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Coronavirus: your FAQs

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

Page last updated: 5 July 2022.

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.

 

We've also produced a series of helpful tools to help members - you'll need to be logged in to access them.

 

Abatement and associates’ pay

 

What’s happening with the NHS contract?

Our advice team have outlined what you need to know about NHS England's fourth quarter contracts:

 

Members can access this advice by signing in and if you're not a member you can join today.

 

Brexit, visas and right to work

Since Brexit, we've published advice on recruitment, Right to Work checks and correct HR procedures  to support you and your practice.

 

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’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. We've been clear throughout the crisis that the government needs to step up to support private dentists, who have been providing essential healthcare throughout exceptionally difficult circumstances.


To support you, we have launched a new private practice advice page. This useful resource brings together advice for members in private practice, whether in England, Wales, Scotland or Northern Ireland. Included is advice on business structures, practice diversification, complaints management and pensions.

 

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.

 

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.

Routine asymptomatic testing remains:


  • Dental staff should still be taking LFTs twice weekly and the results should be reported
  • The most recent England CDO's "Dental framework" says that testing should be carried out for staff in line with any national policies, and the current policy is outlined here
  • Patient-facing staff should continue to test twice weekly when asymptomatic and if they receive a positive LFD test result, they should follow the isolation advice.


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.

 

Northern Ireland: IPC changes effective now 

 

Northern Ireland's Chief Dental Officer, Caroline Lappin, has informed dental practices of changes to the Infection Prevention Control Guidance. A short guide on the updated changes is available.

 

This is effective for all dental settings from 7 July 2022, providing a transition period for review of policies and updating of risk assessments. However, the guidance is valid with immediate effect for those settings who are in a position to implement sooner.

 

The Northern Ireland Regional Manual has also been updated, following the removal of the UK wide Dental Appendix on 27 May.

 

Coronavirus and your practice

4. What if staff members test positive for COVID?

In England, NHS, mixed and private practice staff who test positive for COVID, regardless of whether they have symptoms, are advised not to attend work for at least 5 days. They should follow guidance for people with a positive COVID-19 test result.

 

Staff can return to work after two consecutive negative LFD test results (taken at least 24 hours apart), with the first LFD taken five days after the day their symptoms started or the day their first positive test was taken.

 

If both LFD tests results are negative, they may return to work immediately after the second negative one, provided:

 

  • They feel well enough to work, and they do not have a high temperature
  • They continue to comply rigorously with all relevant infection control precautions and wear personal protective equipment (PPE) properly.

They should – like everyone else in the practice - resume taking twice-weekly asymptomatic LFDs.

 

However, if the Day 5 LFD test is positive, they should continue to test daily until they have received two negative LFD test results, taken 24 hrs apart.

 

In some cases, their LFD will show positive on Day 10; if this is the case, they should discuss what to do with the practice manager who may undertake a risk assessment.


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. As such, people in close contact and who are patient-facing healthcare staff should continue with twice-weekly asymptomatic LFD testing.

 

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. Is the COVID-19 vaccination mandatory?

No, mandatory vaccination is not a condition of employment.

 

7. 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.


8. What's the advice for dentists and staff returning to the UK?

There are currently no COVID-related travel restrictions on returning to the UK from abroad.

 

For more information on guidance in your area see:

 

9. 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.


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.

 

10. 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

11. 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.

 

12. 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.

 

13. 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.

 

 

NHS England contracts

14. What’s happening with the NHS contract?

We have outlined everything you need to know about the approach to first quarter contracts for 2022/23:

  • In England, the NHS published information on 5 April setting out their approach to contracts for the first quarter of 2022/23. There has been some confusion regarding the 95% performance threshold for the period and we are currently seeking clarification on this.
  • In Wales, we have been navigating the options for GDS Practices with an NHS contract. Practices can either opt for the new volumetrics or revert to the UDA-only option for 2022-23.
  • In Northern Ireland, we are disappointed that the Rebuilding Support Scheme officially replaced the Financial Support Scheme from 8 April. Under the new scheme SDR will be uplifted by 25% to encourage activity and there is no threshold for receipt and no upper limit.
  • In Scotland, we are calling for meaningful long-term contract negotiations with the Government. Currently a three month multiplier is in place and we are faced with the end of Covid support payments and a return to the SDR.


15. What is happening with prototype contracts?

In England, prototype regulations will not be extended beyond April 2022, and all practices will return to underlying GDS or PDS contractual arrangements from that date. The DHSC has indicated that, whilst important lessons have been learnt via the prototype process, the evaluation of the scheme has meant that it is not possible to roll out the approach more widely, with that evaluation notably suggesting a fall in the number of patients accessing care.


We have criticised the insufficient support offered to over 100 pioneering practices in England, who are being forced back to working to historic models of care from April after years of testing new ways of providing NHS care. Reverting to the original model will see these practices facing significant challenges. These practices are being offered a helpline and patient leaflets to deal with the change. This will do little to mitigate the disruption caused. We will continue to push for more support to be provided to these practices, who were willing to take risks in the name of improving NHS Dentistry.

 

16. 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, saying that it 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 to 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 advise members on NHS contract issues.

 

17. 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.

 

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 will play our full part in working for meaningful transformation that benefits patients and dental teams.

 

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

 

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. We will update you on any progress made.