Friday 27 August 2021
Use of FFP3 respirators with valves or PAPR hoods
Members will have seen the recent National Patient Safety Alert "Infection risk when using FFP3 respirators with valves or Powered Air Purifying Respirators (PAPRs) during surgical and invasive procedures".
It is a safety critical and complex publication, and deals with the wearing of FFP3 respirators and PAPR hoods (for those "unable to achieve a tight fit with an FFP3 respirator").
The problem is that the air exiting both of these is not filtered, and there have been reports of five incidents where the "dripping of condensation from the exhalation valve" has potentially compromised the sterile field. None of these were in dentistry.
We are therefore seeking advice as to whether this does apply to "high street" dentistry where aerosol generation might be an issue, and will inform members of the response.
Dental careers podcast: Mixing it up
Ever fancied a portfolio career? What does it take to get the balance right?
We interviewed three dentists who have each taken their passion for dentistry and developed an outlet outside of their clinical roles. From charitable work to dental education to committee involvement, they discuss how the opportunities came about and even more importantly - how to juggle multiple work commitments.
"I realised I could make a huge difference to the lives of thousands of people with my dental skills."
Join us for an insightful chat about what it's like to mix it up with a portfolio career.
Listen on Apple podcasts, Google podcasts, Spotify or search "Chairside" on your chosen podcast platform.
England: Patient signatures from 1 September
The Department of Health and Social Care is expected to announce that patients in England will need to start signing NHS PR forms and FP17DC/FP17DCO forms from 1 September. This requirement was halted due to the pandemic. We argued for the current situation to continue, but a further extension has thus far been ruled out.
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: Fall in dental incomes wake up for HS dentistry
Stark figures released by NHS digital demonstrate the precarious position of Health Service dentistry in Northern Ireland finds itself in. Average combined health service and private taxable income for all self-employed dentists in Northern Ireland fell by 4.2% from £68,000 in 18/19 to £65,100 in 2019/20. This is part of a long term trend.
Associate dentists have seen their pay fall in real terms by 36% since 2008/9, and by 43% for practice owners. And these figures largely pre-date 20/21 data, which has been perhaps the most disruptive period for dentistry in living memory. Practitioners who are most committed to providing Health Service dentistry have seen their incomes hit the hardest.
The combined impact of a decade of inadequate fee uplifts, the removal of commitment payments and the stagnation of health service item of service fees have brought us to a point where future health service viability hangs in the balance.
Thursday 26 August 2021
Wales: Recovery of Services
Last week the Deputy Chief Dental Officers in Wales wrote to all GDPs to offer further detail and clarity on a number of outstanding issues.
The letter addressed 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 welcomed 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.
BDA Benevolent Fund's upcoming AGM
The BDA Benevolent Fund's 138th Annual General Meeting will take place on Thursday 2 September at 17:00. This virtual meeting will be an opportunity to see what the charity has achieved in the last year and learn more from the Trustees about how your vital support has helped those in the dental profession.
This year's agenda will include:
- Chairman's report
- Receipt of the annual report and accounts for the year ending 31 December 2020 and a report from the Treasurer
- Re‐election of Trustee Dr Bill Creedon for a third term.
Register to attend by 16:00 on Wednesday 1 September.
England: Nine million children miss out on care
Government must meaningfully support practices to boost capacity, as new official figures underline the collapse in NHS access during the COVID pandemic. New NHS dental statistics for England show that over nine million missed out on care in the year following the first lockdown.
This data is yet to capture the full impact of the pandemic on access to services among adults, where attendance is measured every two years. However, figures already show 12 million courses of treatment were delivered in 2020-21, a decrease of 69% compared to the previous year.
Shawn Charlwood, Chair of the BDA's General Dental Practice Committee said: "To deliver for patients we need real support, and a clear roadmap to ease restrictions. But even before COVID there simply wasn't enough NHS dentistry to go round. We cannot return to a 'business as usual' where access problems are the norm."
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.
Wednesday 25 August 2021
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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Scotland: Free dentistry does not mean business as usual
The Scottish Government has advised patients that yesterday's
introduction of free NHS dentistry for 18-25 year-olds does not mean a return to business as usual.
We have warned the Government that abolition of NHS dental charges will increase patient demand and place hard-pressed dental teams under even greater pressure as they deal with a colossal backlog of unmet dental care need. After the abrupt roll out of these changes, it's essential that Government does what it can to help manage patient expectations and make clear that dental practices will continue to prioritise people with urgent dental problems.
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.
Scotland: FFP3 masks available for online ordering
FFP3 masks have been added to Pecos and can now be ordered by practices, National Services Scotland (NSS) have confirmed. This addition was the final phase in NSS's plan to add all available simple and enhanced PPE online. This change should help practices to control their stock levels.
There is an approximate 6-week transition period for this change to take effect, depending on when the order cut-off date lies within the month for each NHS Board. Any orders placed before the cut-off date will arrive or be collected in the usual way and any orders placed after the date will have the change applied. Practices located within NHS Boards where collection of FFP3 masks has previously been required, may still need to collect them for another few weeks until the next order is put through on the system.
We are sure this change will be welcomed by practices to assist them in controlling their own stock levels.
Tuesday 24 August 2021
England: No change to CQC dental inspections
Members might have been confused by
recent statements made by the CQC about changes to – and movement away from - the established
"transitional monitoring approach". This system was developed during the CQC's understandable reluctance to undertake physical practice inspections during the on-going COVID pandemic and has been relatively well received by the profession.
The CQC are introducing a monthly review for other sectors they regulate, but not for primary care dental services nor NHS trusts. For dentistry, they will continue to:
- focus on safety and how effectively a service is led
- have structured conversations with providers, with a focus on safety and leadership
- use their specific existing key lines of enquiry (KLOEs) to monitor a service
- use digital methods and local relationships to have better direct contact with people who are using services, their families and staff in services
- target inspection activity where we have concerns.
advice our team have collated for members
on the CQC's current approach, which is expected to be followed for the foreseeable future.
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 last week when 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 - do not come to work but do not isolate in the meantime. The person can return to work after 10 days and a negative LFT.
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%. These figures reveal an historic squeeze without precedent in the UK public sector, which is having 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.
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."
Northern Ireland: Self-isolation for HSC workers
Double-vaccinated dental staff who have been in contact with someone who has tested positive for COVID-19 are now exempt from having to self-isolate, and will be permitted to attend work in most instances. This updated guidance advises contacts to get a PCR test on days 2 and 8 of the 10-day period following contact. Colleagues in Northern Ireland should note that this exemption will not apply where the contact is a member of their own household.
Monday 23 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."
Webinar: Infection control problems and how to avoid them
Join us on Thursday 16 September 2021, 19:30 – 20:30, for a webinar from Nikolai Stankiewicz GDP and co-author of BDJ Clinical Guide ‘Infection control in primary dental care'.
Free to members, £50 to non-members. This one-hour presentation will update those working in general dental practice on the principles of cross infection control. It will help you:
- Be aware of the 10 most common compliance problems in infection control
- Understand how these problems can be avoided in their practice
- Ensure the requirements of HTM105, the CQC and GDC are being met.
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.