Updates from week commencing 8 June 2020

All the updates and what we've been working on during the Coronavirus outbreak.

Friday 12 June 2020

16:40

Weekly roundup

Here's my weekly roundup of the major things that happened this week in relation to the COVID-19 pandemic and UK dentistry. I hope you find it useful.

Useful links from the video:

Financial information for Associates: Find out more about the HMRC position on payments to self-employed associates in mixed practice
Download the latest edition of our toolkit for returning to face-to-face care.

16:00

Scotland: Updated SDCEP guidance for reopening practices

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has updated its guidance for reopening dental practices.

Changes to the previous version include:

Phase numbering updated following the CDO’s letter of 8 June which included the renaming of the phases of NHS dental services remobilisation
Addition of advice about appointing a COVID-19 Lead (Section 3)
Minor rewording about environmental cleaning (Section 7.1)
Clarification of the description of examinations (Appendix 3)

SDCEP appreciated the feedback from BDA Scottish committee members on the previous version of the guidance.

15:20

The FCA to consider plight of dentists

As limited face-to-face dental care resumes this week in England, we have made a formal request to the Financial Conduct Authority (FCA) to consider to the challenges facing the dental sector before the FCA takes forward a test case on insurers’ non-payment of business interruption claims.

The FCA has previously stated that most policies with basic cover would not cover COVID-19. However it is now seeking "legal clarity" on business interruption insurance in an attempt to provide greater clarity for businesses and insurers.

We have instructed law firm Brown Rudnick LLP to review the wide range of business interruption policies held by our members and provide tailored legal advice for the dental sector. We have also set out in detail to the FCA, the issues faced by the profession and have asked them to adequately reflect these in its own legal challenge.

We advise members to await the outcome of the FCA process before considering whether to pursue class action litigation. This would be premature at this stage and will not help to solve the cash crisis that members are facing now.

Our Chair Mick Armstrong has said: "Lengthy litigation should remain a last resort, and won’t keep practices afloat today. Our aim is to give our members the best possible understanding of their legal position and the FCA the best understanding of the dental sector."

Brown Rudnick will be joining us to host a members-only webinar on 17 June for dentists to discuss the review conducted by Brown Rudnick, our letter to the FCA and what next steps are likely to look like.

14:05

Upcoming COVID-19 webinar

You can still register for our Understanding your well-being in a COVID-19 world webinar, which will see BDA President Roz McMullan looking at stress and mental wellbeing (1 hour CPD).

Taking place on Thursday 25 June at 19:30-20:30, it will help you to:

Understand signs and symptoms of stress and burnout
Explore the prevalence of stress in dentistry and what we know about COVID-19 and well-being
Gain knowledge of psychological effects on healthcare staff when experiencing a pandemic
Be aware of evidence-based prevention and coping strategies during a pandemic
Be aware of signposting for people experiencing stress and burnout and gain knowledge of the organisations available for support.

12:30

Your questions answered

Our team are working to get you the most up-to-date information on a range of complex topics. Take a look at our answers to some of your most frequently asked questions:

On returning to work:

How can I prepare for reopening?
What about practices in Wales, Scotland and Northern Ireland?
What PPE is essential for reopening?
How can I obtain PPE and book fit-testing?

On staff management and support:

How can I prepare staff for reopening?
How can I support BAME staff?
What if my staff do not want to return to work?

On practice management and COVID-19:

When does the furloughed workers scheme close?
How can I change the terms of employment contracts?
How can I negotiate changes to associate contracts?
Will there be clawback due to the shutdown?

10:35

Have you got the updated edition of our toolkit?

Launched last Friday, the updated edition of our toolkit for returning to face-to-face care aims to provide members with the best possible information and the practical advice you need.

New content includes:

Respiratory protective equipment, RPE (p30)
Types of respirator; What is adequate and suitable?; The limitations of RPE; What to look for in fit-testers; Selecting the right mask; FFP2 or FFP3?
PPE fit-testing (p32)
Dental aerosol contamination reach (p36)

Updated content includes:

Closing dates for the furloughed workers scheme (p20)
Cleaning down of surfaces and floors (p28)
Associate relationships (p21-22)
While primarily meant to support dentists in England as they prepare to re-open from 8 June, it also contains advice and support that’s applicable across the UK.

Our aim is to support you in the practical application of the widely agreed measures, so you can return to face-to-face care with confidence. We will continue to update this toolkit as more information becomes available.

Thursday 11 June 2020

18:10

Warning issued over KN95 masks

Today the Health and Safety Executive released a safety alert about KN95 masks.

The warning states that KN95 must not be used as PPE at work as their effectiveness cannot be assured. KN95 is a performance rating under the Chinese standard GB2626:2006, the requirements of which are broadly the same as the European standard BSEN149:2001+A1:2009 for FFP2 facemasks.

However, there is no independent certification or assurance of their quality and products manufactured to KN95 rating are declared as compliant by the manufacturer.

17:46

A reassuring message on DFT places 2020

We have been in touch with Health Education England (HEE) after some concerns were raised by some new graduates about the availability of DFT places this year. We would like to offer some reassurance.

The DFT organisers believe that they will be able to offer a place to all eligible UK graduates.

In line with the applicant guidance, priority is given to those applicants for whom DFT is the only route available to be included on the NHS Performers List, while applicants who can be included on the NHS Performers List without completing DFT will only be considered for DFT places if there are insufficient suitable applicants who have no alternative route for entry on the NHS Performers List.

UK graduates do not have any other route to join the performers list and are therefore given priority in this system. However, place offers are sent out in batches, so those with a low ranking may only receive their offer in the next few days.

This is the case every year as the allocation process goes through a rolling system, also taking into account that some individuals might decline places that are then re-offered.

UK graduates should not currently feel concerned about the discrepancy between the total number of applicants and the total number of places. Concerns of shortages of 100-200 places are unfounded. If there are any shortages at all, the numbers will be low and HEE believes it will be able to address these.

15:14

Grant available for research into AGPs

The British Endodontic Society has made a grant available for research into dental aerosol generating procedures (AGPs) and COVID-19.

Proposals are invited for short-term research projects aimed at addressing and/or mitigating the impacts of AGPs during the COVID-19 outbreak.

The deadline for proposals is 15 July.

13:57

Wales: New Standard Operating Procedure for AGPs

The Chief Dental Officer for Wales has issued a new SOP for dental practices as part of the recovery plan for dentistry in Wales, and written to dental practices.

This SOP covers AGP protocols and comes in advance of the next phase of de-escalation in Wales, when from 1 July all dentists can offer a greater scope of treatments in practice for COVID-19-negative patients including AGPs for urgent care. If Welsh Government health deescalation plans are revised, the date may be brought forward.

Before 1 July, the expansion of UDCs in general dental practices are permitted. Health Boards will approve designated UDCs. We are seeking clarification on a number of points including the funding for these UDCs and the likely level of patient referrals. We are also making a case that such practices need assured supplies of PPE.

We have also been advised that non-designated UDCs may also be set up ahead of 1 July, which includes UDCs in private practices. Private practices will need to liaise with Healthcare Inspectorate Wales (HIW) about setting up UDCs. The latest published advice from HIW is about AGPs for all practices after 1 July.

It is worth noting that the SOP includes guidance on the fallow period in between treatment of patients. This may be shortened where there is specific evidence that air handling systems can decrease the time needed to sufficiently change the air. Negative pressure rooms can reduce the fallow period to 20 minutes. The advice otherwise is a standard hour.

UDCs in the CDS will continue operating past 1 July to provide urgent care for COVID-19-positive patients until further notice. However, a spokesperson for Public Health Wales has today said that the infection rate in Wales has fallen to low levels, we hope that this means the CDS can plan getting back to treating their own patients in the not-too distant future.

12:45

Our concerns over lack of clinical training in dentistry

We have written to the Chair of the Committee of Postgraduate Deans and Directors (COPDEND) to express our concerns around the lack of clinical training in undergraduate and postgraduate dental education as a result the COVID-19 pandemic.

The letter highlights the issues faced by dental students, new graduates, current FDs and dentists in core and specialty training, as well as those undertaking PLVE.

It also raises the issues of mental well-being across the board and the need to support those providing and receiving training in any capacity. Considerations for clinical training, flexibility of assessment, career pathways, workforce planning and regulatory issues are described. The letter is co-signed by several BDA committee chairs.

We hope to meet with COPDEND to discuss the issues mentioned and work with them to provide necessary support and help with finding solutions for dentists worried about their career progression as a result of the pandemic.

12:20

Making your voice heard: In the news

We're speaking to national and local media daily to represent you and your interests. Here's some of the coverage we've received in the past two days:

The Telegraph provided a comprehensive overview of the impact of lockdown on dentistry on Tuesday. The article includes input from our vice chair, Eddie Crouch, and our estimates that the official backlog is likely to exceed one million by autumn, with strict coronavirus infection control rules reducing the flow of patients to a trickle.
The Times also covered dentists’ warnings of a drastically reduced service. The article features comments from BDA chair Mick Armstrong which highlight worsening access problems around the country.
Yesterday, BBC News Northern Ireland reported on the BDA’s letter to the Minister for the economy, highlighting that dentists who focus on private work in Northern Ireland are at the point of collapse because of a lack of financial support from the Executive.
The Daily Telegraph meanwhile reported on the rising cost of PPE and the impact this has on the dentistry. The BDA’s chair Mick Armstrong is quoted as saying: “Dentists may have reopened their doors but the threat of financial collapse still looms large.”

09:45

England: Pushing for action on NHS payments to associates

One of the conditions applied for contract holders to continue receiving NHS income during the lockdown period was that they pass on earnings to associates, at previous levels. We know most practice owners have paid associates as intended, but there are exceptions. That’s why we set up our contract resolution service. We have been able to address some of the issues brought to us by associates, but a number of cases remain unresolved and we’ve reached an impasse. Back in early May we therefore discussed with NHS England the option for a legislative solution to make sure that associates received the right amount of money. NHS England said that they would work with the Department of Health and Social Care to introduce a change. Despite us raising this repeatedly over the past weeks, we are still waiting for that to happen. We will continue to pursue it until we have an answer.

Practices are now able to reopen for face-to-face care in England. Whilst discussions are ongoing on future NHS contractual provisions, practice owners continue to receive 1/12th of their contractual payments each month. These circumstances raise fresh questions about the conditions attached to ongoing NHS payments to associates, for example in difficult circumstances where they may be unable to return to work. We have asked a fresh series of questions of NHS England and have stressed the urgency in addressing these. We will update you when we know more.

Wednesday 10 June

15:18

Northern Ireland: Campaigning for private practices

We had a lengthy meeting with Acting Chief Dental Officer, Michael Donaldson, yesterday on the position of private practices in Northern Ireland.

We asked him to ensure the dire financial situation facing many mixed/more private-oriented practices are relayed upwards, as both the Health and Economy Minister respond to the issues raised in our two letters of the past week.

We are seeking to set out for practitioners the range of factors/sources of guidance that they will need to consider before arriving at their own decisions on what private dentistry they may offer. We will keep you updated.

14:02

England: Updated guidance on PPE and self-isolation

Updated guidance from NHS England states that from next Monday, June 15, dental practices are required to ensure that staff wear a surgical mask when not in PPE to reduce transmission risks.

It also states that if a staff member has been in contact with someone confirmed as a COVID-19 case, whether a co-worker or a patient, and contact with this person occurred while not wearing PPE, they should self-isolate for 14 days following Test and Trace requirements. Practices are also advised to make business continuity arrangements for staff absence due to self-isolation.

12:05

England: HMRC clarifies position on payments to associates

Given that associates in England are potentially in receipt of NHS earnings as well as separately being eligible for the Government’s Self Employed Income Support Scheme (SEISS), we have been in contact with HMRC to clarify eligibility.

HMRC have now confirmed, if associates fulfil the criteria for the SEISS scheme and they have seen a drop in their overall income (for example due to a reduction in private earnings), they can make a claim for a SEISS grant while continuing to receive NHS payments.

We have also discussed the matter with NHS England. Their expectation is that NHS contract holders should be paying associates in line with previous earnings, consistent with their existing advice.

Please note, if associates are eligible and want to claim the first grant under the SEISS, the claim must be made on or before 13 July 2020. The scheme is being extended and associates may be able to make a claim for a second and final grant in August 2020.

Access to SEISS is limited to self-employed associates earnings less than £50,000. We continue to lobby for the removal of this unfair and arbitrary limit on your behalf.

See our financial impact page for more information.

10:40

Maternity/paternity leave and furlough scheme

It was announced yesterday that people on maternity and paternity leave who return to work in the coming months will be eligible for the government’s furlough scheme.

The scheme closes to new entrants on 30 June, meaning that today is the last day on which staff can be furloughed for the first time. However, the Chancellor made clear yesterday that parents on statutory maternity and paternity leave who return to work in the coming months will be eligible for furlough scheme even after today’s cut-off.

09:00

Wales: Our concern over Health Secretary's comments

We have written to Health Minister Vaughan Gething to express our deep concerns over his statement to the Senedd Plenary session on 3 June.

In the session, North Wales MS, Mark Isherwood, asked about the opening up of dental services across Wales. Mr Gething replied: "I would not want to try to place the opportunity to make money ahead of seeing a range of dental professionals losing their lives if we're taking a cavalier approach".

We are deeply concerned over this statement and the potential implications, as well as the wider negative impact that could result from it. Having been assured of the Minister's support for dentistry in the past, we have requested a meeting to ensure he is better informed regarding the concerns of the profession and the pressing need to restore general dental services in Wales.

We will keep you updated on our progress.

Tuesday 9 June

17:40

Northern Ireland: Framework for rebuilding of health services published

Health and Social Care Minister, Robin Swann, today published a framework for the rebuilding of health and social care services in Northern Ireland. It sees the Minster promises to work with us on recovery:

"The Department and the HSCB will work with the British Dental Association... to rebuild the services provided by General Dental Practitioners... guided by the available medical and scientific guidance."

We will provide feedback on the framework in the coming days and contribute fully to the 12 week consultation process. Our priority is to ensure that dentistry has a voice where decisions are made on recovery, and that the concerns of each field of practice are represented.

15:45

Support for frontline staff

Help for Heroes have made resources on mental health available to NHS staff and other healthcare workers tackling the coronavirus pandemic.

Their Field Guide to Self-Care: Body, Emotion and Mind in Action was originally designed for and with combat veterans, but may be a useful resource for anyone who is feeling stressed or anxious during these difficult times.

The armed forces charity have made this resource open to all, highlighting the similarities in the circumstances faced by the military and frontline NHS staff at this time: challenging environments; working outside of normal areas of work; working with protective equipment and putting themselves at risk.

15:25

Your questions answered

Our team are working to get you the most up-to-date information on a range of complex topics. Take a look at our answers to some of your most frequently asked questions:

On returning to work:

How can I prepare for re-opening?
What about practices in Wales, Scotland and Northern Ireland?
What PPE is essential for re-opening?
How can I obtain PPE and book fit-testing?

On staff management and support:

How can I prepare staff for re-opening?
How can I support BAME staff?
What if my staff do not want to return to work?

On practice management and COVID-19:

When does the furloughed workers scheme close?
How can I change the terms of employment contracts?
How can I negotiate changes to associate contracts?
Will there be clawback due to the shutdown?

13:15

Have you got the updated edition of our toolkit?

Launched last Friday, the updated edition of our toolkit for returning to face-to-face care aims to provide members with the best possible information and the practical advice you need.

New content includes:

Respiratory protective equipment, RPE (p30)
Types of respirator; What is adequate and suitable?; The limitations of RPE; What to look for in fit-testers; Selecting the right mask; FFP2 or FFP3?
PPE fit-testing (p32)
Dental aerosol contamination reach (p36)

Updated content includes:

Closing dates for the furloughed workers scheme (p20)
Cleaning down of surfaces and floors (p28)
Associate relationships (p21-22)

While primarily meant to support dentists in England as they prepare to re-open from 8 June, it also contains advice and support that’s applicable across the UK.

12:30

Government furlough scheme to close to new entrants

The Government’s furloughed workers scheme will close to new entrants from 30 June. From this point onwards, practices will only be able to furlough employees that they have furloughed for a full 3-week period prior to 30 June.

Tomorrow is the final date by which practices can furlough their staff for the first time, so that the current 3-week furlough period to be completed by 30 June. Employers will have until 31 July to make any claims in respect of the period to 30 June.

We know that mixed practices are having difficulty calculating how much they are entitled to claim, so we have created a furlough calculator for mixed practices to help you. And to make it even simpler, we've also put together a demo video on how to use this tool.

We answer more of your frequently asked questions on COVID-19 here.

Monday 8 June 2020

Scotland: Dental services to resume later this month

The Chief Dental Officer Scotland has written to dentists with an outline of when dental practices can reopen in Scotland.

A date for reopening will be announced after the Scottish Government's next review of overall lockdown regulations on 18 June. This will not be a target date – the CDO recognises that not all practices will be able to open right away.

However, later this month practices will be able to see NHS patients requiring urgent care for face-to-face consultation. This will not involve AGPs – any such cases should continue to be referred to the Urgent Dental Care Centres.

The current funding package will remain in place for the phased return to practice, and these payments are not dependent on when practices reopen. The Scottish Government is developing an interim Statement of Dental Remuneration to record activity only; there will be no patient charges.

In the meantime, practices should be using the SDCEP return to practice guidance to prepare for reopening. They should also be working with their NHS Boards to ensure they are fully compliant with the guidance before reopening, and to ensure they have adequate supplies of appropriate PPE. NHS National Services Scotland (NSS) is working with NHS Boards across Scotland to deliver PPE for onward distribution to all dental practices. Last week, NSS distributed more than 3 million individual items of PPE to dental practices.

Northern Ireland: Financial plight of private/mixed practices highlighted to Executive

We are concerned that private-oriented practices in Northern Ireland are being asked to abide by new restrictive operating procedures without receiving the necessary financial support to allow the practice to survive until the restrictions are lifted.

That's why, the Chair of the Northern Ireland Dental Practice Committee has written to the Minister for the Economy, Minister of Health, Minister of Finance and the First and deputy First Ministers to highlight the grave financial situation faced by private-oriented dental practices in Northern Ireland.

This follows the Acting Chief Dental Officer's 5 June email where he stated that: "I am asking for a single approach to the recovery of dental services. I believe that the reasons for the restrictions placed on the provision of dental care apply equally whether the service is Health Service or private."