programme directors and/or postgraduate dean. Under any circumstances, health advice on self-isolation should be followed.
HEE has confirmed that it has written today to all foundation dentists and educational supervisors. If you have not received this letter, please contact your HEE office.
Response from the CDO for England
We have received a response from Sara Hurley, the CDO for England, to our letter sent on Tuesday 17 March 2020 which raised our concerns about official advice to dental teams in England.
Guidance for dentists in Scotland
The Scottish Government also issued COVID-19 guidance, along with an accompanying memorandum that outline the financial support being put in place to mitigate the disruption of service caused by the outbreak. We encourage dentists in Scotland to review these documents. We are working to clarify a number of key issues raised by the guidance and will keep you updated.
Wednesday 18 March 2020
School closures: Are dentists and nurses considered keyworkers?
We're seeking clarification on whether dentists are considered keyworkers after the announcements made about school closures. Schools are now scheduled to close across the UK. Schools in England will close Friday 20 March, except for looking after the children of keyworkers and vulnerable children. Scotland and Wales schools will also close from the same day. Schools in Northern Ireland will close to pupils today and staff on Monday 23 March.
Updated guidance issued in Northern Ireland
Some updated COVID-19 guidance has been issued to support dentists in Northern Ireland. This guidance recognises that it is far from business as usual for GDPs. It also sets out advice in relation to aerosol generating procedures (AGPs) and other treatments.
We hope that details on financial mitigation measures, being considered by the Department of Health, will soon follow. Unlike elsewhere, dentists in Northern Ireland have not yet received details of these mitigations.
Combined with HSCB’s letter issued to practitioners this am, this is another welcome step forward in a rapidly changing situation, However, some questions remain unanswered, such as the risks to pregnant workers.
Working for our members
We're lobbying governments on your behalf and working hard to get you answers and keep you informed during this stressful time.
Here are examples of our recent communications to dentists across the UK:
Our advice team have also extended their hours and are answering members' calls from 08.30-18.00.
Data security deadline moved
NHS practices in England and Wales should note, the final deadline for Data Security and Protection Toolkit submissions has been pushed back to 30 September 2020 to account for COVID-19.
Organisations can choose to complete their submission before that date. If they do and meet the standard required, those organisations will be awarded 'Standards Met' status, as in previous years. Where organisations have separate agreements with commissioners or information sharing partners, the existing deadline remains unchanged, unless agreed between relevant parties. Further advice for organisations completing their toolkit assessment.
Further guidance needed for dentists in England
We’re demanding clarity from government on COVID-19 guidance to dentists in England. The failure to communicate updated guidance on COVID-19 leaves both dental teams and their patients vulnerable.
The World Health Organisation declared a pandemic and the government stepped up its response to containing the spread of the virus. But no updates have since been provided to NHS dentists’ standard operating procedures.
Mick Armstrong, Chair of BDA Board, has been clear: “A service that millions depend on is uniquely exposed, and with no safety net in place. Without clear guidance and support a fully functioning dental service may end up a casualty of this pandemic.”
Dental conferences postponed
Closer Still Media have decided to postpone the British Dental Conference and Dentistry Show (BDCDS) and the Dental Technology Showcase (DTS) 2020.
I believe that postponing the show now is the right decision. It offers dentists and their teams certainty at an early stage.
BDA’s chair on BBC News
Mick Armstrong, Chair of the BDA Board, has spoken to BBC News about the lack of leadership from government. In the interview, he pushed for better guidance to be provided for dentists in the context of COVID-19.
Financial mitigation measures announced
Chancellor Rishi k has pledged additional support for business on top of measures set out in the budget:
- Government-backed loans of £330b open to all businesses, with unlimited lending
- Business interruption loans, with no interest for 6 months, will start next week
- £10k extra cash grant to smallest businesses
- Three month mortgage holiday.
We’re pushing for confirmation that this will be applicable to dental practices. We will update you when there is more information available.
Guidance issued for Scottish dentists
We’re pleased to see COVID-19 guidance was issued by the Scotland’s Chief Dental Officer, Tom Ferris. This outlines the financial support being put in place to mitigate the disruption of service caused by the COVID-19 outbreak in Scotland. We are working with the CDO in Scotland to clarify a number of key issues raised by the guidance.
On behalf of dentists in Northern Ireland
We’ve appealed to Health Minister Robin Swann for urgent intervention. Dentists in Northern Ireland are very concerned, and the current lack of guidance is unacceptable. A letter has been issued to GDPs by HSCB. We hope to see guidance issued today. We’re pushing for it to be as robust as that provided by the Governments in Scotland and Wales.
Tuesday 17 March 2020
Chief Dental Officer for Scotland letter
The Chief Dental Officer for Scotland issued a letter today with guidance to NHS Dental Services on dental provision during the COVID-19 outbreak.
Our message just issued to the Chief Dental Officer (England)
Read our letter issued to the Chief Dental Officer (England) [PDF].
Healthcare Inspectorate Wales statement on Coronavirus
Healthcare Inspectorate Wales (HIW) is to stop its routine inspection and review programme from today, Tuesday 17 March.
Further to the decision to take a balanced, risk-based approach to work over the coming weeks, due to the unfolding COVID-19 situation, HIW has now made a decision to stop its routine inspection and review programme from today, Tuesday 17 March.
Guidance for pregnant staff
Many of you have been calling up to ask about guidance for pregnant staff. We’re very aware that the guidance in relation to pregnant staff and associates in the dental practice is not consistent. We are working to get clarification on this.
The guidance from the UK Government on 16 March 2020, including from the Chief Medical Officer and the Chief Scientific Adviser, is that all people should avoid unnecessary social contact. The UK Government has stressed that this advice is particularly important for people over 70, those with some health conditions, and pregnant women. Whilst the government did not say that pregnant women working in dentistry have to stay at home, we anticipate that the Welsh Government at least will confirm that pregnant dentists and dental staff should remain at home. We would hope for similar guidance from other parts of the UK.
It may be that dental staff have a higher risk of catching airborne viruses due to certain dental procedures. Reception staff will also come into contact with a number of patients and viruses could be transmitted through normal transactions at reception. At the present time, we can only suggest that pregnant women come to their own decisions as to whether they wish to remain working in a dental practice.
Pregnant employees will be entitled to Statutory Sick Pay if they stay at home. If a pregnant associate wishes to remain at home, and subject to her associate agreement, she may be required to provide a locum. That said, we’re conscious that requiring pregnant women to find locums, especially at this time, may cause undue stress.
We therefore would hope and expect that practice owners and associates will work together to reach sensible agreements on these issues.
Leadership needed from NHSE on COVID-19
We have called for leadership from NHS England, after further failure to publish updates to its Standard Operating Procedure for the Coronavirus.
Despite repeat assurances no new versions have been provided since 6 March, during which time the World Health Organisation declared a global pandemic and the UK Government moved from the contain to delay phase of its strategy.
Our chair, Mick Armstrong has said “In a situation which is changing rapidly, advice from NHS England has not been updated, with dentists and their teams frightened and desperate for leadership. This official silence is deafening. Dentists deserve clarity if they can continue providing a safe service for their patients.”
I understand yesterday’s PM’s announcement had to be factored in causing further delay. Still waiting.
Monday 16 March 2020
CQC: Routine inspections cease as of today
Following recent dialogue with the health sector, including the BDA, the Care Quality Commission has confirmed that routine CQC inspections - including in dentistry - will cease as of today. This will hopefully ease the current regulatory burden.
You are not required to wear a FFP3 mask in general dental practice
Recent guidance issued by NHS England is causing confusion among dentists. The formatting of the letter is unclear and to some it appears to state that dentists, as healthcare workers, are required to wear FFP3 masks. This is not the case. You are not required to wear a FFP3 mask in general dental practice. This guidance referred only to healthcare workers working with patients waiting for COVID-19 test results. We have asked them to reformat the advice to remove this ambiguity.
Some dentists are concerned about asymptomatic transmission of COVID-19. At present, government guidelines state that people should self-isolate, only if someone has a new, continuous cough and/or a
temperature of 37.8 degrees or higher. This is the basis on which you should decide whether patients should be treated and whether you or other staff members should come in to work. This may change, as more evidence become available about the nature of the virus and the risk of asymptomatic transmission. We will update you if changes are made.
Unsurprisingly the response to coronavirus has varied around the world. The UK, to some extent, is seen as being an outlier in its approach to managing the pandemic. This variation is also reflected in different nations’ advice to the dental profession. We have been in contact with fellow dental associations across the world and the ongoing intelligence that we receive is helping to shape our own position and how we challenge official positions.
NHS England guidance
NHS England has advice specifically for primary care dentistry:
Primary care advice for clinicians
Standard operating procedures for primary care settings
We are anticipating this advice to be updated today, so keep an eye out. We realise that the current situation is causing huge anxiety within the profession about the right things to do for patients and staff. These still advise dentists to ask a patient’s travel and COVD-19 contact history, this is no longer relevant. However, much of the rest of the guidance remains relevant.
We’re continuing to reflect your concerns to officials and will keep you posted on any developments. The BDA is putting pressure on the relevant organisations such as NHS England – we cannot make decisions about practising in a pandemic on their behalf but we are advising them on the practical implications for our members.