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Coronavirus: your FAQs

We answer your frequently asked questions on COVID-19 and your dental practice.

Page last updated: 3 April 2023.

Here are the answers to your FAQs, which we update as often as possible.

 

 

Coronavirus and the dental profession

1. What is the BDA doing?

We are lobbying the Government to make the voice of dentistry – NHS, private and mixed – heard. We're keeping you up to date and providing you with timely and essential resources.


Pay uplifts

Following the DDRB report's recommendation of a 4.5% pay uplift, with the issue of rising expenses to be dealt with separately, we have been campaigning on your behalf.


In Northern Ireland we recently wrote to the Minister for Health noting that the DDRB's recommended 4.5% uplift does not account for expenses. We also highlighted similar issues in Scotland and in Wales, where we are awaiting a response.


Advice

Our advice team are working to provide up to date advice for members on issues such as stress and wellbeing, private practice and pensions. Extra and Expert members can contact the team for unlimited, one-to-one advice by calling 020 7935 0875 or by emailing advice.enquiries@bda.org.


Contracts

Our advice team have developed in depth, up-to-date advice and templates on associate contracts


Training and learning

Our events portfolio and webinars are available to members covering a broad spectrum of training, clinical seminars, conferences, and webcasts. Our training covers the whole dental team with the knowledge and CPD required to keep you up to date.


Dental tourism

We have been working with the BBC to highlight the pitfalls of dental tourism and the impact on practices throughout the UK. We asked dentists to tell us about their experiences, over 1,000 responded to our survey reporting shocking results.

 

Webinars

Members can watch our webinars on various topics, including: associates' finances, building a private practice, dealing with difficult patients, PPE and stress.

 

Risk assessments
We created a risk assessment to support members in providing urgent care  . We've also updated it with guidance on record-keeping for NHS practices and triaging. And we provided members with risk assessment forms for pregnant staff during the pandemic.

 

2. What is the BDA doing for private dentists?

Protecting you, your patients and your practice's financial viability is our driving focus. The Government needs to step up to support private dentists, who have been providing essential healthcare throughout exceptionally difficult circumstances over the past few years.

Our private practice advice page is a useful resource, bringing together advice for members in private practice. If you are considering offering patients private treatments, either exclusively or alongside NHS work, our private practice advice section contains everything you need to know such as:
The Government's inaction on key issues relating to private dentistry is very frustrating but we will continue to champion your concerns. Private practice dentists have a powerful voice, and we will continue to work hard on your behalf. We are your association, and together we are stronger.


3. What's the latest Infection Prevention and Control (IPC) guidance?

In June 2022, UK Health Security Agency (UKHSA) updated its IPC guidance with new COVID-19 pathogen-specific advice for health and care professionals. This advice should be read alongside the National Infection Prevention and Control Manual (NIPCM) for England and applies to all NHS settings or settings where NHS services are delivered.

 

The Chief Dental Officer's letter of 1 June then set out the next steps for IPC in dental practices following the COVID-19 pandemic. Practices must now make their own decisions about how and when the patients are treated and what PPE might be required, having completed their own risk assessment.

 

Routine asymptomatic testing 


This was paused from 31 August but continues for symptomatic NHS staff and staff in symptomatic NHS-commissioned independent healthcare providers (including return to work testing) which will involve taking an LFT at home. The change has been made because the prevalence in the community has fallen and remains at a comparatively low level.


Facemasks are no longer mandatory:


  • Patients with respiratory symptoms who are required to attend for emergency treatment should wear a facemask/covering, if able to do so, they may be offered one on arrival
  • All other patients are not required to wear a facemask unless this is a personal preference
  • Health staff are not required to wear facemasks in non-clinical areas (eg. reception areas, offices and staff rooms), unless this is their personal preference or there are specific issues raised by the risk assessment.

Screening is at pre-covid levels:


  • The UK Health Security Agency (UKHSA) has said that "defined COVID screening questions are no longer required." However, the public health messaging of "do not attend or call in advance if you have respiratory symptoms or feel unwell" remains
  • Under the pre-COVID approach, unwell patients are asked to contact the practice to discuss their symptoms. This allows the practice to determine the priority and urgency of care and balance the risks
  • When patients present for care with obvious signs/symptoms of a respiratory illness, the published dental framework suggests that practices draw up a protocol for individual triaging and patient expectation management.

Practice risk assessment - the "Dental Framework":


  • The way forward is based very much on common sense and informed risk, together with professional judgement. Completing risk assessments is an important part of this
  • It is not mandatory to follow the framework and this risk assessment is not a rigid set of rules. It is a summary of generic prompts and, as such, not all the examples suggested will be applicable in every dental practice
  • Members can use the BDA version of the risk assessment , which can be amended to suit the unique situations in individual practices. Our short course CPD on Risk Assessment will also be useful for members.

Wales: Updated guidance on respiratory transmitted illnesses 

 

The Welsh Government has published updated guidance on the management of respiratory transmitted illnesses (including COVID-19). This guidance was published following the withdrawal of the COVID-19: Infection prevention and control dental appendix on 27 May 2022. 

 

The guidance covers Service Recovery and learning from COVID-19 in Wales, Risk Assessment and managing the practice environment.


Scotland: Updated IPC guidance

The National Infection Prevention and Cross Infection Control Manual (NIPCM) has been placed on the Scottish Dental website where it is referred to as ‘the source of guidance which should always be followed in General Dental Practice’.

Below is an outline of the current recommendations.

Physical distancing:

Physical distancing is no longer needed for staff, service users or visitors. However, where services wish to continue physical distancing, they may choose to do so.

Respiratory Symptom Assessment questions:

Wherever possible, the respiratory symptom assessment questions should be completed by telephone before the arranged arrival at the facility for all service users and any accompanying carers. If this is not possible, then the questions should be asked on arrival.

Appendix two of the document should be used as a guide for the questions. This includes questions around any diagnosis of COVID-19 in the last 10 days and a question around symptoms of a respiratory illness.

If a patient has had a positive COVID result in the last 10 days or has symptoms of a respiratory illness, then treatment should be delayed unless it is necessary or urgent. It is the case that treatment ‘should’ be delayed not ‘may’ be delayed and transmission-based precautions should be used if treatment goes ahead. 

If you treat a patient on the respiratory pathway, when it is not an aerosol generating procedure (AGP), you must note the following in relation to masks, depending on the type of respiratory infection. If it is a droplet transmitted infection, then a fluid-resistant surgical mask (FRSM) is fine for routine care, but if it is an airborne one, then an FFP3 may need to be worn, even for routine care.

For procedures with a positive COVID infection, FRSM is fine for routine care however, clinical staff should wear an FFP3 for AGPs and they can, of course, wear an FFP3 for routine care if they wish. 

Other PPE for treating a patient on the respiratory pathway includes:
  • Face visor/goggles
  • Gloves
  • Plastic apron
  • A fluid repellent gown should be used if excessive splashing or spraying is anticipated.
Face masks:

The extended use of face masks and face coverings in hospitals, primary care and wider community healthcare guidance is now strongly recommended, rather than stating one should or must, as was in previous versions of the guidance.

Where staff have concerns about potential COVID-19 exposure to themselves during the ongoing COVID-19 pandemic, they may choose to wear an FFP3 respirator rather than an FRSM when providing patient care, provided they are fit tested. This is a personal PPE risk assessment.

Aerosol Generating Procedures:

AGPs include dental procedures using high-speed devices - for example, ultrasonic scalers/high-speed drills.

Post AGP fallow time is NOT required for patients with no evidence of a respiratory infection.
However, unlike England, in Scotland fallow time is still required after an AGP is performed on a COVID patient. This allows the aerosols still circulating to be removed/diluted; this is called Post AGP Fallow Time (PAGPFT). The amount of time required is a function of the room ventilation air change rate. Table 1 gives the exact time calculations.

Treatment rooms in dental practices should be aiming for a minimum of 10 air changes per hour and all treatment rooms should have a poster showing PPE for AGPs.

Respiratory COVID-19 testing:

Asymptomatic testing has been paused, however symptomatic and outbreak testing should still be undertaken. The NHS inform website offers advice on symptoms and any action to be taken after receiving a positive test result.


Northern Ireland: Updated IPC guidance 

The Public Health Agency has advised that the Infection Prevention and Control Measures for Covid-19 in Health and Care Settings Guidance published in May 2022 has been updated.

The significant areas applicable to dental care settings include:

  • A return to the application of standard and transmission-based precautions when dealing with respiratory illnesses
  • Hierarchy of Controls can be used to help implement effective controls and reduce spread of respiratory pathogens 
  • The recommendation for universal masking in all health and social care settings has been removed. This should be determined should be determined by risk assessment and this risk assessment will depend on the presence of any respiratory illness
  • Triaging within all healthcare facilities and non-healthcare facilities, such as client’s own homes, should continue and be undertaken to enable the early recognition of patients with respiratory infectious agents such as influenza or COVID-19. This should be undertaken by staff who are trained and competent in the application of clinical case definitions as soon as possible on arrival and used to inform patient placement and what precautions should be implemented. Untrained staff should seek guidance from their managers.

 

 

Coronavirus and your practice

4. What if staff members test positive for COVID?

The guidance on `Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result` for practices in England changed on 31 March 2023.

 

The main changes are:

 

  • Most healthcare staff who have symptoms of a respiratory infection are no longer asked to test for COVID-19. They should stay at home until they no longer have a high temperature (if they had one) or until they no longer feel unwell
  • Healthcare staff who test positive for COVID-19 are no longer required to have 2 negative lateral flow device (LFD) tests for COVID-19 before they return to work. They should follow the guidelines for the general public who have a positive test result. Line managers should undertake a risk assessment before patient-facing healthcare staff return to work in line with normal return to work processes.

5. What if a staff member has contact with a COVID-19 case?

People who live in the same household as someone with COVID are at the highest risk of becoming infected due to having prolonged close contact. The same applies to people who have stayed overnight in such an environment.

 

It can take up to 10 days for any infection to develop and it is possible to pass on COVID to others, even if that person has no symptoms. Routine asymptomatic testing was paused from 31 August but continues for symptomatic NHS staff and staff in symptomatic NHS-commissioned independent healthcare providers (including return to work testing) which will involve taking an LFT at home. The change has been made because the prevalence in the community has fallen and remains at a comparatively low level.

 

The practice should have a conversation about people in "household or overnight contact" to discuss ways to minimise risk of onwards transmission and these may include considering the possible redeployment to lower risk areas for patient-facing healthcare staff and/or limiting close contact with others, especially in crowded, enclosed or poorly ventilated spaces.

 

In addition, whilst they are attending work, staff must continue to comply rigorously with all relevant infection control precautions. 


In Wales, if a staff member has been in contact with a confirmed COVID case, they must follow a testing process to continue to work in a patient-facing environment. If staff do not agree, they should be redeployed or not attend work for 7 days. Before entering the practice, staff members should:


  • Be asymptomatic
  • Use lateral flow tests each day before coming to work for 7 days
  • Take a PCR test as soon as possible if the confirmed COVID case is in their household. It is advised that employers request staff members receive a negative PCR result before coming into work.

In Northern Ireland, if someone in the dental team comes into contact with a confirmed COVID case and is fully vaccinated, they are advised to isolate and take an LFD as soon as possible.

 

If the LFD is negative, they should stop isolating and take daily lateral flow tests before leaving the house until the tenth day after the last date of contact with the positive case. If the LFD is positive, they should isolate immediately. If the LFD results are negative, but they develop symptoms, they should book a PCR test and isolate immediately.

Staff who are not fully vaccinated must continue to self-isolate for 10 days and should not end self-isolation early.

 

In Scotland, any fully vaccinated close contacts of a case should take an LFD, if this test is negative, they are asymptomatic and have been risk assessed by their line manager they may return to work. To safeguard patients and other staff they will need to take an LFD for each of the ten days following the positive case and report the results to their line manager.

 

Unvaccinated staff should immediately isolate for ten days and have a PCR test as soon as possible. They should not exit self-isolation early. 

 

6. Should I get a COVID-19 booster jab?

Yes. Healthcare workers are being advised to get a booster vaccination if they haven’t already received one. To do this, you can book an appointment online or attend a walk-in vaccination centre.


The Joint Committee on Vaccination and Immunisation (JCVI) has announced that COVID boosters will be made available for frontline healthcare workers, as well as for more vulnerable groups, this autumn. The aim of the booster programme is to increase population immunity and protection against COVID-19 over the winter period. 

 

Boosters will be offered to residents in care homes, frontline health and social care workers, all those aged 65+ and those aged 16 to 64 years who are in a clinical risk group. The JCVI is reviewing the scientific data and further updates on the delivery dates will follow.


7. What about pregnant staff?

If the practice undertakes risk assessments  and acts on outcomes, we understand that the dental environment is a safe one and the pregnant members of the dental team can continue to work safely.


A common-sense approach

As would be expected, managers and other team members must be mindful of colleagues who are pregnant. If you are pregnant and working in a dental practice, it seems right that you wear a mask and follow infection control procedures at all times, no matter your gestation.


Contracting COVID-19 just before or at the time of birth, would obviously bring substantial challenges to all involved and is best avoided, so the closer the pregnancy gets to the due date, the more the practice should be prepared to show flexibility over the parental leave arrangements. See government guidance for further information.


There should also be careful risk assessments for pregnant team members in a patient-facing role with appropriate arrangements to sufficiently minimise their exposure to the virus, taking into account individual risk factors.


Practice risk assessment (updated June 2022)

Pregnant - in patient-facing clinical role

Pregnant - in patient-facing administrative role

Pregnant - in non-patient-facing administrative role

Pregnant - in non-patient-facing decontamination/cleaning role


Self-employed

Pregnant self-employed members of the dental team are free to make their own decision as to whether they work or not; that said, we urge members to work together constructively to ensure that risks are kept to a minimum.


Vaccination and pregnancy

Pregnant members of the dental team are advised to speak to their doctor before receiving the vaccine. You may wish to review the advice produced by the Royal College of Obstetrics and Gynaecology (RCOG) and the Royal College of Midwives (RCM), on pregnancy and vaccination. You may also wish to consult this explainer on COVID-19 and fertility, compiled by Victoria Male, Lecturer in Reproductive Immunology at Imperial College London. It provides evidence-based answers to questions you might have regarding the COVID-19 vaccine, pregnancy, breastfeeding and fertility.

 

8. How can I support ethnic minority staff?

Emerging evidence shows that ethnic minority communities may be disproportionately affected by COVID-19. Organisations should ensure that line managers are supported to have sensitive and comprehensive conversations with their ethnic minority staff. They should identify any underlying health conditions that may increase the risks for them in undertaking their roles. These conversations should also, on an ongoing basis, consider the feelings of affected colleagues, particularly regarding their physical safety and mental health.

 

We've recently conducted a significant piece of research into dentists' experiences of racism, as a joint project with the Faculty of General Dental Practice. Informed by the racism focus group led by BDA President Russ Ladwa, this survey has provided us with a rich vein of data on the reality of racism in dentistry.

 

It's clear that we still face a significant problem with racism within dentistry. BDA Chair Eddie Crouch has encouraged us all to recognise the reality of this, rather deny its existence. This would be the important step towards progress for our profession. For our part, we're continuing our work and research in this area and will update you when we have more information.

 

 

Coronavirus and practice management

9. Do you have Covid-related practice management resources?

Members can access our Covid-related practice management resources including:

 

Risk assessments and safety checks:

Pregnancy and COVID-19:

Read our latest advice in FAQ 9 above, based on government guidance for staff who are pregnant and concerned about safety at work.


Staff should follow correct procedures - including undertaking appropriate risk assessments and acting on the outcomes. These risk assessments were created in line with guidance from Royal College of Obstetricians and Gynaecologists (RCOG)

10. How can I change the terms of employment contracts?

Practices may wish to alter the terms of employment for their employees. This might include: changing the hours that staff work, including breaks, changes to terms about clothing and uniform, and changes to pay or other benefits. There are two ways in which practices can change the terms in an employment contract, either in agreement with the member of staff or through dismissal and rehire. Advice should be sought on both options, members can find out more about the options available to them in our resources to support members during the pandemic.

 

11. How can I negotiate changes to associate contracts?

Changes are best made by agreement with the associate concerned and, once agreed, can take effect quickly and easily. The benefits of such changes should be clearly communicated. Associates are more likely to agree to temporary changes that will be reviewed after a period of a few months. We believe it is in both parties’ interests to negotiate sensible changes.

 

We have produced side letters for associateships in England and Wales that help both parties to work within the current situation.

 

We ask practice owners to make temporary, rather than permanent changes, at least until the situation becomes clearer. We also ask practice owners to not try and force changes that are too onerous or disadvantageous to associates. Before you take action on contract changes, members should seek advice from our practice support team.

 

12. What’s happening with business interruption cover?

On Friday 15 January the Supreme Court issued its judgement in relation to the Financial Conduct Authority’s case on business interruption insurance. Widespread media coverage gave the impression that the decision was a significant outcome for large numbers of small businesses.

 

However, many sets of insurance policy wording were not covered by the scope of the Supreme Court ruling. This was particularly the case where wording was already deemed to be clear regarding exclusions of coverage relating to the COVID-19 pandemic. The impact of the decision will be felt more in relation to ambiguous policy wording, where insurers are now being told again to settle claims.

 

Our assessment, based on previous survey work, is that most dental policyholders are not directly impacted by the FCA decision because claims for cover were excluded.

 

Some QBE policies were overturned in favour of the insured by the ruling, however again based on assessment of the market, we do not believe that many dental practices have those QBE policies impacted by that part of the decision. There are some dental practices insured by QBE, but the Court had already ruled in favour of the insured practices in those cases.

 

There are some positive aspects to the decision for those claimants with an established case:

 

  • Insurers will now find it difficult to argue that they can reduce any loss that happened before lockdown, if that loss is because of a slow-down in activity relating to the COVID-19 pandemic
  • Insurers cannot take any COVID-related issue into account in negotiating a payment
  • Prevention from accessing premises now includes partial prevention from accessing premises. Some policies in the dental sector had wording that required there to be prevention of access.

In summary, most insured businesses (in dentistry and across the economy) did not have a legal route before the Supreme Court decision, and won’t have a claim afterwards. However, the position on damages is now likely to be more simple to calculate where businesses haven’t settled but where claims have been accepted.