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Coronavirus: your FAQs

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

Page last updated: 17 January 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. 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?

New IPC guidance published

The latest UK infection prevention and control guidance for healthcare settings and the updated dental appendix were published in November 2021.

 

Key changes include:

 

  • Removal of the 3 distinct COVID-19 care pathways (high, medium and low)
  • Use of a screening tool to place patients on either a non-respiratory or a respiratory pathway; revert to standard infection control precautions for the non-respiratory pathway
  • Reduction of physical distancing requirements to at least 1 metre for the non-respiratory pathway.

Other recommendations from the previous guidance remain in place:

 

  • Organisations and employers should assess, manage and monitor risk based on the measures prioritised in the hierarchy of controls
  • All patients should be screened for COVID-19
  • Universal masking/face coverings to remain for staff and patients within dental settings
  • Patients with suspected or confirmed respiratory infection should have non-urgent treatment deferred if clinically appropriate
  • Patients on the respiratory pathway whose treatment cannot be deferred should be segregated or isolated from other patients
  • Two metres physical distancing should continue for patients on the respiratory pathway.

We now await the publication of standard operating procedures to define the detailed approach to applying this guidance in each UK nation.

 

 

England

The new Standard Operating Procedures for England have been published, as of 25 November 2021. 


Wales

The joint Deputy Chief Dental Officers for Wales have published a response to the new dental IPC guidance In this they clarify what dental teams in Wales must do to carry out an appropriate risk assessment for COVID-19. They advise practices to have 10 or more air changes per hour to help minimise this risk and include a screening tool for COVID-19.


Northern Ireland

 

The CDO has written to GDPs to set out the process by which the Northern Ireland Operational Guidance will be revised to take account of updated UK IPC Guidance and Dental Appendix.

 

Practices have been reminded to continue to follow the existing guidance issued on 2 February 2021 until the work to produce new Operational Guidance is complete, and a further communication issued to GDPs.


Scotland

New SOPs for dental teams in Scotland have been published. Patients in Scotland will now be placed on one of two pathways, given the likelihood of them carrying a respiratory illness:

  

  • Those on the non-respiratory pathway can be managed in line with pre-COVID standard infection control precautions for non-aerosol generating procedures. However, for an aerosol generating procedure, enhanced precautions will still be required
  • Any patient placed on the respiratory pathway and requiring urgent care will remain subject to enhanced precautions for all procedures, which will include maintaining 'fallow time' gaps of up to an hour between treatments.


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?

It is not a legal requirement to do so, but 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 are only legally obliged to self-isolate if told to do so by NHS Test & Trace.

 

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. 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.

 

6. Must patients wear face coverings?

Current SOPs should be followed, this includes asking patients to wear a face covering. 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.

 

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

If a member of staff has coronavirus, they should follow the stay at home guidance in their area.

 

In England, NHS staff who have received a positive COVID-19 test result are only required to self-isolate for 5 days, if they test negative on days 5 and 6 and are medically fit. 


This means that if you test negative on the morning of day 6 and you tested negative 24 hours earlier, you can return to work on day 6 under the following conditions:

 

  • You do not have any COVID-19 symptoms
  • You do LFTs every day for the remainder of the 10-day isolation period (if any subsequent LFT result is positive, the person should continue to isolate and should wait 24 hours before taking the next LFT)
  • You should take these LFTs at home prior to going to work
  • You must comply with all recommended infection control precautions.

If any of the above cannot be met, the staff member should not come to work and should follow the stay at home guidance for the full 10-day period.


If your LFT test result is still positive on the fourteenth day, you can stop testing and return to work on Day 15. However, a practice can undertake a risk assessment of staff who test positive between Day 10 and Day 14 and who do not have a high temperature and can get them to return to work, depending on the work environment.


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.

 

If a COVID positive 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 COVID positive member of staff comes into direct contact with a patient whilst wearing no PPE, inappropriate PPE or a PPE breach occurs, the patient must be contacted.

 

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.


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

In England, if a member of staff is providing care to a patient and wearing the correct PPE, the patient is not considered a contact and the staff member is not required to do anything.

 

Outside of that situation, if someone in the dental team comes into contact with a confirmed COVID positive case it depends on their vaccination status:

 
If they ARE fully vaccinated, they will be able to continue in their usual role subject to:

 

  • Them not having any COVID-19 symptoms
  • Them arranging a PCR test via the NHS Test and Trace service and having a negative result (however, if a staff member has had COVID in the past 90 days, they should not have a PCR test and should only undertake daily LFTs for this purpose)
  • Them taking LFTs antigen test every day for the 10 days following their last contact with the case before leaving home for work
  • Them complying with all relevant infection control precautions and PPE guidance.

If they ARE NOT fully vaccinated, they should stay at home (as advised by Test and Trace) but normally for 10 days (but see the Day 6/7 early release conditions under Q8 “What if a staff member has COVID-19?”

 

If you are in Wales, Scotland or Northern Ireland please refer to local guidance on self-isolation.

 

In Northern Ireland a letter from Chief Medical Officer, Sir Michael McBride, provides updated guidance on the management of health and social care workers that have had close contact with positive COVID-19 cases. If someone in the dental team comes into contact with a confirmed COVID positive case and they are fully vaccinated (have had two doses of an approved vaccine, and have received a booster dose at least 14 days prior to the date of their exposure to the confirmed case) they will be permitted to return to work as long as they meet the following requirements:

 

  • They have taken a PCR test after their exposure. This PCR should return a negative result. Staff should not attend work while awaiting the PCR test result
  • If the PCR test is negative, the staff member can return to work but should take a daily lateral flow test (including on the same day they receive the negative PCR result) until the tenth day after the last date of contact with the positive case. The lateral flow should be taken before leaving for work each day
  • If a staff member has had a positive COVID-19 PCR test in the past 90 days, they should not have a PCR test unless they develop symptoms. Instead, they should take a lateral flow test (LFT) as soon as possible and before attending the workplace. If it's negative, they can return to work and follow the rest of the guidance - including continuing with daily LFTs.

This checklist is a simple, easy to follow format for employers to make risk assessments on a case-by-case basis and minimise disruption.

 

In Scotland, healthcare staff are now exempt from the requirement to self-isolate for 10 days as long as they are vaccinated, remain asymptomatic, return a negative PCR test and undertake daily lateral flow testing. If staff are not fully vaccinated, or are symptomatic, or return a positive PCR test they must self-isolate for 10 days.

 

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. Ensure you keep records of any absence due to COVID-19 to be able to claim this back from the government.

 

However, this is not the case if you are pinged by the NHS app and told to isolate. The app is advisory and there is no legal requirement for you to isolate, but the Government strongly recommends that you do.

 

 

Coronavirus and the dental team

9. 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.

 

10. Is the COVID-19 vaccination mandatory?

No, if you are working in Scotland, Wales and Northern Ireland.

 

  • In Scotland, the Chief Medical Officer's Office has confirmed that currently there are no plans to introduce mandatory vaccinations for NHS and Social Care staff in Scotland as vaccine uptake rates have been very high.
  • In Wales, no compulsory vaccination requirement will be introduced.
  • In Northern Ireland, a public consultation is underway about the compulsory vaccination of new staff. If you’re a dentist working in Northern Ireland, please email us at shareyourviewsni@bda.org to tell us what you think about this important issue.
Yes, if you are working in England. The Department of Health and Social Care (DHSC) have said that any individuals undertaking CQC regulated activities in England must be fully vaccinated against COVID-19 by 1 April 2022 to protect patients.
 
Unvaccinated individuals will need to have had their first dose by 3 February 2022, in order to have received their second dose by the 1 April 2022 deadline. 

We have updated our advice on the compulsory COVID vaccination. This includes:
 
Letter templates are also available to Expert members for the following:
 

We will update this advice as more information becomes available.

 

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

Yes. Healthcare workers are being advised to get a booster vaccination this winter. To do this, you can book an appointment online or attend a walk-in vaccination centre. 


You're also advised that the current definition of "fully vaccinated" may in time be changed by the UK Health Security Agency to include the booster vaccine. So practices are encouraged to ensure staff are offered a booster. Practices in England, where full vaccination is mandatory for healthcare workers, should particularly take note. 

 

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

The UK Health Security Agency, the National Medical Director of NHS England, and Chief Nursing Officer for England have issued guidance for healthcare workers arriving from abroad.

 

  • If a fully-vaccinated dentist (or member of staff) returns from any overseas travel (not on the Red List, but not including Ireland), they should self-isolate until they have had a negative PCR test
  • In addition, following this, they should also undertake daily lateral flow tests until Day 10 after their return.

The healthcare work advice differs slightly in that the general public will have two days to take a PCR test and all must self-isolate, but can leave self-isolation if the PCR test result is negative.


  • If a non- fully-vaccinated dentist (or member of staff) returns from any overseas travel (not on the Red List, but not including Ireland), they should self-isolate for 10 days. In addition, they must take a PCR test on of before Day 2 and on or after Day 8.

There are currently no countries on the red list. However, you may wish to note, that for red-list country arrivals to the UK:

 

  • A dentist (or member of staff) returning to England from a Red-List country must quarantine for 10 full days in a managed hotel even if they are fully vaccinated
  • They must also take a COVID-19 test on or before Day 2 and on or after Day 8 of quarantining. These tests will be included in the hotel package which must be arranged before arriving in England, as they can be fined up to £4,000 if not and will still have to pay for the quarantine package on arrival
  • In addition, if they break the quarantine rules, they may face a penalty of up to £10,000.

Quarantine package costs: £2,285 for one adult for one room for 10 days (11 nights), with an additional rate for one adult of £1,430.

 

There will, obviously, be implications of potential staff absences on the contractual delivery with NHS England and the BDA is urgently raising the issue with NHS England officials.

 

For more information on guidance in your area see:

 

 

13. 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.

 

14. 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

15. 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.

 

16. 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.

 

17. 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

18. 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.

 

19. 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.

 

20. 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.

 

21. 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.