Friday 5 March 2021
Wales: Delivery of the NHS GDS Contract in 2021
The revised GDS targets in Wales have raised many concerns among dental professionals worried about the delivery practicalities and implications. Several issues were flagged this week when the Wales General Dental Practice Committee and the committee chairs met to discuss them. The concerns include:
Discrepancies in data
There are discrepancies between data provided by practices and how these show on the new
eDEN system. Furthermore, the way the data is being handled within the system may be questionable.
This means that the data seen by your Local Health Board (LHB) may not be the same as the data you have entered. Moreover, the calculations of percentages may not be clear.
We are already hearing of practices being contacted by their LHB contract managers challenging them that they are under-performing.
We advise all practices to log onto their
eDEN account to check that the data matches those inputted and also the percentage calculations. We understand NHSBSA contacts are looking into this but LHB contract managers may not to be aware.
The targets around application of fluoride varnish are of particular concern to members who have said these targets are excessive. Some members have contacted their indemnity provider to understand the implications.
One issue with any hard target is that it can cause unintended outcomes. In this case fluoride varnish becomes a more valuable target than stabilizing the dentition of patients with uncontrolled caries which is costly and time-consuming.
We are currently relaying these concerns to the CDO for Wales, Dr Colette Bridgman and asking for greater clarity on the guidance and its application in practice in the new financial year.
NHS prototypes in England: quarter four targets
Prototype practices have understandably been asking what contractual provisions apply for them in quarter four given that they are not subject to the 45% threshold being used for other practices. We have been raising this issue on a regular basis with the Department of Health and Social Care (DHSC).
NHS England’s letter of 13 July said that, unless any new conditions are applied, the provisions set out in that letter persist. As a reminder, in order to receive full contract value, prototype practices therefore need to continue to:
- Give assurance that they are open for face-to-face interventions, are adhering to contractual hours with reasonable staffing levels for NHS services in place and are performing the highest possible levels of activity, with no undue priority being given to private activity
- Deliver the equivalent of at least 20% of usual volumes of patient care activity. Whilst NHS England hasn’t specified how activity is measures, we suggest practices take a common sense approach to finding a way to measure patient care activity. For example, keeping track of the number of patient appointments each week.
- Not significantly increasing private practice provision at a rate that exceeds that for NHS provision
- Maintain the eTriage system for recording of telephone/remote consultations
- Transmit FP17 data for evaluation of treatment interventions and patient outcomes
- Submit declarations around equivalence of NHS service offer and private service offer
- Submit a declaration over continued staff engagement
Given that we are now coming towards the end of the financial year, we do not expect this position to change. We are pursuing with the DHSC as to what arrangements will apply from April and will update you when we have more to share.
England: NHS contracts for quarter four
As we come towards the end of quarter four, many practices in England will be anxiously calculating where they stand in relation to their NHS target.
As a reminder, practices will need to deliver 45% of pro-rata UDAs for the quarter to achieve 100% of contract value, minus an abatement to account for variable costs not incurred. If practices deliver between 36% and 45% of pro-rata UDAs, a proportionate enhanced rate of payment is made.
Dropping below 36% of delivery means UDAs paid on a one-to-one basis, representing a significant cliff edge, unless exceptional circumstances can be argued. Some practices will also need to be conscious of what happens if they are able to deliver more than 45% of UDAs.
For contractors reaching 45% of activity in the quarter, over-performance of up to 2% can as usual be recognised. The commissioner may pay for the additional activity or it can be credited to the following contract year. If carried forward, it reduces the contractual requirement in 2021/22. A carry over of 4% of activity may also be allowed in specific circumstances agreed with the commissioner.
Once the 45% target has been reached, UDAs will once again be counted at standard rates. So, the enhanced allocation allowed between 36% and 45% of delivery no longer applies. Effectively, 2% over-performance on the annual contract represents 8% of UDAs for the quarter. A practice will breach the 102% threshold once it reaches 53% of UDAs for the quarter, assuming it has fulfilled all relevant requirements in the first three quarters of the year. To reach the 104% annual threshold, a practice needs to deliver 61% of UDAs in the final quarter (45% plus the 16% which is 4% of the annual contract delivered pro-rata). As usual, any UDAs in addition to agreed over-performance will not be paid.
Practices should also be conscious that
NHS England’s letter of 22 December set out a number of other expectations for practices to receive their full contract value. These apply even if the practice has reached the 45% mark. Practices are expected to remain open and providing care in line with the standard operating procedure.
The letter also drew attention to clause 59 of the contract which says that practices will not advise that NHS services are unavailable with a view to gaining patient agreement to undergoing private treatment. We know that some local NHS teams have already signalled their intention to enforce these provisions.
England: 1% pay recommendation to NHS dentistry
Government’s recommendation of a 1% pay rise for NHS dentists for 2021/22 is a body blow for NHS dentistry.
The recommendation was made to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). Our Deputy Chair, Peter Crooks has responded to the 1% figure with the following statement:
“Ministers seem to have forgotten that NHS dentistry can only survive if it is capable of attracting and retaining talent.
“After a decade of real terms pay cuts we need all hands to the pumps to address unprecedented access problems and widening inequality.
“A return to austerity pay will come as a body blow to a service facing a deeply uncertain future. If the DDRB is truly independent it will offer a fair deal that ensures NHS dentistry can remain sustainable.”
Thursday 4 March 2021
Lunchtime webinar on Practitioner Health support services
Register today for our lunchtime webinar on Friday 26 March at 12:30 - 13:30 to
improve your awareness of mental health and bereavement support available to dentists and trainees.
This will be a live interview-style webinar session with Professor Dame Clare Gerada, Medical Director of Practitioner Health, and Roz McMullan, Past BDA President and advocate for wellbeing in dentistry.
It will cover what you need to know about:
Practitioner Health's self-referral support service for mental health issues
How to support your team to know that it's okay to not be okay, and to seek professional help
The other wellbeing and prevention resources available to you.
Scotland: Calling for action on obesity
On World Obesity Day, we're echoing the call of the Scottish Obesity Alliance (SOA) for the Scottish Government to take
strong and urgent action to reduce obesity and health inequalities in Scotland. As members of the SOA Executive, we attended a webinar this week to review the impact of COVID on achieving healthy weight, and next week we will meet with other Executive members (including Obesity Action Scotland, Diabetes UK and Cancer Research UK) to discuss a range of issues affecting obesity, including a healthy diet.
Sugar reduction and maintaining a healthy diet are essential to tackling both tooth decay and obesity. That's why, we have consistently led calls for radical action to lower the nation's sugar intake, with measures ranging from lowering the recommended daily allowance, through to action on marketing, labelling, and sales taxes to help prevent tooth decay.
Have you ever worked as a prison dentist?
After five years of campaigning on behalf of prison dentists, we are now happy to confirm that
prison dentists are no longer excluded from the NHS pensions scheme. If you have ever worked as a prison dentist, you may have been incorrectly excluded from the NHS pensions scheme. Your contributions can now be included retrospectively.
For advice on what this change might mean for you, members can login to access our
prison pensions FAQs
or get in touch with our team on
email@example.com. Non-members can
join today to access our FAQs or reach out to the NHS BSA for more information.
Trade deals may undermine oral health
To highlight the impact future trade deals may have on the government’s plans to tackle obesity in England, and how oral health is set to lose out, we have added our support to
Sustain’s Trick or Trade campaign this World Obesity Day (4 March).
New research by the London School of Economics, found evidence that demands from future trade partners could lead to a flood of cheap, unhealthy foods into the UK, and that some standard trade deal clauses could threaten plans to halve childhood obesity by 2030.
BDA Chair Eddie Crouch has said: “Tooth decay is already the number one reason for child hospital admissions. With COVID set to send health inequalities into overdrive, Ministers must not open the floodgates to products that will further undermine the nation's health.”
Scotland: Updated financial guidance for dentists
Practitioner Services Division (PSD) has updated its
COVID-19 Financial Support Payment FAQs. The first change (section 1.1) reiterates the announcement made in the
CDO's letter on 5 January about the deferred introduction of tiered financial support by three months in the first instance. The second change (section 7.3) is revised advice for associates who are looking for a new job during the pandemic.
We continue to campaign on your behalf and to discuss support payments with PSD and the Scottish Government. We will keep you up to date with developments.
Wednesday 3 March 2021
What dentists need to know about the 2021 Budget statement
Today Chancellor Rishi Sunak MP delivered the Budget statement for 2021. We’ve summarised the key points which might be of interest to you, including:
- The amount you can earn before paying tax is rising from £12,500 to £12,570, and the threshold for the higher rate of tax will increase from £50,000 to £50,270 but these thresholds will then be frozen for five years
- Corporation tax will rise from 19% to a maximum of 25% from April 2023
- Furlough scheme will be extended until end of September
- Self-employment income support scheme has also been extended, but the eligibility criteria – which exclude most self-employed dentists – remain the same
- A 130% ‘super-deduction’ on tax for investments made by companies in qualifying new machinery is being introduced, although it is not yet clear whether dental equipment will be eligible.
Find out more:
Budget 2021 - What you need to know.
Scotland: Hospital dentists report a gradual return to normal service
Our Scottish Hospital Dentists Reference Group met this week to discuss the issues that matter to you in hospital dentistry. Activity levels and other COVID-related issues led the agenda.
Colleagues reported that most areas were increasing activity levels and slowly returning to pre-COVID provision, but expressed concerns about limited capacity at some sites due to the age and design of buildings, the availability of theatre space, and staff shortages. This has increased waiting times for hospital treatment in various areas with some services still treating emergency and urgent referrals only.
Colleagues expressed concerns about the impact of the decision to defer dental student graduations on subsequent training and wider workforce capacity. They also suggested that the next iteration of the Statement of Dental Remuneration should include codes for recording treatments relating to paediatric dentistry and other specialties.
We continue to liaise with the Scottish Government on hospital dentistry issues and will update you when we have more information.
England: Booking your COVID-19 vaccine online
Dentists and locums in England can still
book to receive their COVID-19 vaccination in a vaccination centre or community pharmacy through the NHS Covid-19 Vaccination Booking Service.
As part of the booking process, you will need to self-declare that you are a healthcare worker, the type of role/work you do and the name of your employer. You should also bring ID/proof of employment such as a staff ID badge, a recent payslip or recent letter/email from your employer (dated within the last three months).
Locum staff are also eligible for the COVID-19 vaccination. Locums should follow the above process, but verbally declare they are a locum healthcare worker. They should provide details of their locum agency, proof of General Dental Council registration and a letter of confirmation of locum status from their locum agency (dated within the last three months).
England: Still pressing for NHS payments to associates and practice staff
This morning Shawn Charlwood, Chair of the BDA General Dental Practice Committee, wrote to NHS England and the Department of Health and Social Care regarding those
associates and other practice staff who have not seen NHS income paid at previous levels for the period April to December 2020.
Whilst the vast majority of practices have passed on earnings as anticipated, we know that some have not.
Since the pandemic broke out, we have repeatedly raised this question with DHSC officials as well as with NHS England. Our view is that there are clear ways to ensure that this is properly addressed. Indeed, we wrote to NHS England as far back as 8 May 2020 to outline our proposal to legislate for an obligation to pass on NHS income.
We asked NHS England to agree to amend the Statement of Financial Entitlement so that practices pay associates an amount equivalent to their Net Pensionable Earnings from the equivalent period the previous year, or by other agreed mechanism. We know that DHSC has been considering this proposal now for several months and we have urged again that it now be addressed as we come to the end of the financial year.
Throughout the year, NHS England has repeated that practices are obliged to pass on earnings and if that has not happened, it will be a factor in considering whether practices will receive their full contractual payments. We have urged that, if there is not to be a change to the SFE, practices and associates are at least given a clear indication as to how this matter will be addressed at end of year reconciliation.
We reported earlier in the week that the
NHS BSA had introduced a new pay concerns form
on behalf of NHS England. Associates and practice staff are advised to use this form to report outstanding issues. If historic unresolved concerns are not recorded again on this new form, our understanding is that NHS England will assume they have been resolved.
We will update you when we have more information and continue to campaign on your behalf.
Northern Ireland: Lockdown easing plan announced
Northern Ireland Executive announced a plan to ease out of lockdown restrictions.
‘Moving Forward: The Executive’s Pathway Out Of Restrictions’ sets out a step-by-step approach to the relaxation of the current regulations covering nine pathways, each of which has five phases. We do not believe this will have a direct impact on dentists and dental practices.
There are no fixed dates detailed in the pathway. The first comprehensive formal review of the pathway will be held on 16 March with further reviews on 15 April, 13 May and 10 June. These dates are not indicative of when restrictions will be lifted, they are deemed the most appropriate points for review. We will update you when we have more information.
NHS contract England from April 2021
As we are now only just over four weeks away from the start of the new financial year, many practices are understandably asking what the contractual provisions will be for 2021/22.
We share the profession’s frustrations that once again we are getting so close to the start of a new quarter without a clear idea about the arrangements that will be in place. We have been repeatedly making our concerns clear in our regular meetings with NHS England. Practices need time to be able to plan ahead particularly if we are to see any deviation from the current provisions. In discussions with NHS England, they have indicated that they want to see the contract delivery data for February before making a final decision on arrangements for April. We would expect that information to be available in the next week.
We will continue to press NHS England on as early an announcement as possible and will of course update you as soon as we can.
Tuesday 2 March 2021
Psychological first aid training available
The COVID-19 pandemic has had a huge impact on children, with many reporting that it has made them feel more stressed, lonely and worried. Online
training, developed by Public Heath England (PHE), is now available for those supporting children and young people aged up to 25 years affected by COVID-19.
Children and young people can be very resilient, but crises such as COVID-19 can severely impact their mental health. Getting the right support early on can help prevent problems occurring or worsening. This course may help you or your dental team to provide practical and emotional support to children and young people affected by emergencies or crisis situations.
Discussing vaccination with your team
We suggest that practices discuss the vaccination with all members of the dental team. The University of Bristol has produced a helpful
Communications Handbook on this. It's important that concerns about the vaccine are discussed in good time and sensitively.
The vaccine is important in our fight against coronavirus, but practices should be aware that they cannot insist that staff have the vaccine when it is offered. If, after a discussion, a member of the dental team refuses to have the vaccine, the practice must accept that decision.
In any event, practices should ensure that all members of the dental team continue to adhere to the standard operating procedures and to practice policies and procedures. The situation is no different for associates. For more information on vaccination, pregnancy and the dental team see our
Scotland: Concerns about reduced patient attendance and widening inequalities
raised concerns about the collapse in patient attendance rates due to the pandemic, and the widening gap in attendance rates between people from the most and least deprived areas.
data published last week shows that while registration rates remained high and broadly stable - owing to lifetime registration - the number of children seeing a dentist between May and December 2020 was around a quarter of the 2018-19 average due to the pandemic. Between September and November 2020, the number of adults seen was around a third of the 2018-19 average, before falling to less than 30% of the 2018-19 average in December 2020.
We are concerned that lower levels of participation will inevitably translate into a higher disease burden. For example, early signs of decay and oral cancers are picked up at routine check-ups, and delays will mean both higher costs to the NHS and worse outcomes for patients.
Patients in more deprived communities have traditionally experienced lower levels of participation. The new data show that in 2020, children and adults from the most deprived areas were less likely to have seen their dentist within the last two years than those from the least deprived areas (73.5% compared to 85.7% of children and 55.9% compared to 67.1% of adults). These inequalities in access between the most and least deprived areas have grown since 2019, particularly in children.
Northern Ireland: GDPs and staff are eligible for £500 payments
GDPs and their staff will be included within the eligibility scope to receive £500 payments, the Health Minister, Robin Swann MLA confirmed last week.
This confirmation was part of a response to numerous queries we put to the Department of Health relating to COVID recognition payments and vaccination remuneration.
In his letter, Mr Swann confirmed the following:
COVID recognition payments: GDPs and their staff will be included within the eligibility scope to receive the £500 payments.
Student £2k Special recognition payment: The DoH have chosen a criteria that excludes dental students (and their medical and pharmacy colleagues) from the recognition payment and will not be changing this criteria. This is disappointing, but we will continue to work to ensure dental students are supported as fully as possible during this difficult period.
Vaccinator remuneration: We queried why GDPs are being remunerated at Band 5 which is considerably below their medical counterparts. We have now been informed that while doctors and employed dentists are being paid under their existing terms and conditions, for any other individual it is at the assessed level of the role, which was agreed by the four nations at equivalent to AfC Band 5.
Read the Health Minister's letter to the BDA in relation to COVID recognition payments.
England: CQC promises to address registration delays
We have previously updated you on our efforts to raise your concerns regarding the delay in registration with the Care Quality Commission.
Our Chair, Eddie Crouch has written to Ian Trenholm, the Chief Executive of the CQC, regarding the 16-20 weeks delay for members trying to register a new practice. This delay is having a huge impact on the transfer of dental practices within the current financial year before changes to capital gains commence.
Following a response and a short meeting to discuss this, the CQC confirmed the following:
- They are moving more staff to the registration team
- Practice inspectors, among others are being trained up and will do this job outside of normal working hours.
The CQC confirmed that they are equally frustrated that the backlog had crept up on them and are seeking to put things in place to ensure this problem does not occur again.
Reports from members indicate that expected dates have been given for some practices, but we will continue to voice your concerns and will update you with more progress as soon we hear.
Monday 1 March 2021
England: Associates pay concerns declaration
From Monday 1 March, NHS BSA is launching a
new pay concerns 2021 year-end form on behalf of NHS England. The criteria for completing the new survey form are that:
- You’re a member of a dental team
- You’ve raised pay concerns with your provider
- Your pay concerns haven’t been resolved after speaking to your provider.
If you meet these criteria, we advise you to fill out this form. The information is being collected by the BSA on behalf of NHS England and could be used as part of the contract reviews being undertaken for 2021 year-end.
FFP3 masks: Check your stocks
The Department of Health and Social Care has warned that Fang Tian FT-045A FFP3 masks may not meet the technical specification for FFP3 masks. You are advised to check your stocks of FFP3 masks for these products and not to use them until their investigation has been completed.
Manufacturer: Fang Tian FT-045A FFP3 masks
Supplier: Polyco Healthline
Product Code: BWM541
Scotland: Dental nurses can give COVID vaccines
Following several queries from members, we have received confirmation from the Scottish Government that dental nurses are authorised to be COVID vaccinators.
The national protocols for both the
Pfizer vaccines state that all dentists registered with the General Dental Council and all dental nurses (subject to supervision) are permitted to administer the vaccines. The protocols include the conditions which have to be met by these dentists and dental nurses. The individual vaccine protocols are updated regularly to meet clinical advice from the JCVI.
This clarification is welcome, however decisions about the local deployment of COVID vaccinators are a matter for individual NHS Boards.
Wales: NHS targets and contract reform
In his latest blog, Tom Bysouth, Chair of the Welsh General Dental Practice Committee, updates us on contract reform, NHS financial support and targets for quarters one and two in Wales.
"The possibility of forthcoming targets and contract reform have been a considerable source of stress to many Welsh dentists. Our daily calls with members and most recent mental health survey are proof of this... Here's what you need to know."