Saturday 4 April 2020
Northern Ireland: Updated financial support package announced
Following mounting pressure from our NI Dental Practice Committee throughout the week, the NI Department of Health has published details of a revised financial support package.
GDPs in Northern Ireland can expect to receive 80% of gross S payments – including patient contributions – plus capitation payments and other allowances. In return, it is expected that the staff costs associated with the normal delivery of HSC dental care will continue to be paid by GDPs. Finally, the letter implies that GDPs will be allowed to claim wider government support schemes to cover the shortfall in private earnings.
Breakthrough on furlough for mixed practices
Following our announcement posted here on Thursday evening, we welcome confirmation from both the Treasury and NHS England that mixed practices can make full use of the furlough scheme in proportion to their private activity.
Access to the scheme had not appeared an option for employers receiving public funding from the NHS. The BDA has been pressing NHS England to offer assurances that mixed NHS/private practices could access wider government support to cover private work, as well as support from the NHS.
Friday 3 April 2020
Friday wrap up: What happened this week
Here’s a roundup of the some of the big things that happened and what we've been doing in response.
Meeting with Minister
Mick Armstrong and I had a virtual meeting this afternoon with Health Minister Jo Churchill and colleagues representing other primary care professions in England.
We raised a number of key issues for the dental profession, including the establishment of urgent care centres; adequate personal protective equipment; and the impact of the £50,000 earnings threshold for support to self-employed worker on private dentists in particular.
This is the third week in a row that the Minister has convened a meeting along these lines for primary care to listen to the professions’ concerns.
NIDPC push for DoH financial measures
Today, NIDPC urged the Department of Health to announce details of their financial package by early next week. In a week where GDPs have volunteered in their hundreds to work in the new dental emergency centres, and have taken on additional interim work due to the closure of Out of Hours, it is unacceptable that the Department has been slow to announce details of the package.
We have appealed to the recently announced acting CDO, Michael Donaldson, to intervene to clarify this much needed package. We have also supplied a list of our expectations for a fair and flexible package, drawing from what colleagues in Scotland and in England have secured. This includes clarity on hybrid NHS/Private practices in terms of Department of Health and wider business support measures.
This urgent clarification of the H financial package would allow practitioners to stop worrying about the financial futures of their staff, their associates and their practices, and to concentrate on the enormous task at hand, in what are very dangerous and unprecedented circumstances.
NHS payments: Advice for associates
We have updated our NHS payment guidance for associates within our Coronavirus: Financial Impact page.
The new content covers:
- What practices should be paying associates
- Can practices share NHS income so that private dentists also get some money?
- What if NHS dental performers do not want to be redeployed?
- What if associates believe they are not being paid the money they should be?
Read the new guidance for associates.
Out-of-hours clinics in Northern Ireland no longer in operation
The NI Health and Social Care Board has written to all GDPs to announce its decision to close the out of hours dental clinics. These clinics have now been designated as acute sites and under new guidelines patients will no longer be able to attend. GDPs have been asked to make interim local arrangements for out of hours patients from this point onwards – including over the coming weekend. All practices will have to amend their phone messages accordingly.
Seeking clarity on financial support for practices in Northern Ireland
Our daily efforts to obtain clarity from the Department of Health on the its proposed financial support package for dentists continues.
NIDPC Chair, Richard Graham, has written to Department officials requesting sufficient detail to ease GDP concerns and allow them to concentrate on running the emergency dental care centres. Furthermore, following our call earlier this week with Michael Donaldson, acting CDO, the Health and Social Care Board has updated its FAQs and responded to a list of LDC member queries.
NHS Funding for mixed practices in England
We have written new guidance on furlough workers and NHS income for mixed practices.
This updated advice is in response to yesterday's news from NHS England that mixed practices can claim for furloughed workers in respect of private income and still receive their NHS income. Our guide details what this involves and what you need to do.
Please see our advice in Coronavirus: the financial impact (section 4).
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.
Dentists invited to NHS webinar later today
Chief Dental Officer for England, Sara Hurley and NHS Director of Primary Care and System Transformation, Matt Neligan invite oral health professionals to a webinar on COVID-19 today from 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.
Ltd companies campaign for Government support
Dentists working as limited companies are also affected by this crisis. Over 200,000 people have now signed a petition asking the Government to support the directors of small limited companies, in the same way as the employed have been supported. We stand with the dentists who are campaigning for this support.
Thursday 2 April
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 h, 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."
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 firstname.lastname@example.org.
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 k 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.