3. What is the guidance on COVID-19?
Despite the UK-wide shutdown, all practices should seek to maintain a basic service, that is providing telephone advice, triaging and writing prescriptions for analgesia and medication where appropriate. NHS 111 is overloaded and we have a duty to reduce pressure on the system wherever possible.
All dentists in England should review the advice recently published by NHS England. This includes:
- All routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise
- All practices should establish (independently or by collaboration with others) a remote, urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with advice, analgesia and antimicrobial means, where appropriate.
It also contains important information about NHS financial support for practices. We are now pulling together comments on a number of key issues that require further clarity. If you have any questions about the NHS England letter, please use our form.
Primary Care Support England (PCSE) are also working with NHS England to support dentists. PCSE are prioritising the fulfilment and delivery of supplies and ensuring that performers are on the list and able to provide services to the NHS. Should this situation change, PCSE will update you on its website.
The Welsh government has moved to a red alert. This means:
- Further restrictions on GDS routine care with the new measures for patient telephone-triage and remote prescribing
- Practices may remain open for very limited and carefully risk-assessed patient consultation, but all dental care that can be delayed must be put on hold
- Patients needing urgent care involving AGPs must be referred to properly equipped local Urgent Dental Care Centers. Health Boards are working with practices to co-ordinate referrals.
We are pressing for answers to the concerns of dentists in Wales. Business continuity funding remains a high priority and we have raised concerns about ensuring associates and DCPs are not disadvantaged by dint of being self-employed. We will keep you updated.
The CDO has written with further details about business continuity. This lays out provision for payments of ACV for April May and June with certain expectations attached. We've argued that practices would struggle to pay 100% of staff wages with the ACV payment at 80%.
The CDO also recognises that mixed contract practices will need further financial support for their private practice element. We're pushing for clarification on this and will update you as soon as possible.
Dentists in Wales may also review the guidance previously sent out to Welsh GDPs and CDS dentists. This provides a level of clarification on clinical and financial issues. A bi-lingual public information poster has also been provided for Welsh practices.
We are pushing daily for answers to questions of financial sustainability and the pandemic in Northern Ireland.
All GDPs in Northern Ireland have just received a letter from Michael Donaldson at the Health and Social Care Board outlining the next steps dental practices must take in the latest COVID-19 response. The HSCB guidance includes telephone triage, withdrawing from aerosol generating procedures and importantly, refers to future steps that will be taken, including setting up five central emergency centres to be operated by GDPs and nurses.
Dentists in Northern Ireland should also review the latest guidance and business continuity plans published on 18 March. We are pushing for clarity on a number of issues relating to this and will update you here.
More information is being made available by the Business Services Organisation.
A letter from CDO, Tom Ferris, has outlined Scotland's next phase of COVID-19 preparedness which is now in effect. This includes:
- All routine dentistry to cease
- Pregnant or immunosuppressed team members not to provide or assist in the direct care of patients
- Aerosol Generating Procedures (AGPs) to cease
- Practices to triage, advise and reassure patients via new 'buddy arrangements' whereby patients can contact a dental professional (by phone) during normal work hours
- FFP3 will be available at designated urgent care centres where patients are being assessed and treated.
The letter also seeks to reassure us that the CDO is working to source additional NHS funding to address concerns on practice sustainability.
The Scottish Government previously issued guidance along with an accompanying memorandum that outline the financial support being put in place to mitigate the disruption of service caused by the COVID-19 outbreak in Scotland. We are working to clarify a number of key issues raised by the guidance and will keep you updated.
Dentists in Scotland should review the guidance on COVID-19 provided by Health Protection Scotland. Guidance is also available for COVID-19 in social or community care and residential settings in Scotland. We will update you once new guidance is issued.
4. Where can I get further details about the furloughed workers scheme?
We are getting many calls from members about the furloughed workers announced by the government. Mixed practices in England are particularly concerned, because the terms of NHS help seem dependent on practices not taking other forms of state aid to avoid duplicating financial help. Others have questions relating to whether furloughed workers can be rotated. We are pushing for answers from government to all of your questions. We will provide further advice as soon as we have further information.
5. Who should self-isolate and what should they do?
The government has said that everyone should stay at home unless necessary, for example for travelling to and from work. The government's guidance for staying at home is here. The dentists and their teams will be providing emergency care should follow 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. We also believe that members of the dental team under the age of 70, with an underlying health condition (such as asthma, diabetes, heart disease) should also stay away from work.
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.
6. What if one of my staff or associate dentists is pregnant?
New 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.
7 What if a staff member has coronavirus?
If a member of staff has coronavirus, they should follow government advice and standard sickness procedures should 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. They will need to self-isolate for seven days after which symptoms should have abated, if they are not getting better they should seek medical advice and keep the practice updated.
At present, we do not know whether staff with coronavirus can also be furloughed workers receiving 80% of their pay. We cannot yet confirm whether staff sickness absence may impact on financial help from the NHS. We think it would be unfair if it did and are pushing for answers.
8. What if a staff member needs to care for a dependent?
Generally, if a dependent has been asked to self-isolate, the staff member will have also been given the same instruction and will follow the sick advice above.
If, however the reasoning for dependent care is due to school closures and being unable to find alternative care options, then it can be treated as time off for dependents. This might be paid or unpaid, or could be agreed as holiday, depending on the choice in our model employment contract.
At present, we do not know whether staff at home caring for a dependent can also be furloughed workers receiving 80% of their pay. We cannot yet confirm whether such staff absence may impact on financial help from the NHS. We think it would be unfair if it did and are pushing for answers.
9. Will NHS dentists be redeployed?
Efforts to deal with COVID-19 will likely include wider NHS staff than doctors and nurses. This could involve the redeployment of NHS dental staff. Dental staff have an array of transferable skills such as expertise in cross-infection control and could offer immeasurable help in hospitals or new urgent care centres. We're ready to advise NHS England on the roles that NHS dental staff could reasonably undertake. We will update you when we know more.