COVID-19: Wednesday Update II: NHS England issues new guidance – at last

COVID-19: Wednesday Update II: NHS England issues new guidance – at last

Updated guidance for dental practices has been belatedly issued by Sara Hurley, Chief Dental Officer England and Matt Neligan, Director of Primary Care and System Transformation, NHS England. It covers advice to stop ‘routine, non-urgent dental care’ and contract funding and reconciliation in both 2019/20 and 2020/21.

NHS England has issued the third of a series of updates[i] to general dental practices and community dental services regarding the emerging COVID-19 situation. This has happened about a week after those issued in Wales and Scotland, with many practices having already taken action.

It starts by saying: “We are grateful for the commitment and effort that is going into providingcare for patients and for your forbearance as we seek to provide clarity in a fast-moving situation.”

Changes to Primary Dental Care services

All routine, non-urgent dental care, including orthodontics should be stopped and deferred until advised otherwise.

All practices should establish 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.

If the patient’s condition cannot be managed by these means, then they will need to be referred to the appropriate part of theirLocal Urgent Dental Caresystem. These new arrangements willinvolve providers working with defined groups of patients to manage urgent dental care needs only.

Full details in the guidance

Contracts and funding – 2019/20 contract reconciliation

For the purposes of calculating year end contract delivery, we will consider the year to be March 2019 –February 2020, and we will apply March 2019 data instead of March 2020

For contracts delivering above 96% over this period we will then operate normal year end reconciliation with the ability to carry forward activity to 2020

For contracts delivering below 96% over this period we will enter into normal clawback position up to 100% of total contract value.

Contracts and funding – 2020/21

We will take immediate steps to revise the operation of the 2020-21 contract to reflect service disruption due to COVID19. The aim is to achieve the following:

  • Maintaining cash flow to provide immediate stability and certainty for dental practices;
  • Protecting the availability of staff to provide essential services during the response period to COVID-19;
  • Actively enabling staff time that is no longer required for routine dental activity to be diverted to support service areas with additional activity pressures due to COVID-19;
  • Maintaining business stability to allow a rapid return to pe-incident activity levels and service model once the temporary changes cease;
  • Fairly recompensing practices for costs incurred.

Cashflow - We will continue to make monthly payments in 2020-21 to all practices that are equal to 1/12th of their current annual contract value. We will progress our work with the BDA to finalise an approach to contract value and reconciliation in 2020-21 that takes account of the principles detailed in the guidance.

Workforce

As well as providing remote support to patients who contact your own practice / service with dental problems, we would like to direct the freed-up workforce capacity to support:

  • Urgent dental care services being set up in the NHS regions (see below).
  • NHS colleagues working in wider primary care
  • NHS colleagues working in the acute COVID-19 response
  • Local authority and voluntary services COVID-19 response.

As part of the funding support, the NHS expects that dental practices will fully support the redeployment of professionals and staff working in general dental services to support the wider NHS response, as is happening across the rest of the NHS. In particular, we ask staff contact details are made available immediately and for practices actively to support any national or local calls for help. 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.

Personal Protective Equipment (PPE)

“We will continue to be led by the emerging evidence and are currently seeking urgent updated advice through our NHS Infection Prevention Control (IPC) colleagues and Public Health England. We will implement their guidance throughout our urgent dental care services. Dental public health colleagues are being trained to fit test FFP3 masks and they will be available in regions to carry out this function.”

BDA comment

There are some aspects of the preparedness letter that will need further clarification. For example, work is needed around the precise mechanism for payments for 2020-21. A key area will be how the provisions around protecting associate and staff pay will apply to the many practices that provide a mixture of both NHS and private care. We are concerned about the restriction on practices earning NHS income also accessing wider government support. NHS earnings may make up a relatively small proportion of income and it would seem unfair to apply a blanket constraint.  

[i] Click here to view the updated guidance.

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