Your NHS dentistry and oral health update

Tuesday 21 September 2021 (Issue 26)

An update from Sara Hurley, Chief Dental Officer England

I warmly welcome Health Education England's review on Advancing Dental Care. Today's publication lays out an exciting vision for the future that will strengthen our dental teams by investing in the skills of trainees and qualified professionals, widening access to the profession, and promoting flexible working. My particular thanks go to Malcolm Smith at HEE who has worked hard to deliver this vision. Do take watch Malcolm's short summary of the report on Youtube.

In today's bulletin we have also included important resources from the NHSBSA to help patients and dental teams understand exemptions for NHS dental charges. Please do point patients and staff towards these as appropriate in your practice.

I'm pleased to receive such positive feedback on our special focus bulletin on paediatric dentistry and child oral health, which includes our new dental child recall implementation tool. Please do take a look if you missed it last week.

Best wishes and thanks,

Sara

Updated toolkit on Delivering Better Oral Health by Public Health England

Today Public Health England has published the fourth edition of Delivering Better Oral Health: an evidence based toolkit for prevention (DBOHv4). It is the result of a comprehensive review of the published research evidence on prevention to ensure that the guidance is up to date. It draws on a UK wide collaboration of over 100 well respected experts including frontline dental teams and, for the first time, patient representatives.

Dental professionals are in a prime position to help promote oral health and prevent oral disease. This toolkit helps busy dental teams and healthcare professionals have access to the best evidence of what works for oral health improvement all in one place.

What's new in today's updated toolkit?

• DBOHv4 has been developed through a broad UK collaboration of experts, frontline practitioners and for the first time patient representatives and is intended for use throughout dentistry in the UK.

• DBOHv4 has been published on gov.uk in a new digital format making it easily accessible on mobile devices.

• The summary tables (chapter 2) have not changed significantly but have new content on:
  • prevention of dental caries - new content on infant feeding;
  • prevention of oral cancer - new content on early detection and more detail on tobacco cessation and alcohol reduction;
  • a new table on tooth wear focusing on accelerated tooth wear.
• The importance of effectively supporting behaviour change is acknowledged with this chapter coming immediately after the summary guidance tables with practical examples as case studies.
• Throughout DBOHv4 there is a greater consideration of oral health improvement for older people and other vulnerable groups.​

New report on the future of the dental professional workforce

HEE have published the Advancing Dental Care (ADC) Review Report, the culmination of a three-year review to identify and develop a future dental education and training infrastructure that produces a skilled multi-professional oral healthcare workforce, which can best support patient and population needs within the NHS.

HEE has worked and engaged with trainees, patients and system partners to devise a clear blueprint for change to reform dental education and training, which includes widening access to dental careers and understanding the oral health needs of patients in specific communities, so the skills and competencies of the workforce can be targeted where they are most needed.

Over the next four years, HEE will continue to work collaboratively with system partners to deliver the recommendations of the ADC Review Report across each of England’s seven regions. The proposals include:

Skills development:

• Giving trainees diverse experience of managing complex care, co-morbidities, and a stronger understanding of the communities they serve in changing care models and pathways.
• Better use of the skill mix of the dental workforce and multi-disciplinary team working.
• Options for qualified dentists and dental care professionals to increase their knowledge and skills and develop new capabilities and competence, including leadership, management and research.

Widening access and participation

• More flexible entry routes into training, to widen access and participation and develop more dental professionals in areas of greatest need.
• Supporting the development of apprenticeships to diversify and promote the concept of a local dental workforce approach.
• Co-ordination and distribution of postgraduate training posts, so that it is better aligned to areas with the highest levels of oral health inequalities.

Flexible working:

• Flexible models of Dental Core and Specialty Training to support workforce retention and career progression and an equitable distribution of postgraduate dental training places.
• Digital and blended learning opportunities to deliver dental education and training.
• Options for less than full time training and career breaks, which can support differing lifestyles and wellbeing of trainees.

Encourage patients to check if they are exempt from NHS costs

The NHS Business Services Authority's 'Help with Health Costs' social media accounts are helping the public access online tools to understand if they are exempt from paying NHS costs. 

Patients can use the NHSBSA's useful checker online as well as check the online list of those exempt charge.

Please click on the links below to be taken to the latest NHSBSA social media posts which you can share from your practice's accounts.

Patient exemption checking: a communications toolkit for dental teams in England: This useful guide from NHSBSA for dental teams includes suggested social media content, social media images, printable posters and leaflets, and digital resources. 

Patient exemption checking: a guide for dental teams from the NHSBSA

For dental teams, any time a patient makes a declaration that they are entitled to free or reduced cost NHS dental treatment you must:

• ask them to complete and sign a declaration form (FP17PR) before any treatment begins  
• ask the patient to complete the ‘Claim for free or reduced cost NHS dental services’ section of the form, if they are entitled   
• ask to see evidence of their eligibility  
• note on your practice records if they show a valid exemption certificate, along with the expiry date of the certificate.

Patient exemption checking: a guide for dental teams in England: This guide for dental team members aims to improve your understanding of the rules as to whether a patient is entitled to free or reduced cost NHS dental treatment.

Government consultation on making vaccination a condition of deployment in the health and wider social care sector

Please share your perspectives on whether or not COVID-19 and flu vaccination should become a condition of deployment in healthcare and wider social care settings.

Following a public consultation on making COVID-19 vaccination a condition of deployment for those working in adult care homes, the government recently announced that COVID-19 vaccination would be required of people working or volunteering in  CQC-regulated adult care homes which provide personal or nursing care, in order to protect vulnerable residents. While residents in adult care homes are some of the most at risk from COVID-19, the responses to this initial consultation made a clear case for extending this policy beyond adult care homes to other settings where vulnerable people receive care and treatment.

The Government is therefore now undertaking a further public consultation on whether or not to make COVID-19 vaccination a condition of deployment for other frontline health and social care workers to help protect vulnerable people. The consultation also explores whether flu vaccination should be a condition of deployment given the risks from flu and of flu and Covid co-circulating.

Please take part in the consultation and share your perspectives on whether to make vaccination a condition of deployment in healthcare and the wider social care sector. 

To put forward your views on the proposed policy, please click the link below. This consultation closes at 11:45pm on Friday 22 October 2021.

Making vaccination a condition of deployment in the health and wider social care sector - GOV.UK (www.gov.uk)

These are complex and important issues and the consultation seeks to gather a wide range of perspectives from across the health and social care sectors about whether such requirements should be introduced and how they could be implemented.

Tackling loneliness: a new module from Health Education England

Health Education England have launched a new module on tackling loneliness and social isolation. This module will help health and care professionals understand the importance of loneliness and social isolation, and potential negative health outcomes; recognise and understand risk factors; cover evidence-based interventions; and provide practical advice on having meaningful and compassionate discussions with people who are lonely and isolated.

Further information is on the page Tackling Loneliness and Social Isolation - module.

You will need to register with E-learning for Healthcare to access this module and it is suitable for all staff working in primary care.

NHSBSA's September dental bulletin

The NHSBSA has published it's September update with key information for dental providers and performers, articles include:

• Patient exemption: guidance for dental teams
• Orthodontic PAR scores
• Your Annual Pensionable Earnings and Contribution Statement (SD86C)
• New data items on general dental activity forms
• Replacement form submission
• GDS and PDS contracts: year-end reconciliation
• Our Knowledge Base
• NHS Pension Scheme guidance

You can read the NHSBSA's dental bulletin online.

Latest news from the General Dental Council

September newsletter

The General Dental Council (GDC) has published it's September newsletter, with important news for the dental profession, including:

• The number of registered dental care professionals (DCPs) in the UK has remained stable at 69,625 at the beginning of August, an increase on the 2020 figure of 68,871. 
• Around 2,400 DCPs did not make a CPD declaration by the deadline this year, even though they had paid their annual renewal fee. The GDC are now contacting DCPs in this position to let them know their registration is at risk, and that they now need to submit a completed compliant declaration in order to remain registered.
• The Medicines and Healthcare products Regulatory Agency (MHRA) has notified the GDC that a product manufactured by Global Dental Transfer Ltd., a company based in Israel, has been sold to dentists in the UK. The product, PerioFocus biodegradable periodontal chip containing chlorhexidine gluconate, is marketed as a medical device. Global Dental Transfer does not have a UK distributor and has no presence in the UK. An identical product, the Periochip 2.5mg Dental Insert, is manufactured by the UK Dexcel-Pharma Ltd., and is  licensed as a medicine. The import of an unlicensed medicine in the course of business is a breach of UK regulations (in the absence of a licence to import unlicensed medicines). All dental professionals are reminded to only use UK licensed medicines to treat dental patients. Further guidance is available from the UK Government website.

Pay by installments for your annual retention fee

A new pay by installments option for the Annual Retention Fee has been introduced to support dental professionals who pay their own fee by enabling them to spread the cost over the year with quarterly Direct Debits. More information is available on the GDC website.

HMRC: Employment status guidance for Associate Dentists to be withdrawn with effect from 6 April 2023

The below message is shared on behalf of Her Majesty's Revenue and Customs (HMRC):

From 6 April 2023, we will be updating our Employment Status Manual (ESM) to remove specific occupational guidance for Associate Dentists (ESM4030). 
                                
Where a contract either runs from or over 6 April 2023, Associate Dentists and their engagers won’t be able to rely on ESM4030 to determine the employment status for tax of that contract.

Updates to our general Employment Status Manual, and the availability of the Check Employment Status for Tax (CEST) tool on GOV.UK, have removed the need for much of our traditional occupation specific guidance.

There has been no change in the rules, and removing ESM4030 does not mean we have changed our view on the employment status of Associate Dentists. In future however, we are asking Associate Dentists, or those who engage Associate Dentists, to make an assessment of employment status in the same way as other customers in the dental sector and elsewhere. CEST offers a quick and easy way to do this.

Customers can continue to use ESM4030 until it is withdrawn on 6 April 2023.  HMRC will not be using the withdrawal of the guidance as a reason to open retrospective enquiries into periods prior to 6 April 2023.

If after consulting our guidance you still have questions about determining employment status, you can contact the HMRC employer’s helpline on 0300 200 3200.

By Word of Mouth ... the colleagues we're all talking about!

This edition's shout out goes to our colleagues in the Royal Army Dental Corps, who are celebrating their centenary. RADC delivers good dentistry both in barracks and in active operations. 

Learn more online about the RADC's centenary and how the Corps have responded to the pandemic.

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Previous NHS dentistry and oral health bulletins 

Previous bulletins can be accessed by clicking on the links below:

NHS primary care bulletin

The NHS primary care bulletin provides resources on health policy and practice and we encourage you to sign up for this, too. It is aimed at teams across general practice, dentistry, community pharmacy and optometry. 

COVID-19 advice, guidance and resources

Communications resources for NHS dental practices

Click on the links below to view and download useful communication resources:

• Click here for social media image cards and patient leaflets
• Click here for social media assets and posters explaining IPC requirements
• Click here to download website/social media copy and scripts for answer machine message, text message and emails.

NHS updates to the profession 

Key letters from the Chief Dental Officer and the NHS dentistry and oral health team are online here. 

Transition to Recovery: Dentistry's standard operating procedure

The latest version was published on Friday 16 July 2021. Changes to the previous SOP are in yellow. You can read the SOP online here. 

COVID-19: infection prevention and control dental guidance

The guidance is an appendix to and should be read in conjunction with the national guidance on infection prevention and control for COVID-19 . You can read the general guidance and the specialist dental appendix online here.

Avoidance of doubt note: provision of phased treatments

This document is to support dental professionals, and to clarify where it might be appropriate to provide phased treatment spanning over several courses of treatment (CoT). You can read it online here.

Health and wellbeing support