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 continuing 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 emphasised 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.