Updates from week commencing 18 May 2020

All the updates and what we've been working on during the Coronavirus outbreak.

Friday 22 May 2020

21:50

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:

BDA Indemnity members FAQS

Our letter to Bill Moyes re: the GDC not cutting the ARF

Guidance on how risk assessments can be made (member login required)

Coronavirus: Five things you need to know about the future of dentistry

Wales: The vision for the future of dentistry

18:55

Return to practise in England

Yesterday the CDO England’s group looking at the expansion of dental care took place for the second time. The group includes a range of stakeholders from across dentistry, and the BDA is strongly represented.

As part of these discussions we have repeatedly emphasised the need for expansion of dental care to take place as quickly as is feasibly possible. This is vital given the growing number of patients in need of care and the desire for practices to treat their patients, whether in the NHS or private sector. Yesterday we outlined how a phased approach might allow for care to expand and for practices to start seeing their own patients for certain procedures soon.

The expansion of face-to-face care in England is related to a number of conditions being met. These conditions will be focused on wider public health factors, for example when the R number is low and the prevalence of the virus within the population is reduced. It's also dependant on the wider healthcare system’s capacity. The expert advice around these factors comes from the independent SAGE special advisory group.

We will update you again next week.

18:10

Have your say: Resuming dental care

Members, we want to hear your views on the challenges and issues around resuming routine dental care. This will inform the case we make to government on what we need to ensure our patients can see their dentist again.

The survey should take no more than 10-15 minutes to complete and your answers will remain anonymous. Our Vice-Chair, Eddie Crouch has said: "Dentists need clarity on the plan going forward. Governments also need to hold an honest conversation with patients about what they can expect from dentistry in the future."

17:03

Wales: The new vision for dentistry

This morning Welsh CDO, Dr Colette Bridgman, met with WGDPC representatives to discuss in more detail the Welsh Government’s roadmap for dentistry. This describes the rationale for moving out of lockdown and from the current red alert phase of dentistry into a clearly laid out phased return to general dentistry. This will work in step with Welsh Government’s recently announced plans for moving the country into a phased easing of measures over the rest of the year.

WGDPC previously contributed their views about the future of dentistry to inform the CDO’s planning and this has been a highly fruitful collaboration. The Welsh Government’s final framework and SOPs are now in the public domain:

We welcome the Welsh Minister’s approval of this framework and also appreciate the fast pace of work by dental public health colleagues to bring the SOPs to fruition.

Tom Bysouth, Chair of WGDPC, has written about how we can collaborate across the dental networks in Wales in order to co-produce the detailed business plans that will provide a new way of working in dentistry.

Colette’s vision is that clinicians will provide a leadership network that will be mutually supportive and collaborative. The plan involves a complete departure from the target-driven treadmill of the 2006 contract. Her hope is that all the learning from successful contract reform measures in the last three years will be fully implemented across all the practices in Wales by way of an individual needs and risk assessed prevention pathway for every patient. We are off to a solid start with nearly 50% of practices involved in contract reform already.

There has been much discussion about how this vision will apply to private practices and how they can be integrated within this new framework. Guided by HIW for how this will work on the ground, there is clearly a place for private practices in Dr Bridgman’s plan.

We will continue to work on supporting our members through this very challenging period of transition, and you can be assured that our guidance is fully informed by expert practitioner views and experiences, and is compliant with emerging official guidance.

16:39

Update on BDA Indemnity

BDA Indemnity policyholders have been contacted with regards to the availability of cover in the pandemic.

Our policy provides occurrence-based contractual insurance covering professional liability and legal expenses. During the COVID-19 pandemic policyholders have been increasingly concerned about the extent of their cover for a range of work either in the practice providing telephone triage or at urgent dental centres treating patients in pain.

Policyholders who work under private contractual arrangements have requested reassurance about the extent of their cover. This comes at a time in which there are perceived and actual restrictions on the extent of treatment allowed by NHS contractual arrangements in the four devolved nations.

BDA Indemnity policyholders can confidently look to us to be by their side through these challenging times as they provide dental services in the coming weeks and months whether under NHS or private contractual arrangements.

11:09

Listen to Chair of SDPC on BBC Radio Scotland

Today on BBC Good Morning Scotland, David McColl, Chair of the Scottish Dental Practice Committee, discussed the roadmap for dental practices returning to work as Scotland begins to ease its lockdown restrictions.

Listen in at 55:30.

09:33

Volunteering for the contract-tracing service programme

If you are a registered practitioner who has not been redeployed, you can volunteer with Public Health England to become a clinical contact case-worker.

The role involves conducting public health assessment interviews from home, over the phone, with people who have tested positive for COVID-19. The interviews with patients will be protocol based, and appropriate training will be provided. This opportunity is open to all GDC registered dental professionals, except for dental nurses with less than 18 months experience.

Dentists who are receiving NHS contract payments from their practice should not also receive payments for clinical contact case-working if doing so would be considered duplicative. We understand that NHS dentists may be able to do clinical contact case-working as unpaid volunteers which could avoid a risk of receiving duplicative funding.

Associate dentists looking to volunteer to do clinical contact case-working should speak to their practices as the practices may need associates to do triaging and other work. Associates and practice owners should work together to ensure that associates are able to do contract tracing work where possible.

08:58

Scottish Government publishes post-COVID route map

A four-phase route map through and out of the COVID-19 crisis has been published by the Scottish Government. Dentistry is mentioned on pages 23, 25, 27, and in the graphic on page 44 of this document.

It features the phased return, as outlined in yesterday's letter from the CDO on the re-opening of NHS dental services in Scotland. We will continue to seek clarity on the details of the plan for dentistry and private practices in particular. We will update you once more information becomes available.

Thursday 21 May 2020

17:30

The seismic impact of COVID-19 on the future of dentistry

The repercussions of the COVID-19 pandemic could devastate the UK's dental services. We asked thousands of our members for evidence in response to the government's Health and Social Care Committee's request. Your evidence has informed our analysis of the seismic impact that COVID-19 is likely to have on UK dentistry and what must be done about it. Read more on this from our Chair, Mick Armstrong.

16:30

NHS workforce feedback hub

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

We have already received several important contributions from NHS dentists and are seeking to further boost participation from the dental community. 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.

15:23

Planning for GDS recovery in Northern Ireland

Yesterday saw the first meeting of the General Dental Services (GDS) Re-establishment working group in Northern Ireland. Comprising representatives from Health and Social Care Board, the Department of Health and the BDA, this group aims to produce operational guidance in respect of key issues, such as PPE and social distancing. Tristen Kelso, National Director of BDA Northern Ireland, attended on your behalf and has reflected on the challenges we face as GDS plan for the next phase in Northern Ireland.

12:32

Private dental care in England

Across the pandemic period of strictly limited dental activity, members have raised questions about the application of the official advice to private dentistry. The easing of social distancing restrictions in England has focused attention further on when and how dental care will be expanded and again whether private practices can now provide face-to-face care for their patients.

The General Dental Council has been clear throughout that it has no powers to direct a professional either to offer treatment or to refuse to offer treatment. In England, the Care Quality Commission has confirmed that it cannot require providers of dental care services to close, unless it finds clear evidence of a breach of its regulations. In deciding, it would refer to prevailing guidance, including that from Public Health England, the Chief Dental Officer and the GDC. The CQC encourages dental providers to give proper consideration to communications from the CDO, whether their practice is NHS, private, or mixed.

We have advised throughout this period as ever, all professionals should work in a way which ensures the health, safety and wellbeing of their patients and colleagues and should only provide treatment where it is safe for them to do so. The process of assessing whether it is safe will have to be determined by dentists and their team and involve carrying out the necessary risk assessments, having regard to relevant guidance issued by professional bodies, the NHS/government and other statutory bodies. We have issued clear guidance on how risk assessments can be made by individual clinicians as recommended by the CQC and the GDC (login required). Critically, dentists will also want to ensure that their indemnity provider is content with the scope of any care provided.

Members can also access our updated advice on providing care at this time (login required).

Wednesday 20 May 2020

17:55

Scotland: Pathway for a return to dental practice

The CDO has written to NHS Boards setting out the first steps for the re-opening of NHS dental services in Scotland.

The letter includes high-level plans for a phased return to dental practice:

Phase 1 involves increasing the capacity of the Urgent Dental Care Centres. The UDCCs are currently treating patients with urgent dental care needs, but the centres should now grow their capacity to increase the range of treatments available to patients.
Phase 2 will see NHS practices start to see patients, initially for consultations using non-aerosol generating procedures (AGPs), and later for routine care – including examination and treatment – that can also be provided using non-AGPs. There is no precise timeline for Phase 2, though the Scottish Government expects to have made some progress by 31 July, with consultations available in every practice by then.
Phase 3 will involve a limited introduction of AGPs to dental practices, depending on risk and mitigation. There is no timescale yet for this phase.

The letter includes broad plans for testing, PPE supplies and financial support. The BDA will seek to engage regularly with the Scottish Government to inform the development of the detailed plans.

17:46

Responding to the GDC's decision not to cut ARF

Following today's announcement from the General Dental Council that it will not make changes to the Annual Retention Fee (ARF) levels or introduce an emergency payment scheme to allow registrants to pay by instalments, we have published an open letter to the Chair of the Council, Bill Moyes.

With the profession now facing grave financial uncertainty, we have criticised the failure by the regulator to show flexibility to colleagues, some of whom have seen their incomes fall to zero. It has also called for much-needed transparency in the process for setting the ARF. The GDC retains a budget operating surplus and significant reserves.

BDA Chair, Mick Armstrong, said: "Despite recognising the dire financial circumstances in which many practices and individual registrants find themselves, the GDC has not seen fit to provide even token support, citing no fundamental change to the work it does and the little financial impact the move would have on registrants.

"Greater transparency into the reasoning behind this decision would have been the very least response registrants should have received.

"But the message we are left with is ‘we need all the money and whatever we could do won’t really help you much’."

14:00

Dentistry raised in House of Lords

We were pleased to see a number of members of the House of Lords stand up for dentistry this morning, who in today’s oral questions highlighted to the Government the crisis affecting dentistry.

Lord Hunt called on ministers to set up “a programme of work with the BDA and the CDO, establish a national plan, get dentistry back on track and save the profession from ruin.”

Lord Rogan commented on the sterling efforts of dentists in Northern Ireland volunteering to help in this crisis, but also warned that some practices could collapse without further support.

Lord Duncan highlighted the importance of dentistry to the wider economy and called for business rate relief to be extended to all practices.

Meanwhile Baroness Thornton highlighted the lack of financial support for the sector, and called for better guidance on PPE, and Baroness Boycott warned about the increased risk to the nation’s oral health as more people snack from home.

In total 11 peers took part, and we are grateful to them all in continuing to keep the pressure up.

You can view the whole session on the parliament website, proceedings started at 11:37am.

We will be picking up the points raised both with the members who spoke, and also with the Government during our regular meetings.

13:00

BDA Benevolent Fund webinar tomorrow at 6pm

The BDA Benevolent Fund has developed a series of free webinars for dental students, dentists and their families.

‘How to improve your money mindset’ is the next in the series and takes place tomorrow at 18.00.

Please note: The topics were chosen as a result of a poll of members pre-COVID-19 and its implications, and so this webinar focuses on general financial advice.

12:02

Dentistry being discussed in the House of Lords today

After our tireless campaigning, we are pleased to see that dentistry will be debated in the House of Lords this afternoon. Ahead of the debate Lord Philip Hunt, Treasurer of the All-Party Parliamentary Health Group, said:

"Patients need treatment but urgent care dental hubs mainly offer pain relief and tooth extractions only. Many dentists [are] facing bankruptcy. I will call for a National Plan to sort it out."

You can follow the debate live here.

09:20

The global response to post-lockdown dentistry

Victor Chan, the Chair of our International Affairs Committee, has taken a look at how other countries are preparing to increase dental activity as lockdown restrictions are eased.

He takes a look at what countries such as Australia, Norway, New Zealand and Canada are doing on important issues such as personal protective equipment (PPE) and aerosol-generating procedures (AGPs). These are unprecedented times. As the UK looks towards opening up dentistry again, there is a lot we can learn from what is being tried elsewhere.

Tuesday 19 May 2020

18:55

Care Quality Commission updated advice

The CCQ has updated its advice to practices in England today.

It confirms that:

“The decision to offer dental care services is one for the provider to take.

Alongside guidance given by Public Heath England (PHE) and the General Dental Council (GDC), CQC encourage dental providers to give proper consideration to the communications from the Chief Dental Officer (CDO) regardless of whether their practice is NHS, private, or mixed.

The CQC cannot require providers of dental care services to close, unless we find clear evidence of a breach of our regulations that requires consideration of the use of our powers under the Health and Social Care Act 2008 and associated regulations.

As part of our regulatory function we will assess the extent to which providers are providing an appropriate level of safety within the context of our regulations. In doing so we will refer to prevailing guidance, not limited to but including guidance from PHE, the CDO and GDC to help us reach a judgement on the extent to which the service currently being provided complies with our regulations.”

18:05

COVID-19 and the oral health of older people

Mili Doshi, a consultant in Special Care Dentistry, tells us how COVID-19 impacts the oral health of older people and how dentists should work with medical and social care providers to protect older patients:

"There are significant challenges. We've seen that patients who are being treated in hospital with COVID-19 are more likely to experience poor oral health. Oral care standards may also be slipping in care homes, where inadequate supplies of personal protective equipment (PPE) may be making staff anxious about cleaning mouths. Access to urgent dental care for those who are shielding may also be more challenging. However, there are potential roles for the dental team to help support the care of older people."