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Updates from week commencing 20 September 2021

Read all the updates that took place throughout this week.

Friday 24 September 2021



England: Unacceptable lack of clarity on NHS thresholds


We have strongly criticised the Government for failing to provide clarity on the NHS contractual arrangements set to commence on Friday 1 October 2021.


Funding for NHS high street dentists has been subject to imposed activity thresholds from 1 January 2021, which obliged contract holders to hit a threshold of 45% of pre-COVID activity, or face financial penalties. This rose to 60% from 1 April. At every step, dentists have been given last minute notification to prepare for radical changes in their working model.


This approach has been widely criticised as setting perverse incentives to prioritise routine over urgent care – or 'volume over need' – with a large proportion of practices still struggling to hit targets in the face of COVID restrictions.


This approach is wholly at odds with comments from the Prime Minister made just last week, when he stressed "we want the NHS to be a better place for the dental profession." As Shawn Charlwood, Chair of the British Dental Association's General Dental Practice Committee has said:


"With less than a week to go, NHS practices have no clue about what's expected of them in the next six months.


"The PM said he wanted the NHS to be a 'better place' for dentists. What we're seeing instead is a level of disrespect afforded to no other part of our health service.


"We have been urging reasonable notice repeatedly in our discussions with NHS England but once again we're in the same place."





Nominations are now open!


Nominations are now open for places on our committees and board. We have vacancies across a whole range of our committees as well as on our board of directors.


This year, we have also created specific early career seats on several committees, including key contract negotiating committees in each of the four UK nations.


Everyone is welcome. Find out which committees have open seats and put yourself forward with a brief statement about yourself.





England: Mandatory vaccinations for dentists and staff visiting care homes


From 11 November 2021, it will be mandatory for dentists and staff visiting care homes to be fully vaccinated. New rules will require all CQC-regulated care homes in England to refuse entry to anybody who cannot provide evidence that they have had two doses approved COVID-19 vaccine, or that they have a specified exemption.


This will include any visiting dentists and staff and evidence of vaccination status should be provided via the NHS app or the NHS COVID pass via the NHS website. Any exemption must satisfy the responsible person at the care home that, for clinical reasons, the visiting dentist/member of staff should not be vaccinated with any authorised vaccine and the Department of Health has agreed an exemption on a temporary basis. People working in care homes who have a medical reason why they are unable to have a COVID-19 vaccine will need to temporarily self-certify that they meet the medical exemption criteria.


See our FAQs for more information.





Northern Ireland: COVID payments delay


We have written to the Health Minister, Robin Swann, to express concern at the continued delay in issuing of COVID-19 recognition payments for dentists and their teams.


We are calling on the Minister to announce a definitive payment deadline and ensure that payment for all eligible staff is expedited as quickly as possible. We will update you on progress made.





Northern Ireland: Meeting secured with Health Minister


We have secured a meeting with Health Minister Swann for late October and the future of the General Dentistry Service (GDS) will be top of the agenda. This follows our recent letter to the Department, which was co-signed by 500 practitioners across Northern Ireland and highlighted the collapse in dental earnings over the past decade.


More immediate issues facing general dentistry were also addressed in the second meeting of the GDS Rebuilding Stakeholder Group this month. This group is intended to inform longer-term decision-making. We have made clear that the issues which threatened the sustainability of Health Service dentistry pre-pandemic must be considered by this group. Central to this is the downward trajectory in dental earnings over the past decade. If the Department truly value safeguarding the future of Health Service Dentistry then GDS contract reform must be given a greater priority and sense of urgency.





Wales: New mental health survey


We have launched a new survey looking at how the last six months of the pandemic has affected the profession. This latest mental health survey will focus on the ongoing stress felt by dentists across Wales in regard to day-to-day situations such as working in extended PPE during the summer.


This work follows on from a survey that we sent out in January 2021 which addressed the extent to which dentists felt their mental health had been affected by the COVID-19 pandemic. The results of this survey have been published in BDJ In Practice, with a full research paper to be published in the BDJ later this year. The results have also been presented at the CDS Joint Forum and the Welsh Dental Committee.


We want to gain a balanced and full picture of the situation in Wales so please do take part, whether you feel the pandemic has or hasn't affected your mental health. Your opinions will help us to improve the mental health provision for dentists working in Wales. Please complete our short survey by Monday 25 October 2021.



Thursday 23 September 2021



UK: CMOs back water fluoridation


All four UK Chief Medical Officers have highlighted the benefits of water fluoridation in reducing tooth decay in a new joint statement.


In their statement, the four UK CMOs recognise water fluoridation should be seen as a complementary strategy, and not a substitute for regular dental check-ups and other effective methods of increasing fluoride use. We support this joined-up approach in which tried and tested policies like water fluoridation and supervised tooth brushing in early years settings are expanded, with parallel effort applied to rebuilding high street dental services.


Public Health England modelling shows water fluoridation more than pays for itself in the medium term, owing to a reduction in treatment need. £1 spent equates to £12.71 savings in five years, rising to £21.98 over ten years. We have stressed that upfront investment by Government is vital to unlocking these benefits.


Community water fluoridation is a safe and effective public health intervention that should be part of a package of measures to improve dental health where it is technically feasible and appropriate for local needs. The Health and Care Bill, currently before Parliament, is set to simplify the rollout of the policy in England. 

Around 5.8 million people in England receive fluoridated water, the lion's share artificially added, but in some locations the appropriate level exists naturally within local water supplies.


Our Chair Eddie Crouch said:


"Every dentist will thank the CMOs for recognising the lasting benefits water fluoridation could bring to the nation's oral health. However, these gains are purely theoretical without upfront investment. Spending here will pay for itself, and Ministers need to show they are willing to seize the moment."





England: Changes to Ministerial responsibilities


Following the recent reshuffle, the Department of Health and Social Care has updated Ministerial responsibilities, meaning Maria Caulfield MP now has oversight for NHS primary care, including dentistry.


Caulfield, a former NHS nurse who previously served as a government whip, will occupy the new role of Minister for Patient Safety and Primary Care.


Maggie Throup MP will serve as Minister for Vaccines and Public Health, with responsibility for the 'levelling up' agenda in health.


We welcome both Ministers to their new roles. England suffered from a postcode lottery of access and outcomes when it comes to dental care even before COVID struck, and we have stressed our commitment to work with them to build a genuinely sustainable service.





Delivering Better Oral Health: latest edition


Public Health England has published the latest edition of Delivering Better Oral Health (DBOH), an evidence-based toolkit to support dental teams in improving their patients’ oral and general health.


We endorse DBOH as a thorough and evidence-based guide to prevention. However, we have raised some key concerns about the feasibility of implementing the advice. This is particularly in regard to our concern that the existing NHS dental contract arrangements, and the additional pressures due to the pandemic, may present overwhelming barriers to its delivery in practice.


We hope that implementation of the full document will be seen as guidance, rather than an expectation.


We will continue to raise the issues being faced by practices during these challenging times.



Wednesday 22 September 2021



England: Deadline for SAS contract decision approaches


SAS dentists have until the end of the month to decide if they wish to move to one of the new SAS contracts. NHS Employers in England has updated its guidance in light of the recent pay award of 3% through the DDRB process. SAS dentists may find the documents useful in their decision making about the transition to one of the new contracts. However, the window for expressions of interest closes on 30 September 2021, so be sure to contact your local Trust HR team before then to understand your personal circumstances.


Please note that once the window closes, the right to transfer to one of the new contracts may end so if you are interested do express an interest. Also, the British Medical Association has more information on the transition process on their website.





Funding is vital in new training pathways report


New funding must be provided if the ambitions set out in the Health Education England’s Advancing Dental Care review, published this week, are to be realised.


The report examines training pathways in dentistry and makes a number of recommendations for future change. We support proposals for more flexibility in training, and share concerns raised in the report about underserved areas. We are also supportive of working with the GDC to continue developing a more workable route for mediated entry to the specialist lists.


However, we are concerned that plans may risk destabilising some of the existing training structures that serve current populations. Our committees will now consider the review in detail and will provide further commentary in due course.



Tuesday 21 September 2021



Delivering Better Oral Health: latest edition


Public Health England has today published the latest edition of Delivering Better Oral Health (DBOH), an evidence-based toolkit to support dental teams in improving their patients’ oral and general health.


We endorse DBOH as a thorough and evidence-based guide to prevention. However, we have raised some key concerns about the feasibility of implementing the advice. This is particularly in regard to our concern that the existing NHS dental contract arrangements, and the additional pressures due to the pandemic, may present overwhelming barriers to its delivery in practice.


We hope that implementation of the full document will be seen as guidance, rather than an expectation.


We will continue to raise the issues being faced by practices during these challenging times.





Amalgam: Promoting the interests  of UK dentistry


We have written to the Chief Dental Officers of the four UK nations, seeking their commitment to promote the interests of UK dentistry in international negotiations on the future of dental amalgam.


We have asked the CDOs for the following:


  • To ensure that the UK makes strong representations against a total phase-out, or an excessively rapid phase-down, of dental amalgam at upcoming meetings on the global Minamata Convention on mercury. Whilst we support a gradual reduction in dental amalgam use, this must be underpinned by the development of suitable alternative materials and an increased focus on prevention.
  • To engage with plans to phase out dental amalgam in Europe by 2030. Although the UK has left the EU, Northern Ireland will still be directly affected under the Northern Ireland Protocol, and supply chains to Great Britain will collapse if no action is taken.


Access problems and increasing inequalities due to the pandemic mean that it is more important than ever to avoid the abrupt loss of dental amalgam as a restorative material without ensuring that alternatives are available and mitigating need.


The BDA has been working at a national, European and global level to secure a pragmatic phase-down in the use of dental amalgam, which will balance the needs of dentistry and public health with efforts to protect the environment from mercury pollution – of which dental amalgam is one source.


We have offered to collaborate with the CDOs to ensure a workable solution for UK patients, health systems and the environment.





England: Isolation of fully-vaccinated staff if a household member has COVID


We continue to get a lot of queries about the difference between government advice on self-isolation for "double-jabbed" staff coming into close contact with COVID positive individuals and NHS England's position.


We can now confirm that the advice below is for practices with an NHS commitment; 100% private practices can choose to follow the wider Government advice, or to follow the NHS advice. However, such practices would need to be able to justify their decision making process by undertaking a robust risk assessment.


The wider Government advice is that fully-vaccinated individuals do not need to self-isolate (assuming other precautions are being taken) if a household contact tests positive; however, the NHS advice is that staff will be asked not to come to work for 10 days.


Only in exceptional circumstances, where patient safety is at risk, it may be appropriate for the fully-vaccinated NHS member of staff living with a positive COVID-19 case to return to work, in line with Government guidance, in a risk-assessed way.


To help with this, we have produced a risk assessment  which allows practices in England to consider whether that fully vaccinated member of staff, who has been identified as a COVID household contact, may attend work.  The default expectation is that business continuity arrangements will be put in place and staff will NOT return to work. If a practice can evidence exceptional circumstances and a failure of business continuity arrangements, the practice should contact their local NHS England Commissioning Team to find out what their local process is and this will include an appropriate senior decision maker (e.g. the local Director of Public Health (named contact).  Conditions will include:


  • Staff absence creates a significant risk to the health or safety of patients or service users, health and social care staff who have been identified as a contact of a case of COVID - may be able to attend work rather than self-isolate if they are fully vaccinated (more than 14 days after the second dose)
  • This must only occur in exceptional circumstances and where additional safety measures can be upheld.
  • These staff members should only attend work after having a negative PCR test and daily negative LFD antigen tests; and 
  • These staff members are - and remain – asymptomatic
  • These staff should not treat clinically extremely vulnerable patients





Survey on dental academic pensions


We are seeking to understand the pension arrangements for dental clinical academics, whether it is the NHS Pension Scheme, the USS pension scheme or another workplace pension. Given the attention focused on the USS pension scheme at the moment we are keen to find out what impact this will have on the dental clinical academic workforce and those affected by the proposed changes to contributions and benefits.


The information provided will help inform how we can provide support and information in relation to your pension. Please complete this short survey before Wednesday 29 September to provide us with information about your pension arrangements.



Monday 20 September 2021



Podcast: Starting a dental business


On our podcast, three dentists who each run their own business chat to us about what it's like to take the leap.


They discuss the obstacles, the rewards and answer our most pressing questions such as - when is the right time to do it? What are the right motivations? And, is it worth it?


Our guests have all taken risks to own their businesses including: taking over an independent practice, building a ten-site empire and creating a digital start-up.


Join us for a frank and open conversation about starting a business in dentistry.


"We know dentistry inside out. We may not be financially trained or have done MBAs, but we know dentistry. We know patients, we know patient care."


Listen on Apple podcasts, Google podcasts, Spotify or search “Chairside” on your chosen podcast platform.





October deadline for Annual Retention Fee instalments


Dentists can now opt in to pay their Annual Retention Fee (ARF) by instalments and spread the cost over the course of a year.


Previously, dentists were required to make a single annual payment (currently £680 for dentists and £114 for dental care professionals) by December 31 and 31 July respectively each year. We have pressed for change given this approach represented a major barrier for registrants, particularly those at the outset of their careers.


Dentist registrants now need to let the GDC know before the renewal period opens on 31 October. To make the change:


  • Login via your eGDC account and select the quarterly Direct Debit.
  • If you choose this option, the GDC will collect four quarterly payments of £170.
  • For those on a specialist list, the annual fee of £72 per speciality, will be collected in the first Direct Debit.

The GDC have more information on paying in instalments.





HMRC and associates: No change on self-employment

HMRC has for many years accepted that associate dentists are almost always self-employed. Its guidance has included mention of our associate agreement in its employment status manual, but as of April 2023, this paragraph will be withdrawn.

The withdrawal of this guidance will have no impact on the self-employed status of the majority of associate dentists. Indeed, HMRC has told us that this is a change to their guidance, not a change to the self-employment status of associate dentists. They have simply stopped making reference to third party advice in their own guidance. The National Association of Dental Accountants and Lawyers, the experts on the dental sector, also say the change in guidance will have minimal impact.


We can continue to rely on the current guidance (ESM4030) until April 2023, and HMRC will not be using the withdrawal of the guidance as a reason to open retrospective enquiries into periods prior to 6 April 2023.


Find out more:






Furlough scheme - claims deadline


The Government’s Coronavirus Job Retention Scheme, known as the furlough scheme, will remain open until 30 September 2021. For claims relating to August and September 2021, the government will pay 60% of wages up to a maximum cap of £1,875 for the hours the employee is on furlough.


Employers must top up their employees’ wages to make sure they receive 80% of their wages (up to £2,500) for the hours they are on furlough. The caps are proportional to the hours not worked. Claims for September must be submitted by 14 October 2021 and any amendments must be made by 28 October 2021.


See our guide to this scheme in our information on Practice owners: Advice on paying staff.