09 September 2020
DHSC Trader Readiness webinar presentation
Update 3rd of September 2020
The Department of Health and Social Care has circulated slides of a recent webinar and supporting information on trader readiness ahead of the end of the Brexit transition period.
The presentation provides information on the "staged transition", whereby customs requirements will be introduced over a period of time and most trader will not have to make import customs declarations on 1 January 2021.
In addition, a guidance document is available on trader readiness for the end of the transition period, detailing what medical suppliers need to do in order to be ready for importing and exporting goods.
Also available is Government guidance on GB-EU import and export from 1 January 2021 and a list of customs agents and fast parcel operators from 1 January 2021.
View the presentation
Read the guidance
Breaking news: MHRA reveals plans for post-Brexit medical device regulation
Update 1st of September 2020
The MHRA has published guidance on how medical devices will be regulated in the UK from 1 January 2021.
The key requirements for medical devices placed on the market in Great Britain from 1 January 2021 are:
CE marking will continue to be used and recognised until 30 June 2023
Certificates issued by European Economic Area (EEA)-based Notified Bodies will continue to be valid for the Great Britain market until 30 June 2023
A new route to market and product marking will be available for manufacturers wishing to place a device on the Great Britain market from 1 January 2021
If you are a manufacturer based outside the UK and wish to place a device on the UK market, you will need to establish a UK Responsible Person who will take responsibility for the product in the UK.
From 1 January 2021, all medical devices and in vitro diagnostic medical devices (IVDs) placed on the UK market will need to be registered with the MHRA. There will be a grace period for registering:
4 months for Class IIIs and Class IIb implantables, and all active implantable medical devices
8 months for other Class IIb and all Class IIa devices
12 months for Class I devices
The guidance also reveals that the new UKCA (UK Conformity Assessed) mark will be used for medical device and will be able to be applied from 1 January 2021. From 1 July 2023, to place a device on the Great Britain market, you will need to meet the requirements for placing a UKCA mark on your device. The UKCA mark will not be recognised in the EU, EEA or Northern Ireland markets. If you already have a valid CE mark on your device, you will not be required to re-label the device with a UKCA mark until 1 July 2023 for placement on the Great Britain market.
UKCA marks will be issued by new UK Conformity Assessment Bodies (CABs), which will be designated by MHRA. UK NBs with MDD designations will not have to undergo a new designation process.
The Department of Health and Social Care will be holding a webinar to discuss the guidance on Thursday 3rd September at 9:30am. The registration link can be found below.
Read the guidance
Register for the DHSC webinar
Report on the resilience of mixed NHS/Private dental practices published
Update 1st of September 2020
A new Short Life Working Group (SLWG) report investigating the resilience of mixed NHS/Private dental practices following the first wave of the COVID-19 pandemic has now been published.
The report was prepared via the Offices of the Chief Dental Officer, and was the work of a short life working group bringing together a unique range of official and professional bodies, including the BDIA. It examines the current national and local financial support packages available to dental practices and the dental sector, and the consensus of the SLWG group was that, “there is no evidence to substantiate the likelihood of a dearth of dental practices on the high street in 18 months’ time. However, capacity and capability exists within the mixed practice setting to further support NHS provision, address the backlog of unmet need and extend flexible commissioning initiatives to target oral health inequalities”.
It sets out key recommendations, including calls for an extension of the coronavirus job retention scheme for the dental sector, lengthening the repayment period for Government loans, and extension of business rates relief for dental practices. The Annexes of the report also feature the proposals to Government for sector specific support recently prepared by the BDIA.
The report utilised some wide ranging survey data gathered by the BDA that found in England:
Two thirds of dental practices (66%) are running at less than a quarter of pre-pandemic capacity
79% are likely or extremely likely to face financial difficulty in 3-6 months
54% lack confidence their practice could maintain current staffing levels in the coming year
78% determine 'fallow time' to be the greatest obstacle towards increasing activity levels.
Read the report
Welsh CDO provides update on COVID-19 recovery in dentistry
Update 28th of August 2020
The CDO Wales, Colette Bridgeman, has issued a letter to primary care dental teams outlining the progress made in the resumption of dental activity, as well as details of a review of the Standard Operating Procedure (SOP) for treatment and arrangements for the supply of PPE.
Aerosol Generating Procedures:
The letter notes that the SOP has been reviewed as progress is made through the "low amber phase" and as restrictions in Wales have been "gradually and cautiously" lifted. The revised SOP includes changes relating to AGPs and "settle time" before cleaning:
No settle time is required for most non-AGP procedures. For non-AGP procedures that have produced a significant about of splatter/ droplets (for example a difficult extraction) it is recommended that there should be a minimum of 10 minutes between the end of the procedure (e.g. the tooth being removed) and the next patient entering the room to allow larger droplets to settle and enable effective cleaning.
For AGPs in a room with the recommended number of air changes (>10ACPH) as outlined in HTM-03-017,8 a minimum of 16 minutes is considered appropriate for short AGP treatments (>10 min) where high volume (HV) suction is used, extending to 18 minutes for AGP treatments of 40 minutes.
Where other mitigating factors are also used e.g. rubber dam, fallow times cannot be below 10 minutes. A minimum of 10 minutes must remain for larger droplets to settle prior to surgery decontamination and before the next patient enters the room irrespective of the calculated fallow time and any mitigation.
Supply of Personal Protective Equipment:
The letter also states that the Welsh Government will "continue to assist with supply of FFP3 or FFP2 masks for NHS service delivery" and that this will be "dependent on continued wider availability of PPE".
The letter states that there is a "limited type of mask available" and that if fit testing to the supplied type is not successful then providers will have to "fund and secure alternative masks or consider the use of a re-usable respirator".
Further, the CDO reports the Welsh Government's intention during the recovery phase "to supply PPE to practices who are unable to obtain adequate stocks, or being charged excessively for their PPE from their usual supplier". We are seeking further clarification from the Welsh Government on this statement.
Read the Welsh CDO letter
Read the Welsh SOP
Latest COVID-19 update from CDO England
Update 28th of August 2020
The Chief Dental Officer for England, Sara Hurley, has issued the latest in a series of letters to dentists outlining the latest developments in the resumption of dental activity.
The letter reports that the Urgent Dental Care and Transition To Recovery Standard Operating Procedures have been updated. These updates include COVID-19 screening questions to be asked in line with the case definition for possible COVID-19 and isolation requirements including quarantine advice for those entering or returning to the UK.
Importantly, the letter also addresses the fallow period for Aerosol Generating Procedures. It notes that Public Health England (PHE) have confirmed that the requirement for fallow time is still in place as set out below and in appendix 1 of the Transition to Recovery SOP.
As such, the guidance for England remains:
- A post AGP downtime or ‘fallow period’ is required for droplets to settle and 99% of respirable particles (droplets and aerosols) released during the AGP to be removed from the air.
- Fallow time is calculated from the point that the AGP ceases; not the end of the patient appointment time.
- FFP2 /3 masks and PPE must be worn by any staff operating in or reentering the surgery setting during the fallow time.
- Subsequent patients should not enter the surgery until the fallow time has fully elapsed.
The section on fallow time ends by noting that the CDO will be working with PHE to further develop guidance for dental practices in England with a focus on fallow time when the SDCEP review has been published.
Read the England CDO letter
Read the England SOP
Updated COVID-19 infection prevention and control guidance
Update 24th of August 2020
New infection prevention & control guidance has been published by Public Health England. The UK-wide guidelines, applying to all healthcare settings, identify three distinct care pathways based on high, medium or low COVID-19 risk.
The guidance places primary care dentistry in the medium risk pathway, and where AGPs are delivered in the high risk pathway.
For those caring for patients/individuals on the high or medium risk pathways, there is no change in the level of PPE needed to protect staff and in effect this means that the existing IPC guidelines for dentistry remain as presently set out in appendix 1 of the Transition to Recovery Standard Operating Procedure.
Read the updated guidance
Read the standard operating procedure
Dentists added to Government emergency PPE Portal
Update 21st of August 2020
The Department of Health and Social Care (DHSC) has now added dentists and orthodontists in England to the list of primary and social care providers able to order and receive emergency supplies of critical coronavirus PPE through a Government portal.
The portal will enable dentists to order and receive emergency supplies of Type IIR masks, aprons, gloves, visors and hand hygiene free of charge. Weekly order limits will be calculated based on a practice's number of UDAs and UOAs per year.
The portal is intended solely as an "emergency top-up system" and dentists should continue to use their existing business-as-usual and wholesaler supplier routes to access PPE.
In Scotland, supplies of PPE are being provided by NHS National Services Scotland. Deliveries are being made to Health Boards across Scotland for onward distribution to all dental practices.
The Association is involved in continuing discussions with the office of the Chief Dental Officers and DHSC regarding the ongoing provision of PPE supplies to dental practices and will remain in close contact in relation to the operation of the portal.
Read the PPE portal guidance
BDA response to reporting of WHO guidance on dentistry and COVID-19
Update 14th of August 2020
The BDA has criticised misreporting of World Health Organisation guidance in relation to COVID-19 and dentistry. The BDA has said that the guidance has been "incorrectly interpreted as cautioning against attending the dentist for all but urgent cases".
The full BDA statement, which is supported by the BDIA, can be found below. The statement rightly identifies the importance of the safe provision of oral care, as well as the extensive PPE and decontamination measures in place in dental surgeries:
Dentists: reckless reporting of WHO guidance sends dangerous message to patients.
The British Dental Association has warned against misreporting of latest guidance from the World Health Organisation, which has been incorrectly interpreted as cautioning against attending the dentist for all but urgent cases.
The document, published on 3 August, advocates that “Oral health care involving AGPs (aerosol generating procedures) should be avoided or minimized, and minimally invasive procedures using hand instruments should be prioritized” for settings “with widespread community transmission.”
It is inappropriate to apply this advice in the UK’s current context, where dentists already operate extremely high levels of decontamination. At present the authorities have mandated dentists to use full PPE - as used in ICUs - for AGPs combined with a 60 minute fallow period between patients. Approaches vary by country, with many not operating a fallow period, and some are as short as two minutes. The UK’s approach is highly cautious by international comparison and is currently under review.
There is no evidence of transmission through dental AGPs since they resumed in June in England. The BDA believes there is a need to balance AGP risk against risk to patient oral health, particularly given the huge drop in oral cancer checks at routine appointments since lockdown. Oral cancers are responsible for more deaths in the UK than car accidents.
BDA Chair Mick Armstrong said:
“The World Health Organisation has cited best practise for widespread community transmission of COVID. We have adopted a highly cautious approach in the UK and patients should be reassured that care is safe.
“Dentists are now facing a huge backlog of patients who have struggled with pain through lockdown. Misrepresenting this guidance simply serves to discourage millions from seeking the care they need.
"Practices are already going over and above to minimise the risk of viral transmission. Reckless reporting will only mean patients bottling up problems, from decay to oral cancer.”
Read the WHO guidance
Report on ventilation, water and environmental cleaning in dental surgeries
Update 5th of August 2020
As we await the SDCEP report on the fallow period, a Short Life Working Group including representatives from all devolved administrations, Public Health England and academia has published a new report on ventilation, water and environmental cleaning in dental surgeries relating to COVID-19.
The document reviews and makes recommendations for remobilisation, development of guidance and other activities (e.g. training) with respect to ventilation (and associated aspects) within dental practices and treatment rooms in relation to COVID-19 based on the best available evidence and consensus expert opinion.
The document makes a number of recommendations in relation to Aerosol Generating Procedures and associated fallow periods. Areas covered include staff and patient management, the mechanical or natural ventilation in the surgery, cleaning and disinfection procedures, the usage of PPE and particular considerations to be taken into account in relation to multi-chair clinics.
The following points from the report may be of particular interest to members:
Are there any mitigating techniques which may reduce the Post-AGP Fallow Time (PAGPFT)?
Weak evidence exists that the use of high volume suctioning and/or rubber dams can reduce the volume of droplet/aerosols which are released into the room.
Is there a minimum post AGP fallow time?
The appropriate post AGP fallow time should be determined from the ventilation rate in the room and any additional mitigations. The fallow time should not be reduced below 10 minutes regardless of ventilation, as this is the time taken for larger droplets to settle out onto surfaces.
Are there mitigations that can be introduced to reduce the post AGP fallow time?
The amount of aerosol that is generated can be reduced by using high volume suction and dental dam with low volume suction. It is estimated that these actions could reduce the amount of aerosol generated by over 90%.
Addition of recirculating air cleaning devices could enhance the effective air change rate
(but will not provide additional fresh air). The impact of such devices will depend on the specific device air flow rate and the size of the room. Devices should be correctly sized and the impacts on the room air flows considered. Recirculating air cleaning devices based on HEPA filter systems or UV-C are likely to be effective. Other technologies should be approached with caution as there is little evidence for effectiveness in practice.
Read the report
End of Brexit transition period guidance
Update 31st of July 2020
DIT issues guidance for the end of the Brexit transition period
The UK has left the EU and is currently in the transition period which will end on 31 December 2020. Businesses should take action now to start preparing for new trading rules which will be in effect from January 2021.
The Department for International Trade has outlined three steps for businesses to take to minimise disruption and take advantage of new opportunities:
- Head to GOV.UK/transition to take a short survey and receive a personalised list of actions for you and your business to take.
- Sign up to email alerts to stay up to date with any further changes.
- Plan ahead and take the steps needed to complete your actions and prepare your business for the new trading rules.
An enquiry form is also available for questions not covered by the guidance
Access the guidance
Rapid review of dental Aerosol Generating Procedures published
Update 28th of July 2020
A rapid review of dental Aerosol Generating Procedures (AGPs) and their mitigation in international dental guidance documents has been published by the COVID-19 Dental Services Evidence Review (CoDER) Working Group.
The review aims to:
Assess how aerosol generating procedures (AGPs) are defined and classified in international guidelines
Identify what AGP mitigation is advised for both COVID and non-COVID patients
Report recommended time gaps (fallow periods) between treating COVID and non-COVID patients in the same surgery following provision of AGPs
Identify any mitigating factors that allow reductions in the length of fallow periods.
(Assess whether there is a relationship between COVID-19 epidemiology and World Bank income status with PPE provision – to be reported later).
(Assess the quality of linked evidence to recommendations – currently in progress to be reported later).
Key findings from the review include:
The review reports on national recommendations for AGPs and their mitigation from 58 countries.
There is a highly variable level of details provided across international resources.
Just over half of the documents (56%) provide a definition of AGPs.
98% of countries state that AGPs can be provided for non-COVID patients.
94% of countries recommend the use of a face mask and goggles or a face shield for non-COVID patients.
Surgical masks are advised by 21 countries (33%) for non-COVID patients while 44 countries (70%) recommend the use of FFP2/N95 masks and 12 countries
(19%) recommend the use of FFP3 masks.
82% of documents recommend the use of a pre-procedural mouthwash for non-COVID patients.
48% of documents suggest a fallow period after the providing AGP treatment for non-COVID patients, with times ranging from 2 to 180 minutes.
Most countries making recommendations for COVID patients advised the same mitigation as for non-COVID patients.
There is a lack of evidence provided to support the majority of recommendations in the documents.
Download the review
Government publishes post-Brexit import & export guidance
Update 14th of July 2020
The Government has published detailed guidance on the operation of the GB-EU border following the end of the Brexit transition period on 1 January 2021.
After the transition period, the UK Government will implement import controls on goods moving from the EU to GB, in a manner similar to the UK’s current treatment of Rest of World (RoW) goods. These controls will be introduced in three stages: January, April, and July. It is expected that the EU will also implement full import controls on goods moving from GB to the EU from 1 January 2021.
As a result, there will be significant changes to the process for moving goods between GB and the EU. All businesses moving goods across the GB-EU border will need to take account of these and adapt accordingly.
The document sets out how and when these changes will be applied, and the actions that businesses need to take in order to prepare.
Download the guidance
CDO England update: all practices to resume face-to-face treatment by 20 July
Update 13th of July 2020
The latest COVID-19 update to general dental practices and community dental services from the Chief Dental Officer, England, has stated that all practices are expected to mobilise for face-to-face interventions by 20 July.
The CDO acknowledges that it "may not be possible to deliver historical [UDA] activity levels during this period" but that practices are expected to make "all possible, proactive efforts" to be delivering "as comprehensive a service as possible".
The update also provides information on contractual arrangements for dental practices. It notes that work is being undertaken on an appropriate mechanism with which to measure activity, care and outcomes - taking into account constrained capacity and increased PPE costs. The update proposes the following arrangements:
Moving, from 8 June, to a 0% abatement for all contracts.
For UDC practices this will apply automatically from 8 June.
For non UDC practices this is conditional on specific assurance that individual practices are open for face-to-face interventions, 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.
Accordingly, any practice not delivering the equivalent of at least 20% of usual volumes of patient care activity will be deemed to be non-compliant with the above criteria.
In addition any practice that has significantly increased private practice provision at a rate that exceeds that for NHS provision while we provide this funding stability may be deemed to be non-compliant with the above criteria. Specific assurance will be sought from contract holders on this matter and in the event of any subsequent concerns spot checks may be carried out to provide assurance.
Where this assurance is not received, reverting to operating pre-existing contract arrangements from 20 July.
Read the update
BDIA calls for Government financial support for the dental and medical device industries
Update 9th of July 2020
Working in partnership with our colleagues at the Association of British HealthTech Industries (ABHI), the BDIA has, this week, contacted key Government Ministers and personnel, as well as the Shadow Health Secretary and Ministers, presenting a proposal for sector specific support for HealthTech companies whose revenues have reduced significantly with the cessation and then slow and piecemeal resumption of more widespread dental and medical treatments and care.
Our position is that whilst industry welcomes the resumption of activity across the medical and dental sectors, the return of businesses to significant and sustainable levels remains some time away, and activity levels are unlikely to return to ‘normal’ for the foreseeable future. Whilst companies are expected to offer a full range of products and services to the dental and medical professions to support activity and patient care to the very highest standards, there is concern that this may not be financially sustainable due to current and future reduced trading activity. The BDIA and ABHI have, therefore, expressed some concern that without additional sector-specific Government support, there could be a risk to high quality jobs in a key sector as well as to patients who need products supplied by affected companies.
As we believe that existing Government support measures do not currently adequately address the specific needs of the sector we are calling on Government to offer new support in the form of interest free drawdown loans for otherwise viable businesses that have been disproportionately affected by the pandemic, to be repayable once a dental or medical supply business has returned to a positive cash-flow situation.
Read the proposal
PPE tax cut extended until end of October
Update 3rd of July 2020
HM Treasury has announced that the temporary scrapping of VAT on PPE, initially stated to run from 1 May until 31 July, will now be extended until the end of October.
As a result, the temporary zero-rating of PPE will apply for a total of 6 months, with the Government estimating that it will save care homes and businesses £155 million.
Previously, Ministers had removed import duties from PPE and medical supplies intended to assist with the response to the coronavirus pandemic in April 2020.
The decision was made under an exceptional basis allowed by EU rules during health emergencies. The European Commission recently indicated support for member states to introduce temporary VAT reliefs to mitigate the impacts of the Covid-19 pandemic.
Read the announcement
Scotland indicates date for Phase 3 resumption of dental activity
Update 26th of June 2020
In line with its previously published COVID-19 'route-map', the Scottish Government has provided an indicative date for the move to the next phase of its resumption plan.
The announcement states that Scotland's Phase 3 measures will start coming into effect from 10 July.
Specifically for dentistry, it states that from 13 July all dental practices may begin to see registered patients for non-aerosol routine care and that "work will begin to return aerosol generating procedures to practice safely".
These indicative dates will be subject to approval at the 9 July review point.
Read the announcement
Comparison of UK return-to-practice guidance for dentistry
Update 17th of June 2020
The Scottish Dental Clinical Effectiveness Programme, in cooperation with dental stakeholder organisations, has published a comparison of UK return-to-practice guidance and dental standard operating procedure documents.
The comparison gathers together the guidance from England, Scotland and Wales as well as the British Dental Association and Faculty of General Dental Practice.
The guidance is compared across 5 areas:
- Practice organisation
- Patient care
- Infection Prevention & Control
- Other items
The comparison indicates broad similarity between the various guidance documents, but indicates areas where some divergence exists.
Read the comparison
FGDP(UK) and CGDent COVID-19 guidance synopsis
Update 17th of June 2020
The Faculty of General Dental Practice (UK) and College of General Dentistry have published a synopsis of their guidance on the implications of COVID-19 for the safe management of general dental practice.
The synopsis, designed to be used in conjunction with their guidance document, highlights key recommendations at each stage of the patient journey: pre-appointment, patient attendance, during treatment and after treatment.
The document also includes guidance on risk, detailing risk stratification for Aerosol Generating Procedures and risk assessment of clinically vulnerable patients.
The synopsis and supporting guidance document can be accessed below.
Read the guidance and synopsis
Health and Safety Executive PPE Warning
Update 12th of June 2020
Health & Safety Executive issues warning over KN95 face masks
The Health & Safety Executive (HSE) has issued a safety alert regarding face masks claiming to be of KN95 standards.
The HSE reports that these masks may provide an inadequate level of protection and "are likely to be poor quality products accompanied by fake or fraudulent paperwork".
"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."
The safety notice states that KN95 masks must not be used as PPE at work as their effectiveness cannot be assured, and that non-CE masks cannot be sold as PPE and must be "removed from supply immediately". The only exception is for PPE organised by the Government for use by NHS or other healthcare workers.
Read the safety alert
Updated NHS England guidance on PPE and self-isolation
Update 11th of June 2020
NHS England has issued updated guidance for healthcare providers, including dental practices, aimed at minimising nosocomial infections in the NHS.
The guidance states that, from June 15th, all staff in dental practices will be required to wear a surgical face mask when not in PPE or in a part of the facility that is COVID-secure.
Any staff testing positive for coronavirus should follow Test and Trace self-isolation procedures. Any staff coming into close contact with someone with a confirmed case of COVID-19 should also follow these procedures. Close contact excludes circumstances where PPE is being worn in accordance with current guidance.
Read the guidance
Final day to place employees on furlough
Update 10th of June 2020
Final day to place employees on furlough under the Job Retention Scheme
Today (10th June) is the last day for employers to place their employees on furlough under the Coronavirus Job Retention Scheme.
From 1 July onwards, furlough will be restricted to employees whose employers have already made a Coronavirus Job Retention Scheme claim, meaning that the last three-week furlough period for new entrants must begin today.
Members are reminded that they can make use of our Business Support Helpline on 0844 561 8133 (quoting membership number 28763) if they need further advice.
Coronavirus Job Retention Scheme
Update on resumption of dental services in Scotland and Wales
Update 9th of June 2020
The Chief Dental Officers of Scotland and Wales have both provided updates on the resumption of dental services.
In Scotland, CDO Tom Ferris has stated that practices will be told when they can see NHS patients for face-to-face consultation who are in need of urgent care, using non-AGPs, at the next 3-weekly review of lockdown regulations on 18 June. It is noted that NHS Services Scotland have ensured "Adequate stocks of appropriate PPE through a central distribution system".
Further, a revised Statement of Dental Remuneration is expected shortly, which will include a list of treatments that dental contractors providing NHS services can provide under Phase 2 of the remobilisation plan.
In Wales, CDO Colette Bridgman has confirmed that the resumption of dental services in Wales will be gradual and "in line with the Welsh Government's cautious, wider approach to easing lockdown". She notes that the first phase of resumption will begin from 1 July and will be prioritised by need.
Read the CDO Scotland statement
Read the CDO Wales statement
Public Health England's Interpretation of COVID-19 Guidance for Dental Industry Essential Maintenance and Service Engineers and Technical Staff Attending Dental Practices
Update 8th of June 2020
In response to a request from the BDIA, Public Health England has provided its interpretation of guidance for dental industry essential maintenance and service engineers and technical staff attending dental practices during the COVID-19 pandemic. We have summarised this guidance into a short document which we are pleased to publish today.
The guidance signposts to existing decontamination and infection control procedures, such as those contained in HTM 01-05, as well as measures specific to the Government’s COVID-19 response with particular precautions relating to Aerosol Generating Procedures (AGPs) and the usage of appropriate PPE.
We would encourage any member companies with members of staff attending dental practices to familiarise themselves with the guidance.
Download the document
NHS communications to dental patients
Update 5th of June 2020
Following recent cross-organisation discussions on patient facing communications relating to the resumption of wider dental practice, the NHS has produced some simple patient facing messages covering accessing dental care and what a patient can expect when attending a dental practice.
"What to expect from your dental practice"
"Accessing dental care"
"Accessing dental care: changes"
NHS England Dental Standard Operating Procedure Published
Update 4th of June 2020
NHS England has published its new Standard Operating Procedure (SOP) for dental practices, outlining a phased transition towards the resumption of the full range of dental provision.
Introducing the new SOP, the Chief Dental Officer notes that, during the initial resumption of dental services, "the baseline expectation is for practice based urgent dental care (UDC) provision, with flexibility for practices to do what is best for their patients". The subsequent pace of progression will need to be risk-managed by individual practices subject to the SOP's Infection Prevention & Control and PPE requirements.
The SOP features 8 key principles:
- Phased approach to full resumption based on risk management
- Continue to provide remote consultations for all patients
- Provide advice, analgesia and antimicrobials (where appropriate) in the first instance
- Observe social distancing measures at all times
- Minimise all face to face patient contact
- Clear safety standards for PPE and Infection Prevention & Control
- Appropriate sequencing and scheduling of patients
- Refer all possible/confirmed patients to UDC sites until phased resumption is complete
Specifically on PPE, the SOP states that PPE protocols in line to government advice must be adhered to:
- For non-AGP care: standard infection control precautions PPE, eye protection, disposable fluid-resistant (Type llR) surgical masks, disposable apron and gloves should be worn.
- For all AGPs: to prevent aerosol transmission, disposable, fluid-repellent gown or approved equivalent, gloves, eye/face protection and an FFP3 respirator should be worn by those undertaking or assisting in the procedure. FFP2 respirators can be used when FFP3 respirators are not available.
Further detail on PPE requirements and all other measures for adoption by practices is contained in the SOP available below.
Read the NHS England Standard Operating Procedure
FGDP(UK) guidance on the safe return to general dental practice
Update1st of June 2020
The Faculty of General Dental Practice and College of General Dentistry have published guidance concerning the safe management of dentistry during the COVID-19 outbreak.
The guidance adopts the "ABC" (Aspirational, Basic, Conditional) approach, with basic measures being a minimal standard. The guidelines cover five sections:
- Pre-appointment – ensuring patients are well informed and suitably prepared ahead of their visit to the dental practice
- Patient attendance (pre-treatment) – covering measures from entering the building to accessing the clinical area, including the communication of new infection control and prevention procedures to patients along with changes to waiting areas
- During treatment - including consideration of PPE, procedural risk mitigation, decontamination and medical emergencies, as well as recommendations for approaches to aerosol generation
- After treatment – including procedures to protect patients and staff and the use of an appropriate fallow period following high risk aerosol exposure
- Management/governance tasks – including risk assessments for all staff members and awareness of the need to encourage staff to monitor and support if they feel unwell
Read the guidelines
Counterfeits and Cybercrime - Be vigilant
Update 1st of June 2020
With the welcome news of the start of the resumption of more widespread dental activity from 8th June and encouraging reports of increasing economic activity amongst BDIA members, it is timely to remind companies of the ‘unprecedented’ number of cyber scams in operation and counterfeit product circulating in global markets.
With cybercrime at high levels we would urge all members to stay alert and be vigilant, be it showing caution with emails and attachments, or thoroughly checking financial transactions. In this busy time of re-starting business and taking new orders it is easy to drop your guard and give a ‘scammer’ a way in, or opportunity to defraud you – so please be extra vigilant.
Members will also be aware of the significant number of counterfeit and non-compliant masks and respirators being made available, along with other ‘new’ products associated with COVID-19 mitigation, so again, we would urge caution when dealing with any new suppliers or products.
Government technical specifications for PPE
List of Notified Bodies
Resumption of dental services in England from Monday 8th June
Update 28th of May 2020
The BDIA has welcomed the announcement from the Chief Dental Officer England this evening of the resumption of widespread dental activity, including AGPs, in England from 8th June.
It had been anticipated that the resumption of more widespread dental activity in England would take the form of ‘phased activity’ as outlined in the devolved nations. However, the CDO and NHS have now confirmed that any dental practice in England that is suitably prepared can now provide the full range of dental care, including AGPs from Monday 8th June. This approach is very positive news and may well initially see differential levels of treatments made available, with individual dental practices making the decision to resume treatments at differing rates depending on individual circumstances. The pace of resumption will depend on ongoing PHE PPE advice, availability and, where necessary, respirator fit testing, as well as the implementation of appropriate cross-infection control and staffing and distancing arrangements.
BDIA President, Daniel Davis, comments, “I am delighted that the Government has now given the go-ahead for the resumption of widespread dental treatment in England from 8th June, something that the BDIA has been working towards for some weeks. I am pleased and proud that the Association has been able to play a central role in this process through its ongoing participation in key meetings with representatives of many Government departments and organisations, the BDA and other professional groups”.
Read the announcement here
Restoration of dental services in Wales
Update 27th of May 2020
The Welsh Government has published its final framework for dentistry, outlining its plans for the restoration of dental services and the de-escalation of the COVID-19 red alert pandemic plan - "from June/July 2020 to March 2021 and beyond".
As has been set out in Scotland and indicated by the CDO England, the Welsh Government has stated that the resumption of dental treatment will require a "phased approach". The progression of this phased approach will be tied to other key milestones in the pandemic, such as the rate of community transmission, testing and the development of a vaccination programme.
The document also recognises the importance of "the continued supply of level 3 PPE to UDCs and the availability of standard PPE to dental practices".
Three stages are outlined:
1. Planning for de-escalation from RED alert to heightened AMBER: continuation and strengthening of UDCs for those in need of AGPs. Many of these patients will have on going and definitive treatment need and will need re-assessing in their routine dental practice, receiving dental care and preventive interventions that do not involve an AGP.
2. Address the backlog: provision of definitive care for those who have received urgent care in UDCs, those who contacted practices during the RED alert phase with a dental problem and/or pain or swelling and have an ongoing treatment need. Includes treatment for those not meeting the criteria for urgent/emergency care, but with dental problems/treatment that had been delayed/postponed/self-managed.
3. Reinstatement of routine assessment and care.
The document also details the Government's handling of NHS contractual arrangements and the scientific evidence underlying its approach.
Available alongside the framework are three further documents: the Welsh Government's De-escalation Standard Operating Procedure, Pandemic Plan for Dentistry in Wales and the Welsh CDO's accompanying letter concerning restoration of services.
Read the Welsh framework
Read the Welsh de-escalation SOP
Read the Welsh de-escalation Pandemic Plan
Read the Welsh CDO's letter
Scotland's 'route map through and out of the crisis'
Update 22nd of May 2020
Further to the plan for the remobilisation of dentistry in Scotland that we circulated yesterday, the Scottish government has now published its route map for easing the country's lockdown restrictions.
Dentistry is mentioned several times in the document, which sets out a four phase plan for the lifting and variation of restrictive measures, whereby Phase 4 represents the "full range of health and social care services".
The route map "provides an indication of the order in which [the Scottish Government] will carefully and gradually seek to lift current restrictions, but does not attempt to specify dates for all of the different phases". The document explains that the decision to progress to a new phase will be based on meeting "particular criteria", such as those set by the World Health Organisation.
Read the route map
Phased plan for remobilisation of NHS Dental Services in Scotland
Update 21st of May 2020
The CDO Scotland, Tom Ferris, has outlined a three phase plan for the remobilisation of NHS dental services. The key phases of remobilisation that have been identified are:
Phase 1: Increasing Capacity of Urgent Dental Care Centres (UDCCs)
- Dental practices will remain closed to face-to-face patient consultation during this stage and should work with their NHS Boards to prepare to receive patients under Phase 2(a).
- UDCC capacity is being expanded to increase the scope of treatments available.
Phase 2: Restarting Dental Practices
- 2(a) - all dental practices to open for face-to-face consultation for patients in need or urgent care that can be provided without AGPs.
- 2(b) - face-to-face consultation to be expanded to routine care, including examination, and treatment that can be provided using non-AGPs.
- UDCCs to continue with referrals for AGPs.
Phase 3: Introducing AGPs to Dental Practices
- Limited introduction of AGPs to dental practices, dependent on evidence of risk and possible mitigation.
The CDO also reports on the supply of PPE to support remobilisation, COVID-19 testing and financial support measures.
Read the update
Government technical specifications for PPE
The Government has circulated essential technical requirements for COVID-19 PPE. The guidance applies only to potential manufacturing for direct Government procurement or donations for frontline health and care purposes.
The document is aimed a manufacturers intending to make and supply high volumes of gowns, gloves, masks, respirators, eye protection, aprons and coveralls to the UK to protect health and care workers from COVID-19 where the item does not have a CE mark or you wish to propose the alternative use of an existing CE marked product against the relevant legislation:
- If intended to protect the wearer : EU Regulation 2016/425 on Personal Protective Equipment (PPE)
- If intended to protect the patient: Medical Devices Regulations (MDR 2002) which implements Directive 93/42/EEC on medical devices (MD).
- If you claim it is dual purpose (MD and PPE), the product must comply with MDR. In addition, they must meet the relevant basic health and safety requirements (BHSR) of the PPE Directive.
Download the Specification
CQC updated advice for practices
Update 20th of May 2020
The Care Quality Commission has issued updated advice to dental practices in England.
The CQC has confirmed that the "decision to offer dental care services is one for the provider to take".
It encourages dental providers to "give proper consideration to the communications from the Chief Dental Officer (CDO) regardless of whether their practice is NHS, private, or mixed" but notes that it "cannot require providers of dental care services to close" unless there is clear evidence of a breach of its regulations.
The CQC further notes that it will "assess the extent to which providers are providing an appropriate level of safety within the context of our regulations" and will, accordingly, refer to "prevailing guidance, not limited to but including guidance from PHE, the CDO and GDC to help us reach a judgement on the extent to which the service currently being provided complies with our regulations”.
Updated COVID-19 symptom advice & Resumption of treatment in Wales
Update 16th of May 2020
Updated coronavirus symptom advice issued
The UK's Chief Medical Officers have issued new information about coronavirus symptoms, stating that all individuals should self-isolate if they develop a new continuous cough, fever or anosmia.
Anosmia - the loss or a change in your normal sense of smell or taste - had been discussed in relation to coronavirus earlier in the year but has now been formally recognised as a symptom that should trigger self-isolation.
The statement is available below.
Read the statement
Imminent dental resumption road map for Wales
As the BDIA continues to participate in a series of weekly meetings organised by the CDO England and NHSE on the resumption of more widespread dental treatment in England, discussions also continue apace in Wales. Welsh CDO, Dr Colette Bridgman, has been involved in discussions over the previous weeks regarding the next steps and how general dentistry will begin to be restored to a new normal in Wales later in the summer.
We understand that there may be a road map published by the Welsh Government in the coming week. We will circulate this as it becomes available.
NHS England and CDO – Resumption of wider dental activity
Update 15th of May 2020
Yesterday NHS England and the Office of the Chief Dental Officer hosted the first of a series of meetings to discuss the approach to expanding dental care in England. The BDIA was represented by Chief Executive, Edmund Proffitt. The meeting featured Health Minister, Jo Churchill, and also involved representatives from the Department of Health, General Dental Council, Care Quality Commission, Faculty of General Dental Practice, Faculty of Dental Surgery, Association of Dental Groups and Public Health England.
It was generally recognised that dental care should be expanded as early as was safely possible, with a desire for a consistent approach towards the position of both NHS and private dentistry. Any progress towards resumption looks likely to take into account and reflect pandemic conditions, rather than be tied to a specific timetable or dates. There was a wide ranging discussion on the different potential approaches to implementing broader dental activity and the group will meet again next week. We will be working with all the parties involved to push for clear communication of the roadmap to enable the profession and industry to adequately plan for the resumption of wider dental care.
From an industry perspective, the Association raised a number of points, including specific issues relating to PPE provision, availability and cost, its ongoing ARC activity and the provision of clear guidance for industry personnel, such as engineers, attending AGP and non-AGP performing practices going forwards.
Working Safely During Coronavirus guidance published.
Update 12th of May 2020
The Government has published new guidance to help ensure safety in the workplace during the coronavirus pandemic.
A total of 8 guides have been published, offering advice specific to a range of industries and working environments. Of particular interest to members will be the documents focussing on factories, plants and warehouses as well as offices and contact centres.
The guides addressing the following areas:
- Thinking about risk
- Who should go to work
- Social distancing at work
- Managing your customers, visitors and contractors
- Cleaning the workplace
- Personal protective equipment and face covering
- Workforce management
- Inbound and outbound goods
Read the guidance
Dentistry discussed in Parliament
Update 6th of May 2020
We were pleased to see the issue of dentistry during the coronavirus pandemic raised in Parliament yesterday, with the Health Secretary, Matt Hancock, taking questions on support for dental practices and the resumption of treatment.
Mr Hancock stated that it was "important to get dentistry back on its feet" as MPs stressed the challenges facing dental practices across both private and NHS treatment. Continuing, Mr Hancock acknowledged the role of PPE as well as the challenge of aerosol generating procedures and said that he would outline proposed plans for reopening dentistry in a safe way.
We are continuing to work with stakeholders across Government, Parliament and the NHS to ensure that the key role of industry is taken into consideration as these plans for the resumption of dentistry are developed.
BDIA briefs Shadow Minister, removal of VAT for PPE
Update 1st of May 2020
Briefing with Shadow Minister
The Chief Executive and Policy & Public Affairs Manager had the opportunity to brief Shadow Minister for Public Health and Patient Safety, Alex Norris MP, yesterday on a range of key issues for the industry.
The Shadow Minister was very supportive of dentistry and the dental industry, and was keen to support the safe return to wider dental treatment while being aware of the challenges that will need to be addressed in doing so.
As well as providing a comprehensive overview of the impacts of COVID-19, we also encouraged Mr Norris not to lose sight of other issues facing our sector, such as the impact of Brexit and the Medical Device Regulation.
As part of his brief, Mr Norris will also be working on the Medicines and Medical Devices Bill and has requested the BDIA's input as the legislation progresses through Parliament. We will be arranging further briefings to assist in this process as we look to the future of UK device regulation.
Removal of VAT for PPE
The Government has announced that, as a temporary measure, PPE purchased for protection from infection will be zero rated for VAT.
The new temporary zero rate, which will apply to PPE supplies as defined by Public Health England's guidance, will apply from 1 May to 31 July 2020.
Read the announcement
Read the Public Health England guidance
BDIA launches AGP Resilience Challenge
Update: 20th of April 2020
The effects of COVID-19 on dentistry have been immense, leading to the cessation of all non-urgent dental care. Going forwards, any resumption of widespread dental treatment will involve changes for both the industry and the profession. As we move closer to a potential easing of lockdown restrictions it is important to turn our attention to how our industry can respond and adapt to this new environment and contribute to the safe expansion of dental activity.
In guidance released by NHS England and the Chief Dental Officer it is clear that Aerosol Generating Procedures (AGPs) are a very significant concern due to their potential for transmitting the virus. AGPs account for a large proportion of dental activity and present a particular challenge in terms of adopting appropriate personal protective equipment and decontamination procedures.
To respond to this situation the BDIA is launching a new initiative, the AGP Resilience Challenge (ARC), with the aim of contributing to a better understanding of the issues surrounding the mitigation of the potential risks associated with AGPs and how the industry can facilitate the provision of safe and effective dental treatment going forwards.
NHS England issues new guidance for dental services
Update: 16th of April 2020
NHS England has issued a new version of its COVID-19 standard operating procedure guidance, with an accompanying update from the Chief Dental Officer, addressing urgent dental care (UDC) provision.
The standard operating procedure sets out that each UDC system should deliver:
- a clear local message for the public that routine dental care is not available during this delay phase of the COVID-19 pandemic and advise them what to do if they have a dental emergency
- a remote consultation and triage service whose outcomes are
- advice, analgesia, antimicrobials where appropriate (AAA); or
- referral, when absolutely necessary and treatment cannot be delayed, to a designated UDC site for a face-to-face consultation and treatment
- a face-to-face consultation and treatment service using a range of providers and locations supported with appropriate PPE for the clinical procedures (AGP, non-AGP) to be carried out at the site. Aerosol generating procedures (AGP) should be avoided unless absolutely necessary.
Other points of note include:
- In the absence of an NHS-designated UDC service, a dental practice may undertake non-AGP face-to-face dental assessment and care with Level 2 PPE.
- Where AGPs are necessary within UDC services, the use of high power suction and rubber dam is recommended where possible.
- The use of 3-in-1 syringes, ultrasonic scalers or other pieces of dental equipment powered by air compressor should be avoided at this time and should not be the only reason to wear an FFP3 mask. If, however, they are used as an adjunct to treatment with high-speed drills, staff will already have donned PPE for AGPs.
- Decontamination following treatment should follow HTM01 05. In addition, when an AGP has been used, it is recommended that the room is left vacant with the door closed for 20 minutes in a negative pressure isolation room or one hour for a neutral pressure room before performing a terminal clean.
Read the guidance
Read the CDO's letter
Government publishes COVID-19 PPE plan
Update: 14th of April 2020
A new cross-government UK-wide plan to ensure supply of Personal Protective Equipment (PPE) has been published. The document outlines three components of the Government's plan: Guidance, Delivery and Future Supply:
The document summarises current guidance on PPE usage in different clinical and non-clinical settings, including links to recommendations based on care settings and procedure type.
The Government states that "emergency drops" of PPE have been organised for primary care providers in the community, including dentists and urgent dental care centres. Further, the Government has "released PPE to wholesalers for onward sale to these providers".
A new ordering website for PPE is being developed. The website will enable easier registration of PPE requirements. Until the website is launched, essential equipment will continue to be issued based on the expected number of COVID-19 patients.
A new, dedicated unit has been established to focus on securing PPE supplies and is identifying global suppliers to meet demand.
There are no restrictions in place on individual organisations sourcing PPE from suppliers, providing the PPE is compliant with requirements.
Read the PPE plan
Update: 8th of April 2020
Free BSI standards
As part of its response to the COVID-19 pandemic, BSI has made a range of standards available to download free of charge. Of particular interest to members will be the standards discussing risk management and business continuity, personal protective equipment and hygiene.
BSI Standards -Business Continuity
BSI Sstandards -PPE
BSI Standards - Hygiene
Updated PPE guidance, dentists' financial support and counterfeit masks
Update: 3rd of April 2020
Updated PPE guidance
The Government has issued revised guidance on the use of Personal Protective Equipment in relation to infection control and prevention for COVID-19.
The main changes introduced in the latest update are:
- enhanced PPE recommendations for a wide range of health and social care contexts
- inclusion of individual and organisational risk assessment at local level to inform PPE use
- recommendation of single sessional (extended) use of some PPE items
- re-usable PPE can be used. Advice on suitable decontamination arrangements should be obtained from the manufacturer, supplier or local infection control
- guidance for when case status is unknown and SARS-CoV-2 is circulating at high levels
- recommendation on patient use of facemasks
The guidance recommends filtering face piece respirators (single use) for any aerosol generating procedure and Type IIR fluid-resistant surgical masks for other dental procedures with possible or confirmed cases of COVID-19.
Updated PPE guidance
Financial support for dentists
The Scottish Government has issued a memorandum providing more details about its funding package for dentists. The document includes revisions to the previously announced funding measures, noting:
The financial support measures which have now be put in place will provide contractors providing GDS with 80 per cent of their NHS gross item of service income. This will equate to their average monthly NHS item of service income in the 2019/20 financial year but will now crucially include the NHS patient charge element normally paid directly to the practice.
Meanwhile in England, the British Dental Association has reported that NHS England has provided clarification regarding its announcement of financial support for dentists. In its letter of 25th March, NHS England stated:
Practices benefiting from continued NHS funding will not be eligible to seek any wider government assistance to small businesses which could be duplicative.
NHS England has now confirmed that principles outlined in this letter are intended to apply to NHS income only. NHS contract holders in mixed practices wishing to claim under Government support schemes should ensure that this is in relation to the proportion of private income only, in line with calculations for determining NHS and private income for business rates reimbursements.
Scottish funding memorandom
NHS England letter 25th of March
Counterfeit and non-compliant face masks
Whilst we urge you all to be vigilant with regard to counterfeit and non-compliant face masks, the government is, in this exceptional situation, allowing the MHRA the powers to authorise the supply a non-CE marked devices in some cases in the interest of the protection of health. This will be under regulations 12(5), 26(3) and 39(2) of the Medical Devices Regulations 2002.
We feel that it is important to remind members of the MHRA guidance on face mask/PPE, as the regulations are different depending on the type of face mask.
Surgical (medical) face masks
This type of mask, intended to protect the patient, are Class I medical devices and must meet the design and safety requirements of the Medical Device Regulations (MDD/MDR) and be CE marked before you can sell them in the UK, or you may be able to apply for exemption from the regulations.
If the surgical masks you want to supply are sterile, then you also need a CE certificate from a notified body for the sterility aspects. The MHRA regulates these types of masks and the Guidance on Class 1 Medical Devices gives further information.
General face masks
If the masks are intended to protect the wearer, they are regulated as personal protective equipment and need to meet the regulations covering PPE products. They will need a notified body to verify the relevant requirements are met. They are not medical devices.
If you need advice on these regulations, or wish to make any exemption/derogation requests for PPE contact the Department for Business, Energy and Industry Strategy (BEIS) at OPSS.email@example.com
If you are looking to purchase new supplies of PPE the manufacturer should be asked to provide all necessary evidence to prove the legitimacy of their products, including evidence of any derogations granted by the MHRA. We would urge all members to be extremely diligent when dealing with potential new suppliers of PPE.
Read about the regulatory status of PPE
See the MHRA guidance
Be aware of counterfeit face masks!
Update: 2nd of April 2020
Unfortunately, it is no surprise that at this time when there is such heavy demand for face masks counterfeit and non-compliant products are appearing on the market.
In the UK and Europe, surgical masks are Class I medical devices and must display a CE-mark and comply with the requirements of standard EN 14683: Medical face masks - Requirements and test methods.
Please display extra caution if you are contacted by a potential new supplier or are exploring new sources of supply.
The MHRA’s website contains details of device manufacturers registered with the MHRA which you can search by company name or product type (Device Code) eg. surgical face mask.
The US Centre for Disease Control and Prevention (CDC) also has a useful page on counterfeit respirators/masks that are appearing on the US market.
MHEA Register of device Manufacturers
US CDC information
BDIA COVID-19 situation summary
Update: 31st of March 2020
The Association has been updating members regularly on a range of COVID-19 related measures and activities. We now feel it appropriate to take stock and summarise some of the key points relating to BDIA members and their customers.
BDIA member companies – Government support
The Government has announced a number of support schemes for companies and the self-employed. Currently we understand that:
- Members are making significant use of the Coronavirus Job Retention Scheme to access support to continue paying part of their employees’ salary for those who would otherwise have been laid off.
- Many SME members intend to make use of the Statutory Sick Pay Rebate.
- A number of members are applying under the temporary Coronavirus Business Interruption Loan Scheme which supports small and medium-sized businesses with access to loans, overdrafts, invoice finance and asset finance of up to £5 million and for up to six years. Members are finding interest rates vary and are shopping around for the lowest rates.
- A number of members are exploring eligibility under the HMRC’s Time to Pay Service
See all the Government Business Support Measures
BDIA Members – Working from home
BDIA member companies encompass a very broad spectrum of business activity, with some lending themselves more towards home working than others. On the whole, members have introduced widespread home working, with the majority of staff who are able to work from home doing so. Where necessary some staff are still attending premises such as warehouses and manufacturing sites. In these circumstances employers should ensure that employees are able to follow Public Health England guidelines.
For members with staff working on site, as part of its guidance for schools, colleges and local authorities on maintaining educational provision, the government has published a list of critical sectors in relation to the COVID-19 response. Schools should continue to offer provision for children of parents "whose work is critical to the COVID-19 response" including "those who work in health and social care and in other key sectors".
Guidance for childcare
Guidance for employers
Business Conditions – BDIA members
The CDO England’s third update to General Dental Practices and Community Dental Services issued on 25th March stated that: All routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise. Similar advice has been issued across the Devolved Administrations. Following this, members have reported that pretty much all sales of dental products and equipment have reduced to a fraction of what they had been, with general dentistry effectively shut down. Members have also been reporting some customer payment issues. Some sales of PPE, where available, continue, as does a very small amount of product to support the provision of emergency dental treatment.
In other areas:
Following urgent calls from the BDIA and a number of other medical device stakeholder organisations in light of the coronavirus outbreak, the European Commission has recently announced that it is working on a proposal for the delay of the entry into force of the Medical Device Regulation by one year to May 2021.
Despite the COVID-19 position, discussions are continuing on the UK’s future relationship with the EU, although both Chief Negotiators are self–isolating after displaying disease symptoms. The first meeting of the Withdrawal Agreement Joint committee was held by teleconference on 30th March.
Over the last weeks NHS England and the Devolved Health Authorities have published details of financial packages for dental practices, which we have reported in detail to members, as dental practices have effectively ‘closed down’ following the guidance provided to them by the CDOs and health authorities, with some confusion remaining over the provision of emergency dental treatment.
Our colleagues at the BDA are currently focussing on the following main issues affecting your dental customers:
- NHS Payments - Seeking clarity on payments for NHS dentists in all four UK countries. In England the BDA hopes to confirm that mixed NHS/private practices will continue to receive their NHS contractual payments and it wants these practices to be able to then access wider Treasury support in direct proportion to their private commitments.
- PPE - The issue of what PPE is essential in which circumstances has been a hot topic since the start of the coronavirus outbreak. The BDA await updated advice on PPE, with the four Chief Dental Officers working together.
- Urgent care centres - The development of urgent dental care systems is of huge importance to the profession and the BDA has 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 remains an issue. In Northern Ireland the new dental emergency centres are currently being phased in.
- Redeployment – Currently each nation has variously set up a process for seeking dental volunteers to help with both urgent care and the wider NHS effort.
- Self-employment - The Chancellor confirmed a package for self-employed workers last week which excluded anyone earning over £50,000. This has an impact on dentists and those in private practice with no access to ongoing NHS earnings. The BDA is raising this with the Chancellor.
Public Health England PPE update
Update: 31st of March 2020
Public Health England PPE update
Public Health England has issued a letter providing an update on the supply of Personal Protective Equipment under the coronavirus pandemic. The letter notes that NHS Supply Chain has, over the past two weeks, delivered 170 million FFP3 masks, surgical masks and other PPE equipment for NHS trusts and 58,000 other healthcare settings.
The letter states that every "GP practice, dental practice and community pharmacy" has received a PPE delivery. However, this claim has already been challenged, including by the British Dental Association.
The letter goes on to clarify PHE's current guidance as follows:
PPE for high-risk procedures
Recommended PPE to be used by healthcare workers delivering or assisting with an aerosol generating procedure including in Intensive Care Units or the hot zone of an Emergency Department:
long sleeved disposable gown
eye protection (disposable goggles or full-face visor).
PPE for other settings
Recommended PPE to be used by healthcare workers within one metre of a patient with possible or confirmed COVID-19 including staff working in hospitals, primary care, ambulance trusts, community care settings, care homes:
fluid repellent facemask
eye protection if there is a risk of splashing or exposure to respiratory droplets.
Read the letter
Support for self-employed announced
Update: 27th of March 2020
The Chancellor has announced a grant scheme to support the self-employed as part of the Government's package of measures during the coronavirus crisis.
Under the scheme, self-employed individuals may be eligible for a direct cash grant of up to 80% of their profits, up to £2,500 per month, for at least three months.
The scheme will be open to those with a trading profit of less than £50,000 in 2018-19 or an average trading profit of less than £50,000 from 2016-17, 2017-18 and 2018-19. To qualify, more than half of their income in these periods must come from self-employment. Eligible individuals will be contacted by HMRC.
HMRC guidance, including additional details on eligibility criteria, can be found below along with a further link to the Government's Business Support page with information on the full range of support measures announced to date.
Read the announcement
Read the HMRC guidance
Coronavirus Financial Support
Movement advice for Critical Workers
Update: 26th of March 2020
Earlier this week the Government announced a new set of measures to tackle the spread of coronavirus, including that employees should only travel to and from work where this work "absolutely cannot be done from home".
As our survey last week revealed, many BDIA members have already implemented very significant levels of home working. However, it is clear that the work of some employees of member companies may not be possible to be done from home.
Furthermore, those involved in the health and social care supply chain "including producers and distributors of medicines and medical and personal protective equipment" have been included in the Government's list of Critical Workers in relation to school closures.
Accordingly, a group of leading life sciences associations has suggested the following principles that employers may wish to consider in relation to employees they have identified as carrying out essential activities:
- Employees travelling to carry out essential activities should carry with them a letter bearing the logo of their employing organisation.
- The letter should state that they qualify as a critical worker under the Government’s classification and have the necessary qualifications and endorsements to carry out their duties.
- Employees should carry with them photographic identification.
Further clarification on this issue is currently being sought. We will advise members of any changes to this advice based on the latest recommendations from Government.
Updated NHS England advice for dentists
Update: 25th of March 2020
NHS England has issued updated advice for general dental practices and community dental services regarding the ongoing COVID-19 pandemic. The latest guidance more closely aligns the advice for England with that already issued to dental teams in Scotland, Wales and Northern Ireland. It states that for primary dental care services:
1. All routine, non-urgent dental care including orthodontics should be stopped and deferred until advised otherwise.
2. 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.
3. Patients whose condition cannot be managed by these means will need to be referred to their Local Urgent Dental Care system.
4. All community outreach activities such as oral health improvement programmes and dental surveys should be stopped until advised otherwise.
The letter also sets out NHS England’s arrangements for contracts and funding. These measures include:
- Changes to 2019-20 contract reconciliation.
- Revision of the 2020-21 contract to reflect service disruption due to COVID-19.
- Cashflow - maintaining monthly payments in 2020-21 too all practices equal to 1/12th of their current annual contract value.
- Contract value and reconciliation - working to finalise an approach to contract value and reconciliation for 2020-21, taking account of the following principles:
- contract delivery and year end payment for the period of the COVID-19 response should be assumed to have been maintained at a level that allows continued employment of staff (despite reduced actual activity).
- Practice staff should be available to offer capacity to other NHS priority areas and this will include helping to staff the new Nightingale Hospital that is being established in London and other similar facilities that may be established over the coming weeks
- That all staff are paid at previous levels.
- Payments based on an agreed and fair reduction for any variable costs associated with service delivery (e.g. in recognition of reduced consumable costs) will be applied to all contract values.
- Practices benefiting from continued NHS funding will not be eligible to seek any wider government assistance to small businesses which could be duplicative.
Read the letter
BDA criticises NHS England advice for dentistry
Update: 25th of March 2020
The British Dental Association has criticised the clinical advice issued to dentists in England, saying that it has failed to offer the clarity and support that has been seen in the devolved nations.
Authorities in Wales, Scotland and Northern Ireland have all issued guidance recommending that routine dental treatment cease, that only emergency cases are treated and to limit contact to protect both patients and staff.
The BDA has described the response in England, which still allows for some routine treatment despite uncertainty around protective equipment and protocols and does not offer the financial support measures seen elsewhere in the UK, as a threat to the future of NHS dental services.
Read the press release
COVID-19: Government announces new restrictions
Update: 24th of March 2020
The Prime Minister has announced a range of new restrictions and measures in response to the coronavirus crisis.
From today, people will only be allowed to leave their homes for the following purposes:
- shopping for basic necessities, as infrequently as possible
- one form of exercise a day - for example a run, walk, or cycle - alone or with members of your household;
- any medical need, to provide care or to help a vulnerable person; and
- travelling to and from work, but only where this is absolutely necessary and cannot be done from home.
To ensure compliance with its instruction for people to stay at home, the Government will immediately:
- close all shops selling non-essential goods, including clothing and electronic stores and other premises including libraries, playgrounds and outdoor gyms, and places of worship;
- stop all gatherings of more than two people in public – excluding people you live with;
- stop all social events, including weddings, baptisms and other ceremonies, but excluding funerals.
Additional guidance has also been made available and can be accessed below.
At this stage, and in the absence of a specific definition from the Government, there remains uncertainty around the term "absolutely necessary" as it relates to businesses and jobs. We are seeking clarification on this point and will circulate any updates to members.
Read the update
Read the guidance
Coronavirus Business Interruption Loan Scheme - Stakeholder Briefing
CDO Wales update - dentistry moved to red alert
Update: 23rd of March 2020
Further to last week's update from CDO Wales, Colette Bridgman, of an amber alert for dentistry, this has now been upgraded to a red alert.
As a result of the change, the CDO has advised the following for dental teams in Wales:
- Routine scheduled dentistry needs to cease for the time being.
- Aerosol generating procedures (AGP), that are being avoided, should now stop.
- Dental team members who are pregnant or otherwise immunosuppressed should not provide or assist in the direct care or assessment of patients.
- Practices and services can remain open (via a local rota and skeleton staff) and should make every effort to triage, advise and reassure patients who have a dental problem by telephone. This will avoid patients travelling and presenting at the practice or clinic, to minimise contact with people with symptoms or with those who are infected but asymptomatic.
- Dentists can offer remote prescription, analgesics and antimicrobials, by contacting local pharmacists. The pharmacist can supply a medicine provided the dentist undertakes to provide a physical prescription within 72 hours of making the request (Human Medicines Regulations).
- All dental treatment that can be should be delayed at present.
Treatment should only continue using "robust PPE procedures", where patients are asymptomatic and only to meet urgent need. Urgent treatments that cannot be delayed and that require aerosol generating procedures are to be referred to the team's Health Board designated Emergency/Urgent Dental care centre.
The letter also advises of 4% flexibility for 2019/20 contract delivery, whereby up to 4% of UDA activity can be credited toward meeting the 100% contract target.
CDO Wales letter
Update: 23rd of March 2020
The British Business Bank has provided additional information concerning the Coronavirus Business Interruption Loan Scheme, which is available as of today.
The key benefits of CBILS highlighted for SMEs are:
Up to £5m facility: The maximum value of a facility provided under the scheme will be £5m, available on repayment terms of up to six years.
80% guarantee: The scheme provides the lender with a government-backed, partial guarantee (80%) against the outstanding facility balance, subject to an overall cap per lender.
No guarantee fee for SMEs to access the scheme: No fee for smaller businesses. Lenders will pay a small fee to access the scheme.
Interest and fees paid by Government for 12 months: The Government will make a Business Interruption Payment to cover the first 12 months of interest payments and any lender-levied fees, so smaller businesses will benefit from no upfront costs and lower initial repayments.
Finance terms: Finance terms are up to six years for term loans and asset finance facilities. For overdrafts and invoice finance facilities, terms will be up to three years.
Security: At the discretion of the lender, the scheme may be used for unsecured lending for facilities of £250,000 and under. For facilities above £250,000, the lender must establish a lack or absence of security prior to businesses using CBILS. If the lender can offer finance on normal commercial terms without the need to make use of the scheme, they will do so.
The briefing document below sets out SME eligibility criteria and also signposts to other support resources available.
COVID-19 Support for Businesses - Job Retention Scheme
Update: 23rd of March 2020
On Friday 20th March the Chancellor announced the Coronavirus Job Retention Scheme as part of the government's package of measures to support businesses and employees. Under the scheme, all UK employers will be able to access support to pay part of their employees' salary for those employees that would otherwise have been laid off during the coronavirus crisis.
To access the scheme, employers will need to:
· designate affected employees as ‘furloughed workers,’ and notify employees of this change - changing the status of employees remains subject to existing employment law and, depending on the employment contract, may be subject to negotiation
· submit information to HMRC about the employees that have been furloughed and their earnings through a new online portal (HMRC will set out further details on the information required)
HMRC will reimburse up to 80% of furloughed workers wage costs, up to a cap of £2,500 per month.
This support is in addition to other measures such as the Coronavirus Business Interruption Loan Scheme. Further details of all government support for businesses can be accessed below.
COVID-19 support for business
Updated CDO England preparedness letter
Update: 20th of March 2020
CDO England, Sara Hurley, has issued an updated preparedness letter to primary care dentists. The update follows her response yesterday to the British Dental Association's request for up-to-date guidance.
In today's letter, the CDO advises dentists to ‘consider the potential risk of asymptomatic cases attending in this delay phase and reduce exposure of staff and patients to infection by avoiding all aerosol generating procedures wherever possible’.
Formalising guidance referred to in her previous letter, the CDO asks practices to:
1. Radically reduce the number of routine check-ups by cancelling patients from vulnerable groups (and offering cancellation to anyone else who wishes to do so) to reduce the need to travel and have close contact with others in waiting rooms and surgeries. This will also conserve supplies of PPE for urgent care and free up capacity for urgent and necessary care that cannot be delayed.
2. Agree local arrangements to consolidate, where necessary, the provision of any essential, routine NHS work that cannot be delayed and urgent dental problems. Services should not be delivered to those with potential covid symptoms or those in their households, following the current guidance. Information about this service should be available to all potential patients and at any point of referral.
3. Set up mechanisms to establish whether any potential patient or anyone in their household has symptoms, prior to any visit, by phone or text.
4. Consider the potential risk of asymptomatic cases attending in this delay phase and reduce exposure of staff and patients to infection by avoiding all aerosol generating procedures wherever possible.
5. Clearly display the materials on COVID-19 available on the website https://www.england.nhs.uk/coronavirus/primary-care/
6. Use robust infection control procedures, wiping down surfaces between patients with extra vigilance to include door handles etc. and use standard PPE – We have set out new guidance on the use of full face visors as an alternative for certain situations to masks and eye protection.
Practices are asked to exercise clinical judgement in applying this guidance, and to refer patients who have COVID symptoms to local services which are being set up who will have appropriate facilities and PPE for these patients.
CDO England letter
COVID-19 'key worker' definition published and dentists may be redeployed
Update: 20th of March 2020
'Key worker' definition
As part of its guidance for schools, colleges and local authorities on maintaining educational provision, the government has published a list of critical sectors in relation to the COVID-19 response.
Schools should continue to offer provision for children of parents "whose work is critical to the COVID-19 response" including "those who work in health and social care and in other key sectors".
Clarification on "health and social care" is provided as follows:
Health and social care
This includes but is not limited to doctors, nurses, midwives, paramedics, social workers, care workers, and other frontline health and social care staff including volunteers; the support and specialist staff required to maintain the UK’s health and social care sector; those working as part of the health and social care supply chain, including producers and distributors of medicines and medical and personal protective equipment.
The guidance continues by stating that if workers think they fall within one of the critical categories they should "confirm with their employer that, based on their business continuity arrangements, their specific role is necessary for the continuation of this essential public service."
Critical sectors and key workers
Dentists could support other NHS sectors
The government's Coronavirus Bill 2020 could mean that dentists may be asked to redeploy across the NHS to support the workforce in other areas.
"Medical practitioners and other healthcare workers from a range of disciplines and settings are likely to be required to help deal with a coronavirus outbreak. For example, dentists and GP practice nurses may be asked to assist staff in NHS hospitals in administering injections and medication that would normally only be administered by hospital medics."
No further information is available as yet. We will be closely monitoring any further developments in this area.
Coronavirus Bill summary
BDIA Updates and New Comms, Guidance for Dentists and the Dentistry Show is postponed
Update: 18th of March 2020
BDIA Resilience Plans
Your Association has drawn up a COVID-19 Resilience Plan for its own ongoing operations in order to continue to provide members with timely and helpful information and services.
We have produced a short video to bring you all up to speed on what the BDIA is doing.
A new BDIA Comms Tool – “FONE IN FRIDAY”
With an increasing number of members working from home where possible and a significant number of uncertainties facing the industry, the BDIA is trialling a new open telephone chat for members planned for Friday afternoons from 3.00- 4.00pm.
Members are invited to call in any time between 3.00—and 4.00pm, starting this Friday afternoon - 20th March - to join an open informal teleconference chat with BDIA staff and any other members who have dialled in to discuss and share dental industry issues, concerns, updates and news. We hope to use this platform as an exchange of ideas and views, as well as further expanding the BDIA’s ‘on the ground’ knowledge of day-to-day operational issues in these difficult times.
You can find joining details below – why not give it a go and see who else has rung in:
Meeting ID: 611 720 551
+44 203 051 2874 United Kingdom
+44 203 481 5237 United Kingdom
+44 203 481 5240 United Kingdom
+44 131 460 1196 United Kingdom
Find your local number: https://zoom.us/u/advdtkgDcj
Guidance for Dental Practices - England, Scotland and Wales
The British Dental Association has written to CDO England, Sara Hurley, requesting clarity from government for dental practices as no updates have been provided to NHS dentists’ standard operating procedures in England since the World Health Organisation declared a pandemic and the government stepped up its response to containing the spread of the virus. We understand that guidance for England should be published soon.
Scotland’s CDO, Tom Ferris, has issued guidance outlining contingency measures and the financial support being put in place to mitigate the disruption of service caused by the COVID-19 outbreak in Scotland.
The Welsh CDO, Colette Bridgman, has recently issued a letter moving Welsh Primary Care Dental teams on to Amber Alert on the basis that ‘providing routine dentistry as normal is no longer sustainable.
Dentistry Show and British Dental Conference postponed
Closer Still Media has decided to postpone the British Dental Conference and Dentistry Show (BDCDS) and the Dental Technology Showcase (DTS) 2020. They will now take place on Friday 4 and Saturday 5 September 2020 at the Birmingham NEC.
Useful Government information sources on COVID – 19
Update: 18th March 2020
COVID-19 Financial Measures, Emergency Legislation and Research
Government Economic Intervention – Business Support
The government has introduced a package of financial measures in response to COVID-19 which includes £330bn in loans, £20bn in other aid, a business rates holiday, and grants for retailers and pubs. Help for airlines is also being considered.
The package of measures to support businesses include:
• a statutory sick pay relief package for SMEs
• a 12-month business rates holiday for all retail, hospitality and leisure businesses in England
• small business grant funding of £10,000 for all business in receipt of small business rate relief or rural rate relief
• grant funding of £25,000 for retail, hospitality and leisure businesses with property with a rateable value between £15,000 and £51,000
• the Coronavirus Business Interruption Loan Scheme to support long-term viable businesses who may need to respond to cash-flow pressures by seeking additional finance
• the HMRC Time To Pay Scheme
Details of the government support can be found here.
Business Support Helpline
Companies can also contact the government’s Business Support Helpline for free advice.
Business Support Helpline (England)
Telephone: 0300 456 3565
Monday to Friday, 9am to 6pm
Find Business Support Scotland
Telephone: 0300 303 0660
Textphone: 0800 023 2071
Monday to Friday, 8:30am to 5:30pm
Business Wales Helpline
Telephone: 0300 060 3000
Monday to Friday, 8:30am to 5:30pm
Invest Northern Ireland
Telephone: 0800 181 4422
Monday to Friday, 8:30am to 5pm
In his announcement yesterday the Chancellor promised that if this package was not enough, he would go further.
Emergency measures to give ministers powers to take timely action to respond effectively to the progress of the coronavirus outbreak will be introduced to parliament this week. The DHSC states that measures in the Coronavirus Bill are temporary, proportionate to the threat we face, will only be used when strictly necessary and be in place for as long as required to respond to the situation. Measures will include new laws to protect public health, increase NHS capacity, strengthen social care and support the public to take the right action at the right time.
There will be additional employment protections and compensation for those volunteering in health and social care, and highly skilled health and care staff will be protected where they go above and beyond their day-to-day duties or return to the frontline as part of mass mobilisation. The new laws are intended to protect life and the nation’s public health and ensure NHS and social care staff are supported to deal with significant extra pressure on the health system.
In summary, the key measures fall into five categories:
• Containing and slowing the virus
• Easing legislative and regulatory requirements
• Enhancing capacity and the flexible deployment of staff across essential services
• Managing the deceased in a dignified way should we experience excess deaths
• Supporting and protecting the public to do the right thing and follow public health advice
A summary of the Bill can be read here.
Imperial College Modelling
Imperial College has recently published one of the scientific papers that has re-shaped recent government policy on COVID-19. The paper looks at non-pharmaceutical interventions to reduce COVID-19 mortality and healthcare demand. It contains some quite concerning data and shows various outcomes for a number of mitigation scenarios. Under all scenarios the peak infection (critical care beds occupied per 100,000 population) level falls between mid-April and mid-June, providing some insight into the protracted requirements of ‘lockdown’. It also covers the possibilities of a ‘second wave’ (November – December) based on various mitigation strategies.
The paper can be read here.
Update: 17th March 2020
Following yesterday’s Government press conference on COVID-19 (Coronavirus), the following guidance on social distancing and vulnerable people has been published:https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
You can also follow the DHSC Twitter feed at: https://twitter.com/DHSCgovuk/status/1239648471994507266
Minister of Health, Matt Hancock, statement made on 16th March 2020.
The Secretary of State for Health and Social Care, Matt Hancock addressed the House of Commons on the evening of 16th March. A link to the speech can be found here: https://www.gov.uk/government/speeches/controlling-the-spread-of-covid-19-health-secretarys-statement-to-parliament.
Update: 16th March 2020
National Supply Disruption Response
Steve Oldfield, Chief Commercial Officer at the Department of Health & Social Care (DHSC), has issued a letter to suppliers regarding the government's response to the ongoing COVID-19 outbreak.
The letter, which is tailored toward NHS supply, advises that the National Supply Disruption Response (NSDR) will be stood up to monitor the situation and provide resolutions. As per NSDR plans for EU Exit, suppliers are requested to follow "usual mitigation procedures" in the first instance to seek resolutions. NSDR processes will address supply disruption incidents where normal procedures and mitigations are unable to provide a resolution. Information is provided outlining actions that should be taken in the event of supply disruption to your supply arrangements for products and services.
The letter is available here: https://bdia.org.uk/BDIA/media/Documents/Newsletter%20documments/200313_NSDR_1_.pdf
Office for Life Sciences Bulletin
The Office for Life Sciences (OLS) has provided an update on the business impact of COVID-19. The update summarises recent government guidance, and also requests evidence from businesses on:
The impacts across supply, demand and labour markets
Actions being taken by firms to address these impacts
Any gaps in the Government response from your perspective.
Members are invited to submit any such information to firstname.lastname@example.org directly, or to Adam Stanley on email@example.com to form part of a BDIA submission. Any information we receive will be treated in strictest confidence.
The bulletin can be viewed here: https://bdia.org.uk/BDIA/media/Documents/Newsletter%20documments/13-03-20-Office-for-Life-Sciences-Bulletin.pdf
13th March 2020
The BDIA has pulled together some key Government websites providing information on Coronavirus (COVID – 19) which may be helpful to members.
UK Government Response: https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response
This site contains NHS information, guidance for organisations, travel guidance, the number of cases and risk in the UK, and the UK Action Plan. This is the key resource for the latest information and advice.
Guidance for employers and businesses: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/guidance-for-employers-and-businesses-on-covid-19
This site provides Government guidance specifically to support employers and businesses with their preparations. This provides guidance on what to do if someone suspected or confirmed to have COVID-19 has been in business settings; what advice to give to individuals who have travelled to specific areas; and actions to take if staff come into contact with someone who is self-isolating or is a possible or confirmed case of COVID-19.
The Government is focusing its public information campaign on the importance of hand washing, stressing the importance of washing hands more regularly and for twenty seconds, which can be found on the link below.
Special Business Readiness Bulletin
The Department for Business, Energy & Industrial Strategy has published a special bulletin briefing for trade associations concerning COVID-19. The bulletin summarises business support announce in the recent Budget, including new business loan facilities, changes regarding statutory sick pay, small business grants and business rates changes.
See the link here: https://bdia.org.uk/BDIA/media/Documents/Newsletter%20documments/Special_Business_Readiness_Bulletin.pdf
We will update this site regularly when new information is available
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