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Coronavirus: your FAQs

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

Page last updated: 23 April 2021.

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 to address my concerns?

We are lobbying the Government to ensure that your needs are represented at this difficult time. We are working to get you answers as fast as possible and keep you up-to-date with this ever-changing situation.

 

We've produced a series of helpful tools to help members through some of the more complex areas of the current crisis. We hope you'll find them useful. You will need to be logged in to access them.

 

Abatement and associates’ pay

What happened with quarter four targets?

We negotiated for some months with NHS England regarding the support package for contract holders in England. We refused to sign up to a deal which saw practices face steep financial penalties if they were unable to hit 45% of their pre-pandemic UDA targets.

We produced advice for the profession:
Advice - NHS England quarter four targets advice : Download our comprehensive advice for members.
 
What’s happening with the 2021-2022 NHS contract year?
NHS England has increased the targets for dentistry from 45% to 60%, and in orthodontics from 70% to 80%. The cliff-edge drops in funding remain at 36% for dentistry and 56% for orthodontics.
 
We produced advice for the profession:
Advice - NHS England targets April to September 2021 : Download our comprehensive advice for members.

England - Examples of pay calculations for BDA side agreements

Wales - Side agreement for associates April to September 2021

Video: Martin Woodrow round up what is happening in regard to NHS contracts across the UK as of 1 April.

Video: James Goldman further explains the UDA targets and side agreements for 2021
Blog: Ministers double down on NHS targets

 

Webinars
Members can watch our webinars on various topics, including: PPE, fit testing, furlough and financing, business interruption insurance, and stress and COVID-19.

 

Remote consultation guide
We've put together guidance on how to conduct a remote consultation with your patients   and avoid some of the common pitfalls.

 

Risk assessment
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’ve 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 in these difficult times. The reopening of practices across the UK has not undone the financial impact of the crisis on many businesses. We continue to campaign at a national and regional level on issues such as ventilation funding and PPE.

 

Indeed, we’ve been clear throughout the crisis that the government needs to step up to support private dentists, who are providing essential healthcare in exceptionally difficult circumstances.

 

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 within the BDA and we will continue to work hard on your behalf. We are your association and together we are stronger.

 

3. What is the latest guidance on COVID-19?

England

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID-19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway. An SDCEP review, conducted in January 2021, has reiterated the importance of following this guidance.

 

Reviewed standard operating procedures (SOPs) have now been published. The document, 'Transition to Recovery', is available on the NHS website, and all key changes have been highlighted in yellow. Deputy CDO, Jason Wong, summarised these changes as follows:

 

  • Symptomatic staff can access testing via the GOV.UK website (or call 119) and should identify themselves as essential workers.
  • Staff with symptoms of COVID-19 should stay at home as per advice for the public. Staff who are well enough to continue working from home should be supported to do so. If staff become unwell with symptoms of COVID-19 while at work, they should put on a surgical face mask immediately, inform their line manager and return home.
  • Lateral flow antigen testing is now being rolled out in primary care for asymptomatic staff delivering NHS services in England. Primary care contractors that ordered lateral flow devices on or before 17 January 2021 will now have received their delivery. Orders received after that date will be delivered as part of their business as usual deliveries from PCSE.
  • Patient-facing primary care staff are asked to test themselves twice weekly and report their results to Public Health England (PHE), via the NHS Digital online platform. Please be aware that it is a statutory requirement to report all results, including negative, positive or void.
  • For patients who are COVID-19 possible/confirmed cases and contacts (seen in designated Urgent Dental Centres only) - avoid AGPs where possible, unless there is no alternative treatment option and/or the AGP intervention cannot be deferred.

We also encourage you to review our resources for providing safe care during the pandemic. 

 

Government advice to reduce contact and travel will inevitably impact patient behaviour across all parts of the UK. Practices should also note that shielding guidance is again in place for those who are clinically extremely vulnerable.

 

The CDO England has confirmed that that dentists and their teams, whether in NHS or private practice are considered critical workers.

 

We have produced a letter for members to share with their children's schools , confirming that dentists in England are key workers, which may assist you during this time.

 

Wales

Updated SOPs for non-COVID-19 dental patients in Wales were published on 17 December 2020. See also the accompanying letter from the Chief Dental Officer to Primary Care Dental Teams in Wales.

 

It is to be used alongside the Welsh Government’s guidance to help dental teams complete Assessment of Clinical Oral Risks and Needs (ACORN) forms for patients, both routine and urgent. See our Coronavirus and NHS dentistry in Wales section below for more detail.

 

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway. An SDCEP review, conducted in January 2021, has reiterated the importance of following this guidance  .

 

Northern Ireland

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway. An SDCEP review, conducted in January 2021, has reiterated the importance of following this guidance  .

 

You can find the latest communication on operational guidance on the Business Services Organisation (BSO) website .

 

Scotland

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID--19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway. An SDCEP review, conducted in January 2021, has reiterated the importance of following this guidance  .

 

Revised Standard Operating Procedures (SOPs) have been published for dentists in Scotland. These follow SDCEP's recent rapid review of AGPs and publication of the four-nation dental Infection Prevention and Control Guidance.

 

Advice to wholly private practices was issued on 17 November following the introduction of the five lockdown tiers or protection levels in Scotland from 2 November.

 

For practices in Level 4 (which has the highest restrictions), the focus of care should be restricted to essential or urgent treatment of clinically diagnosed conditions, where no treatment would have a significant adverse impact on the wellbeing of the patient. No aesthetic procedures or elective treatments should be undertaken in Level 4 areas.

 

Practices in Levels 0, 1, 2 and 3 can offer a range of treatments and procedures, but must continue to fully adhere to all public health advice. This includes social distancing and the use of PPE and face coverings, which should not be removed unless there are sound clinical reasons to do so.

 

We also provide resources to support members providing care during the pandemic. These are  designed to complement the SDCEP guidance, download them for practical advice on various issues, including indemnity, employment relations, and staff terms and conditions.

 

 

Coronavirus and your practice

4. Should I use the NHS COVID-19 app?

You may find the NHS COVID-19 app a useful way to monitor your risk level. If using the NHS COVID-19 app, the Government recommends that you pause the contact‐tracing function on the app when you are in dental surgeries. The app should not continue tracing your contacts during this time because you are working in highly specialised environment, trained in infection prevention and control processes, and wearing medical grade PPE as required.

 

You should also be aware that notifications from the app to self-isolate are not legally binding. You should only self-isolate when told to do so by NHS Test & Trace personnel or a medical professional.

 

See guidance on how healthcare workers can use the NHS COVID‐19 app for more information. Please distribute all relevant guidance to your staff.

 

In Northern Ireland the Health and Social Care Board contact tracing app is in operation.

 

5. Should my practice use lateral flow tests?

Lateral flow tests are available to test staff for COVID-19. However, you should note that a one-off negative result in a lateral flow test does not guarantee that you are COVID-19 free. These tests appear to report a relatively high rate of false negatives.

 

A positive test result meanwhile does not guarantee COVID-19 infection and should be confirmed with the PCR test as soon as possible. You should inform your manager of a positive result and arrange a confirmatory PCR test via the established testing routes. If you test positive, you should self-isolate immediately, along with your household contacts until the results of the PCR test is known. If the result is negative, you can all stop isolating; however, if it is positive, you must continue to self-isolate for 10 days.

 

If your practice is using LFTs, please note that if you have tested positive for COVID by PCR in the past 90 days, you are exempt from re-testing.


Whether or not you choose to use lateral flow tests, it is essential that all dental practices continue to follow the current infection control guidance. This remains essential to reduce transmission and protect those around you.

 

6. What if a patient has COVID-19?

If dentists are providing direct care to a patient with COVID-19 and are wearing the correct PPE in accordance with the current IPC guidance, they are not considered a contact for the purposes of contact tracing and isolation, and are not required to self-isolate.

 

7. Must I see patients without face coverings?

The safety of both staff and patients is of paramount importance and face coverings or face masks should be worn by patients in a practice setting, in line with government guidance. However, a patient should not be refused access to care if they are unable to wear a face covering.

 

For these patients, practices should ensure that they can take all reasonable steps to identify practical working solutions with the least risk to all involved. For example: offering the patient a mask, if the patient is willing to wear one; booking the patient into a quieter appointment slot; seeing them in a separated area, or providing care via a remote appointment.

 

If a patient is deaf or has hearing loss, you are advised to temporarily lower your face covering while maintaining social distancing. These patients should not be turned away and this is the safest way to communicate with someone who relies on lip-reading or facial expressions.

 

8. What if a staff member has COVID-19?

If a member of staff has coronavirus, they should follow government advice. Staff who have COVID-19 symptoms or a positive test result should self-isolate for 10 days, or for 14 days if they are admitted to hospital.

 

If the member of staff lives in a household with someone who has COVID-19 symptoms or has tested positive for COVID-19, they should also self-isolate in line with the government guidance.

 

Standard sickness procedures should also be followed. Staff should contact the practice immediately and update them on when they will be able to return. They will either be entitled to sick pay or, depending on the terms of their contract of employment, statutory sick pay. Check your contracts of employment and the practice's policy on sick pay.

 

Please note, the Coronavirus Job Retention Scheme is not intended for short-term absences from work due to sickness.

 

9. Should patients be notified?

If a member of staff is providing care to a patient and wearing the correct PPE, they are not considered a contact for the purposes of contact tracing and isolation, and are not required to inform the patient for self-isolating purposes.

 

However, if a the member of staff with COVID-19 comes into direct contact with a patient whilst wearing no PPE, inappropriate PPE or an PPE breach occurs, the patient must be contacted. The patient should told to isolate for 10 days and be given guidance on getting tested if they develop any symptoms.

 

The member of staff should also submit the details of close contacts to the NHS Test and Trace service, which would then let any colleague or patients know if they have been in close contact with a person who has tested positive for COVID-19 and should self-isolate.

 

10. What if a staff member is told to self-isolate?

Dental teams should note that notifications from the NHS COVID app to self-isolate are not legally binding.

However, you must self-isolate when told to do so by NHS Test & Trace personnel or a medical professional.


If you are told to self-isolate and you have COVID-19 symptoms, you should do so for either ten days starting from the day after the day you got symptoms, or for ten days from four days before you had the test, whichever is longer.

 

If you have no symptoms, but you have been told to self-isolate by Test and Trace, you should do so for ten days.

 

If Test and Trace tell you that you were in close contact, you will be told to isolation for ten days starting with the day after the last day you came into close contact with the positive person. A close contact is defined as:

 

  • Having face-to-face contact with someone at a distance of less than 1 metre
  • Spending more than 15 minutes within 2 metres of an individual
  • Travelling in a car or other small vehicle with an individual
  • Or in close proximity to an individual on an aeroplane.

For more information on contact tracing and self-isolation, see government guidance.

 

Staff staying at home for these reasons should be treated as if they are on sick leave. The government has said that statutory sick pay (SSP) should be payable from the first day of the sickness period. Employers with fewer than 250 employees will be eligible to reclaim two weeks' SSP for each employee who has been affected by COVID-19. This has not yet been formalised in emergency legislation, but it may include a clause allowing it to be backdated. Ensure you keep records of any absence due to COVID-19 to be able to claim this back from the government.

 

11. When can staff return to work?

You do not need a negative COVID-19 test before returning to work after illness or self-isolation. Once your period of self-isolation is complete or your clinical symptoms have improved and you have had no fever for 48 hours, you may return to work. This Public Health England flowchart may help you.


If the member of staff's symptoms are not better after 10 days, or their condition gets worse, they should speak to their occupational health department, if you have one, or use the NHS 111 online coronavirus service.

 

12. What if staff are anxious about returning to work?

Practice owners should be sympathetic to any concerns staff may have about returning to work and to try to resolve them.

 

It may be that the employee is concerned about travelling into work or has specific concerns that relate to the safety of the workplace. If the employee cannot work from home, these concerns might be addressed by permitting the employee to work different hours to avoid peak commuting periods, take paid or unpaid leave, or carry our different duties whilst at work. If the employee's anxiety means they are too unwell to attend work, then they may be treated as being on sick leave. If the employee suffers with severe anxiety, this may amount to a disability and medical advice should be sought.

 

Current public health advice, the employee's specific concerns about returning to the practice and their particular circumstances, should be taken into account before any disciplinary action is taken. The BDA Practice Support team is ready to advise members in this situation.

 

 

Coronavirus and the dental team

13. How can I access the COVID-19 vaccine?

In England, NHS England have now confirmed that all dentists, teams and support staff – in both NHS and private settings – will receive priority access to the COVID vaccine. This is welcome news for all dentists and team members across England.

 

In terms of next steps:

  • High street NHS dentists and teams - sit tights and wait, you are on the list.
  • Dentists working in trusts - your HR will have matters in hand.
  • Private practices - you will be covered, but you must ensure your CQC accounts  are up to date. This data will be passed to the vaccination programme for follow up.

  • Locum dentists - Locums who are working with a practice can be done as part of that practice, and that locums between employment aren't patient facing and so are not part of the priority group at this time. NHS England have acknowledged that some falling between the cracks, but have said that they are looking for solutions and will update the profession shortly. 

The message is do not contact your GP, you will be on the list and will be contacted to receive your priority access to the vaccine. 

 

In Northern Ireland, General Dental Practitioners (GDPs) and their frontline staff should now be able to schedule their COVID-19 vaccinations. Details on how to do this have been sent to GDPs by the Health and Social Care Northern Ireland. This follows the assurances we sought, that dentists and their teams working on the frontline would be prioritised and receive their vaccinations early in the roll-out.

 

In Scotland, most NHS Boards have started vaccinating dentists and their teams. Where this is not yet the case – for example, in NHS Highland – the Board has indicated that it plans to begin vaccinations by the end of January. We have contacted the NHS Highland to express concerns about the delay there, and we continue to liaise with the Scottish Government to ensure dentists and their teams are prioritised during the early rollout of vaccinations.

 

In Wales, the CDO confirmed that dental teams, including those in private practices, would be invited to receive the COVID-19 vaccination in the second phase of roll-out following the most vulnerable group.

 

The Minister for Health and Social Services established the new Primary Care COVID-19 Immunisation Service (PCCIS). This is a national contracting mechanism for Health Boards to engage providers to deliver COVID-19 vaccinations from within Primary Care. Some dentists have already started to receive the jab, although the speed of roll-out might vary between Health Boards.

 

14. If I'm vaccinated, is full PPE essential?

Yes. Even once vaccinated, it is essential that dentists and dental teams continue to follow the infection control guidance currently in place.

 

There are several reasons for this. As government guidance states, it may take a week or two for your body to build up some protection from the first dose of vaccine. We also know that some people may still get COVID-19 despite having a vaccination, and while this should be less severe, taking precautions reduces this risk.

 

More importantly, while a full course of the vaccine will reduce your chance of becoming seriously ill, it is not yet known whether it will stop you from catching and passing on the virus. It is expected to reduce this risk, however, until more is known you should continue to follow the guidance to help reduce transmission and protect those around you.

 

15. Is the COVID-19 vaccination mandatory? 

Whilst the BDA believes the COVID-19 vaccines are both safe and essential, it is not compulsory to have the COVID-19 vaccination. The vaccine is important in our fight against coronavirus, but practices should be aware that they cannot insist that staff have the vaccine when it is offered.

 

We suggest that practices discuss the vaccination with all members of the dental team. Concerns about the vaccine should be discussed in good time and sensitively.

 

Pregnant members of the dental team may 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.

 

Pregnant members of the dental team are also advised to speak to their doctor before receiving the vaccine. You may also 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, and on vaccination misinformation.

 

The University of Bristol has produced a helpful Communications Handbook on this. Nevertheless, after a discussion, if a member of the dental team refuses to have the vaccine, the practice has to accept that decision. In any event, practices should ensure that all members of the dental team continue to adhere to the standard operating procedures and to practice policies and procedures. The situation is no different for associates.

 

A practice is unlikely to be found liable, if a staff member or patient caught COVID via a member of staff who had refused to take the vaccine, unless it can be shown that their failure to follow procedures lead to someone catching COVID. We believe any such case would be very difficult for the claimant to prove.

 

16. What about staff returning from abroad?

Anyone arriving in England from anywhere outside the UK, Ireland, the Channel Islands or the Isle of Man you need to self-isolate for 10 days. You must also have proof of a negative coronavirus test to travel to the UK, Ireland and the Channel Islands from outside.


Practice owners cannot tell staff not to go on holidays. However, they can discourage staff from going on holiday abroad by making it clear that they will have to follow any public health quarantine advice on their return and may not be paid during that time or asked to treat it as a further period of annual leave.

During quarantine, if the member of staff can work from home, then they should be paid as normal. If this is not possible, then the question of whether they get paid will depend upon the circumstances. SSP is unlikely to be payable to someone who is under quarantine, unless they have the virus, have symptoms of the virus, are living with someone with the virus or with symptoms of the virus, are shielding or have been told to self-isolate by the NHS.

 

Whether contractual sick pay is due, will depend on the wording of the contract. Where the contract does not provide for sick pay, the practice owner could decide to pay contractual sick pay on a discretionary basis, taking into account factors like whether the employee had travelled abroad voluntarily and could have avoided the subsequent quarantine restrictions. Alternatively, the quarantine period could be treated as an additional period of paid annual leave.

 

Travel to the UK from a number of countries is currently banned, here's the list of banned countries.

 

See the latest government guidance for travel to England . Northern Ireland and Wales currently follow the same guidelines as England. If you are in Scotland, please refer to the specific advice from the Scottish Government .

 

17. What if I'm pregnant?

The available guidance
Please note, the following is based on the current available government advice.

 

If staff follow correct procedures - undertake risk assessments and act on outcomes plus wear appropriate PPE - we understand that the dental environment is a safe one and that pregnant members of the dental team can continue to work safely. We now have established Standard Operating Procedures and a good supply of PPE which gives members of the dental team substantial protection against catching coronavirus.

 

A common-sense approach
As would be expected, managers and other team members must be mindful of colleagues who are pregnant. The following of all practice policies (such as wearing the correct PPE, hand washing and social distancing) to avoid transmission of the virus between team members is essential. Masks should be worn throughout the practice in staff rooms and other non clinical areas where other staff are around.

 

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 roles with appropriate arrangements to sufficiently minimise their exposure to the virus, taking into account individual risk factors.

 

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, and on vaccination misinformation. 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.

 

18. 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.

 

It is also important to note in this context, that PPE fit-testing requires men to shave their beards. Men who do not wish to shave their facial hair for religious reasons are currently being advised to wear a PPE hood instead and tuck it into their gown.

 

 

Coronavirus and practice management

19. Can staff still be furloughed?

The government’s Coronavirus Job Retention Scheme, also known as the Furlough scheme, will remain open until the end of September 2021. Under the scheme employees will continue to receive 80% of their current salary for hours not worked, up to a maximum of £2,500.

 

Practices can also bring furloughed employees back to work on a part-time basis. If your practice qualifies to claim under the scheme, you now have the flexibility to decide the hours and shift patterns of their employees – with the government continuing to pay 80% of salaries for the hours they do not work.

 

This means that you may, with staff agreement, designate employees as furloughed workers. This includes employees who are currently self-isolating. People on maternity and paternity leave who return to work are also eligible for the government’s furlough scheme.

 
You can then submit information to HMRC's online portal about the employees that have been furloughed and their earnings. See our advice on furlough for more information and resources on this process.

 

20. 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.

 

21. 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.

 

22. 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.

 

We are working with lawyers Brown Rudnick to offer you a further webinar outlining in more detail the implications of the ruling. We will update you once that becomes available.

 

23. Can I avail of multiple forms of government assistance?

Yes. We have lobbied all four governments for a clear answer on this and at present we know:

 

England: The Treasury and NHS England have confirmed that mixed practices can make full use of the furlough scheme in proportion to their private activity, without endangering their NHS funding. This will be a relief to many mixed practices, and comes after consistent campaigning on your behalf.

 

Northern Ireland: A full list of the business support measures  that have been put in place in response to COVID-19, and the Department of Health have stated that they expect dental practices in NI will be eligible for support from both UK-wide and NI Executive sources.

 

Wales: Some dental practices were eligible for Economic Resilience Funding earlier on in the lockdown if their practice had a rateable value below £12,000. However, no practices are currently eligible for government business grants, because practices have remained open operating under the amber alert SOP.

 

Scotland: On 9 April, the Scottish Government clarified that mixed dental practices that receive NHS support funding, can also apply for support from other government sources to cover the private element of their income. These latter claims should be proportionate to the amount of private dentistry delivered.

 

Members with mixed practices, we've put together a tool to help you calculate how much you are entitled to claim   as part of the furlough scheme. Watch this demo video to help you use our furlough calculator. We also recommend that members watch our advice webinar on financing and furlough  .

 

 

NHS England contracts

24. What’s happening with the 2021-2022 NHS contract year?

NHS England increased the targets for dentistry from 45% to 60%, and in orthodontics from 70% to 80%. The cliff-edge drops in funding remain at 36% for dentistry and 56% for orthodontics.

 

We are clear this was an unacceptable increase, building on what was already an unacceptable policy, and news came just days before its planned imposition.

 

However, we secured some needed concessions, and this announcement came with a commitment to see through meaningful reform of the GDS contract in 2022.

 

GDPC Chair Shawn Charlwood has a full update on all the key developments. And we have produced advice for the profession: 

 

 

25. What happened with quarter four targets?

We negotiated for some months with NHS England regarding the support package for contract holders in England. We refused to sign up to a deal which saw practices face steep financial penalties if they were unable to hit 45% of their pre-pandemic UDA targets.

 

We produced advice for the profession:

 

 

26. What is happening with prototype contracts?

Following the latest announcement on NHS contractual arrangements in England for the first half of 2021/22, we are seeking clarification from the Department of Health and Social Care around the conditions to be applied to prototype practices.

 

Whilst we await confirmation of the position, there remains an expectation as set out for all other contractors that prototype practices will maximise safe throughput in the spirit of meeting as many prioritised needs as possible during the current time. We will update you as soon as possible.

 

27. What's happening with lockdown abatement? 

Practices should be aware that the abatement for the period 1 April – 7 June 2020, when dental practices were closed for face-to-face care, is being taken from NHS schedules from April 2021.

 

This 16.75% deduction from NHS dental contractors' remuneration will be taken between April and July 2021. It will be taken in four equal instalments over the coming months. An estimate of the amount deducted each month would be £725 per £100,000 of contract value. 

 

It should be noted that all UDCs (which will be classed as being established for the whole duration of the closed period) and orthodontic close-down contracts will be exempt from abatement for the period.

 

28. What's happening with overperformance?  

We understand that NHS Business Service Authority has written to NHS dental practices in relation to overperformance during the 2019-2020 contract year. The letter we have seen says that such overperformance will automatically get carried forward into the 2021-2022 contract year unless otherwise agreed.

 

This may suit some practices well. If a practice did overperform in 2019-2020, and if it may struggle to meet the 60% threshold in the period from April to September 2021, that overperformance could help.

 

However, some practices that overperformed in the 2019-2020 contract year may be well placed to perform at least 60% in April to September, and may therefore  want to carry the 2019-2020 overperformance forward to 2022-2023. 

 

If so, you must email nhsbsa.dentalcases@nhs.net no later than 31 March 2021 do explain what option for your overperformance you want them to consider. NHS BSA will then liaise with your LAT who may contact you. Our advice teams are happy to advice members on NHS contract issues.

 

29. Has progress been made on contract reform?

We've passed the tenth anniversary of the contract reform process kicking off, and UDAs are still with us. However, we welcome the recent statement from officials and the Minister which indicates fresh commitment to seeing reform through, led by NHS England.

 

See this joint statement from Gabi Darby (NHS England) and Shawn Charlwood (Chair of GDPC):

 

"Today's letter on NHS dental contract arrangements, issued jointly by Health Minister Jo Churchill, NHS England and the Chief Dental Officer represents an important new chapter in progressing contract reform in England.

 

The commitment to pursue rapid meaningful change across the next year will be particularly valued by those working in NHS dentistry. All parties have recognised the profession is seeking faster progress on contract reform. NHS England and the British Dental Association are optimistic that the commitments given represent a new start for system reform, with DHSC having asked NHS England to lead in moving the process forward over the next 12 months and beyond.

 

NHS England and the BDA look forward to working together immediately and at pace to take forward system reform, exploring how we can make the joint principles set out in today's letter work for the profession and patients. Whilst we know that contract reform is not straightforward, we hope and expect that the six aims will offer a transparent framework to enable us to develop a reformed NHS system that provides high quality patient care and an environment where professionals can work to their full potential.

 

We will now begin the process of developing reform and will report back progress as soon as we can."

 

What's outlined on system reform appears a mixture of potential 'quick wins' by October 2021 and wider ranging reform by April 2022.

 

This reflects the constant lobbying we have undertaken and is in no small thanks to so many members of the profession reaching out to their own MPs. We welcome this fresh commitment to change and we will play our full part working for meaningful transformation that benefits patients and dental teams.

 

Coronavirus and NHS dentistry in Wales

30. What is the latest on NHS GDS contract payments?

The Welsh CDO has written to all primary care dental teams in Wales, providing detailed guidance on the contractual arrangements for quarter one and two FY2021-2022. This covers issues such as specialist contracts, UDA delivery, mandatory use of ACORN findings, fluoride varnishes, AGPs, ventilation, and new patients. We're preparing a side agreement for associates, which covers this period and will make it available as soon as possible.

 

For now, the pandemic activity data gathering system that reflects the amber alert phase put in place last summer continues. This has been adopted by more than 95% of practices with an NHS contract and we urge you to continue to submit additional pandemic activity data via the e-referral service and be diligent in performing the ACORN assessments once a year for each patient.

 

Going forward, it is likely that there will be some soft targets for patient throughput that will be tailored to individual practices for the next one or two quarters. These will likely include fluoride varnish applications for adults and children and be partly based on the patient population RAG scores obtained from the ACORN data and also the level of urgent work each practice is still undertaking. The dental activity reports submitted via the FP17W to NHSBSA are also going to be key in building up a picture for each practice.

 

The CDO has been clear she wants to get away from a one size fits all approach and that applies to contract reform as well. We support this in principle. We will continue to be your voice in this debate and we will update you as soon as we have more information about contract payments and activity measures and also any news about the contract reform project recommencing.

 

31. How do I apply for ventilation funding?

The Welsh Government’s commitment to offer capital funding to help dental practices secure new equipment to expand patient numbers was announced in December. Health Minister Vaughan Gething MS has set aside £450,000 in 2020-2021 funding to support dental practices in improving surgery ventilation. Some practices are already receiving support. You can find out more about it here or by contacting your Local Health Board for further information.

 

32. Are dental practice inspections on hold?

We understand that Healthcare Inspectorate Wales (HIW) are currently only undertaking rare visits in-person to dental practices where there has been a triggering event, otherwise their inspections of practices are still on hold during the pandemic amber alert phase.  HIW are planning on introducing a Quality Check system of practice premises. DCP practices will be treated in the same way as dental surgeries. The first 15-20 pilot quality checks will be undertaken March-May 2021. We have asked to contribute to the consultation process in addition to widespread sharing of proposals so colleagues can be as prepared as possible. We await the draft.

 

Practices were notified recently regarding the reduction in fees and the invoices were subsequently issued. HIW have extended the payment deadline until the end of March 2021 and advised that they will not issue the fees becoming due on 1 April 2021 until the summer.

 

Coronavirus and employed dentists

33. What's happening with appraisals?

In England, NHS Employers are recommending ‘light touch’ appraisals for CDS dentists until April 2021. A similar approach is in place for hospital dentists. As part of the Joint Negotiating Committee (Dental), we agreed this approach, based on recent guidance issued by the Academy of Royal Colleges (AoMRC).

 

Our joint recommendation is for a similar approach for salaried dentists, with the following considerations being made by appraisers and appraisees:

 

  • Dentists have the right to request a formal appraisal. Where this is not the case, this year’s appraisal discussion should be informal, enabling a summary of activity undertaken to be captured through discussion. Expectations for written evidence should be minimal and manageable.
  • Appraisal discussions should have a clear focus on health and wellbeing, enabling dialogue between the appraiser and the dentist and identification of any support needs.
  • No dentist should be disadvantaged in terms of pay progression for not having met objectives set before the pandemic

We would like to remind employers and staff that the indicative training allowance can be spent prospectively and/or retrospectively (not just ‘in year’). For full details, please see the NHS Employers webpage.

 

34. Where can I go for support?

During this time, you may have to make clinical decisions that prioritise scarce resources. For guidance on the ethics of this, please see the FAQ we produced along with the BMA . This won’t answer every question you have, but we hope that it will support and guide you in making the decisions asked of you.

 

If you are looking for advice on a work-related issue:

 

  • Members employed on national terms and conditions within the salaried/community dental service, in dental schools, in the armed forces or a variety of other employed roles with in the NHS, please contact: employmentrelations@bda.org
  • Members working under hospital terms and conditions can contact the BMA for employment relations support: 0300 123 1233 (please quote your BDA membership number).

This may prove quite stressful and members should be aware that they have access to our 24-hour counselling service. We’re here for you and we encourage all those under stress to reach out.

 


Coronavirus and dental training

35. How can I prepare for DCT interviews?

Part of COVID-19’s impact on Dental Core Training (DCT) has been to make all interviews for National Recruitment virtual for the first time ever. This is a whole new format and it is difficult to predict exactly how they will be conducted and assessed.

 

Thankfully, we can assume that many of the same qualities and skills will still be tested. And although the process may be daunting, you’re not alone in preparing for this. Based on the last few years of national recruitment, Anurag Srinivas has written a blog putting together some top tips for DCT interviews. We hope this gives you a good starting point and a bit more confidence as you prepare for your interview.