Your NHS dentistry and oral health update

Tuesday 22nd December 2020

An update from Gabi Darby and Sara Hurley

Dear colleague,

As the NHS continues to respond to this unprecedented public health incident, we want to offer our sincere gratitude for the commitment and professionalism that you and your teams have shown in this rapidly evolving situation. As Sara said in the NHS' Christmas tribute to those working in primary care, your compassion and dedication has been truly humbling.

During the last period of national restrictions, NHS dental services remained open. We can confirm that regardless of the tier an area is in, NHS dental services in England should remain open to treat patients in line with the standard operating procedure and the national infection prevention control guidelines for dentistry, which remain unchanged. Private practices can also remain open. This was confirmed on Sunday on the Government's Tier 4 web pages.

Today, we have written to all dental providers with the detail of the contractual arrangements for Q4 which can be found here. These are good arrangements that achieve two crucial things. First they maximise patient access and second they recognise the constraints practices are under.

Throughout the last 9 months, whilst continuing to receive their monthly 1/12th ACV for meeting certain conditions, dental practices have adapted and have safely delivered a consistent trend of increasing access and are offering a broader range of clinical activity to patients. The management of patient flow with social distancing, the establishment of clinical bubbles, familiarity with practice processes and IPC protocols, along with the revision of post AGP down time have all supported the increasing trend in attendance rates and activity.

The targets reflect the need to make improvements in patient access to NHS care when the evidence shows that there is clinical need and that practices have capacity to deliver the 11.25% of their annual UDA contract and 17.5% of their annual UOA contract that these targets equate to before the end of Mach.

We know that many practices are in fact going beyond the target level and would encourage all who are able to do safely in line with operating procedures to continue to do so, making full use of NHS funding for the benefit of patients.

There may be exceptional circumstances when these activity targets may not be deliverable. That's why we have asked NHS commissioners to use discretion to make exceptions. Further detail is set out in the associated guidance which can be found here.

We're also pleased to confirm that lateral flow antigen testing is being rolled out to all front-line patient facing NHS dental staff. This is an important step in empowering practices to stay open and see as many patients as possible. Importantly as well, we're making it easier for NHS dental teams to receive the flu vaccine from pharmacies. More detail is in this bulletin.

We've also produced a useful leaflet for patients which explains how to access NHS dentistry which you can find below.

Thank you for your continued dedication to our patients and we hope, whatever your plans this Christmas, you get a well-deserved break.

Gabi and Sara

Gabi Darby
Director of Primary Care Commissioning Transformation

Sara Hurley
Chief Dental Officer England

Contractual arrangements for Q4: The key documents

The formal letter to dental practices with the detail of the contractual arrangements for Q4 can be found online here.

The NHS Business Services Authority (NHSBSA) has published guidance to support dental contract management arrangements for the 2020/21- year-end reconciliation which can be found online here.

Dental Contract Reform (DCR) Prototypes

The Department of Health and Social Care (DHSC) organised engagement events for prototype practices over October and November to discuss some of the data which has been analysed from the first 3 years of prototyping, and to feed into the evaluation process. The virtual meetings were addressed by minister Jo Churchill, who thanked the practices and staff for their work on contract reform and their response to the Coronavirus pandemic. NHSE and DHSC also appreciate the range of care which has been delivered by the prototypes during this period, including involvement in the delivery of urgent care and in supporting the local dental and more general pandemic response. The pandemic has had a variable impact on the way prototypes have been delivering their services and meeting the needs of the patients, and discussions are currently taking place with the BDA, led by DHSC, regarding the best way to deal with the capitation and activity elements of the DCR contract models for the final quarter of the 20/21 year.

Reintroduction of shielding advice in Tier 4 areas

As you know, the Government has introduced Tier 4 restrictions to some areas (London and parts of the South East). The Deputy Chief Medical Officer has confirmed that shielding advice for Clinically Extremely Vulnerable (CEV) individuals will be reintroduced in these Tier 4 areas. This shielding advice is identical to that which was in place nationally from 5 November to 2 December.

Those at highest risk in Tier 4 areas and advised by government to shield are eligible for support including free delivery of medicines (where friends, family, or local volunteers are unable to provide help) and statutory sick pay where unable to work from home. CEV individuals in Tiers 1-3 should continue to follow the government advice for those at highest risk specific to each of these tiers.

The government is writing to all CEV patients affected by the shielding advice in Tier 4 areas to inform them of this guidance. Letters will be sent in the week commencing 21 December and are online here. These letters emphasise the importance of CEV individuals continuing to engage with the NHS, and confirm that they will be prioritised for the COVID-19 vaccination in advance of the general population (as per current JCVI guidance).

The government is aware that the letters to CEV individuals may face postal delays over the Christmas period. Patients for whom the NHS holds an email address will receive the letter via email this week. The government is planning to use national and local media to communicate the advice to patients quickly.

As during the previous period of shielding advice, this will be an inevitably difficult and worrying time for CEV people. We anticipate that patients may have questions about the advice they should follow. We are very grateful for your continued efforts in supporting those at highest risk from COVID-19 during the pandemic and will be in touch to provide further updates as necessary.

Making it easier for dental teams to receive the flu vaccine

Responsibility for offering a free flu vaccination to frontline health care workers rests with the employer, as part of their occupational health responsibility. A dental professional who is employed by a NHS trust would have their flu vaccine provided by that NHS trust.

It is recommended that NHS independent contractors, which include dental practices as well as general practice, pharmacists and optometrists, offer vaccination to their employed staff. But we have heard that some colleagues have been struggling to access a flu vaccination because they are not covered by an Occupational Health Scheme. We can confirm that the Government has updated their guidance to allow community pharmacies to offer the flu vaccine to frontline health workers (including dental professionals) through private vaccinations.

Lateral flow testing for staff in NHS dental settings

Lateral flow antigen testing, in conjunction with PCR testing, aims to reduce further transmission and enhance the resilience of NHS services, by improving virus detection. Patient-facing staff - including in dental settings - are being asked to test twice-weekly using self-administered nasal swabbing and report their results through an online platform. Any positive lateral flow antigen tests will need to be followed up by a confirmatory PCR test.

The NHS has sent a letter to all primary care contractors with information on how to order and receive deliveries of lateral flow antigen testing kits for staff.

Primary care contractors should have received an invitation to order lateral flow testing devices directly from Primary Care Services England (PCSE), who will be managing the ordering and delivery process. Following receipt of an invitation, organisations should log on and complete their order as quickly as possible. The final closing date for orders across all contractors will be Wednesday 30 December. Primary care contractors should already have access to the PCSE online portal, which is normally used to order secure stationery and supplies such as prescription pads, needles and syringes. However, if any primary care contractors do not have access, they should contact PCSE.

Dental charges clarification from the DHSC

The NHS web-pages have been updated to reflect the new dental charges that came into effect on Monday 14th December.

Please also note, that the urgent band referenced in the Department of Health and Social Care's Dental Patient Charge Uplift 2020/21 written statement includes repairs to appliances. The DHSC has since clarified that this is an error, and bridge and denture repairs remain as charge exempt items. A clarification statement has been issued by the NHSBSA.

Exemption to Dental Charges – a reminder on maternity entitlements

A patient is entitled to free NHS dental treatment if, at the time they are accepted for their course of treatment, they are pregnant or have had a baby in the last 12 months.

The NHS' standard operating procedure for dentistry encourages practices to prioritise and recall patients for completion of a postponed course of dental treatment (CoT). In looking ahead to the New Year practices may wish to consider the re-call options for mums-to-be and new mothers to ensure any delays/postponement of a “check-up” during COVID is scheduled before their child’s first birthday and thus ensure access and care under the exemption criteria is fully utilised.

If patients do not have a current maternity exemption certificate you may wish to signpost them to the NHSBSA website for more information about the digital maternity exemption certificate. Further patient information is available online.

PPE order limits extended over the Christmas period

On behalf of the DHSC, the NHSBSA has announced that the PPE Portal will be operational over Christmas. Delivery partners (Royal Mail and our Pallet Carrier) will not be delivering on Christmas Day and Boxing Day. Orders made during this time should still be delivered within 5 days. To make allowance for any potential disruptions or increased need, order limits have been increased by 25% for all providers, as of Tuesday 8 December, and until at least the 4 January.

Call the customer service team on 0800 876 6802 if you have any questions about using the PPE portal. The team is available from 7am to 7pm, 7 days a week, to help resolve your queries.

Click here for latest guidance for the PPE Portal and order limits for dentists.

Reimbursement for COVID-19 PPE

The DHSC has published guidance on reimbursing primary care providers for the additional costs incurred in purchasing COVID-19 PPE. COVID-19 PPE is classed as the PPE that providers are required to use over and above Business-as-usual (BAU) use, due to COVID-19 infection control guidance, rather than what would have been used pre-pandemic. Eligible primary care providers include NHS dental contractors.

NHS dental practices should already be obtaining their COVID-19 PPE free of charge through the DHSC portal, so no further reimbursement will be made for PPE purchased after the date of 31 December 2020.

Practices can claim for PPE purchased between 27 February and 31 December 2020 for use in the delivery of NHS dental services as a result of COVID-19 infection control guidance. Dental practices will be able to claim for this personal protective equipment (PPE) between 18 January and 20 February 2021, which means no claims will be accepted after 20 February 2021.

Due to the dental reimbursement scheme being operated by the NHSBSA, information on how to complete a claim will be provided via the NHSBSA COMPASS portal prior to the scheme going live on 18 January 2021.

Further detail is in the dental appendix to the national guidance.

What can your NHS dentist do for you? A new patient poster

We have created a new A4 two-sided poster / leaflet that can printed, downloaded and shared with patients about their NHS dental service.

It includes information on access during the pandemic, what treatments are available, the attributed costs (updated Monday 14 December 2020) and emergency care details, all signposting to the NHS website.

We hope having this information all in one place is useful for patients.

You can download the poster at the public information dental resources section of Public Health England's website. Just click "download" and along with other useful materials, the poster is in the first folder "What can your NHS dentist do for you".

Frequently Asked Questions from our November webinar on infection prevention control and post-AGP downtime

Last month, Sara Hurley held a webinar on how infection prevention control and the new fallow time requirements work in dental settings. You can find the answers to some of the frequently asked questions here.

Dentistry undergrad webinar on 14th January 2021

Our undergrads are the dental professionals of the future and we know couldn't be more proud of how they've coped with what has been a pretty tough year for many. They volunteered to help out, coped with disruption to their everyday lives and kept on studying. The Chief Dental Officer is hosting a webinar for undergrads with the Dental Schools Council, the GDC and Health Education England to update on what we're doing to limit disruption to studies and entry into the profession, give undergrads the latest information on the pandemic's impact on dentistry and we'll take questions, too.

The webinar will take place on Thursday 14th January 18:00 - 19:00 on Microsoft Teams.

Please do share this sign up link with any undergrads you know.

Dental Diversity Action Group

In the welcome discussions prompted by the global Black Lives Matter movement and the personal accounts of discrimination and bias, its become clearer than ever that change in dentistry is needed. In taking the lead on this important initiative the Office of the Chief Dental Officer is hosting and supporting the Diversity in Dentistry Action Group. The Group aims to listen and allow others to be heard; to understand and acknowledge the presence of a discriminatory problem(s); to educate others to become aware of the issues and why they require resolution; and action to help address, mitigate, prevent and reinforce positive messaging that dentistry is a healthcare career open and welcoming to all.

The Group is looking at producing profession wide commitments to equality and diversity. If you would like to be involved please email the Chief Dental Officer's team at ENGLAND.CDOExecutive@nhs.net

By word of mouth ... the colleagues we're all talking about!

St Johns Dental is one of Worcestershire's first wave Urgent Dental Care (UDC) centres who have contributed exceptionally throughout the Covid-19 pandemic period. Even as they have now stepped back up for their own patients, they continue to offer access slots for patients who have not seen their dentist for a significant amount of time and are not in ongoing treatment.

The practice has now seen over 1000 UDC patients in addition to seeing their own patients, an excellent achievement! We are incredibly grateful for all the hard work they have shown, to Dr Harkamel Gill and his team of staff; Natalie Evans, Dr Mariam Aftab, Dr Meera Bhadresa, Dr Aparana Bhardwaj, Dr Vidhya Reehal, Dr Taranjit Sangar and Dr Ali Visram, Chloe Bick, Princess Bowett, Charlie Chapman, Sarah Edwards, Ruth Jenkins and Emma Richardson. We wish them all a Merry Christmas!

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A reminder of the latest COVID-19 advice and guidance

NHS updates to the profession

Previous updates from the Chief Dental Officer and the NHS dentistry and oral health team are all online here.

Transition to Recovery: Dentistry's standard operating procedure

The latest version was published on Tuesday 27 October. Changes to the previous SOP are in yellow. You can read the SOP online here.

Urgent Dental Centres: Standard Operating Procedure

Changes to the previous SOP are in yellow. It was updated on Tuesday 27 October and is online here.