Your NHS dentistry and oral health update

Wednesday 22 December 2021 (Issue 37)

An update from Ali Sparke and Sara Hurley

Dear colleague,

We are grateful for the hard work of the entire dental team during the pandemic. As we go into 2022, it is clear that more action must be taken to increase access and dental activity for our patients. 

We must now proceed to set thresholds which maximise safe patient activity and access. In November 2021, before the infection prevention control (IPC) changes, mean performance was 75% of contracted monthly UDA activity, with over a third of practices delivering above 85%. The changes to IPC guidance allow us to take a further significant step towards the full recovery of NHS dental provision and more detail is below.

We understand that many of you have questions about the Omicron variant. The mode of transmission for the Omicron variant remains the same; the continuing advice from UK IPC is to maintain diligent implementation of the recently published IPC guidance. This includes practice risk assessments and implementation of mitigations in line with the hierarchy of controls with an emphasis on ventilation throughout the practice and in particular areas where AGPs are undertaken. All patients should be screened for potential COVID-19 infection, ideally prior to attendance at the setting and on arrival, using the COVID-19 screening questions. An example of COVID-19 screening questions can be found at Appendix 1 of the UK IPC Guidance. With regards the sample screening questions practices are advised to regularly check the online version of Appendix 1 for any amendments.

Practices should continue to follow clinical prioritisation, especially for urgent care and priority groups such as children. As there is no patient registration within dentistry patients must be prioritised against clinical need and priority groups regardless of whether the member of public is on a practice’s business list or not – this is a condition of ongoing financial support.

The NHS is clear - a key component of clinical prioritisation is following NICE guidelines on check-ups, it isn't just a contractual requirement to follow them (as it has been for many years), its a professional responsibility and right now it is of critical clinical necessity. 

Over the last year and a half, the NHS has made a significant commitment to NHS dental contractors to minimise financial risk and support contractors through the pandemic. We are grateful for your dedication to patients in return. The gradual return to pre-pandemic activity thresholds has reflected the proven ability of NHS dental practices to deliver and has been designed to maximise safe access for patients whilst offering fairness to contractors. 

We hope you have a pleasant Christmas break and we look forward to working with you in 2022.

Best wishes,

Ali & Sara

The key contractual updates for 2022

The below is a summary of the major changes. Contractors should read the detail in full with the accompanying guidance.

• Key steps in 2022 to deliver for patients in NHS dentistry: Letter to all primary care contractors with requirements for Q4 and 2022/2023

Quarter 4 2021/2022 and contractual requirements for financial year 2022/2023

• Practices should plan on the basis that NHS income protection will come to an end in April 2022 and we will revert to usual contract management arrangements.

• Between January and March 2022 clawback will not be applied to practices delivering at least 85% of contracted UDAs, reflecting the level many practices have already been delivering before the IPC changes and giving practices some contractual flexibility as they adjust to new IPC guidance. There will be no lower threshold in Q4, so that for delivery below 85% normal clawback will apply.

• For orthodontic contracts clawback will not be applied to practices delivering at least 90% of contracted Units of Orthodontic Activity (UOAs).  The rate of clawback will then reduce linearly down to a lower threshold of 85% of UOAs, with delivery of those lower thresholds earning practices 90% of contractual income for Q4. Below this lower threshold normal clawback will apply. 

• The variable cost reduction, reduced in Q3 to benefit practices, will be retained at the lower level of 12.75%, applied to non-delivered activity.

Exceptions process

• The exceptions process will remain in place, providing a safety net for practices. Full details can be found in the policy book for primary dental services and appendix 49. 

• To be considered for relief, contractors are required to demonstrate that they have been impacted in a specific way over and above the impact that the pandemic has had across the wider contractor group generally. 

• The established process outlined in chapter 17 of the Policy Book for Primary Dental Services should continue be followed. Contractors wishing to claim exceptional circumstances must notify the commissioner as soon as possible and within five working days. 

• Providers are encouraged to liaise with commissioners at the earliest opportunity if they feel that any contractual conditions are not being met, and to work with the commissioner to improve compliance in order to improve access and reduce the likelihood of clawback being necessary.

End of year reconciliation 2021/2023

• Any contract which has delivered 100% of their actual contracted activity across the year will be eligible for their full contract value. This will also apply to contractors who have met the required thresholds for full NHS income protection in each time period, minus any variable cost adjustment. 

• Any activity above the performance threshold allocated to an earlier period will automatically be applied to the period where it would offer the contractor the greatest financial value. 

• Delivery over the performance threshold required for full NHS income protection may be used to offset performance under the threshold in an earlier time period i.e. activity above 65% in Q3 may be used to offset performance below 60% in H1 and activity above 85% in Q4 may be used to offset performance below 65% in Q3, or 60% in H1.
• Performance in excess of the threshold for full NHS income protection or the minimum threshold necessary to avoid full clawback in any period cannot be carried forward into any subsequent time periods. 
• Where a contractor has delivered in excess of 100% of their actual contracted activity in Q4, after offsetting against prior performance under thresholds as described above, OR delivered in excess of 100% of total contracted activity across the year then this activity will be remunerated at their indicative UDA contracted rate for 2021/22 to a maximum of 110%, creating an additional income opportunity in year.

Amendment to UK Infection Prevention Control (IPC) guidance

The UK's Infection Prevention Control (IPC) cell has published a consensus statement in response to the emergence of the Omicron variant of SARS-CoV-2.

The UK's main IPC guidance has been updated with the following statement added:

"In response to Omicron and other Variants of Concern (VoC) it is recommended that staff and organisations continue to undertake risk assessments using the hierarchy of controls which include, an evaluation of the ventilation in the area, operational capacity, physical distancing and prevalence. Where an unacceptable risk of transmission remains following this risk assessment, it may be necessary to consider the use of respiratory protective equipment (RPE) in clinical areas where  suspected or confirmed COVID-19 patients are being managed".

The dental appendix has not been amended as the appendix is already in line with the above update.

Changes to staff isolation guidance for NHS staff and contractor groups 

The government has announced the move to Plan B in England in response to the emerging risks of the Omicron variant. The UKHSA has also updated its COVID-19: management of staff and exposed patients or residents in health and social care guidance to reflect self-isolation changes when in contact with a confirmed or suspected Omicron variant case.

This letter to all dental contract holders provides a summary of the latest guidelines and applies to all staff including substantive clinical and non-clinical roles, bank staff, contractors and suppliers; students working in all facilities, settings and organisations delivering NHS care and volunteers working in settings with patients.

Access to lateral flow tests

All NHS staff can order lateral flow tests online through GOV.UK and should aim to test themselves twice weekly in line with NHS England and NHS Improvement’s lateral flow asymptomatic testing guidance.  

Due to high demand, ordering lateral flow test tests from GOV.UK has been temporarily impacted, but UKHSA are expanding their delivery capacity so more people can order tests. There is no shortage of lateral flow tests.

If practice teams are having difficulty accessing lateral flow tests from GOV.UK, these can also be collected from pharmacies. 

Care Quality Commission inspections continue in dentistry

The Care Quality Commission (CQC) has postponed on-site inspection activity in acute hospitals, ambulance services and general practice for the next three weeks with immediate effect - except in cases where we have evidence of risk to life, or the immediate risk of serious harm to people. This is to ensure that these providers focus on the vaccination/ booster programme. The CQC will continue risk-based inspection activity in other sectors, including adult social care, mental health, independent health and the dental sector.

More information is on the CQC website.

Call to get your COVD-19 vaccination 

The NHS has set out plans to accelerate the booster programme, which includes opening extra pop-up vaccination centres and extending opening hours to offer more jabs to more people.

Vaccination sites have been asked to operate 12 hours a day, seven days a week wherever possible and in every community, there should be slots available at least 16 hours a day.

Local NHS teams will also work with local authorities, the voluntary and community sector, to prioritise delivery and make it as easy as possible for people to get their top up protection, as well as redeploying admin and clinical staff to support with vaccinations.

The Chief Dental Officer encourages all members of the dental team, both clinical and non-clinical, to book your booster without delay, to protect yourselves, your patients and your colleagues.

Vaccination as a condition of deployment

Individuals undertaking CQC regulated activities in England must be fully vaccinated against COVID-19 no later than 1 April 2022 to protect patients, regardless of their employer, including secondary and primary care. The regulations will apply equally across the public (NHS) and independent health sector. 

NHS England has published formal guidance on vaccination as a condition of deployment.

NHS England has curated resources to aid 1:1 conversations around staff vaccine hesitancy. These tools can be used as part of the 1:1 conversations to address specific areas of concerns and hesitancy that individual staff may have. The toolkits contain key messages, FAQs, social media posts, videos and other materials to assist with building a targeted communications campaign.

For further information on how to have a 1:1 conversation to support vaccine uptake, please see the ‘Guidance to support COVID-19 vaccine uptake in frontline staff’.

Breastfeeding, fertility and pregnancy

• Questions and answers on COVID-19 Vaccines in pregnancy (video)
• Royal College of Midwifes (RCM) and Royal College of Obstetricians and Gynaecologists (RCOG) guidance on COVID-19 in pregnancy and breastfeeding (page 5 for COVID19 vaccinations)

Ethnic minority communities

• COVID-19 vaccination toolkit for Black African and Black African Caribbean communities
• British Islamic Medical Association Vaccine frequently asked questions
• Responding to vaccine hesitancy resource pack

Signing up to this bulletin

Have you been sent this bulletin by someone else? 

This bulletin is a round up of all the latest news and important resources for anyone working in NHS dental services. We'll send it out as and when important news needs to come your way. If you've already signed up but didn't receive the update, then check your junk folder for the confirmation email and make sure you've followed the instructions to complete sign up.

Previous NHS dentistry and oral health bulletins this year

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

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 Thursday 25 November. 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