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Coronavirus: your FAQs

We answer your frequently asked questions on COVID-19 and your dental practice.

Page last updated: 25 September 2020.

 

Here are the answers to your FAQs, which we update as often as possible.


 

Coronavirus and the dental profession

1. What is the BDA doing to address my concerns?

We are lobbying the Government to ensure that your needs are represented at this difficult time. We are working to get you answers as fast as possible and keep you up-to-date with this ever-changing situation.

 

We've produced a series of helpful tools to help members through some of the more complex areas of the current crisis. We hope you'll find them useful. You will need to be logged in to access them.

 

Toolkit for returning to face-to-face care
Download our returning to face-to-face care toolkit to support dentists to reopen as safely and efficiently as possible. We have versions for dentists in England, Wales and Scotland.

 

Abatement and associates’ pay
Our essential advice for members in England tells you what you need to know about abatement. We’ve put together a guide for members on associate payments during the pandemic in England  . We’re also supporting associates to resolve pay disputes, to see if we can help you please start by logging your pay dispute with us.

 

Webinars
Members can watch our webinars on various topics, including: PPE, fit testing, furlough and financing, business interruption insurance, and stress and COVID-19.

 

Remote consultation guide
We've put together guidance on how to conduct a remote consultation with your patients  and avoid some of the common pitfalls.

 

Risk assessment
We created a risk assessment to support members in providing urgent care  . We've also updated it with guidance on record-keeping for NHS practices and triaging.

 

2. What is the BDA doing for private practices?

Protecting you, your patients and your practice's financial viability is our driving focus in these difficult times. We know that the crisis has brought many private practices near a financial cliff edge. The staggered re-opening of practices across the UK does not undo the financial impact the crisis has had on many businesses and so we’ll continue to campaign at a national and regional level to make sure your voice is heard.

 

3. What is the latest guidance on COVID-19?

England 

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway.


The Office of the Chief Dental Officer England has published Standard Operating Procedures   to cover a phased transition for dental practices towards the resumption of a full range of dental provision.

 

We encourage you to review our toolkit for returning to face-to-face care to support you and your team to resume practising as safely and efficiently as possible. This will give members the best possible advice on every stage of reopening, so you can reopen with confidence.

 

Wales

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway.


The most recent Standard Operating Procedure (SOP) published by the Chief Dental Officer Wales covers aerosol procedures, as dentists are now allowed to offer more treatments in practice and the criteria for urgent care has been relaxed.

 

It is to be used alongside the Welsh Government’s guidance to help dental teams complete Assessment of Clinical Oral Risks and Needs (ACORN) forms for patients, both routine and urgent. See our Coronavirus and NHS dentistry in Wales section below for more detail.

 

Northern Ireland

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway.


A phased return for dental services in Northern Ireland is underway. The Acting CDO, Michael Donaldson, has issued a letter to all General Dental Practitioners on the re-establishment of dental services in Northern Ireland. The letter outlines three phases of re-establishment and indicates that guidance for practitioners on re-establishment will be issued in the coming days.

 

Phase two, the provision of non-urgent care, resumed on 29 June. Phase three, which includes aerosol-generating procedures, began on 20 July. However if your practice can demonstrate that key conditions around infection and prevention control are met, you can move to phase 3 already.

 

Scotland

The latest UK-wide guidance  applying to all healthcare settings, which supersedes the previous COVID -19 Infection Prevention and Control Guidance, places primary care dentistry in the medium-risk pathway, and where AGPs are delivered in the high-risk pathway.

 

Phase 3 of reopening began on July 13. Dentists are now able to see patients for routine care but any treatments requiring an aerosol-generating procedure (AGP) will still be referred to the urgent dental centres (UDCs).

 

A letter from the Chief Dental Officer and the memorandum to dentists was issued by the Scottish Government with further details about the return to dentistry.

 

We have also adapted our toolkit for returning to work for members in Scotland. It is designed to complement the SDCEP guidance, download it for practical advice on various issues, including indemnity, employment relations, and staff terms and conditions.

 

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has published a practice recovery toolkit  which all practices in Scotland should use as the basis for re-opening during phase two of remobilisation. 

 

Coronavirus and reopening your practice

4. How can I prepare for reopening?

England
NHS England's fifth letter of preparedness indicated that, all NHS practices are now expected to be providing face-to-face interventions and delivering as comprehensive a service as possible (whilst recognising that capacity may still be constrained).


The Transition to Recovery Standard Operating Procedure on 4 June referred to the pace of progression towards the resumption of the full range of routine dental care. It included aerosol generating procedures (AGPs) needing to be risk-managed by individual practices, subject to following the necessary infection prevention and control and PPE requirements.


NHS England proposed that the return of care should be staged with an initial focus on urgent and emergency care, patients whose care was interrupted and those who need more frequent recalls.
However, many practices are still struggling with capacity, and this presents a problem for patients being able to access care. Feedback from practice owners tells us that most are still operating at less than a quarter of pre-COVID activity levels.


Guidance from NHS England also states that dental practices are required to ensure that staff wear a surgical mask when not in PPE to reduce transmission risks. 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.


Members can download our toolkit for returning to face-to-face care. This toolkit aims to help teams implement the changes needed to gear up to providing appropriate treatments at appropriate times.

 

Wales
Since 1 July dentists have been allowed to offer more treatments in practice and the criteria for urgent care have been relaxed. Practices can now be at heightened amber status and only offering non-AGPs, or in low amber status and offering AGPs as well, as long as they are set up and signed off by the relevant authority.

To support you in this, we have adapted our toolkit for members in Wales. It is to be used alongside the Welsh Government’s guidance to help dental teams complete Assessment of Clinical Oral Risks and Needs (ACORN) forms for patients, both routine and urgent. Health Improvement Wales have issued a series of FAQs to help you with completing the ACORN.


For more information on changes to NHS dentistry in Wales please see section below.
 
Northern Ireland
Phase three of the timetable for dental recovery in Northern Ireland, which includes aerosol-generating procedures, began on 20 July.


However, while aerosol generating procedures (AGPs) were permitted to resume, the failure of Department of Health to supply Level II PPE, while continuing to apply an abatement of 20%, means that dentists here are incurring considerable additional costs. We’ve made progress on funding for NHS practices.


But we have made it absolutely clear that urgent action must be taken to safeguard dentistry and dental practices in Northern Ireland – private and public, and are pushing for a joint meeting between the Finance and Health Ministers and the BDA.
 
Scotland
Dentists in Scotland were allowed to return to routine non-aerosol generating procedures from 22 June. In light of this news, we published our new Toolkit for Scotland to help high street practices prepare for reopening.


The Scottish Government has advised that dentists in mixed NHS-private practices should follow the advice from the CDO about returning to work as well as the guidance published by SDCEP.


The Scottish Government acknowledges that some dentists in mixed practices wish to carry out AGPs on private patients, providing they have appropriate PPE and follow the relevant procedures. The Government recognises that dentists’ formal contractual arrangements are with their local NHS Boards, therefore they should discuss with their Boards what private care they can provide, and what preparations and risk management are required.


Previously, the National Clinical Director and CDO issued a joint letter to private practices and Healthcare Improvement Scotland (which is responsible for inspecting private practices) has issued guidance on reopening. The guidance stresses the importance of patient and staff safety, and of not contributing to an increase in the R number.


The Scottish Dental Clinical Effectiveness Programme (SDCEP) has published a practice recovery toolkit  which all practices in Scotland should use as the basis for re-opening during phase two of remobilisation.

 

5. What PPE is essential for reopening?

Dental practices must have the correct PPE available to provide face-to-face care while community transmission of COVID-19 continues. This includes: masks, fluid repellent gowns, show covers, eye protection and gloves.

 

Facemasks make up one component of PPE. They are used most effectively in conjunction with eyewear, gloves, face shield and protective outerwear. For non-aerosol generating procedures (non-AGPs) fluid-resistant surgical masks (FRSM) Type II are advised and used with the wider PPE measures detailed below.

 

For AGPs the FFP2 respirator’s greater comfort makes it the mask of choice while providing sufficient protection for aerosols created in the dental environment. FFP3 (filtering face piece level 3) masks meanwhile provide greater filtration and potentially provide some marginal protection compared to an FFP2 mask.

 

Where, for cultural, religious or health reasons facial hair is present which will affect the seal of FFP2/3 masks, practices should consider as an alternative, the use of an FFP2 mask with a Type II fluid resistant surgical mask over the borders, in conjunction with a face shield/visor. A through risk assessment needs to be implemented at a local level if this suggestion is adopted. Another alternative is the use of a powered air purifying respirator (PAPR) hood. This does not require any fit-testing but wearers may have difficulty using loupes and other aids.

 

However, there’s more to PPE than masks. For more information on PPE and returning to face-to-face practice see our toolkit.

 

6. How can I obtain PPE and book fit-testing?

Some dentists are having difficulty securing a reliable and affordable supply of PPE. We’re also concerned by reports that dentists are having difficulties securing an appointment for fit-testing.

 

The Office of the Chief Dental Officer England has said that PPE for dentists is available from dental wholesalers for practices to purchase. This should include equipment necessary for aerosol generating procedures (AGPs) including gowns or coveralls, and FFP2 respirator masks.

 

NHS practices in England are being invited to register with the PPE Portal. It is set up to supply PPE, free of charge, to health and social care providers. The intention is that practices use their usual suppliers for routine orders, but to give them access to these supplies in emergency situations. If you have any questions, please contact the PPE Portal Customer Service team on 0800 876 6802.

 

The HSE website has advice and training materials  on fit-testing respirator masks. Fit-testing  is required for FFP2/3 masks to determine if a particular size or model provides an acceptable fit for each team member who will be wearing them. It needs to be conducted by a trained fit tester to verify that the respirator device performs as intended.

 

See this nationwide directory of fit-testers  and list of approved training providers .

 

7. What if my staff do not want to return to work?

We recommend that you communicate with staff in an open and cooperative manner at this difficult time.

Health and Safety at Work legislation says to take reasonably practicable measures to ensure staff safety. To that end, we recommend you have clear rules on how dental practices should operate in place. Members can download our toolkit on returning to face-to-face care for support and advice.

 

If you have taken these steps and clearly communicated them to your staff, but they refuse to return to work, then you may be able to consider disciplinary action. We advise members to take advice before taking any disciplinary action as employees may have legal protection.

 

If employed NHS staff do not wish to return to work, see question 21 below for more information.

 

8. Should I screen staff for COVID-19?

We recommend you consider implementing a daily health screening check point and log for all employees entering the workplace. Our daily screening log  can be used to document this. Dental staff should pay special attention to their own symptoms and stay home or be sent home immediately with symptoms of COVID-19 (fever, cough, sore throat, headache and muscle soreness, which may be accompanied by nasal symptoms).

 

This is one of the many steps we recommend practices take to ensure they are operating as safety as possible for staff and patients. Members should see our toolkit on returning to face-to-face care for a comprehensive overview of the practical steps we recommend.

 

 

 

Coronavirus and the dental team

9. How can I prepare staff for reopening?

In order to reopen as safely and efficiently as possible, staff should be given time to:

 

  • Get used to the idea they will be returning to work
  • Understand the risks relating to COVID-19 and what the practice is doing to control those risk
  • Undertake any online training the practice may want staff to complete to get ready for new policies and procedures in place at the practice
  • Attend the practice for fit-testing of masks (where required non-clinical staff do not need fit-tested masks)
  • Ensure they have arrangements in place to look after any dependants at home
  • Seek further medical advice as to whether they can return to work (if, for example, they have a particular medical condition).

For further advice on how best to deal with staff concerns and manage staffing issues, members should see our toolkit for returning to face-to-face care.

 

10. What about staff returning from abroad?

The government has said that no travel is “risk-free” during the pandemic and that people returning from some countries should self-isolate for two weeks.

 

People arriving from exempt countries do not need to self-isolate. There is a list of exempt countries on the gov.uk website . Please note, this list changes regularly.

 

Our advice is to check whether you are returning from one of the countries which are exempt from the quarantine guidelines . If you are in Scotland, please refer to the specific advice from the Scottish Government  (Northern Ireland and Wales currently follow the same guidelines as England). If the country is not on the exempt list, you will need to self-isolate for 14 days.

 

Please note, SSP is not payable for staff self-isolating after returning from holiday.

 

Subject to being eligible under the job retention scheme, practices may be able to furlough staff who are self-isolating after returning to the UK. If it is possible under the rules of the scheme, both employer and employee would need to agree.

 

If the furloughed workers scheme cannot be used, then staff who have to isolate should either be on paid holiday (if the member of staff has paid holiday to take) or unpaid leave. Whether it is paid or unpaid leave should be subject to agreement between the parties.

 

11. Who should self-isolate and what should they do?

Dentists and their teams will be providing emergency care should follow government guidance on whether it's safe for them to do so .

 

We believe members of the dental team over 70 years of age should stay at home.

 

Members of the dental team under the age of 70, but with an underlying health condition (such as asthma, diabetes, heart disease), are at increased risk. Guidance says people in this category can go to work, but they should stay at home as much as possible. People in this category should not be forced to return to work in a dental practice. The risks should be assessed in each case. The risks can be reduced if there is space in the practice to maintain social distancing and/or if people with increased risk can avoid taking part in AGPs.

 

Advice has been published for pregnant women who are working in the NHS  and other work settings. Women who are less than 28 weeks pregnant should practise social distancing but can continue working in a patient-facing role, provided the necessary precautions are taken. Women who are more than 28 weeks pregnant, or have underlying health conditions, should avoid direct patient contact. It has also recommended that pregnant women, regardless of gestation, should be offered the choice  of whether to work in patient-facing roles during the pandemic.

 

Staff should also stay at home if they, or a member of their family, have coronavirus symptoms (the latter group should self-isolate for 14 days following the family member's diagnosis). Others will also have been advised to self-isolate. Staff staying at home for these reasons should be treated as if they are on sick leave.

 

The UK Government has said that statutory sick pay (SSP) should be payable from the first day of the sickness period. Employers with fewer than 250 employees will be eligible to reclaim two weeks' SSP for each employee who has been affected by COVID-19. This has not yet been formalised in emergency legislation, but it may include a clause allowing it to be backdated. Ensure you keep records of any absence due to COVID-19 to be able to claim this back from the government.

 

We recommend that you communicate with staff in an open and cooperative manner at this difficult time. Members can download our toolkit on returning to face-to-face care for support and advice.

 

12. What if I'm pregnant?

The Royal College of Obstetricians and Gynaecologists has recently archived its advice for employers and pregnant women on the risks of COVID-19 as it feels “a single recommendation is no longer appropriate.” We are currently reviewing the evidence available, as we look to provide the best possible advice to our members on this important issue.

 

13. How can I support BAME staff?

Emerging evidence shows that black, Asian and minority ethnic (BME) communities may be disproportionately affected by COVID-19. Organisations should ensure that line managers are supported to have sensitive and comprehensive conversations with their BME staff. They should identify any underlying health conditions that may increase the risks for them in undertaking their roles. These conversations should also, on an ongoing basis, consider the feelings of BME colleagues, particularly regarding their physical safety and mental health.

 

It is also important to note in this context, that PPE fit-testing requires men to shave their beards. Men who do not wish to shave their facial hair for religious reasons are currently being advised to wear a PPE hood instead and tuck it into their gown.

 

14. What if a staff member has COVID-19?

If a member of staff has coronavirus, they should follow government advice. Staff who have COVID-19 symptoms or a positive test result should self-isolate for 10 days, or for 14 days if they are admitted to hospital.
 
Standard sickness procedures should also be followed. Staff should contact the practice and update them on when they will be able to return. They will either be entitled to sick pay or, depending on the terms of their contract of employment, statutory sick pay. Check your contracts of employment and the practice's policy on sick pay.

 

Please note, the Coronavirus Job Retention Scheme is not intended for short-term absences from work due to sickness.

 

15. What if a patient has coronavirus?

A recent update to COVID-19 guidance on the management of health and social care settings and the Test and Trace programme, has clarified the position of dentists with regards patients who are later found to have COVID-19.

 

We now know that if dentists are providing direct care to a patient with COVID-19 and are wearing the correct PPE in accordance with the current IPC guidance, they are not considered a contact for the purposes of contact tracing and isolation, and are not required to self-isolate for 14 days.

 

16. What do I need to know about redeployment?

Many dentists and dental staff are volunteering for redeployment. Many others are working in urgent care settings, or providing remote advice. Some dentists are taking the opportunity to work in different arenas and learn new skills.

 

We recommend that you read our financial impact page for more information and use our Redeployed Duties and Training Log  on a daily basis to keep track of your work, as you may need these records later. We also urge members to contact BDA Health Assured if you find your mental wellbeing is under stress during this challenging time.

 

As practices reopen, they will want associates and other members of the team to return to work. Those who are volunteering should therefore make arrangements to return to work at their practice. We recommend you discuss the situation with your practice and reach an agreement. Though it should be noted that we are still waiting to find out the contract terms on which the NHS will pay dental practices to reopen and start providing NHS dentistry.

 

 

Coronavirus and practice management

17. NHS England contracts and abatement: what do I need to know?

We’ve put together a guide for members on associate payments during the pandemic in England  . Our video of essential advice on abatement also tells you what you need to know about abatement in England.

 

Abatement is an agreed reduction in the NHS contract payment for any variable costs associated with service delivery. The contract value paid to an NHS practice is intended to cover all the costs relating to the delivery of that contract. For example, if you have not been practising for three months then your laboratory bills, consumables and corresponding costs would have reduced in that time. This reduction in your expenses for the period in which you were not providing face to face care must be reflected.
 
The NHS has said it will honour contract payments, but it is reducing that overall figure to take off the costs not spent (abatement). Practices need to know this abatement figure in order to understand their NHS income. The abatement is applied to the whole contract not at the individual performer/associate level.

Abatement to be applied to most contracts from 1st April up until 8 June will be 16.75%. This figure is based on an approximate assessment of variable costs that will not have been incurred when practices were closed to face-to-face care (such as laboratory costs and materials).

 

For practices that have operated as urgent care centres during that period, there will be no abatement for the time they have been providing urgent care. That different approach recognises the extra costs for UDCs, on set-up, protective equipment and potentially staffing.
 
For the period from 8 June onwards, when practices have begun to provide face-to-face care again, 100% of contract value will be paid, with no abatement. This recognises the additional costs of providing care during the current period, again for example in terms of PPE. Practices are expected now to be making all possible efforts to be delivering as comprehensive a service as possible to patients.
 
Practices will not be measured on the delivery of Units of Dental Activity during this period. However specific assurances will be requested that individual practices are open for face-to-face care, 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 over NHS activity.
 
Practices will need to deliver at least 20% of usual volumes of patient care activity to receive their full contract value. Importantly, we have agreed with NHS England that the definition of patient care activity includes all clinical contact that dentists or dental care professionals have with patients either face to face, by telephone or video consultation counted by the BSA via completed courses of treatment or via the COVID-19 triage portal.
 
The period to be assessed will be all clinical contact that dentists or dental care professionals have with patients either face to face, by telephone or video consultation from 20 July to 16 September 2020. This will be compared to the number of courses of treatment only, provided by the contractor in the equivalent period in 2019. Remote advice and care is included in the calculation for 2020 but not for the equivalent period in 2019. If practices are unable to meet the 20% threshold, then they will be required to revert to payment based on UDAs.
 
This above arrangement is temporary and we are working with NHS England to establish a revised mechanism for the later part of this financial year as activity gradually increases.
 
Since 25 March, there have been conditions attached to practices continuing to be paid. Included in those has been a requirement on practices to ensure that all staff, including associates, non-clinical and others, continue to be paid at previous levels. All practices will be asked to provide assurance over their continued engagement of staff, and to give an explicit declaration that they have not gained any windfall profits.

 

A recent letter of clarification from NHS England reiterates practices' obligations around passing on payments to staff, including associates. It recommends the use of Net Pensionable Earnings as the best way to do this, which has been our stated position for some time. However, it also recognises that other methods of payment can be appropriate where agreed.

 

This abatement is not routine and will only apply in this pandemic when face to face activity within a practice has to cease. In a non-pandemic situation if a practice has to close because of fire or flood then force majeure provisions apply and UDAs may be carried forward. This would not have been helpful in a pandemic situation where during the abatement period there are no UDA targets.

 

The issue of abatement affects general dental practitioners providing NHS services. It does not affect Community or Hospital dentists.

 

18. When does the furloughed workers scheme close?

The Coronavirus Job Retention Scheme will close on 31 October 2020. In the meantime, it is no longer open to new applications, but practices who had previously claimed under it, can continue to do so until October.
 
From 1 July, employers could bring furloughed employees back to work for any amount of time and any shift pattern, while still being able to claim this grant for the hours not worked.

 

From 1 August 2020, the level of grant is being reduced each month. To be eligible for the grant employers must pay furloughed employees 80% of their wages, up to a cap of £2,500 per month for the time they are being furloughed. See the government’s outline of the changes made to the scheme.

 

 

19. How can I change the terms of employment contracts?

Practices may wish to alter the terms of employment for their employees. This might include: changing the hours that staff work, including breaks, changes to terms about clothing and uniform, and changes to pay or other benefits. There are two ways in which practices can change the terms in an employment contract, either in agreement with the member of staff or through dismissal and rehire. Advice should be sought on both options, members can find out more about the options available to them in our toolkit for returning to face-to-face care.

 

20. How can I negotiate changes to associate contracts?

Changes are best made by agreement with the associate concerned and, once agreed, can take effect quickly and easily. The benefits of such changes should be clearly communicated. Associates are more likely to agree to temporary changes that will be reviewed after a period of a few months. We believe it is in both parties’ interests to negotiate sensible changes.

 

We have produced side letters for associateships in England and Wales that help both parties to work within the current situation.

 

We ask practice owners to make temporary, rather than permanent changes, at least until the situation becomes clearer. We also ask practice owners to not try and force changes that are too onerous or disadvantageous to associates. Before you take action on contract changes, members should seek advice from our practice support team. There is more information on the options available in our toolkit for returning to face-to-face care.

 

21. What are you doing about business interruption cover?

We have taken legal advice in respect to insurers not paying insurance claims made by dentists in regard to business interruption during the COVID-19 pandemic.

 

We have instructed law firm Brown Rudnick LLP to examine insurance policies affecting dental practices. It is now working with our members to gather relevant evidence on the full range of polices in the sector. This legal advice will shape the guidance that we will be offering a profession that has been blindsided by a lack of effective insurance during a period that has seen routine care suspended and cash-flow for many practices fall to zero. Members can watch a recording of our webinar with law firm Brown Rudnick LLP on the legal issues relating to business interruption policies and the pandemic  .

 

The Financial Conduct Authority (FCA) has begun its own legal process to weigh up policies covering almost every business sector in Britain. We were the first trade union or professional body to directly engage with the FCA following the failure of most polices to pay out for losses incurred during the pandemic. We welcomed the news, but we have expressed concern that the FCA's ‘one size fits all’ approach will fail to address the specific needs of our members. We are pushing for clarity on whether challenges affecting dentists will be taken into account by the court.

 

The High Court hearing on business interruption insurance concluded on 30 July, but a judgment is not expected until later in the year due to the huge amount of material under review, the possible impact of the decision and complexity of the arguments.

 

Much of the legal argument has centred on causation and the requirement for the loss suffered by the insured to have been caused by the "insured event" (for example the occurrence of a notifiable disease within a 25 mile radius of a premises).

 

The insurers said that, regardless of the events insured against, no policy was ever designed to provide cover for a national pandemic, and as a result of the national lockdown, businesses would have suffered losses anyway. However, the FCA argued that the national lockdown only occurred because of each and every individual case of COVID-19, which can each properly be described as a cause of the insured's losses.

 

We know that this is an important issue for many dentists and we will update you when we know more.

 

22. Dentists can't access business rate exemptions, what are you doing about this?

New measures were introduced in the 2020 Budget to give business rate exemptions to retail businesses. Dental practices were not included in this. We believe that in the context of the business disruption caused by the COVID-19 outbreak, it is essential that this exemption be widened to include dental practices. We've made representations to the Government to that effect and we will update you on any progress made.

 

23. Can I avail of multiple forms of government assistance?

Yes. We have lobbied all four governments for a clear answer on this and at present we know:

 

England: The Treasury and NHS England have confirmed that mixed practices can make full use of the furlough scheme in proportion to their private activity, without endangering their NHS funding. This will be a relief to many mixed practices, and comes after consistent campaigning on your behalf.

 

Northern Ireland: A full list of the business support measures  that have been put in place in response to COVID-19, and the Department of Health have stated that they expect dental practices in NI will be eligible for support from both UK-wide and NI Executive sources.

 

Wales: The CDO has acknowledged the need for financial assistance for the private portion of mixed practices' incomes. The Welsh Government has now introduced two grants to support businesses in Wales   through the Coronavirus pandemic. Grant Number 2 is relevant to eligible dental practices should their rateable value be £12,000 or less.

 

Scotland: On 9 April, the Scottish Government clarified that mixed dental practices that receive NHS support funding, can also apply for support from other government sources to cover the private element of their income. These latter claims should be proportionate to the amount of private dentistry delivered.

 

Members with mixed practices, we've put together a tool to help you calculate how much you are entitled to claim  as part of the furlough scheme. Watch this demo video to help you use our furlough calculator. We also recommend that members watch our advice webinar on financing and furlough  .

NI-guidance-on-the-management-of-RCP-Outcome-6C.pdf 

 

Coronavirus and NHS dentistry in Wales

24. What's changing for NHS dentists in Wales?

From 1 July 2020, practices will receive 90% of their contract value. This will then move up to 100%, potentially from September. In return for this 90% of contract value, practices will work within the scope of the de-escalation plans, at present in the amber phase, and work through the back-log of patients as best as possible on a prioritisation of needs basis.

 

Practices can be in heightened amber and only offering non-AGPs, or be in low amber and be offering AGPs as well, as long as they are set up and signed off by the relevant authority.

 

Key to this offer of 90% is the move away from the UDA system, and its replacement with the UDAS, (units of dental assessment). This is a move from payment based on activity, toward payment based on patient need and number. This new model may stay after March 2021, and we all can shape it.

 

There is no patient number target up to March 2021 because of the challenges with social distancing and thus throughput. We have stood very firm on this in discussions with the Welsh Government.

 

We support the protection of the contract value and the move away from the activity treadmill and we welcome confirmation that there will be no patient number target up until March 2021. However, we appreciate that many questions remain and can only be answered with time. We are working to keep you as up to date as possible.

 

On patient charges, please note that if a patient attends the practice for treatment, an FP17W needs to be completed and submitted in the usual way, and a charge should be paid if applicable. Exceptions are to be made for patients attending a UDC or receiving telephone triage, charges are not applicable in these cases.

 

25. What do I need to know about ACORN?

The Assessment of Clinical Oral Risks and Needs (ACORN) is a risk assessment form and includes the things we should all be recording in any good examination. These are an important part of the move to the new UDAS system described above.
  

There are two versions, one for routine care and another slimmed-down version for emergency patients. Colleagues have rightly raised concerns about some data being recorded on the urgent form. We don't think that every urgent patient should be offered a routine assessment. The requirement is to complete the necessary data points on the FP17W. This must depend on the practice's capacity and ability to take on 

new patients.

 

We recommend having a good audit trail of ACORN forms. Data points on patient risk and need are essential. Please also be aware, the ACORN forms will change occasionally, so please expect things to alter with time. We have raised this issue with the Welsh Government and asked for clarity for you.

 

26. What if I want to stick with UDAs?

You will know better than anyone else what is best for your individual practice, and you can stay with the UDA model if you wish. In making any choice, we encourage you to consider social distancing, provision of AGPs and patients throughput. UDA numbers will also be ghosted in the background, so practices will be able to see a comparison.

 

Please also note that there could be clawback if you stay with the UDA. Your UDA target would be 75% of the original. This target did not count for April, May and June. So when deciding whether to stay with the UDA model, you should factor in how much activity you can complete going forward, and whether it will allow you to meet your UDA target.

 

If you feel it is best for your practice to stick with the UDA system, letting your Health Board know would be a good place to start.

 


Coronavirus and employed dentists

27. Who should I talk to about redeployment?

Employed dentists are already being asked to undertake duties to help support their medical colleagues in the COVID-19 response. This will likely increase in the coming weeks.

 

  • Community/Public Service dentists
    Community dentists should firstly be allocated by their local NHS to undertake appropriate primary care treatments. After this demand has been met then CDS dentists are welcome to volunteer for wider NHS redeployment.
  • Hospital dentists
    Hospital dentists wishing to undertake other duties should make this known to their lead consultant/clinical director. Lead consultants/clinical directors should then liaise with their hospital medical director to determine the deployment of these dentists. We have communicated this position to the Association of Dental Hospitals and have asked the BMA to cascade this through their LNC network.
  • Academic dentists
    Clinical Academic dentists wishing to undertake other duties should make this known to their Undergraduate Dean. Undergraduate Dental Deans should then liaise with Undergraduate Medical Deans and in turn hospital medical directors to determine the deployment of these dentists in the hospitals connected to the dental school. We have communicated to Dental Schools Council that this is our default position and have asked the BMA to pass this on through their LNC network.

 

28. How should I prepare for redeployment?

If you are asked to undertake other duties during the outbreak, this may include working in another dental discipline that you haven’t undertaken for a while or something completely outside of dentistry. You should take the following steps to make sure you are safe while undertaking other duties:

 

  • Step 1 
  • Agree, with your NHS clinical director/line manager and their equivalent in the area to which you are to be redeployed, a task list or role specification. This task list will state clearly the tasks that you will be expected to do. Ensure the task list is clearly defined and ill-defined statements such as ‘any other duties’ are not included.

     

  • Step 2 
  • If you are happy, in principle, with the task list provided, discuss whatever training is required for you to safely perform the duties. Get a firm commitment to the date of this training and opportunity to shadow a colleague based in the new area.

     

  • Step 3 
  • Check with your indemnity provider that they will cover you for the new duties.

     

  • Step 4 
  • Undergo the training and make notes of what you were taught. Recording on mobile phones may be particularly useful.

     

  • Step 5 
  • Report for your new duties. Establish who will be providing operational supervision.

     

  • Step 6 
  • Complete our Redeployed Duties & Training Log  on a daily basis.

     

  • Step 7 
  • Talk to other colleagues, not necessarily dentists, in the area in which you are working. Discuss any concerns you may have with your operational supervisor. Contact us if you feel under any pressure to act beyond your task list.

     

  • Step 8 
  • Consider contacting BDA Health Assured if you find your mental health and general wellbeing is being challenged.

 

29. Will my indemnity cover me?

If you undertake wider duties to support the NHS, these will be covered by extended NHS indemnity. If you also hold a policy with another provider, you will need to confirm with them if your cover will extend to these additional duties. You may need to undergo training to be covered for any additional duties undertaken.

 

30. Are appraisals being suspended?

Very few dentists will be working their normal contracts and work patterns over the coming weeks and months. To that end, we have asked for appraisals and mandatory training for CDS dentists to be suspended f0r the next six months. Further guidance from the Welsh government regarding annual appraisals on the Dental Appraisal System. We have received confirmation that for CDS dentists in Wales these will be suspended until 1 October 2020.

 

Appraisals for Community Dentists in Northern Ireland have also been suspended until September 2020.

 

The Scottish Government have also confirmed the suspension of appraisals for PDS dentists.

 

Appraisals and mandatory training has been suspended until September 2020 for dentists employed in England under a Salaried Primary Dental Care Service terms and conditions. For hospital dentists in England and Scotland, appraisals have already been postponed. 

 

We are seeking clarity on appraisals for hospital dentists in Wales and Northern Ireland.

 

31. Where can I go for support?

During this time, you may have to make clinical decisions that prioritise scarce resources. For guidance on the ethics of this, please see the FAQ we produced along with the BMA . This won’t answer every question you have, but we hope that it will support and guide you in making the decisions asked of you.

 

If you are looking for advice on a work-related issue:

 

  • Members employed on national terms and conditions within the salaried/community dental service, in dental schools, in the armed forces or a variety of other employed roles with in the NHS, please contact: employmentrelations@bda.org
  • Members working under hospital terms and conditions can contact the BMA for employment relations support: 0300 123 1233 (please quote your BDA membership number).

This may prove quite stressful and members should be aware that they have access to our 24-hour counselling service. We’re here for you and we encourage all those under stress to reach out.

 


Coronavirus and Dental Core Trainees

32. What do I need to know about redeployment?

We advise dental core trainees to review the following documents and to take the following eight steps to prepare for redeployment.

 

FAQs from Health Education England (HEE)


Links to resources for COVID-19 e-learning


Information on rotas management from NHS Employers and the BMA

 

If asked to undertake other duties during the outbreak, this may include working in another dental discipline that you haven’t undertaken for a while or something completely outside of dentistry. You should take the following steps to make sure you are safe while undertaking other duties:

 

  • Step 1 
    Agree, with your NHS clinical director/line manager and their equivalent in the area to which you are to be redeployed, a task list or role specification. This task list will state clearly the tasks that you will be expected to do. Ensure the task list is clearly defined and ill-defined statements such as ‘any other duties’ are not included.

  • Step 2 
    If you are happy, in principle, with the task list provided, discuss whatever training is required for you to safely perform the duties. Get a firm commitment to the date of this training and opportunity to shadow a colleague based in the new area.

  • Step 3
    Check with your indemnity provider that they will cover you for the new duties.

  • Step 4
    Undergo the training and make notes of what you were taught. Recording on mobile phones may be particularly useful.

  • Step 5 
    Report for your new duties. Establish who will be providing operational supervision.

  • Step 6 
    Complete our Redeployed Duties & Training Log  on a daily basis to keep track of your work. This may need these records later.

  • Step 7 
    Talk to other colleagues, not necessarily dentists, in the area in which you are working. Discuss any concerns you may have with your operational supervisor. Contact us if you feel under any pressure to act beyond your task list.

  • Step 8
    Consider contacting BDA Health Assured if you find your mental health and general wellbeing is being challenged.