coronavirus

BES announces new Covid-19 research grant

The British Endodontic Society (BES) has announced a new research grant of up to £40,000 in response to the current Covid-19 pandemic. The Society is inviting proposals from UK-based applicants wishing to undertake short-term research that addresses or mitigates the impacts of Aerosol Generating Procedures (AGPs) during the Covid-19 outbreak.

“The impact of Covid-19 on dentistry has been significant and as we begin to return to the ‘new normal’, we face a complex and evolving situation” said Dr Sanjeev Bhanderi, BES President. “There is an abundance of guidance available, but a common theme is the lack of robust evidence to guide the adoption of behaviours in practice. Many questions surround AGPs in dental practice and the interaction of these with Covid-19 so the BES is investing in research that will lead to a better understanding” he finished.

Applicants do not need to be BES members and the closing date for submissions is 15 July 2020. The application process is outlined on the BES website and all applications will be considered by the BES research panel appointed by the BES Council. Due to the immediacy of this research, the successful applicant will be notified by July 31st 2020. https://britishendodonticsociety.org.uk/profession/grants/call-for-research-to-address-the-impact-of-aerosol-generating-procedures-in-dentistry-with-respect-to-covid-19/

NASDAL offers clarification on SEISS

The National Association of Specialist Dental Accountants and Lawyers (NASDAL) have welcomed clarification on the potential issues that may arise when dentists were eligible to claim the Self-Employment Income Support Scheme (SEISS) grant whilst also receiving their usual level of NHS income. It was highlighted that the amount of grant received may exceed the reduction of private income.

The eligibility criteria for the SEISS grant requires that you have been adversely affected by Covid-19 and that your average self-employed earnings (from all sources) over the last three tax years have not exceeded £50k pa. HMRC have confirmed that if part of a dental practitioners’ income (private income) reduces, but another part remains the same (NHS income), it is legitimate for a claim to be made in full and retained.

Alan Suggett, specialist dental accountant partner in UNW LLP and NASDAL Media Officer, said, “We have received communication from the BDA following discussions with NHS England on this matter and they confirmed that receiving both NHS income and the SEISS grant does not constitute a duplication of wider government support and therefore does not breach any of the terms of the NHS contract payment arrangements.”

Fellow NASDAL accountant Johnny Minford of Minford & Co, who has a number of clients in Northern Ireland, added, “However, our Principal colleagues in Northern Ireland still have a problem as the mechanism there does not permit a double claim and the choice is in the hands of associates. There could be practices where the associate has chosen to claim SEISS, so the practice gets NONE of the IOS payment due for the associates’ proportion of the healthcare.”

Dentists issue open letter to Matt Hancock

As dentists start re-opening across England, the British Dental Association (BDA) has issued an open letter to Health and Social Care Secretary Matt Hancock this morning, calling for urgent support to keep the service afloat and avert a likely collapse in patient access.

The professional body has said that it is now inevitable that patient access in England will fall below levels seen in access ‘hotspots’ such as West Yorkshire, Cornwall and Cumbria. With social distancing policies remaining in place, and most practices reporting their ability to deal with a quarter of previous patient numbers, the BDA has said there is no possibility of the service delivering anything more than a fraction of the 39.72m courses of treatment that were delivered by NHS in England in 2018/19. 

The BDA has also demanded urgent action from across government to provide clarity on key worker status – which has seen dentists unable to access childcare, to integrate the service into official PPE supply chains, and for ongoing financial support, including extension of business rates relief.  

Dentist leaders have said the conversation must now begin on replacing a model for the service that has been rendered irrelevant in the face of lower patient numbers and higher costs. Industry sources have estimated the PPE costs alone for certain courses of treatment have increased by up to 6,000%.

BDA Chair Mick Armstrong said: “Today, high street dentistry was meant to start resuming across England. The reality couldn’t be further from the truth. Few practices have opened their doors, and those that did were operating at a fraction of their pre-pandemic capacity. 

“The Health Secretary must now take responsibility to avert the existential crisis facing a service struggling with sky-high costs and radically reduced patient numbers. For years, communities from Cornwall to Cumbria struggled to get appointments but were ignored. Without action from this Government access problems – on an unprecedented scale – are going to be visited on millions of patients, in every part in England.”

NASDAL: Uncertainty reigns

The National Association of Specialist Dental Accountants and Lawyers (NASDAL) has called for clarification over a number of key financial issues affecting the profession.

Alan Suggett, specialist dental accountant partner in UNW LLP and NASDAL Media Officer said, “We quite understand that matters of patient safety and all things clinical taking are precedence in the current situation. However, dentists and practices need resolution on a number of financial and contractual issues. We cannot ignore the fact that dental practices are businesses. Indeed, a recent Dental Protection survey showed that more than one in two (53%) dental professionals said financial worries were having the biggest impact on their mental health in the face of Covid-19.

“A new NHS contract in line with the Prototypes must be introduced. The CDO (England) letter says “…mechanisms for the full 2020/21 contract year with the intention of reintroducing a link to delivery of activity and outcomes”. For the foreseeable future an activity-based NHS contract will be unworkable. Now is the time to implement the vision of the late Sir Jimmy Steele and achieve preventative dental care within a viable financial framework for NHS practitioners. Until this happens, our clients must attempt to make plans and financial forecasts with no idea of what the new NHS contract financial landscape will look like”

Other issues lacking clarity include NHS contract payment abatement, and duplication of government support e.g., SEISS, Bounce Back loans, and Small Business Rate Relief grants.

Johnny Minford, of Minford Dental Accountants commented, “in regard to SEISS, a number of difficult questions arise for dentists carrying out both the NHS and the private work. Many dentists earn more than the £50,000 threshold, but some don’t, for a variety of reasons.

The self-employed grant (SEISS) is paid if an individual’s taxable profit is less than £50,000, after capital allowances, but before pensions or superannuation. However, HMRC is unaware of any income under the NHS contract provisions. There is therefore a risk that the NHS Covid payment rules may be breached when the receipt of SEISS, in addition to NHS Covid earnings, exceeds pre-Covid income levels.

A recurring theme from the NHS is ‘reasonableness’. It is vital that NHS practitioners keep notes and records of the factors leading to decisions taken, and why they were made. This will give the best protection against comeback.”

Alan Suggett went on to add, “the fact that UK dentistry and healthcare are devolved, has further added to a sense of confusion. We would like the CDOs of England, Wales, Scotland and Northern Ireland, and the appropriate devolved administrations, to realise how vital clarity of financial matters is to NHS contract holders, and communicate this in a clear and unambiguous format as a matter of urgency. As a non–partisan association, NASDAL are happy to engage with and assist these parties with this vital task. The CDO (England) has stated that ‘all parts of the UK will be aligned’. However the differences in the systems of delivery of NHS dentistry mean that this cannot be achieved without an integrated plan dealing with technicalities.”

Dentists: PPE costs will cripple service, as millions set to go without care

Dentistry now faces financial meltdown, with costs of delivering care skyrocketing as practices  reopen, says the British Dental Association.

The cost of PPE only, ignoring other treatment costs, for treating a single patient using Aerosol Generating Procedures (AGPs) – using high speed instruments like a drill – was around 35-45p pre pandemic, and could now stand at £20-30 depending on exact PPE requirements and usage.

Higher end PPE is now required for AGPs that form the overwhelming majority of dental treatments, that involve the use of high speed instruments that can carry viral load into the air.

Industry sources estimate that the combination of intense competition and pressure on global supply chains for PPE and the PHE guidance for enhanced PPE required across non-AGP and AGP activity, means that PPE costs per patient could increase by around 7 times (or 700%) for non-AGP activity and around 60 times (or 6,000%) for AGP activity when compared with pre-COVID -19 activity.

Surgical face masks (type IIR) have increased in price from around 6-8p each pre-Covid to around 60p each today. New Public Health England PPE requirements for higher end PPE are requiring kit never previously needed, including respirator masks, and fluid resistant gowns required for both the dentist and a nurse. FFP2 masks are now ranging from around £4-£5 each, and disposable fluid resistant gowns around £5 each.

Practices face growing risk of financial collapse. With practices facing higher costs, and radically reduced patient numbers, practices report they will struggle to remain open. Only 8% of those polled by the BDA estimate being able to maintain financial viability based on anticipated patient numbers and added costs post lockdown.

Dentistry is currently reliant on commercial wholesalers for kit like masks. The BDA is pressing for urgent access to the government supply chain for PPE, and for the temporary VAT cut on PPE – that closes on 31 July – to be extended, and potentially to become permanent given widespread use across the UK economy.

PPE shortages are affecting the majority of high street dentists, with only 35% currently having the necessary PPE to resume face to face patient care. Levels of capacity in most practices reopening are less than 25% of pre-pandemic levels, potentially leaving millions without access to care.

The BDA has said it is now inevitable that patient access across England will fall significantly below levels seen in former access ‘hotspots’ such as West Yorkshire, Cornwall and Cumbria. Dentist leaders anticipate only a tiny fraction of the nearly 40 million courses of treatment delivered by NHS in England last year to be possible under current conditions.

BDA Chair Mick Armstrong said: “Dentists have little prospect of meeting the backlog built up during lockdown when we face PPE shortages and crippling increases in costs. Dental practices are businesses and the sums no longer add up. A service running on empty will barely be able to scratch the surface of even urgent cases. Normal service can only resume for millions of patients if government is willing to step in.”

PPE and RPE: Preparing for return to the Dental Surgery – webinar taking place at 6pm

The British Dental Conference and Dentistry Show is partnering with Dakatra, with support from the British Association of Dental Nurses, to produce a new webinar – PPE and RPE: Preparing for return to the Dental Surgery – this evening at 6pm. Those interested in taking part can register here for free.

Questions will be answered on PPE, RPE Fit Testing and the practicalities of returning to practice. The panel will comprise: Kariem El-Boghdadly, Consultant Anaesthiologist; Samy Darwish, Specialist Periodontist; Tarik Shembesh, Oral Surgeon; Cat Edney, Dental Therapist; Ashvin Babber, Dentist; and Rebecca Silver, Dental Nurse.

The panel aims to discuss the considerations required when using respiratory protective equipment in healthcare settings.

Objectives:
– To discuss the principles of respiratory protection and equipment.
– To differentiate between surgical masks & different types of respirators FFP1, FFP2, FFP3, reusable & loose fitting.
– To describe how this impacts the dental team and dental practice including routines and processes.
– Raise awareness on different employer and employee responsibilities.
– To discuss the potential impact Covid-19 has on the provision of dentistry and the PPE choices for the dental team.

Learning content:
The CPD event is aimed at Dental Professionals and their supporting staff to gain a better understanding of the principles of respiratory protection in the healthcare workplace through sharing guidelines, best practice & our experiences.

Development outcome:
The CPD event meets the criteria for the GDC’s development outcomes B, C & D.

As practices reopen in England, BDA Chair Mick Armstrong explains why it won’t be ‘business as usual’

BDA Chair Mick Armstrong explains why dentists opening from today (8 June) in England will not be ‘business as usual’ and calls for more support for dentists and their teams, to help get them back to work and treating patients in need, in this statement released:

I think we are all still recovering from the bombshell on that dentists would be able to open their doors to patients on 28 May, many of you read the news via the ticker tape on the BBC. This was nothing short of ‘disrespectful to the profession’ as my colleagues have pointed out numerous times on national TV and radio.

We knew that colleagues wanted to get back safely and effectively, for themselves, their staff and their patients. But the Government, once again, ignored what dentists had to say and implied to the public that dentists would all be opening and ready from 8 June.

We know that this will not be the case for many, here’s 5 things you need to know:

1. Managing patient expectations: a mountain to climb
This is not a return to ‘business as usual’. I know many of you will have had your phones ringing off the hooks. Colleagues have said to me they’ve had patients shouting down the phone to them, unable to understand why they can’t get an appointment next week.

Whilst we’ve said we are relieved to be able to get back to work, we weren’t given any notice, and we haven’t been given the right support from Government to help us get back to seeing our patients. We’ve been working hard to get dentist’s stories out in the local and national media, putting this announcement that first appeared on a BBC ticker and Matt Hancock’s ‘thanking’ us into some context.

Our spokespeople have been highlighting why huge numbers of patients can’t be seen – the backlogs, the lack of PPE, making changes to practice facilities to enable social distancing, the need for extended time between patients to decontaminate, the problems with getting staff back to work who’ve been redeployed or furloughed, and the issues for many staff in getting childcare, or who vulnerable and/or need to shield.

We’ve demanded clarity for dentists and their team members having ‘key worker’ status so they can access childcare if needed. We’ve been outlining what patients will experience when we do get back to work and when they do make it through our doors, so their expectations can be in line with our ability to treat them.

2. Shrinking stocks of PPE and rising costs
We’ve been saying since this crisis started that getting hold of the right PPE is one of our major issues. In the early days of the pandemic we asked dentists to donate their stocks to frontline hospitals, ICUs, GPs, pharmacies and care homes, and many of you generously did. This helped to keep many of our healthcare colleagues safe and prevent the spread to their patients. But this has left dentists without access to existing supplies with the price of even basic face masks jumping from pennies to pounds.

We’ve called on NHS England to include dentists in the supply chain, which they have now promised, but we know even some UDC centres are struggling with supplies. Industry sources estimate that the need for new kit and the pressure on the supply chain means PPE costs per patient will increase by 700% for non-AGP activity and around 6,000% for AGP, compared to pre-pandemic costs.

Our survey showed that less than one in five practices will be able to offer a full range of treatments, especially those that require AGP (which represents the overwhelming majority of modern dentistry), mainly because of a lack of kit. And we continue to hear some horrifying stories of Victorian and DIY dentistry that patients who are so desperate to get out of pain, are feeling the need to resort to because they can’t get to see a dentist. This cannot continue.

3. Ongoing financial support will be needed
For both NHS and private practices, we know that fewer patients and increased costs mean many of you are facing financial meltdown and closure – we’ve had some support, but if the Government pulls the plug on this, many contract holders may just walk away. The numbers simply won’t add up.

For private practices, we’ve been campaigning to ask for financial help, as most couldn’t access any of the Government support on offer, couldn’t get relief from business rates, and even those that are able to get back to work, we know the books will still be harder to balance. Without private care, NHS dentistry will be gridlocked, as patients will struggle to find anyone able to help them.

These problems have long term consequences for patients and the profession. England already had access problems, but now with these added challenges, we are likely to only be able to see a fraction of patients, as the queues get longer and longer.

4. Weathering this emotional rollercoaster: support for dentists’ wellbeing
I think physically and emotionally, a lot of dentists and their teams are in a very difficult place at the moment. I feel we are really now at rock bottom and I want to acknowledge that, in spite of the many who may be managing to ‘carry on’ and ‘make it work’, many more are faltering under the pressure.

What feels like endless last-minute missives from the Government, our regulators, and commissioners, confusing guidance, pages of documents to read, scared colleagues and team members, angry patients, making the finances add up – we are facing a perfect storm.

If you are struggling, please don’t feel you are alone, there is support out there – BDA members can access Health Assured, or you can try the Practitioner Advice and Support Scheme (PASS) via your Local Dental Committee. Dentists can also access the NHS Practitioner Support Programme, Dentists’ Health Support Trust, and ConfiDental. If you urgently need support, the Samaritans are willing to listen, at any time of day or night.

5. Together we are stronger
We’ve set out our case to government in an open letter to Matt Hancock. Lobbying is a key part of what we do. But throughout this crisis, we have been pulling our resources together to provide everything we can for our members. Our advice, services, toolkits and webinars have been designed solely to help support you through this crisis.

We’ve tried to keep you regularly updated and we will continue to do that, but we need your support too. We understand that dentists have been squeezed financially, and BDA membership might feel like a ‘dispensable’ cost. I would strongly urge you to remember that it isn’t – we can only continue to do what we do with the support of our membership. We can get through this, but only if we stand together.

Mick Armstrong, Chair
BDA Board

Oral Health Foundation teams with the French Dental Association and Unilever to launch Covid-19: Practical Guide

To assist to resumption of dental services, the Oral Health Foundation has joined with the French Dental Association and Unilever to release some simple and easy-to-follow recommendations. ‘Covid-19: Practical Guide’ is available to download here and is divided into five areas:

  • Organisation of the practice
  • Patients
  • Treatment
  • The provision of care
  • Bio cleaning and waste management

In addition, the Oral Health Foundation has produced further downloadable resources for dental practices that can be found at www.dentalhealth.org/coronavirus.

Dentists: Skeleton dental service going back to work at a fraction of pre-Covid capacity

There will be no return to ‘business as usual’ for dentistry as a little over a third (36%) of England’s practices prepare to reopen on Monday 8 June, at a fraction of their pre-pandemic capacity, a new poll for the British Dental Association (BDA) shows.

Evidence gathered from over 2,000 practices in England suggests:

  • The majority (over 60%) of dental practices estimate they will be able to treat less than quarter of the patient numbers they saw pre-Covid.
  • Barely 15% are in position to offer a full range of treatment, with capacity to offer Aerosol Generating Procedures (AGPs), using high speed instruments that constitute the majority of activity.
  • Key drivers include PPE shortages, with only 1/3 of practices having PPE to hand to provide face-to-face care, and only 25% reporting they have been fit tested to use them.
  • Dentists have also indicated other barriers with a high impact on their plans for reopening, including emerging from cash flow problems (78%), difficulties getting practices ready for social distancing (63%), and access to childcare (40%) – where failure to offer necessary clarity on their key worker status has seen children turned away from schools and nurseries.   

While over 80% of practices expect to reopen to some level by the end of June, major constraints will remain on the service. Decontamination and social distancing policies mean longer treatment slots, with surgeries sometimes sitting fallow between patients – leaving many practices unable to maintain their financial viability in the face of fewer patients and higher costs. 

The BDA has said these grim findings underline the need for support from government. It has called for immediate clarification on key worker status for dental team members, and action on PPE supplies.

Dental practices are among the only businesses on the high street still paying business rates, with even the bookmakers receiving rates relief. Sector leaders have also called for vital support like the furlough scheme – that 80% of practices have made use of – not to be pulled away prematurely when levels of clinical activity remain so low. 

BDA Chair Mick Armstrong said: “Anyone expecting dentistry to magically return on Monday will find only a skeleton service. Those practices reopening now face fewer patients and higher costs and will struggle to meet demand. Dentists returning to work still lack the support offered to our neighbours on the high street, and even clarity on key worker status when it comes to childcare. Ministers must change tack if dentistry is going to survive the new normal.”

The BDA poll covered dental practices in England, with 2,053 respondents (over a fifth of the estimated total of 10,000 practices). Fieldwork was completed between 1-4 June 2020.

Covid-19: Dental Protection survey reveals top 5 worries for dentists

A survey of dentists in the UK has revealed the key issues affecting their mental wellbeing during the pandemic. In the Dental Protection survey of nearly 500 dental professionals, five in 10 (53%) said financial worries were having the most impact on their mental wellbeing. Lack of work and lack of adequate PPE were cited by nearly 4 in 10 (37% and 38% respectively).

The survey also shows that dentists are more concerned about their patients’ health, than their own, with 43% saying concern for the health of patients is having the most impact on their mental well-being, and 34% saying they are concerned for their own health.

In March 2020, Dental Protection announced a support package, worth the equivalent of two months’ subscription for free, to acknowledge the concerns of dentists who have experienced a significant drop in their workload and a dramatic fall in income due to Covid-19.

In addition, it extended its counselling service for those dentists experiencing work-related stress due to the crisis. The service is provided through a third-party partner and is completely confidential.

Last week Dental Protection also reassured all members in England who choose to return to work that they will continue to be supported and set out some points for those operating in the private sector to consider when making the decision. 

Raj Rattan, Dental Director at Dental Protection, said: “Dentists are among the most dedicated healthcare professionals in the world. I am not surprised that so many have put the concerns of their patients’ health before their own in this survey. The extent to which financial worries are impacting on our members’ mental well-being is also evident and concerning. We hope that the subscription relief we have provided has made some difference, along with access to counselling. Many dentists have been hard-hit by the loss of income in recent months with the private sector most affected. It is difficult to predict how long it will take before practice activity returns to levels seen prior to the pandemic. We want to reassure all members that Dental Protection is here to offer support and in the event of a claim, complaint, or related inquiry arising from your decision to re-open, we are here if you need to request assistance.”