Thursday 2 April 2020
New personal protective equipment guidance
New guidance has been published today jointly by the public health agencies across the UK and the Academy of Medical Royal Colleges setting out recommended personal protective equipment (PPE), including for primary care dentistry. The advice restates the previous position that a filtering face piece respirator is recommended for aerosol generating procedures (AGPs), but that for other direct patient care, a fluid-resistant (type IIR) surgical mask remains appropriate.
We continue to have serious concerns about the advice that fluid resistant surgical masks and other routine personal protective equipment (PPE) offer adequate protection for non-aerosol generating procedures in dental care. We will update our position shortly.
NHS and private financial support for mixed practices in England
Following ongoing BDA dialogue, it is our understanding that NHS England now confirms that the application of the principles outlined in the preparedness letter of 25 March 2020 for practices benefitting from continued NHS funding are intended to apply to NHS income only. Contract holders wishing to claim against additional Government support schemes should ensure that this is in relation to the proportion of private revenue only.
In line with the methodology of determining private and NHS income used for business rates reimbursements contractors are advised to use the proportion of gross income that relates to GDS/PDS contract value as NHS revenue, the balance being private share. Those contractors who claim business rates reimbursements will have this data readily available.
NHS England expects that as part of the 2020/2021 reconciliation process practices will be expected to declare that they have not applied for any duplicative Government funding and provide evidence of the portion of NHS/private income used in any applications for additional support.
Further NHS funding guidance issued for dentists in Scotland
Following the CDO’s recent letter outlining revised financial support for NHS dentistry in Scotland, the Scottish Government has issued a memorandum setting out more details about the funding package. In addition, Practitioner Services has published a Q+A to answer some of the queries it has received from dentists. We continue to seek clarification on the NHS funding / furlough issue, and to pursue possible funding sources for private practices.
An update on progress made so far this week
It's been another busy day for us. We're working hard on your behalf to protect your health, your patients and your practice. Here's an insight into the work being done in all four countries this week:
England: I've written a piece on the challenges we're facing and the progress we've made in supporting dentists in England during the Coronavirus outbreak.
Wales: Tom Bysouth, Chair of the Welsh General Dental Practice Committee, has outlined recent progress made in supporting dentists in Wales during the COVID-19 outbreak.
Scotland: David Cross, Vice Chair of the BDA Scottish Council, has detailed three things BDA Scotland is doing for dentists impacted by COVID-19.
Northern Ireland: Richard Graham, Chair of the Northern Ireland Dental Practice Committee, has shown that we're raising your issues at the highest levels.
CQC offers new guidance on DBS checks
The Care Quality Commission (CQC) has today published interim guidance on Disclosure and Barring Service (DBS) and other recruitment checks, for providers who will be recruiting staff and volunteers to health and social care services in response to COVID-19.
This guidance is in response to temporary changes the DBS have made to their applications and processes.
It will be in operation while the Coronavirus Act 2020 remains in force.
Frontline medical staff must have adequate PPE
We support fellow healthcare workers on their concerns around Personal Protective Equipment (PPE). Equally, we reiterate our concern over the current official advice that fluid-resistant surgical masks and other routine PPE offer adequate protection for non-aerosol generating procedures. We strongly advise that any professional should carry out a full risk assessment before agreeing to see any patient face-to-face for urgent care. We are deeply troubled at the government’s efforts at supplying PPE to front line staff.
Securing funding to keep Scottish NHS practices open
David McColl, Chair of Scottish Dental Practice Committee, has written a blog to detail the committee's campaign that successfully resulted in funding from the Scottish Government to ensure the sustainability of NHS dentistry. We're pleased the government heeded our concerns and found additional funding that will provide 80% of Items of Service plus patent contributions. This will be a huge relief to many dentists and allow their practices to remain viable until the pandemic crisis subsides.
Wednesday 1 April 2020
Shareena Ilyas elected to BDA Board
Shareena Ilyas has been elected to the London seat of our board.
Shareena is an associate and an experienced general dental practitioner, having started her career in dentistry in 1998 at St Bart’s & the Royal London Hospital of Medicine & Dentistry. She has worked in various general practice posts across London and south England and as well as being a GDP, is a coach/mentor.
Shareena has said: "This is a challenging time for dentists all over the UK, with London, the area I represent being particularly hard-hit by the COVID-19 outbreak. It's essential that we stand together during this time of national crisis to support one another and the profession."
BDA Head of Advice: Advice for DCPs
James Goldman, the Head of Advice teams at the BDA, provides advice on four issues for DCPs: the Government's furloughed workers scheme, the challenges for private practices, support for self-employed DCPs and redeployment.
Appraisals for CDS dentists in Wales suspended until October
Very few dentists will be working their normal contracts and work patterns over the coming weeks and months. To that end, we asked for appraisals and mandatory training for CDS dentists to be suspended for the next six months. We have just received confirmation that appraisals for CDS dentists in Wales will be suspended until 1 October 2020. We will update you once decisions have been reached in the other nations.
Dentists invited to NHS webinar this Friday
Chief Dental Officer England Sara Hurley and NHS Director of Primary Care and System Transformation Matt Neligan invite oral health professionals to a webinar on COVID-19 this Friday 3 April, 17.00-18.00. Due to the numbers expected to join, they ask that you submit questions/comments via the chat function.
You can connect shortly before it starts here.
Dentists volunteer for emergency hubs in Northern Ireland
Emergency Dental Care Clinics are being set up to provide urgent care in Northern Ireland during the COVID-19 pandemic. The Health and Social Care Board asked for 100 dentists to volunteer their services. So far over 400 have signed up! We're delighted to see such commitment among GDPs to maintaining emergency dental treatment during this time. This is one of the many examples we've seen of dentists working to support their communities in this time of crisis.
Practice owners: Help us gather evidence on business risk
Every practice in the UK is already feeling the impact of this pandemic. We're campaigning on your behalf, but to best do this we need more evidence. That's why, we’ve asked practice owners for their views on the risks ahead. We urge you to share your views with us, so that we can make the case to government with hard evidence.
COVID-19: Practical guidance for members on assessing risk
Yesterday we advised dentists that any professional should carry out a full risk assessment when considering seeing patients face-to-face for urgent care. We have developed some risk assessment guidance to help members do this (login required). We urge you to read this guidance to support you in providing urgent care.
Pay dispute claim service coming soon
We will soon launch a pay dispute claim service for associates. This is designed to help those whose corporate or practice owner is not passing on income due under the financial agreements made with governments.
Of course, we expect the overwhelming majority of corporates or practice owners to do this. In the rare instance where this is not happening, associate members can ask us to take up this issue on their behalf. We will try to resolve all issues constructively with the practice.
The service will be available once the formulas for remuneration have been agreed and published by government.
We know that everyone is anxious and fearful right now. Our primary aim with this service is to ensure that any issues are resolved in a satisfactory way for everyone involved and so that effective working relationships are maintained. We expect very few associates to need this.
Tuesday 31 March 2020
Urgent care and personal protective equipment
Urgent dental care centres are being set up across the UK, usually with separate processes for known COVID-19 positive patients. A number of areas are setting up separate 'cold' urgent dental care settings for patients who are not symptomatic. The current official advice based on guidance from Public Health England is that fluid-resistant surgical masks and other routine personal protective equipment (PPE) offer adequate protection for non-aerosol generating procedures in these circumstances.
The BDA's position is that there is doubt as to the safety of this advice, given developing knowledge about Coronavirus and the increasing level of infection in the UK population. We strongly advise that any professional should carry out a full risk assessment, including telephone triage, before agreeing to see any patient face-to-face for urgent care in these circumstances. Our risk assessment advice will follow shortly. Dentists and dental teams should not feel pressured into working in any environment in which they feel uncomfortable or unsafe. Members should contact the BDA for support and advice if they are concerned.
BDA Indemnity offers cost reductions of up to 80%
To support you during the COVID-19 pandemic, we will be enabling members to immediately reduce rates of our Indemnity coverage while maintaining all of the benefits, protections and security of the RSA-underwritten policy.
The adjusted rates reflect the dramatic changes in working hours and workload of dentists, and typically represent savings of 70-80% for associates and 65-70% for practice owners who were previously working the equivalent of 3 days or more per week.
Len D'Cruz, head of the BDA’s indemnity team has said “We’re in uncharted waters. A dentist leaving themselves without any cover right now is sailing without a life jacket. While we’re all working out what form of practice we’ll be doing in the coming months, whether it’s triage from home or on the frontline at an emergency clinic, it’s more important than ever to have contractual indemnity cover. A practice owner whose staff are taking calls and doing their best to advise patients will still want vicarious liability protection".
Members with policies can request their cover to be amended by emailing us details of their situation. Please email us on email@example.com.
For details of the policy please visit our Indemnity policy webpage.
Employed dentists: Answering your questions
Some employed dentists are being asked to undertake other duties as part of the COVID-19 response. To help you to prepare for this, we have answered your most frequently asked questions on redeployment and other issues. We will update this page when further information becomes available.
CQC considering action against practices offering routine care
The Care Quality Commission have announced that they are prepared to take action against dental practices who are still seeing patients for routine treatments.
This follows the call last week from NHS England for all dentists to cease routine treatment. The instruction was to triage via the telephone and refer those in need of active treatment to urgent dental care centres. The CQC acknowledge that there has been a delay in getting these centres up and running, however is hopeful that this will be resolved soon.
Since this advice was issued, it has become clear that some practices are still seeing patients for routine care including aerosol-generating procedures. This would expose the dental staff and the public to unnecessary risk of virus transmission. The CQC have said that where these reports are accurate, they will consider taking action using their regulatory powers.
Monday 30 March 2020
Good news for NHS dentists in Scotland
We're relieved to see the Scottish Government issue a revised funding package for NHS dentists. This will provide 80% of the average income from items of service and patient contributions. This is what we asked for – a more equitable funding solution. This should hopefully provide much-needed reassurance to many dentists. We will continue to investigate what funding sources may be available to private practices.
Phil Grigor, National Director of BDA Scotland, has said: "This funding package will be a huge relief to many dentists. It will allow their practices to remain viable until the crisis subsides. We are pleased that the Government have heeded our concerns. We thank the CDO and his team for their efforts to secure this funding which will help to ensure the sustainability of NHS dentistry in Scotland.”
What's happening this week
This week we are seeking clarity on payments for NHS dentists in all four UK countries. In England we are hoping to confirm that mixed NHS/private practices will continue to receive their NHS contractual payments. We want these practices to be able to then access wider Treasury support in direct proportion to their private commitments.
We are also focusing on Personal Protective Equipment (PPE). The issue of what PPE is essential in which circumstances has been a hot topic since the start of the Coronavirus outbreak. As has been PPE availability. We await updated advice on PPE - this time with the four Chief Dental Officers working together. We are seeking to influence that advice by providing relevant and vital information based on experiences in the UK and across the globe.
Urgent care centres
The development of urgent dental care systems is of huge importance to us. We have argued for non-urgent procedures to cease, but are concerned with the state of progress of the establishment of urgent care centres. The availability of PPE for these systems is also an issue. We continue to discuss this with NHS England nationally. Meanwhile In Northern Ireland the new dental emergency centres are currently being phased in and we are regular contact with the HSCB about redeploying dentists to these centres.
Redeployment is a key area this week. Each nation has variously set up a process for seeking volunteers to help with both urgent care and the wider NHS effort. In England, volunteers have been asked to respond to an NHS survey, whilst some dentists and teams have already stepped forward to help with local urgent and emergency care. As there is an expectation that NHS practices and staff help out, we suggest that you keep a record of the efforts made to get involved.
This continues to be an important area this week. In Northern Ireland we are continuing to press for clarification from officials on guidance for furloughing staff.
We also have new and comprehensive advice on furloughed staff within Coronavirus: Financial Impact.
Last but certainly not least, we will continue to press the Government on the issue of financial support for the self-employed. The Chancellor Rishi Sunak confirmed a package last week, but that excluded anyone earning over £50,000. This has an impact on dentists and those in private practice with no access to ongoing NHS earnings. We immediately wrote to the Chancellor and raised our concerns, which we also took to the Health Minister. We then asked dentists to help us make our argument. Nearly 5,000 of you have replied to our short survey on earnings, so thank you for the valuable input. We’re now going back to the Chancellor to reiterate our point that financial support needs to be extended.
Dentists dispute Government PPE claims
We dispute the claim made during yesterday's Downing Street briefing by the Communities Secretary, Robert Jenrick who stated that all dental practices have received fresh supplies of personal protective equipment (PPE).
In reality, practices have received no additional stock and NHS England plans to roll out a dedicated emergency dental service have barely got off the ground.
Following our recommendations and official advice, routine care has ceased at all dental practices this week. Most are now triaging calls from patients over the telephone.
In the absence of a functioning and properly equipped emergency system, many practices are reporting that they have nowhere to direct these patients. As our Chair Mick Armstrong has said “The reality is dentists are busy fielding calls from patients in pain, but with nowhere to send them. Weeks have been lost that should have been spent setting up a properly equipped emergency dental service.”
Wales: Guidance on handling patient needs and remote prescribing
Dentists in Wales continue to operate under the national red alert. We have provided guidance on handling patient needs in general dental practice, and on remote prescribing to support you during this challenging time.
Northern Ireland: Plans for urgent care
The Health & Social Care Board have written to NI GDPs to remind them that they are expected, with standard PPE, to continue to see patients who meet the following criteria:
- Do not meet the COVID-19 case definition
- Do have an urgent dental care need (examples provided)
- Care can be provided using non-aerosol generating procedures.
The letter also updates GDPs on HSCB's current plans for the planned urgent dental care centres including staffing requirements, nursing arrangements, equipment supply, Access NI requirements and indemnity provision.
Scotland call for funding to avoid closures
More than 600 dentists in Scotland have joined us in urging the Scottish Government to provide additional funding to maintain dental practices during the pandemic crisis. Recent news coverage has highlighted the risk to practices that are dependent on patient charge for revenue. It has also emphasised the importance of ensuring the sustainability of NHS dentistry. The CDO, Tom Ferris, stated that the Scottish Government is seeking additional funding but warned that practices would have to take a “hit”. An announcement is expected this week.
Self-employed dentists: Help us put our case to the Chancellor
We believe that Chancellor Rishi Sunak's pledge last week to support self-employed workers - only available to those who earn less than £50,000 - is unsatisfactory and short-sighted. It leaves behind a highly trained, highly skilled workforce. Someone who earned £49,000 has money waiting for them, but their colleague who earned £51,000 does not.
The average earnings of an associate dentist today are £69,000. This is far below the £200,000 average income of the top 5% the Chancellor quoted in his press conference. We want to put forth our case, yet again, to the Chancellor with the numbers to back us up. Can you help us?
Please answer three questions and share with colleagues.
Poster for practices
Download, print and display this poster in your windows to help the local community understand why the practice is shut. You may also find our advice to patients on why routine dentistry cannot go ahead during the outbreak useful.
Saturday 28 March 2020
Dental workforce redeployment in England
The Chief Dental Officer England and NHS England are producing a framework for the voluntary redeployment of the dental workforce to areas of need within the wider NHS, based on the competencies of each team member. Any dental team member wishing to work in the wider NHS can register their interest via the survey link on the NHS England & NHS Improvement website.
Further details, including frequently asked questions, will be shared next week.
You may recall that the preparedness letter from NHS England published earlier in the week set out an expectation that dental practices would support redeployment as part of on-going funding provisions. We have raised questions about how the funding arrangements, and access to wider government financial support, relate to mixed NHS/private practices and are hopeful we will be able to report back next week.
We are also in the process of providing our own advice around redeployment, relevant in particular to dentists in employed roles.
Separate processes for redeploying NHS staff are under way in the other UK nations.
Friday 27 March 2020
Friday wrap up: What happened this week
As everyone knows, this has been a huge week in the world of news, health and politics. We’ve done our best to keep you informed and updated as well as campaigning on your behalf at all times. Here’s a roundup of the some of the big things that happened and what we've been doing in response. We'll be back to do it all again next week.
Wishing you all a healthy weekend.
PPE discussions with Public Health England and NHSE
We’ve been engaging with NHS England and Public Health England on the current advice in relation to personal protective equipment and the procurement arrangements for PPE.
We know there has been ongoing confusion around varying interpretations of advice around the situations in which higher end PPE should be used. We understand that PHE are looking to update their advice (applying to all UK nations) and that this is likely to be a place-based approach to protective equipment. We’ll update you when we know more.
Clarifying support measures with the Health Minister
Mick Armstrong and I met (virtually) Health Minister Jo Churchill at lunchtime today alongside other primary care representatives to discuss the latest key issues in relation to the pandemic. We raised the need to clarify the position of dentists around wider state support if they are mixed NHS/private practices and continuning to receive NHS income. We’re hopeful of a resolution on this issue soon. We also discussed the confusion over PPE advice, the need to move ahead with urgent care provision and the position of dentists earning over £50,000 being excluded from the Chancellor’s self-employment support package.
Hybrid practices and financial support in Northern Ireland
We have written to the Northern Ireland Health Minister Robin Swann regarding support measures and the hybrid nature of dental practices.
Furloughed workers scheme: more details
The government provided details of the furloughed workers scheme on Thursday 26 March 2020. We still don’t know how the question of furloughed workers will tie into help from the NHS. We are trying to find out and working closely with the NHS to get urgent answers for members.
The key points of the furloughed workers scheme are:
- You can claim up to 80% of furloughed workers usual monthly wage costs
- The maximum that can be claimed is
o £2,500 a month, plus
o Employer NI contributions and
o minimum automatic enrolment employer pension contributions
- Scheme can be used at any time during period from 1 March 2020 to the end of May 2020. The scheme may be extended if necessary.
- The scheme is not expected to be used by employers who are receiving other public funding, including NHS dental practices. We are urgently trying to work out a way of ensuring that mixed practices can get some money from the furloughed workers scheme to cover private work, as well as money from the NHS.
- You can claim for any employees who were on your PAYE payroll on 28 February 2020, whether full-time, part-time, or employees on a flexible contract.
- You can claim for employees you made redundant after 28 February 2020, as long as you rehire them.
- Whilst being furloughed, employees cannot do any work for you.
- Wages of furloughed workers are subject to usual income tax and other deductions.
- Employees who work reduced hours during this time are not eligible for this scheme. They will have to be paid in the normal way.
- Normal equality laws apply to who you furlough and who you don’t.
- Employees placed on unpaid leave after 28 February 2020 can be furloughed.
- Employees on sick leave or self-isolating should get SSP, but can be furloughed after.
- Employees must be furloughed for at least three weeks. You can therefore rotate who is furloughed as long as those who are furloughed are furloughed for at least three weeks.
We are constantly trying to glean more information and clarify the situation for you. You can keep updated via our Financial Impact page.
BDA Head of Advice: Self-employed, furloughed, workers, mixed practices
James Goldman, the Head of Advice teams at the BDA, provides a short update on recent financial support schemes from the Government including help for the self-employed, furloughed workers, redeployment and help from the NHS.
For more information please read our Coronavirus: Financial Impact page.
Thursday 26 March 2020
Treat people equitably: Our message to the Chancellor
Read our letter.
Fast track retired dentists who are willing to volunteer
We have written to the GDC raising concerns around the restoration procedures for retired dentists wishing to volunteer their time for the COVID-19 response in a dental capacity.
While fast track procedures for returners are available in other professions, this is not the case in dentistry. We therefore call on the GDC to put pressure on the Government to include dentistry in the emergency legislation for this purpose and put out a more supportive statement to the profession about the work it is doing in the current crisis.
In a separate move, the GDC has issued a new statement looking at working in non-dental settings, and at remote prescribing.
Clarification on business continuity in Wales
The Welsh CDO has written today with further details about business continuity. This lays out provision for payments of ACV for April, May and June and the expectations attached to it. We’d made clear that practices would struggle to pay 100% of staff wages with the ACV payment at 80%. Given the Chancellor's announcement today about support for self-employed workers, we consider this condition on practice owners needs further review.
We note the recognition from the CDO that mixed-contract practices will need commercial financial support for their private practice element.
We will continue to work with the CDO on updating advice regarding keeping practices open for any urgent treatment in the GDS setting. Meanwhile, the clear message is to provide telephone triage and remote prescribing for non-urgent patients.
Measures to help self-employed fall short
The measures announced by the Chancellor this evening to support the self-employed during the COVID-19 outbreak will not support the majority of self-employed dentists. This is an untenable situation and we will campaign to change it.
Dave Cottam, Chair of General Dental Practice Committee, has said: “Many self-employed dentists working in largely or exclusively private practice have seen their incomes fall to zero. Failure to offer them a safety net will not only hit highly skilled individuals, but will have a devastating impact on the essential services they provide. When NHS dentistry is already stretched to breaking point, letting private practices go to the wall would be criminally irresponsible."
Call for CDS appraisal and training requirements to be suspended
We are calling for appraisal and mandatory training requirements for CDS dentists to be suspended until 26 September 2020 at the earliest. This should apply to all dentists employed on the SPDCS/Community Dental Services/Scottish Public Dental Service/Community Dentists contract. Redeployment of these dentists within the NHS is possible. We argue this suspension should be agreed as soon as possible to remove a concern they may have about engaging fully in the COVID-19 response.
Call for suspension of patient fines
We have asked the Department of Health and Social Care to suspend the issuing of dental patient penalty charge notices in light of the COVID-19 outbreak.
Charlotte Waite, Chair of our England Community Dental Services Committees, wrote that “at this most challenging of times, it is morally wrong to be fining patients for making honest mistakes when many are worried about their own health, the health of their family and friends, and their financial situation.”
Northern Ireland: Arrangements for urgent dental cases
HSCB have issued further information on how GDPs should respond if their practice is unable to offer urgent dental care. You are firstly expected to make arrangements with a neighbouring practice. You are also urgently requested to use your HSCNI emails to put forward names of dentist and nurse teams to be fitted for FFP3 masks. This is needed to staff the initial clinics of the planned urgent dental care centres. HSCB have also issued an updated set of FAQs.
Measures to support self-employed expected
The Chancellor is expected to make an announcement today about financial support for self-employed people unable to work during the pandemic. As most dentists are self-employed, we are taking a keen interest in the detail. The jigsaw of money measures being put in place is complex and difficult to navigate. The relationship between the anticipated self-employed measures, the different NHS financial packages, the arrangements available for furloughing staff and wider business support is complicated. We are pushing for clarity from government, so we can give you the best advice as soon as we can.
Wednesday 25 March 2020
Our questions for NHS England
We have received a huge volume of questions regarding today's letter from NHS England and the emerging COVID-19 situation. We have already been in contact with NHSE to highlight many queries and to ask for a meeting to discuss your concerns. We have also formulated and sent a further 22 comprehensive questions covering finance, redeployment and urgent care. These questions are initial queries, not an exhaustive list.
We are currently reviewing the hundreds of queries that have been sent in since, and will be doing our best to get them over to NHSE tomorrow and Friday.
Read the questions we are asking NHS England.
NHS England's advice to practices: More detail
As we updated earlier today, NHS England has published its third preparedness letter for general dental practices and community dental services regarding the emerging COVID-19 situation.
The letter contains some important updates on advice around the practise of dentistry and financial support for dentists. Significantly, the clinical advice is now largely consistent across the UK.
As outlined in the letter, the latest advice is:
- All routine, non-urgent dental care should be stopped and deferred until otherwise advised.
- All practices should establish (independently or by collaboration with others) a remote urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with advice, analgesia and antimicrobial means where appropriate.
- If the patient’s condition cannot be managed by these means, then they will need to be referred to their local urgent dental care system.
In terms of the financial support being offered, because of the disruption caused to the current month, for the purposes of calculating year end contract delivery, NHS England will consider the current year to be March 2019 to February 2020, and will apply March 2019 data instead of March 2020 to contractual performance.
For the financial year 2020-21, NHS England will continue to make monthly payments that are equal to 1/12th of current annual contract values.
We will then work with NHS England to consider contract value and reconciliation in 2020-21 to take into account the difficulties of delivery for the period of the COVID-19 pandemic.
Contract delivery and year end payment will be assumed to have been maintained at a level that allows continued employment of staff (despite reduced actual activity).
Practices are expected to ensure that associates and other staff continue to be paid at previous levels.
Practices will also be asked to offer available staff capacity to other areas of the health service, including urgent dental care and wider aspects of care. The letter says that practices benefiting from continued NHS funding will not be eligible to seek any wider government assistance to small businesses which could be duplicative.
There are some aspects of the preparedness letter that will need further clarification. For example, work is needed around the precise mechanism for payments for 2020-21. A key area will be how the provisions around protecting associate and staff pay will apply to the many practices that provide a mixture of both NHS and private care. We are concerned about the restriction on practices earning NHS income also accessing wider government support. NHS earnings may make up a relatively small proportion of income and it would seem unfair to apply a blanket constraint.
We are aware the in some parts of the country, some work is already underway to establish urgent care systems, but more needs to be done to make sure that patients have access to appropriate care and dentists and their teams understand the practicalities of working in these systems. More clarity is needed in this area as well.
As always we will keep you updated as and when we have more information.
No need to inform CQC of changes due to COVID-19
The CQC sent out a bulletin earlier today to dental providers, which was rapidly overtaken by the communication from the Chief Dental Officer. They have since clarified that there is no need to notify CQC of the changes in practice arrangements due to COVID-19.
NHS Boards in Scotland moving to emergency-only clinics
Following the CDO's letter issued on 23 March, and the further restrictions announced by the Prime Minister later that day, each NHS Board in Scotland is planning to provide emergency-only clinics in its local area. These plans will reflect the circumstances in each area, and will be issued by individual Boards rather than centrally by the Scottish Government.
We are continuing to press the Scottish Government for additional funding mitigation measures for dental practices.
Business support available in Northern Ireland
Here is a full list of the business support measures that have been put in place in Northern Ireland in response to COVID-19.
The list includes UK-wide measures announced by the Chancellor and additional support provided for local businesses by the NI Executive. The Department of Health have stated that it is their expectation that dental practices in NI will be eligible for support from both UK-wide and NI Executive sources.
We continue to raise the hybrid nature of many practices with officials, and are seeking urgent clarity at this time of uncertainty for dentists in Northern Ireland.
NHS England issues advice to practices
Issue 3 - Preparedness letter for primary dental care: 25 March 2020
- All routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise.
- All practices should establish (independently or by collaboration with others) a remote urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with:
- Antimicrobial means where appropriate.
The letter also contains important information about NHS financial support for practices. We are now pulling together comments on a number of key issues that require further clarity. If you have any questions about the NHS England letter, please use our form.
We are receiving a large number of questions from members, particularly those with mixed practices. We are taking your concerns and to NHS England and seeking clarification on a number of issues. Please could you continue to submit your queries via our form and we will collate them.
Pharmacies and prescriptions
Another issue we have been made aware of is to do with pharmacies. Many are partially closed and some aren't accepting paper prescriptions. However, despite years of lobbying, electronic prescribing and SCR access has not been granted to dentists. This is yet another important issue that we will be raising later today at the NHS England primary care stakeholders group. We will keep you updated on any outcomes.
Guidance expected today for dentists in England
We expect NHS England to issue updated advice today to clarify how practices should approach clinical care in the context of COVID-19. We also expect them to outline the financial support arrangements which will be put in place in relation to NHS contracts. We will update you when we know more.
Our obligation to patients
Mick Armstrong, the Chair of the BDA Board, highlights our obligation to patients in the midst of this crisis:
"Whilst we wait for official guidance in England, many practices have already decided to cease routine care and some have closed completely. Could I take the opportunity to remind colleagues that we still have an obligation to our patients especially during the pandemic crisis. We should be maintaining a basic service, providing telephone advice and triaging and appropriate prescription of analgesia and medication. NHS 111 is overloaded and we have a duty to reduce pressure on the system wherever possible."
COVID-19: A message to members
Tuesday 24 March 2020
Official indifference is leaving us all at risk
Tonight we have lambasted NHS England over their failure to update clinical advice to reflect the seriousness of the UK’s situation. We have made it clear that they have threatened the future of NHS dental services through their inaction and failure to set out a support package.
The BDA and authorities in Wales, Scotland and Northern Ireland have all recommended that routine treatments cease and emergency only services are provided. Given recent advice on restricting movement, and the uncertainty over the safety of both patients and staff, this is of huge importance.
Current advice in England is still that some regular care can continue, despite the country now being in effective lockdown. Dentists are seeking clarity on which patients can be seen safely with limited availability of protective equipment. Without proper PPE, and protocols there is a disproportionate risk to the safety of patients and dental teams that can no longer be permitted to continue.
NHS practices have been given no assurances from Government, private practices are being denied access to wider business backing and individual dentists are mostly self-employed and without the support offered to employed staff. We have described this as a recipe for disaster.
Read the full press release from our Chair, Mick Armstrong.
We're still here to help
I just wanted to reassure members that, despite the increasingly rigorous restrictions on movement across the UK, the BDA is still here to support you.
Some things will obviously be limited at the moment, for example face-to-face education and physical library services. However, we are still able to offer you the full range of support and advice through our expert teams. Our staff may now be working from home rather than 64 Wimpole Street, but hopefully you’ve not experienced any disruption to our service; we are available and doing our best to help, advise and inform. Our advisers in particular have been exceptionally busy, understandably so, with anxious members seeking help so please do bear with us.
Many of you have been finding the answers that you need through our Coronavirus website content. Just yesterday we had 150,000 visitors to our Live updates, COVID-19 FAQs, Financial impact and Advice for Associates pages. We're updating all of this content frequently throughout the day to offer you the most reliable and useful content that we can. We're pleased to hear how helpful you have been finding it. Many members have been replying with local observations and with details of their own situations and experiences. We are acutely aware that we haven’t been able to bring you all the answers you need but I trust you’re finding our correspondence to the nations helpful during this time.
Needless to say, times are strange and changes are swift so thank you for your patience and positive feedback. More updates to follow soon.
Chancellor on financial support for self-employed
In response to urgent questions on financial support for the self-employed, Chancellor Rishi Sunak has told the House of Commons:
- The Government is working urgently on solutions for self-employed. Help is coming, but policy is very complex and should not be rushed
- Self-employed are all eligible for the business interruption scheme
- VAT has been deferred
- The Universal Credit enhanced rate is available to all self-employed, which includes housing support
- Self-assessment tax payments have been deferred until January 21.
We are reviewing these policies and how they affect our members and will offer further advice in days to come.
NI: Letter to Minister for Economy
We have sent a letter to Diane Dodds, Northern Ireland Minister for Economy, this morning requesting support for business in response to the unprecedented financial impact of Coronavirus.
We have asked for clarity on what financial supports are open to dentists at this time.
We will keep you updated with any response we receive.
The expected joint statement on dental education from the GDC, Dental Schools Council, COPDEND, the dental faculties and the Joint Committee on Postgraduate Training in Dentistry, was published late on Monday 23 March 2020.
We are still evaluating the information however, in summary the proposals are:
- BDS face-to-face final exams will not take place. However, dental schools and universities are establishing online systems to enable final exams to be sat for undergraduate students in their final year of study. There is the possibility of various sittings, to enable those ill or self-isolating on the date of the final exam to complete their exam on an alternative date. Some individuals might be provided with a development plan by the dental school to take into their career. Those who are not ready to sit final exams will be informed by their school. The DSC have pulled together FAQs for final year dental and DCP students
- The organisations expect that foundation and vocational training places for graduating BDS students will be announced as planned on 12 June and that they will start on time (August in Scotland, September elsewhere). GDC registration should be able to be completed without delay, facilitated by the regulator. The organisations are currently seeking assurance from national health services that NHS performer numbers will be available in time for foundation and vocational training. Starting on training programmes will be preceded by a mandatory clinical skills session. Graduating students will also be issued with a summary clinical portfolio.
- For those currently undertaking foundation or vocational training in the UK, the organisations expect that foundation dentists will be able to complete their training with minimal, if any, disruption to timescales. The BDA is unsure about how this should work in the absence of clear guidance.
- With regard to specialty programmes, the dental faculties of the Royal Colleges have paused all examinations. However, there are ongoing discussions to explore the option of delivering these examinations in a different way.
- In terms of DCP training, the GDC is in touch with education providers and awarding bodies about plans and considerations for running final assessments, potentially online, with the aim of minimum disruption for students.
We will consider the statement and any follow-up information in depth and request further clarification on the detail. If and when appropriate guidance is published, we will provide relevant links and information through this Live updates page.
Monday 23 March 2020
Self-employed dentists face huge uncertainty in the face of COVID-19
So we’re joining with our friends the Association of Independent Professionals and the Self Employed to ask the government to create a temporary income protection fund to support all self-employed workers and freelancers.
Northern Ireland: next steps announced
All GDPs in Northern Ireland have just received a letter from Michael Donaldson at the Health and Social Care Board outlining the next steps dental practices must take in the latest COVID-19 response.
The HSCB guidance includes telephone triage, withdrawing from aerosol generating procedures and importantly, refers to future steps that will be taken, including setting up five central emergency centres to be operated by GDPs and nurses.
NHS financial support for dentists in England
We have again been in regular dialogue with the team at NHS England today to urge the importance of agreeing financial support for practices. We are making the case that whatever support is put in place, associates should benefit from any arrangements. We know that the delay to any announcement on this issue is hugely frustrating and is adding to the burden of stress on dentists and their teams, and have made that clear to NHS England. We will update you when we can.
Scotland's next phase of COVID-19 response
A letter from CDO, Tom Ferris, has outlined Scotland's next phase of COVID-19 preparedness which comes into effect close of play today.
The next phase will include:
- All routine dentistry to cease
- Pregnant or immunosuppressed team members not to provide or assist in the direct care of patients
- Aerosol Generating Procedures (AGPs) to cease
- Practices to triage, advise and reassure patients via new 'buddy arrangements' whereby patients can contact a dental professional (by phone) during normal work hours
- FFP3 will be available at designated urgent care centres where patients are being assessed and treated.
The letter also seeks to reassure us that the CDO is working to source additional NHS funding to address concerns on practice sustainability.
Orthodontic patients: Advice from BOS
The British Orthodontic Society is advising that no orthodontic patient should attend any clinic at this time. In an extreme emergency, the patient should contact the practice or unit by phone and discuss ways of resolving their problem at home.
Patients should be deterred from attending clinics for their own protection and that of the clinical staff.
CPD requirements: request for leniency
We have sent a letter to the General Dental Council, requesting that they do not enforce requirements for GDC registrants this year.
Read our letter to Ian Brack, CEO and Registrar, General Dental Council.
Wales moves to red alert
The Welsh government has moved to a red alert. This is a welcome development that reflects our own position as outlined in a letter to Dr Colette Bridgman, Wales CDO, on Friday, in which we pressed for this change.
A red alert for Wales means:
- Further restrictions on GDS routine care with the new measures for patient telephone-triage and remote prescribing
- Practices may remain open for very limited and carefully risk-assessed patient consultation, but all dental care that can be delayed must be put on hold
- Patients needing urgent care involving AGPs must be referred to properly equipped local Urgent Dental Care Centers. Health Boards are working with practices to co-ordinate referrals.
In our letter we highlighted the reality that many general dental practices are already operating a skeleton service, and asked that official guidance recognise this. We emphaised our growing concerns for staff and patient safety, particularly in the light of social distancing measures announced on the same day by the Prime Minister.
For now, practice business continuity funding remains a high priority and we are in consultation with Dr Bridgman. We have raised concerns about ensuring associates and DCPs are not disadvantaged by dint of being self-employed, and we have asked that government funding be made available to dental laboratories as they start to shut down through lack of work.
We have discussed how mixed contract practices will lose private income and that this will be detrimental to practice viability without alternative support. We have flagged the severe challenges being faced by wholly private practices and the need for Welsh Government to provide business easements and income support.
Read the comprehensive guide to a Red Alert Phase.
Coronavirus: dealing with the financial impact
In our new coronavirus content, The financial impact, we offer guidance in response to the additional pledge for business that the chancellor, Rishi Sunak, set out on Friday afternoon.
- Coronavirus job retention scheme covering 80% of workers' salaries
- Government-backed loans of £330 billion have been made open to all businesses
- Business interruption loans, with no interest for six months, will be available
- £10,000 extra cash grant for the smallest businesses.
We offer more detail and guidance on paying practice staff during closures and how, with their agreement, you can designate employees as furloughed workers. We have included a draft letter to give to your employees. We also set out the options for practice owners during closures as well as business interruption cover and advice for associates.
Like all of our COVID-19 content, this information will be continually updated and added to as and when new information comes to hand. We are doing our best to keep you on top of the changes and feeling supported in these ever changing circumstances.
Campaigning for self-employed dentists
We're deeply concerned that the government has yet to introduce sufficient measures to protect the self-employed during this time of uncertainty. Most dentists in the UK are self-employed. We're lobbying government for assurances on your behalf and are seeking to ensure that any protection for NHS contract holders in England also benefits associates. We are looking to work with other organisations representing self-employed workers to make the case on your behalf. We will update you on progress made here.
For now, I'd like to remind you that you are not alone. The BDA Benevolent Fund is set up to support dentists in financial hardship. Members can access counselling at any time through our Health Assured programme. And we are continuing to campaign for better provision for self-employed dentists during this time of national crisis.
Sunday 22 March 2020
BDA issues urgent advice to dentists
In all four nations of the UK, governments and officials have issued recent advice in relation to the provision of primary care dentistry. This clinical advice has reflected the UK Government's developing position in relation to increasing social isolation, reduction in use of public transport and use of health services, and also growing unease, as infection levels grow, about the potential for spread of COVID-19 from asymptomatic patients.
Official advice across the UK is not exactly the same, but there is a consistency in guidance that there should be a reduction in the amount of routine dental activity, particularly in respect of vulnerable groups and importantly that staff and patient exposure to potential infection should be reduced by avoiding all aerosol generating procedures wherever possible.
Appropriately, all dentists should exercise their own clinical judgement, taking into account their own practising circumstances. However, given the high proportion of patient interaction in dentistry that has the potential to involve aerosol generation, the BDA believes that for most practices it is likely that compliance with the guidance of the various UK administrations will mean a significant reduction in routine clinical activity. Indeed, for many practices, the practical consequences of the guidance will mean ceasing routine care entirely, given the difficulties of identifying in advance patients who will not need aerosol generating procedures. The BDA supports dentists and practices choosing to stop regular patient treatment.
We believe that current guidance should be more explicit given the continuing spread of the virus and uncertainty around asymptomatic transmission and the associated risks. Given this uncertainty, the BDA recommends that no aerosol generating procedures are undertaken on any patient without appropriately fitting FFP3 masks, other required protection equipment and protocols.
Further, given the uncertainty and reflecting the practical consequences of the current official advice, we recommend that practices cease routine dentistry and operate an advice and emergency service only. Consistent with Government advice to limit social contact, face to face contact should be kept to a minimum but telephone advice should remain available during normal hours. This service will be important for patients, particularly until fully fledged emergency provision is in place. Each practice should make its own risk assessment of what is safe and what can be delivered by way of an ongoing emergency only service.
The situation is changing rapidly and it may well be that as the pandemic evolves emergency only treatment and patient contact will only be deemed appropriate in particular setting and temporary practice closure may become mandatory.
As things stand, the chance of advanced PPE equipment, protocols and training being widely available to avoid this seems unlikely, with resources appropriately being directed to intensive care. In any case, the development of Government advice around social isolation has the potential to further limit the availability of routine care.
The purpose of this advice is to give maximum protection to dentists and staff but it remains an individual practice decision as to what level of service continues to be provided on the basis of rigorous risk assessment.
Again there will be variation across and within UK countries, but local discussion should be taking place around the provision of NHS urgent dental care, particularly as the amount of routine care decreases. Arrangements for the provision of emergency care will become increasingly important if and when the country moves towards further social isolation and further lockdown of normal activities. Dentists involved in urgent care in specialist centres will require full personal protective equipment including FFP3 face masks.
Clearly, a reduction in clinical activity will have financial consequences for practices and for associates. The BDA is acutely aware of this and we continue to make the case forcefully to all administrations that support is offered to protect dentists' NHS income and that this protection extends to associates. We are also conscious of the impact on private dentistry and are arguing to government that private practices should have appropriate access to the range of wider financial support being made available to business across other sectors.
Saturday 21 March 2020
New advice for pregnant women working in the NHS and other settings has been published
Women who are less than 28 weeks pregnant should practise social distancing but can continue working in a patient-facing role, provided the necessary precautions are taken.
Women who are more than 28 weeks pregnant, or have underlying health conditions, should avoid direct patient contact.
Read the Royal College of Obstetricians and Gynaecologists' advice.
Support from BDA Benevolent Fund
The BDA Benevolent Fund recognises that the coronavirus (COVID-19) outbreak is causing disruption and uncertainty for dentists and dental students. We know that sickness, self-isolation and practice closures will have impact on earnings and on mental health.
If you are worried that you cannot meet your essential household expenditure, you can find further information about how to apply for financial support on our website. You can also access a free budget planner to help you assess your finances and make plans for the future.
We also provide support towards medical, legal and life and wellbeing issues. This includes access to counselling sessions via our partnership with Health Assured and their 24/7 helpline.
Friday 20 March 2020
Wales will waive 4% of practice UDA target - further explained
We have been assured that the last two weeks in March are covered by a 4% waiver of practice UDA target. This means if you have completed the requisite UDAs up to mid-March you will not be subject to clawback. The Welsh Government has today given further guidance on how the calculation works. See our updated FAQ for further details.
Routine dental treatment significantly reducedWe have responded to new guidelines on the Coronavirus outbreak which probably spells the end of most routine care in England, lamenting the absence of any current safety net to support services through this crisis. Read our complete response to the new guidelines.
Role for employed NHS dentists in COVID-19 response
We have sent a letter to NHS England to discuss the valuable role employed NHS dentists could undertake in the response to COVID-19.
We are aware that it is likely that efforts to deal with the Coronavirus pandemic will ultimately include wider NHS staff than doctors and nurses. We welcome the opportunity to discuss the transferrable skills held by academic, community and hospital dentists. These are highly trained experts in cross-infection control and hospital-based MDT working.
We believe that the dentists we represent could provide a valuable service to the wider NHS in this challenging time.
BDA meets Health Minister
Mick Armstrong and I had a (virtual) meeting this afternoon with Health Minister Jo Churchill, alongside general medical practice and pharmacy colleagues. The Minister wanted to hear our concerns around the impact of the COVID-19 pandemic.
We highlighted ongoing uncertainty around clinical advice; concern around airborne aerosols and adequacy of protective equipment; planning for the treatment of urgent care as the pandemic develops; the part that dentists and teams can play in the wider healthcare effort; and the crucial need for financial support for both NHS and private practices. All points seemed to be well received and the Minister committed to weekly discussions.
We will continue to update you with outcomes from these discussion.
Government announces wage subsidy
The government will pay 80% of wages for employees not working, up to £2,500 a month, Chancellor Rishi Sunak has pledged this evening. We are seeking clarity if this policy will apply to the self-employed.
Financial scheme secured for NI practices We welcome the announcement of a financial support scheme designed to help dental practices in Northern Ireland remain financially sustainable through the disruption caused by COVID-19. The new scheme from the Department of Health hopes to provide the assurance practice owners, practitioners and staff require at this difficult time. Read more about the new financial deal for Northern Ireland.
Communicating with you
We're working hard to get you answers and keep you informed during this stressful time. Here are our recent communications to our members in Northern Ireland and Scotland:
Our advice team have also extended their hours and are answering members' calls from 08.30-18.00.
Dental practices need business rates relief
We have urged government to extend the Business Rates Retail Discount of 100% to include dental practises to ease potentially crippling losses from the Coronavirus pandemic.
The relief is currently offered to the leisure and hospitality sectors which includes shops, restaurants, cafes and cinemas, live music venues and hotels. Premises that are used by dentists, doctors and others are excluded.
While NHS practices currently receive some help with rates, private practices receive no support. In an open letter to Secretary of State for Housing, Communities and Local Government, Robert Jenrick, we have called for a full extension of relief to all practices.
England CDO sends ‘preparedness’ letter
NHS England and Office of the Chief Dental Officer have issued an up-to-date ‘preparedness letter’ for primary care dentistry. Of particular note it advises practices to ‘consider the potential risk of asymptomatic cases attending in this delay phase and reduce exposure of staff and patients to infection by avoiding all aerosol generating procedures wherever possible’.
This is the second in a series of regular updates to general dental practices and community dental services regarding the emerging COVID-19 situation.
Wales will waive 4% of practice UDA target
Funding models for practices with NHS contracts are being developed in consultation with us. We have been assured that the last two weeks in March are covered by a 4% waiver of practice UDA target. This means if you have completed the requisite UDAs up to mid-March you will not be subject to clawback. Read Director of BDA Wales, Dr Caroline Seddon's blog for further details. Members in Wales were emailed at 5:05pm on Thursday 19 March 2020.
Dentists and their staff are key workers
We have received clear confirmation that dentists and their staff will be designated as key workers during the pandemic.
Officials have confirmed that team members meet the criteria set out by the Department for Education earlier this morning.
The move follows recent discussions between the BDA and NHS England. With schools and nurseries facing shut down UK-wide this move should enable all team members with children to remain in practice, with provisions in place for childcare.
We believe this should apply to teams operating in private practice, and are seeking urgent clarity.
Dentists to be redeployed to support NHS
As the pandemic develops, it is possible that our profession will be asked to redeploy across the health service to provide extra-ordinary support to an already depleted NHS workforce. There would clearly need to be careful consideration about what roles dentists and their teams might take. The government website provides more on that notion. There is no further detail available yet, but we will be involved in any discussions.
"Medical practitioners and other healthcare workers from a range of disciplines and settings are likely to be required to help deal with a coronavirus outbreak. For example, dentists and GP practice nurses may be asked to assist staff in NHS hospitals in administering injections and medication that would normally only be administered by hospital medics." Published 19 March 2020.
Thursday 19 March 2020
National data opt out delayed until 30 Sep 2020
The National data opt out policy which was due to be implemented in England from 30 March 2020 has been delayed six months until 30 September 2020.
The National data opt out is a service that allows patients to opt out of their confidential patient information being used for research and planning - not direct patient care. Organisations which were already part of the policy will still need to remain compliant, however, new organisations, which includes NHS dentistry across primary and secondary care, do not now need to comply until September. At that point the decision will be reviewed.
For more on this read the letter from NHS Digital and NHSX.
Guidance from NHS England
We understand that, once again, the updated NHS England guidance on coronavirus (the single operating procedure) has been delayed and will not be published this evening. We are anticipating publication tomorrow morning, Friday. But we have been anticipating publication every day this week. We continue to make representations that this is simply unacceptable.
Letter from CDO for Scotland
CDO for Scotland Tom Ferris has sent a letter to the NHS boards to distribute to dentists, further clarifying the financial support measures that he previously set out in a letter on 17 March 2020. The recent correspondence covers some of the points that we raised in our feedback and also includes specific guidance around the use of aerosol generating procedures. We will continue to liaise with the Scottish Government on financial support and guidance for dentists.
Supporting dental students, trainees and recent graduates
The Dental Schools Council (DSC), the Joint Committee on Postgraduate Training in Dentistry (JCPTD) and the General Dental Council met yesterday, to discuss arrangements to support dental students, trainees and recent graduates across the UK in the context of COVID-19.
They've told us that a joint statement will be issued tomorrow, Friday 20 March. This will cover students on undergraduate BDS courses, those undertaking training to be a dental care professional, dental professionals in foundation or vocational training and in postgraduate specialty training. We are hoping this statement will also offer more clarity on the situation with dental exams, following news today that GCSE and A-levels exams have been cancelled in England, Scotland and Wales.
In addition, the four statutory postgraduate education bodies, HEE, NES, HEIW and NIMDTA have issued
guidance to employers of dentists in training with regard to the impact of COVID-19 on postgraduate training programmes. This includes dental foundation training, dental core training and specialist training.
They've assured us that they're working closely with other education stakeholders to mitigate against any negative impact on trainee progression through their programmes. They realise that the limitations in place due to COVID-19 may compromise the ability to gain required competencies. The situation is under daily review and updates will be on-going.
Foundation dentists and other dental trainees should raise any concerns about personal circumstances with their educational supervisors, training programme directors and/or postgraduate dean. Under any circumstances, health advice on self-isolation should be followed.
HEE has confirmed that it has written today to all foundation dentists and educational supervisors. If you have not received this letter, please contact your HEE office.
Response from the CDO for England
We have received a response from Sara Hurley, the CDO for England, to our letter sent on Tuesday 17 March 2020 which raised our concerns about official advice to dental teams in England.
Guidance for dentists in Scotland
The Scottish Government also issued COVID-19 guidance, along with an accompanying memorandum that outline the financial support being put in place to mitigate the disruption of service caused by the outbreak. We encourage dentists in Scotland to review these documents. We are working to clarify a number of key issues raised by the guidance and will keep you updated.
Wednesday 18 March 2020
17:58 School closures: Are dentists and nurses considered keyworkers?
We're seeking clarification on whether dentists are considered keyworkers after the announcements made about school closures. Schools are now scheduled to close across the UK. Schools in England will close Friday 20 March, except for looking after the children of keyworkers and vulnerable children. Scotland and Wales schools will also close from the same day. Schools in Northern Ireland will close to pupils today and staff on Monday 23 March.
17:00 Updated guidance issued in Northern Ireland
Some updated COVID-19 guidance has been issued to support dentists in Northern Ireland. This guidance recognises that it is far from business as usual for GDPs. It also sets out advice in relation to aerosol generating procedures (AGPs) and other treatments.
We hope that details on financial mitigation measures, being considered by the Department of Health, will soon follow. Unlike elsewhere, dentists in Northern Ireland have not yet received details of these mitigations.
Combined with HSCB’s letter issued to practitioners this am, this is another welcome step forward in a rapidly changing situation, However, some questions remain unanswered, such as the risks to pregnant workers.
17:00 Working for our members
We're lobbying governments on your behalf and working hard to get you answers and keep you informed during this stressful time.
Here are examples of our recent communications to dentists across the UK:
Our advice team have also extended their hours and are answering members' calls from 08.30-18.00.
15:30 Data security deadline moved
NHS practices in England and Wales should note, the final deadline for Data Security and Protection Toolkit submissions has been pushed back to 30 September 2020 to account for COVID-19.
Organisations can choose to complete their submission before that date. If they do and meet the standard required, those organisations will be awarded 'Standards Met' status, as in previous years. Where organisations have separate agreements with commissioners or information sharing partners, the existing deadline remains unchanged, unless agreed between relevant parties. Further advice for organisations completing their toolkit assessment.
14:05 Further guidance needed for dentists in England
We’re demanding clarity from government on COVID-19 guidance to dentists in England. The failure to communicate updated guidance on COVID-19 leaves both dental teams and their patients vulnerable.
The World Health Organisation declared a pandemic and the government stepped up its response to containing the spread of the virus. But no updates have since been provided to NHS dentists’ standard operating procedures.
Mick Armstrong, Chair of BDA Board, has been clear: “A service that millions depend on is uniquely exposed, and with no safety net in place. Without clear guidance and support a fully functioning dental service may end up a casualty of this pandemic.”
14:05 Dental conferences postponed
Closer Still Media have decided to postpone the British Dental Conference and Dentistry Show (BDCDS) and the Dental Technology Showcase (DTS) 2020.
I believe that postponing the show now is the right decision. It offers dentists and their teams certainty at an early stage.
12:45 BDA’s chair on BBC News
Mick Armstrong, Chair of the BDA Board, has spoken to BBC News about the lack of leadership from government. In the interview, he pushed for better guidance to be provided for dentists in the context of COVID-19.
09.30 Financial mitigation measures announced
Chancellor Rishi Sunak has pledged additional support for business on top of measures set out in the budget:
- Government-backed loans of £330b open to all businesses, with unlimited lending
- Business interruption loans, with no interest for 6 months, will start next week
- £10k extra cash grant to smallest businesses
- Three month mortgage holiday.
We’re pushing for confirmation that this will be applicable to dental practices. We will update you when there is more information available.
09:30 Guidance issued for Scottish dentists
We’re pleased to see COVID-19 guidance was issued by the Scotland’s Chief Dental Officer, Tom Ferris. This outlines the financial support being put in place to mitigate the disruption of service caused by the COVID-19 outbreak in Scotland. We are working with the CDO in Scotland to clarify a number of key issues raised by the guidance.
09:30 On behalf of dentists in Northern Ireland
We’ve appealed to Health Minister Robin Swann for urgent intervention. Dentists in Northern Ireland are very concerned, and the current lack of guidance is unacceptable. A letter has been issued to GDPs by HSCB. We hope to see guidance issued today. We’re pushing for it to be as robust as that provided by the Governments in Scotland and Wales.
Tuesday 17 March 2020
18:25 Chief Dental Officer for Scotland letter
The Chief Dental Officer for Scotland issued a letter today with guidance to NHS Dental Services on dental provision during the COVID-19 outbreak.
18:20: Our message just issued to the Chief Dental Officer (England)
Read our letter issued to the Chief Dental Officer (England) [PDF].
17:34: Healthcare Inspectorate Wales statement on Coronavirus
Healthcare Inspectorate Wales (HIW) is to stop its routine inspection and review programme from today, Tuesday 17 March.
Further to the decision to take a balanced, risk-based approach to work over the coming weeks, due to the unfolding COVID-19 situation, HIW has now made a decision to stop its routine inspection and review programme from today, Tuesday 17 March.
16:20: Guidance for pregnant staff
Many of you have been calling up to ask about guidance for pregnant staff. We’re very aware that the guidance in relation to pregnant staff and associates in the dental practice is not consistent. We are working to get clarification on this.
The guidance from the UK Government on 16 March 2020, including from the Chief Medical Officer and the Chief Scientific Adviser, is that all people should avoid unnecessary social contact. The UK Government has stressed that this advice is particularly important for people over 70, those with some health conditions, and pregnant women. Whilst the government did not say that pregnant women working in dentistry have to stay at home, we anticipate that the Welsh Government at least will confirm that pregnant dentists and dental staff should remain at home. We would hope for similar guidance from other parts of the UK.
It may be that dental staff have a higher risk of catching airborne viruses due to certain dental procedures. Reception staff will also come into contact with a number of patients and viruses could be transmitted through normal transactions at reception. At the present time, we can only suggest that pregnant women come to their own decisions as to whether they wish to remain working in a dental practice.
Pregnant employees will be entitled to Statutory Sick Pay if they stay at home. If a pregnant associate wishes to remain at home, and subject to her associate agreement, she may be required to provide a locum. That said, we’re conscious that requiring pregnant women to find locums, especially at this time, may cause undue stress.
We therefore would hope and expect that practice owners and associates will work together to reach sensible agreements on these issues.
11.00: Leadership needed from NHSE on COVID-19
We have called for leadership from NHS England, after further failure to publish updates to its Standard Operating Procedure for the Coronavirus.
Despite repeat assurances no new versions have been provided since 6 March, during which time the World Health Organisation declared a global pandemic and the UK Government moved from the contain to delay phase of its strategy.
Our chair, Mick Armstrong has said “In a situation which is changing rapidly, advice from NHS England has not been updated, with dentists and their teams frightened and desperate for leadership. This official silence is deafening. Dentists deserve clarity if they can continue providing a safe service for their patients.”
I understand yesterday’s PM’s announcement had to be factored in causing further delay. Still waiting.
Monday 16 March 2020
CQC: Routine inspections cease as of today
Following recent dialogue with the health sector, including the BDA, the Care Quality Commission has confirmed that routine CQC inspections - including in dentistry - will cease as of today. This will hopefully ease the current regulatory burden.
You are not required to wear a FFP3 mask in general dental practice
Recent guidance issued by NHS England is causing confusion among dentists. The formatting of the letter is unclear and to some it appears to state that dentists, as healthcare workers, are required to wear FFP3 masks. This is not the case. You are not required to wear a FFP3 mask in general dental practice. This guidance referred only to healthcare workers working with patients waiting for COVID-19 test results. We have asked them to reformat the advice to remove this ambiguity.
Some dentists are concerned about asymptomatic transmission of COVID-19. At present, government guidelines state that people should self-isolate, only if someone has a new, continuous cough and/or a temperature of 37.8 degrees or higher. This is the basis on which you should decide whether patients should be treated and whether you or other staff members should come in to work. This may change, as more evidence become available about the nature of the virus and the risk of asymptomatic transmission. We will update you if changes are made.
Unsurprisingly the response to coronavirus has varied around the world. The UK, to some extent, is seen as being an outlier in its approach to managing the pandemic. This variation is also reflected in different nations’ advice to the dental profession. We have been in contact with fellow dental associations across the world and the ongoing intelligence that we receive is helping to shape our own position and how we challenge official positions.
NHS England guidance
NHS England has advice specifically for primary care dentistry:
Primary care advice for clinicians
Standard operating procedures for primary care settings
We are anticipating this advice to be updated today, so keep an eye out. We realise that the current situation is causing huge anxiety within the profession about the right things to do for patients and staff. These still advise dentists to ask a patient’s travel and COVD-19 contact history, this is no longer relevant. However, much of the rest of the guidance remains relevant.
We’re continuing to reflect your concerns to officials and will keep you posted on any developments. The BDA is putting pressure on the relevant organisations such as NHS England – we cannot make decisions about practising in a pandemic on their behalf but we are advising them on the practical implications for our members.
Friday 13 March 2020
Face mask shortages
We’ve been in regular contact this week with government officials and the industry to try to ensure a continuing supply of face masks to practices as we know there have been significant problems. A process has been set up to enable suppliers to get hold of stocks held by government and get them out to practices. This is likely still to involve some rationing.
Across the four countries of the UK, dentists are worried about the potential impact of the coronavirus on their businesses. Some patients are reluctant or unable to attend for treatment and staff may be forced to take time off. It’s a particularly bad time for the virus to hit, at the end of the financial year when practices are desperate to hit NHS targets, and in England and Wales, get through their Units of Dental Activity or face clawback.
We’ve made clear the real concern within the profession on this issue to all four of the UK administrations and are arguing for a lenient and sympathetic approach. We are discussing with NHS England how ‘force majeure’ will be applied in these circumstances. That is a contractual provision which allows for deferment of activity where practices are unable to meet targets for reasons outside of their control. Pandemic is listed as one of the reasons for force majeure to kick in. However, deferment of activity alone will not solve the problem, particularly if we see an extended period of impact. We are making the case for alternative approaches and will keep you posted on how we get on with those discussions.
On-going dialogue with governments
Within all four countries, there is on-going dialogue with officials about the impact of the coronavirus. In England, we are part of an NHS England primary care clinical stakeholder forum. NHS England has produced a Standard Operating Procedure for primary dental care settings. This is a live document that will be updated regularly. We have fed a series of comments into the document so far and will continue to do so to make sure it is as clear as it can be.
That framework is due for an update today to reflect official advice around identification of cases and self-isolation so keep an eye out for that. If you spot anything in the framework that doesn’t make sense, let us know and we will feed into NHS England.
In Northern Ireland, we are actively pressing the Executive to introduce financial mitigation measures. In a letter to the Health Minister this week, we set out the potentially extremely serious financial implications faced by general dental practitioners. The CMO and senior HSCB officials have assured us the Department is, “committed to maintaining the same level of Health Service dentistry after Coronavirus, as before”.
We’re in regular contact with the healthcare regulators, whether individual or place based. The Care Quality Commission in England has said that they will focus activity where it is needed most to ensure people receive safe care. At the moment, routine visits are continuing, but the CQC has asked for ongoing discussion about the impact of inspection on providers.
Response to COBRA
For the time being, practices are largely striving to deliver business as usual, albeit in very difficult circumstances. The Prime Minister’s briefing yesterday didn’t move the official advice in relation to pandemic that much further. But there may come a time soon when we will all be advised, or even mandated, to restrict movement and activity.
In healthcare settings, that may mean a reduction in treatment, possibly even emergency-only provision at some point. Again, we are seeking to clarify with officials what such circumstances would mean for dentistry. We may need to think laterally about our approach, for example, whether there are opportunities for dentists and teams to redeploy into other roles, utilising their clinical skills for patient benefit. Again, this is very much a live issue.
Wednesday 11 March 2020
The Chancellor has pledged to offer ‘whatever it takes’ to support NHS services responding to the COVID-19 outbreak. This includes a £5bn emergency response fund. So far, we know that:
Small firms will have access to business interruption loans of up to £1.2m. This is potentially good news for dental practice owners worried about the impact of COVID-19. However, the details remain unclear so we’ve asked government officials for clarification
Deferred tax payments may also be agreed with HMRC, if you are in financial difficulty
Statutory sick pay will be paid to all those who are advised to self-isolate, even if they don't have symptoms
Firms with fewer than 250 staff will be refunded for sick pay payments for two weeks, again we’re seeking clarification on the detail
Benefits will also be quicker and easier to access for self-employed. Contributory employment and support allowance (ESA) will be claimable from day one, rather than day eight. The minimum income floor for universal credit will be removed. The requirement to physically attend a job centre will be removed – everything can be done on the phone and online.
See more on our 2020 budget coverage.