Please rotate the screen to Landscape view for best viewing experience.

Close
Speak to an Expert: 01409 254 354

news

COVID-19 CODE Advice

 

 

For those carrying out the Daily Review and Action Plan, please note that this article has now been archived and is only up to date as of 1st May 2020. 

Follow our current news feed here

1st May 2020

Authors: CODE’s Alex O’Neill, George Browning and Hannah Larkworthy

Friday 1st May Update

Compass
Members in England may have recently received an email from the NHS concerning a new COVID-19 Triage form which has been launched in Compass. Any practice taking triage calls with open contracts in Compass, including data collection only contracts, should create a new triage form whenever advice is given to a patient from 29th April. Records of triage activity prior to 29 April 2020 should be maintained in the practice; however, data entry of this information in Compass is not mandatory. It is possible to add your historic data into Compass and the NHS recommended that this is carried out if resources allow. More information, including a FAQs section can be found here.

NHS Contract Payments
Some members in England have reported that they have received their April UDC contract payment from the NHS in full. As confirmed in the CDO webinar last Friday, the percentage of contract payments Practices will receive during the COVID-19 crisis is still being finalised by the NHS. It is therefore possible that the NHS may retrospectively take April’s deduction from a future UDC monthly payment. CODE is therefore recommending that Practices consider putting aside a proportion of their April payment to ensure they have sufficient cash flow if a deduction is taken from a future month’s payment. 

Operating Post-Lockdown
Members may be interested in reading the views of Julian Perry on what reopening a dental practice could look like once the lockdown has been lifted. An article in Dentistry contains a link to a presentation written by Dr Perry, Dr Eddie Coyle and Dr Rebecca Sadler which provides an overview of what measures and guidance could be considered when opening, managing and operating practices post COVID-19 lockdown. It is worth noting that this is not official guidance, but may give an indication of the types of changes to standard operating procedures based on the views of leading professionals and evidence from countries who are ahead of the UK in terms of infection progression.

Here at CODE our culture and mission is to support and guide our members as best we can. You may therefore be wondering why we’ve not provided written policies or guidance about Coronavirus (COVID-19) in iComply. The current situation is extremely fast moving and government advice is changing on a daily basis. If we were to replicate information being published by the NHS and the government into policy documents etc. there is a real risk that by the time it is available to you, it will be out of date.

It’s CODE’s position that a daily review and action plan is significantly more useful to practices trying to navigate the compliance implications of the pandemic. It is very likely that we will continue to see guidance being published as relaxed restrictions are gradually phased  in. After the crisis ends inspectors may wish to see an audit trail of how the practice ensured they were following the latest instructions and what actions were taken. CODE has released a COVID-19 Daily Review and Action Plan to help the profession create these audit trails.

We are therefore advising you to seek information directly from the government website, CDO letters and NHS websites on a daily basis then update your action plan. It is important to pay special attention to the advice from the CDO in your region as there have been significant differences in the clinical advice being provided in England, Wales, Scotland and Northern Ireland. More information on this can be found in the Clinical Advice Section below.

The following article is designed to help you through questions you may have related to the management of dental practices during the current outbreak of COVID-19 and to provide you with some of the key links you may need.

CDO Webinar
The England CDO and the Director of Primary Care and System Transformation held a webinar on Friday 24th April. The webinar reinforced information regarding key issues that are already covered in this article. In addition, it was confirmed that final decisions have yet to be made regarding 2020-21 contract delivery, adjustment from 1/12 payments for variable costs and the time period that the NHS will support practices with payments. It was stressed that private practices wanting to set up an NHS mail account can email exeter.helpdesk@nhs.net to get an ODS code. The CDO, Sarah Hurley, also confirmed that they are looking ahead to consider what steps practices will need to take to reopen once restrictions have been eased. Although no decisions have yet been made on this, Ms Hurley confirmed that practices will be given plenty of notice to implement any changes to operating procedures. A recording of the webinar can be found here.

Letter from CDO in England – 15th April 2020
The Chief Dental Officer for England, Sara Hurley, has now published a fourth letter providing further information to the profession on a number of issues including the operation of urgent dental care systems, availability of personal protective equipment (PPE), redeployment and volunteering, and contracts and financial arrangements. This letter is accompanied by Standard Operating Procedures for Urgent Dental Care (UDC) Systems.

Following on from the CDO’s webinar on 3rd April, this letter has clarified that:

  • Routine dental care should not be provided during this delay phase of the COVID-19 pandemic
  • a remote consultation and triage service whose outcomes are
    • advice, analgesia antimicrobials where appropriate (AAA); or
    • referral, when absolutely necessary and treatment cannot be delayed, to a designated UDC site for a face-to-face consultation and treatment (Practices should contact local commissioners for details of how to refer to their nearest hub)
  • If there is no UDC system available locally, a dental practice may undertake non-AGP face-to-face dental assessment and care with Level 2 PPE. Any face-to-face treatment must be delivered in line with the guidance set out in the UDC SOP
  • Public Health England’s guidance on PPE (last updated on 12 April 2020) is applicable to all settings, including dental settings 
  • Mixed practices can receive both NHS funding and have access to the furloughed worker scheme in proportion to their private income
  • Clarification has been provided on the application of the March 2019-February 2020 activity period for the purposes of calculating 2019/20 contract reconciliation. This is relevant to practices whose activity levels in March 2020 had been anticipated to be higher than March 2019, or where the practice had opened after 1 March 2019. The CDO has confirmed that practices may agree with their commissioner to use the following activity from the Compass system as the basis for 2019/20 contract reconciliation: 

11 months April 2019 to February 2020 plus in agreement with commissioners, an additional month that may be one of:

    • March 2019 (default)
    • March 2020 or
    • average UDA delivery over an appropriate three-month period in 2019/20 agreed with their commissioner

UDAs or patient charges can not be claimed for a patient contact/triage via telephone. Practices undertaking telephone triage are advised to keep a manual record of patients triaged by telephone, with the view that this data collection will help support and inform development of contract management arrangements for 2020/21. Practices undertaking urgent treatment provided within UDC systems should adhere to the current regulatory framework for FP17 submission and applying patient charges

  • The CDO expects practices, who are being financially protected through NHS England’s financial measures, make reasonable efforts to support staff to redeploy to support the wider COVID-19 response, including in local UDC systems, Nightingale hospitals and wider parts of the NHS as highlighted above.  More information on redeployment can be found in the specific guidance published by NHS England

 

Things Practices Should Do Now

CODE has identified the following as being of key importance and actions that practices should be taking immediately:

  • Current clinical advice differs between England, Wales, Scotland and Northern Ireland. Therefore, practices should refer to the clinical guidance published by their relevant Chief Dental Officer. Information can be found in the Clinical Advice section below
  • Practices in England should regularly refer to the Dental NHS briefing documents and Primary care briefings updated by NHS England on a regular basis. All this guidance is applicable in England, however, practices in other regions of the UK may wish to use for reference should certain procedures not be covered by the governing bodies and regulators in their devolved administration
  • For guidance on standard operating procedures in all parts of the UK, Practices should refer to the most up to date guidance from their Relevant Chief Dental Officer and governing body. As the situation develops the guidance is changing at very short notice, it is therefore important that Practices review relevant guidance aimed at Primary Care and Dental Practices and implement any new instructions 
    • All relevant publications from the Chief Dental Officer in Wales are published here. Additional information from the NHS is also being emailed directly to Dental Teams, so Practices should check their inbox daily
    • All key dental advice from the Northern Ireland can be found here
    • All guidance documents from Health Protection Scotland including guidance for dental teams can be found here. Additional information from the NHS is also being emailed directly to Dental Teams, so practices should check their inbox daily
  • It may help for practices to assign a ‘COVID-19 Lead’ to take responsibility for keeping up to date with guidance, disseminating information to the team and creating/implementing action plans (an excel sheet may be useful here)
  • Practices should make sure they are registered with the Central Alert System as the government will be using it to disseminate information directly to you. This is the same system used for other alerts such as drugs and medical equipment
  • Practices should review their Disaster Planning and Emergency Procedures (M 255), paying particular attention to the contingency arrangements section and consider what they would do if the practice was closed, including where to send patients who require emergency treatment. As the situation develops the government may provide more specific advice on this. It is therefore important that you review the Business Continuity section below where we will update on region specific directions
  • Practices should ensure that all relevant information is communicated to the public. This includes information posters issued by Public Health England and a recorded telephone message for incoming calls from patients. Information on the content of these calls can be found in the dental specific NHS briefing documents and will be subject to change as the situation develops. Wales and Northern Ireland have separate posters that should be used
  • Practices should ensure that their staff are aware of the government’s guidance to the public, so they know steps they may need to take themselves
  • Practices that are closing should make formal notification to their inspecting body (CQC/HIW/RQIA/HIS). This may change if all practices are instructed to close. iComply members can follow the Notifications to a Regulator Policy (M 233-NTC). Practices with NHS contracts will also need to notify the appropriate team (Regional team or Healthboard) to avoid breaching your contract. You should also notify your patients via their preferred method of communication
  • NHS practices in Wales who wish to receive funding will be asked to log the number of phone calls received, the number of occasions a dentist gave remote advice, the number of prescriptions made, the number of referrals to the urgent/emergency centres and the number of instances where a patient was assessed or treated. Practices will be contacted by their Health Board and be provided with a pro-forma to fill out and complete every fortnight 
  • We have released a free ‘Covid-19 Care Package’ for all practices which contains a selection of essential documents, helpful templates and other useful tools to help you manage your practice through this difficult time. You can download the care package here

 

Clinical Advice

CODE does not offer clinical advice—however, we can direct you to where you can get detailed information on how to clinically manage the virus and changes you should be making in your practice now:

  • Practices should be familiar with the clinical management of COVID-19. Public Health England’s guidance on investigation and initial clinical management of COVID-19 infection can be found here
  • Specific guidance on infection control can be found here. Further updated guidance on the use of Personal Protective Equipment (PPE) is updated regularly here
  • The British Orthodontic Society is advising that no orthodontic patient should attend any clinic at this time. They are advising that in an extreme emergency, patients should contact the practice or unit by phone and discuss ways of resolving their problem at home
  • The GDC has published further guidance on high level principles for good practice in remote consultations and prescribing
    • Routine dental care should not be provided during this delay phase of the COVID-19 pandemic
    • A remote consultation and triage service whose outcomes are
      • advice analgesia, antimicrobials where appropriate (AAA); or
      • referral, when absolutely necessary and treatment cannot be delayed, to a designated UDC site for a face-to-face consultation and treatment (Practices should contact local commissioners for details of how to refer to their nearest hub)
    • If there is no UDC system available locally, a dental practice may undertake non-AGP face-to-face dental assessment and care with Level 2 PPE. Any face-to-face treatment must be delivered in line with the guidance set out in the SOP
    • Public Health England’s guidance on PPE (last updated on 12 April 2020) is applicable to all settings, including dental settings and should be observed when treating patients face-to-face
    • All community outreach activities such as oral health improvement programmes (e.g. Starting Well, routine non-urgent work in care homes) and dental surveys should be stopped until advised otherwise
    • In order to provide accurate information to the public all dental practices should update their messaging and websites; contact their regional commissioner should practice availability hours alter as a result of staffing levels; and inform the commissioner of these changes and the arrangements for cover 
  • The Chief Dental Officer for Wales has published two letters on 17th March and 23rd March to primary care dental practices in Wales providing specific clinical advice for dentists which practices should implement immediately. Further guidance is available here. Practices in Wales have been asked to:
    • Cease routine scheduled dentistry for the time being
    • All dental treatment that can be should be delayed at present
    • Aerosol generating procedures (AGP) should now stop
    • Pregnant or otherwise immunosuppressed dental team members should not provide or assist in the direct case or assessment of patients
    • Practices should make every effort to triage, advise and reassure patients who have a dental problem by telephone
    • Dentists can offer remote prescriptions, analgesics and antimicrobials, by contacting local pharmacists. Guidance on remote prescribing in Wales can be found here
  • The CDO in Wales has published a user-friendly toolkit for dental practices. This toolkit compiles information that has so far been released and offers guidance and supporting information to enable the continuity of services by dentists in Wales. The bulk of the information used in this toolkit is contained in the “Red Alert Phase Escalation” document provided by the All Wales Clinical Dental Leads COVID-19 Group
  • The Chief Dental Officer for Scotland has written to NHS dental services outlining actions they should now take. These include:
    • All routine dentistry should cease
    • Pregnant or otherwise immunosuppressed dental team members should not provide or assist in the direct case or assessment of patients
    • All AGPs should now cease
    • All patients should be triaged and advised via the telephone where possible. Where an assessment in person is required, robust PPE procedures should be used
    • All urgent procedures that cannot be delayed must be directed to a Practice’s NHS Board designated PDS/HDS urgent care centre
    • Practices should work with local practices to establish a ‘buddy system’ to ensure that people are able to contact dental professionals during normal working hours via telephone. NHS Boards will work with local practices to understand the locality based ‘buddying’ arrangements in place and ensure that practices have details of the referral pathway to urgent care centres
    • In the event of a significant and rapid escalation of COVID-19 NHS Boards will move to a centralised urgent care only service for people who are asymptomatic for COVID-19
    • Scottish Dental Clinical Effectiveness Programme (SDCEP) have published guidance on management of acute dental problems during COVID-19 which includes prescribing guidance
    • Health Protection Scotland have provided updated advice on infection prevention and control in urgent dental care settings
    • Further guidance has also been issued on PPE use in Scotland (at page 14)
  • The Head of Dental Services for Northern Ireland has published specific clinical advice for dentists which practices should review and implement immediately.  This includes updated guidance published on 23rd March and some FAQs. Practices in Northern Ireland have been asked to:
    • Cease all aerosol generating procedures in general practice
    • Practices should remain open and continue to see patients who, following screening against the case definition by telephone in advance, are not suffering from COVID-19
    • Practices should not direct patients to the out-of-hours sites as they are working under the same restrictions
    • Practices should familiarise themselves with the patient pathway and refer all patients who require urgent dental and have COVID-19 to their designated treatment centre.  Further guidance has been published on temporary arrangements for urgent dental care in Northern Ireland

 (Do not rely solely on the list above as it WILL change and does not include some region-specific advice, especially regarding the approach to emergency treatment and required PPE. Follow the advice directly in CDO communications and NHS links)

Government Support 

Practices may be concerned about the impact this pandemic will have on their business. It is important that practices are aware of the support that is available to them.

  • Self-Employed Income Support Scheme – eligible self-employed individuals (including members of partnerships) will be able to claim up to £2,500 in support announced by the government on 26th March. The new scheme will provide a cash grant worth 80% of an individual’s average monthly trading profit over the last three years (up to a maximum of £2,500 per month). The scheme will be open to:
    • Those with a trading profit of less than £50,000 in 2018-19 or an average trading profit of less than £50,000 from 2016-17, 2017-18 and 2018-19
    • Those with more than half of their income in these periods must come from self-employment
    • Those who are already in self-employment

Individuals who think they may be eligible should not contact HMRC now. HMRC will use existing information to check potential eligibility and invite applications once the scheme is operational.

The earliest grants will be paid will be the beginning of June, however, in the interim the self-employed will still be able to access other available government support for those affected by coronavirus including more generous universal credit and business continuity loans where they have a business bank account.

If individuals have reported a profit of over £50,000 they may still be eligible for the Coronavirus Business Interruption Loan Scheme or Bounce Back Loans (more details below) .

  • Coronavirus Job Retention Scheme – all UK employers will be able to access support to continue paying part of their employees’ salary for those employees that would otherwise have been laid off during this crisis. To be eligible for the scheme, Practices must continue to pay employees from their own funds—HMRC will then reimburse 80% of furloughed workers’ salary up to a cap of £2,500 per month. If Practices wish to take advantage of this scheme, they will need to:
    • designate affected employees as ‘furloughed workers’ and notify the employees directly of this change in their employment status. Practices need to be mindful that this change in employment status is subject to existing employment law and, depending on a worker’s employment contract, may be subject to negotiation   
    • submit information to HMRC about the employees that have been furloughed and their earnings through a new online portal.
  • The government has announced that they are bringing forward legislation to allow small- and medium-sized businesses and employers to reclaim Statutory Sick Pay (SSP) paid for sickness absence due to COVID-19. More information on this can be found here
  • Practices may also be able to benefit from the government’s new Coronavirus Business Interruption Loan Scheme (CBILS). This scheme will support loans of up to £5 Million in value which will be interest free for six months.  More details on the scheme and the list of accredited lenders is available on the British Business Bank Website. In the first instance, Practices should approach their own provider – ideally via the lender’s website. They may also consider approaching other lenders if they are unable to access the finance they need. If Practices currently receive small business rate relief, they will be eligible for a one-off grant of £10,000. If eligible, businesses do not need to apply and will instead be contacted by their local authority
  • From 4th May Practices may be able to utilise a government scheme which aims to improve small businesses’ access to credit during the crisis following reports of a high proportion of businesses not being approved for Coronavirus Business Interruption Loans. Bounce Back Loans of between £2,000 and £50,000 will be available to UK businesses who have been negatively affected by COVID-19. More information will be published by the government in the next few days
  • All businesses and self-employed people in financial distress, and with outstanding tax liabilities, may be eligible to receive support with their tax affairs through HMRC’s ‘Time to Pay’ service. These arrangements are agreed on a case-by-case basis and are tailored to individual circumstances and liabilities. If you are concerned about being able to pay your tax due to COVID-19, call HMRC’s dedicated helpline on 0800 0159 559
  • The government has deferred Value Added Tax (VAT) payments for three months. This is an automatic offer with no applications required. Businesses will not need to make a VAT payment during this period (20 March 2020 – 30 June 2020). VAT refunds and reclaims will be paid by the government as normal 
  • For those that are self-employed, Income Tax payments due in July 2020 under the Self-Assessment System will be deferred to January 2021. Taxpayers will be given until the end of the 2020 to 2021 tax year to pay any liabilities that have accumulated during the deferral period 
  • Clinical and non-clinical staff either employed by the NHS or working with an NHS funded employer delivering an NHS funded Primary Care contract during the COVID-19 response, can sign up for coaching support through a new initiative launched by the NHS. You can register and book a coaching session by visiting the Looking After You Too site. Sessions are available 07:15 – 22:00 and the first session will last up to 45 minutes.  The sessions will be delivered virtually, via a video platform, but telephone appointments are also available

Business Continuity and Financial Support

  • The Chief Dental Officer for England published a letter on 25th March which discussed financial support for NHS practices and included information on how NHS funding and contracts will be calculated in light of the pandemic. In the subsequent letter on 15th April, she clarified that mixed practices can receive both NHS funding and have access to the furloughed worker scheme in proportion to their private income (e.g. If 40% of a practice’s revenue comes from private income, then in addition to receiving full NHS funding a practice will be able to claim 80% of their private wage bill (private wage bill = 40% of total wage bill) from the furloughed workers scheme). Practices will need to carefully calculate what they can claim and keep clear records. It has been suggested that Practices  calculate this in line with the methodology of determining private and NHS income used for business rates reimbursements. Contractors are advised to use the proportion of gross income that relates to GDS/PDS contract value as NHS revenue, the balance being private share. Those contractors who claim business rates reimbursements will have this data readily available
  • The CDO in England has provided details on the application of the March 2019-February 2020 activity period for the purposes of calculating 2019/20 contract reconciliation. This is a particular issue where activity levels in March 2020 had been anticipated to be higher than March 2019, or where the practice had opened after 1 March 2019. In recognition of these circumstances, practices may agree with their commissioner to use the following activity from the Compass system as the basis for 2019/20 contract reconciliation
    • 11 months April 2019 to February 2020 plus
    • in agreement with commissioners, an additional month that may be one of:
      • March 2019 (default)
      • March 2020 or
      • average UDA delivery over an appropriate three-month period in 2019/20 agreed with their commissioner. 

Any clawback repayments relating to contract year 2019/20 may be payable over the financial year, with full balance payable by 31 March 2021

  • The government has updated their advice and extended testing so that essential workers can self-refer for a test if they are exhibiting symptoms. These tests are available to all NHS staff who are currently supporting patients, to allow them to return to work if they test negative. More information on the process can be found here. Note that this applies to England only. See separate guidance for information about who can get tested in Scotland, Wales and Northern Ireland 
  • Wales – Practices should familiarise themselves with the information contained in guidance from the Welsh Government. This includes information on steps practices should take to manage current demand and capacity. Practices have been asked to review and submit their business continuity plans. CODE has sought clarification from Health Boards in Wales who have confirmed that practices should ensure that patients and the public have access to urgent care and advice when needed. We therefore recommend that practices ensure the ‘Incapacity of Staff’ section of the Disaster Planning and Emergency Planning Procedure (M 255) is up to date to include reciprocal arrangements with neighbouring practices for staff cover and relocations of patient appointments if necessary
  • In Wales practices will continue to receive practice monthly income. Flexibility has been offered for up to 4% of the contract if needed. This means up to 4% (of UDA activity) can be credited where this flexibility is needed toward meeting the 100% contract target. This flexibility acknowledges practices may struggle to meet 100% activity due to the current COVID-19 pandemic through staff absences, cancelled appointments etc. and to help ensure contractual payments take this into account.  Further information about this scheme was provided on 26th March by the Chief Dental Officer in Wales and can be found here
  • All independent dental practices in Scotland who provide NHS General Dental Services have been asked to complete and submit a standard form business continuity plan to their NHS Board a Business Continuity Plan. This plan can be found here and should be completed as soon as possible
  • In Scotland, there are a series of measures that have been put in place to support practices who provide NHS services.  Details of these measures can be found here. Additionally, the CDO in Scotland announced on 30th March a revised funding package which will provide 80 per cent of the average income from item of service and patient contributions; more details can be found here. The Scottish government has also issued FAQs about funding support for dentists
  • Practices in Northern Ireland will be eligible to apply for a support payment to stabilise their Item of Service (IoS) income for each month. This would involve support payments being made each month to cover the shortfall in IoS income in 2020 and will be based on 2019 income levels. The payments will be abated by 20% to reflect the variable costs that will not have been incurred.  More details can be found here. Further clarification was provided by the Department of Health in Northern Ireland in response to some queries raised about these financial measures as well as redeployment of staff
  • Practices in Northern Ireland may also be able to apply for a number of other measures to support businesses during the pandemic. More details on these measures can be found here
  • Practices in Northern Ireland should complete a template business continuity plan and submit to the Health and Social Care Board. On receipt of this plan a payment of £100 will be provided to the practice
  • In Northern Ireland, appraisals for community dentists have been suspended until September 2020. Additionally, Clinical Directors have been asked to make sensible changes to mandatory training and CPD requirements in light of the current situation. However, national guidance has been issued on the minimum requirements for staff returning to the HSC. More information can be found here
  • NHS England are asking all those that work in dentistry to consider redeployment to assist with National COVID-19 response. Those who are interested have been asked to complete a questionnaire to register their interest. More information on redeployment can be found here
  • CQC have released interim guidance on DBS and other recruitment checks, for providers recruiting staff and volunteers to health and social care services in response to coronavirus (COVID-19). More information can be found here

 

General Business Concerns 

  • Schools in all regions of the UK are closed until further notice except for children of key workers and vulnerable children. Dental staff redeployed by the NHS or working in UDCs are considered as key workers. However, the Education Secretary has highlighted the pressure schools are likely to be under and therefore asked that key workers think carefully about weather their work is critical in the response to Coronavirus, and if it is not, has requested they keep their children at home
  • Practices should check with their insurance provider if they are covered. Many businesses are unlikely to be covered as most business interruption insurance policies are dependent on damage to property, which will exclude pandemics. Some practices may have purchased a specific add on relating to notifiable diseases, but some of these will still specify damage to the building. Some businesses may have purchased supply chain or denial of access cover which may meet their needs in this case
  • No CQC, HIW, CPI, HIS and RQIA routine inspections are currently taking place. The CQC have released a statement setting out their approach to regulation during the coronavirus pandemic. The CQC have adopted an ‘Emergency Support Framework’ which is designed to be flexible to allow inspectors to respond to the changing needs of the health and social care system, including conducting emergency inspections where necessary. More information can be found here
  • NHS England have announced that the Data Security and Protection Submission Deadline has been pushed back to 30 September 2020
  • Practices who require an NHSMail email account can follow the process here

HR FAQs 

The iComply HR team have put together a very helpful set of FAQs which cover the majority of questions currently being asked on the helpline. In situations where paying full pay is discretionary, we would advise practices to consider doing the most they can for their employees at this difficult time.

  • Is there any support available for my employees, including if I have to close the Practice, I have heard about the Coronavirus Job Retention Scheme?

The government has proposed measures to help support employers with paying their workers under the Coronavirus Job Retention Scheme, please see further guidance here. If eligible, you will receive a grant from HMRC to cover the lower of 80% of an employee’s regular wage or £2,500 per month, plus the associated Employer National Insurance contributions and up to the minimum automatic enrolment employer pension contributions on that subsidised wage. 

  • Following the government’s announcement about the Coronavirus Job Retention Scheme guidance, when would my employees be classed as furloughed workers?

Furloughed means that employees have no work for them due to the impact of COVID-19. Workers who are full-time, part-time, employees on agency contracts and flexible/zero hour contracts are eligible. The government will not reimburse 80% of wages for employees who are still completing work for your practice, including on an ad-hoc basis, whether they are in the normal premises or working from home. Please see further guidance here

  • Can employees undertake training or volunteer work whilst being classed as a furloughed worker?

Please see government guidance here. Employees can undertake training or volunteer work subject to public health guidance, as long as they are not:

    • making money for your practice or a company linked or associated to your practice
    • providing services to your practice or a company linked or associated to your practice

If workers are required to complete training courses whilst they are furloughed, they must be paid at least their appropriate minimum wage for the time spent training, even if this is more than the 80% of their wage that will be subsidised

  • Can apprentices continue their training whilst on furlough?

Please see government guidance here. Apprentices are able to continue to complete their training during a period of furlough. Any time spent training, must be paid at the appropriate Apprenticeship Minimum Wage, National Minimum Wage or National Living Wage

  • Can Company Directors be furloughed?

Please see government guidance here. Company Directors are eligible to be furloughed and receive support through the Coronavirus Job Retention Scheme. Company Directors owe duties to their company which are set out in the Companies Act 2006. Where furloughed directors need to carry out particular duties to fulfil the statutory obligations they owe to their practice, they may do so provided they do no more than would be judged reasonably necessary for the purposes, such as, they should not do work they would carry out in normal circumstances to generate commercial revenue or provides services to or on behalf of their practice

  • Is there a minimum timescale for workers to be furloughed?

The minimum length of furloughing is 3 weeks

  • Do I have to furlough all of my employees?

You do not need to place all of your employees on furlough. Equality and discrimination laws apply during a period of furlough, as such, you need to ensure any employees selected for furlough is through a fair process. This could be achieved by asking for volunteers

  • Can employees be furloughed more than once? For example, to participate in a rota?

Employees need to be furloughed for a minimum of 3 consecutive weeks. However, you can place employees on furlough more than once, as long as the minimum length of each furloughed period is 3 weeks

  • Can I class employees as furloughed workers who are on sick leave or self-isolating?

Please see government guidance here. You are able to furlough employees who are currently sick for business reasons, alongside other employees. Please note, short term absence or self-isolation should not be a consideration in deciding whether to furlough an employee. Employees who are shielding can also be placed on furlough

  • Is my employee on maternity leave entitled to be classed as a furloughed worker?

Employees who are currently, or due to be, on maternity leave are entitled to maternity pay in accordance with their contract of employment. Please review your Maternity Leave and Pay Policy (M 233-MLP) in iComply

  • How do I calculate 80% of my workers’ pay?

Please see government guidance here. Please see link to Coronavirus Job Retention Scheme calculator here. The employee’s actual salary before tax as of 19th March 2020 should be used to calculate the 80%. If, based on previous government guidance, you have calculated your claim based on the employee’s salary as at 28th February 2020 (and this differs from their salary in their last pay period prior to 19th March 2020) you can choose to still use this calculation for your first claim. For employees whose pay varies, if the employee has been employed for a full twelve months prior to the claim, you can claim for the higher of either:

    • the same month’s earning from the previous year
    • average monthly earnings from the 2019-20 tax year

If the employee has been employed for less than a year, you can claim an average of their monthly earnings since they started work until the date they are furloughed.

If the employee has been employed for less than a month, you should work out a pro rata for their earnings so far, and claim for 80%. 

 Employee’s wages will be subject to usual income tax and other deductions. 

You can claim for any regular payments you are obliged to pay your employees. This includes wages, past overtime, fees and compulsory commission payments. However, discretionary bonuses and commission payments should be excluded.

  • How do I calculate furlough pay for my employee returning from maternity leave?

Please see government guidance here. For employees returning from leave their furlough, pay should be calculated against their salary, before tax, not the pay they received whilst on statutory leave. For employees whose pay is variable, their pay should be calculated using either the:

    • same month’s earning from the previous year
    • average monthly earnings for the 2019-2020 tax year
  • Are new starters eligible for the Coronavirus Job Retention Scheme?

Please see the government guidance here. The government amended this guidance on the 15th April 2020 to confirm that employees who were on your PAYE payroll on 19th March 2020 and were notified to HMRC on an RTI submission on or before 19th March 2020 are eligible to be classed as furloughed workers. Employees must have been on your PAYE payroll on 28th February 2020 to be classed as furloughed workers 

  • Am I able to re-employ staff who left the practice or were made redundant and claim their wages through the Coronavirus Job Retention Scheme?

Please see the government guidance here. For employees that were made redundant, or stopped working for the practice on or after 28th February 2020, you are able to re-employ them, place them on furlough and claim for their wages through the Coronavirus Job Retention Scheme. This applies to employees that were made redundant or stopped working for the practice after 28th February 2020, even if the practice does not re-employ them until after 19th March 2020. This also applies as long as the employee was on your payroll on 28th February 2020 and had been notified to HMRC on an RTI submission on or before 28th February 2020

  • Can an employee be placed on furlough by more than one employer?

Employees can be placed on furlough by more than one employer and receive 80% of their regular wage up to £2,500 per month for each job

  • Can employees undertake other employment whilst being classed as a furloughed worker?

Please see government guidance here. If your contracts of employment allow, employees may undertake other employment while you have placed them on furlough. This will not affect the grant you can claim under the Coronavirus Job Retention Scheme. Employees will need to be able to return to work for the practice if you decide to stop furlough and they must be able to undertake any training you require while on furlough

  • Can employees take holiday and bank holidays during a period of furlough?

Please see government guidance here. Employees are able to take holiday, including bank holidays, during a period of furlough. Any time taken as holiday or bank holiday, should be paid at 100% or, if their pay varies, calculated on the basis of the average pay in the previous 52 working weeks

  • What are the timescales for the Coronavirus Job Retention Scheme?

The scheme is backdated until 1st March 2020 and is initially open for 4 months. You are able to backdate your furlough claims to the first date that the employee did not work on or after the 1st March 2020

  • Should I confirm in writing to my employees that they are being furloughed?

You should confirm in writing to employees who have been furloughed and retain a copy of this letter in their personnel file. You can download a furlough letter template from our COVID-19 Care Package here

  • How do I claim reimbursement of wages for furloughed workers’?

The government has set up an online portal for claims to be submitted. Please see login link here and further guidance here. Once you have made a claim, you will receive a claim reference number. HMRC will then check that your claim is correct and pay the claim amount by Bacs into your bank account within 6 working days

  • What do I need to submit to HMRC to claim?

Please see government guidance here

You will need to submit:

    • your ePAYE reference number
    • the number of employees being furloughed
    • National Insurance Numbers of the employees
    • names of the employees 
    • payroll number of the employees (optional)
    • your Self Assessment Unique Taxpayer Reference or Corporation Tax Unique Taxpayer Reference or Company Registration Number
    • the claim period (start and end date)
    • amount claimed 
    • bank account number and sort code details
    • your contact name
    • practice registered name
    • practice address
    • your phone number
  • Can we class our workers as furloughed and receive NHS funding?

It has been confirmed that mixed practices can claim from the government under the Coronavirus Job Retention Scheme in respect of the proportion of private income. Practices who claim under the Coronavirus Job Retention Scheme will still receive their NHS income. For example, If 50% of a practice’s revenue comes from private income, then in addition to receiving full NHS funding a practice will be able to claim 80% of their private wage bill (private wage bill = 50% of total wage bill) from the Coronavirus Job Retention Scheme. An example would be to furlough all employees for part of the period and pay in full in accordance with your NHS contract for the remainder of the period. In this example, if the Practice is affected for 6 weeks, all of your employees could be furloughed for 3 weeks and paid in full for 3 weeks. As far as we are aware, there is not a specific calculation to be used. We would recommend using a fair and consistent calculation across all of your team and documenting to evidence the calculation used as the NHS have stated that they will be asking for evidence of this. We recommend that you seek financial support from your accountant

  • Do we have any further information regarding redeployment?

Please see guidance from NHS England here. The CDO expects practices, who are being financially protected through NHS England’s financial measures, to make reasonable efforts in supporting staff to redeploy to the wider COVID-19 response, including in local UDC systems, Nightingale hospitals and wider parts of the NHS as highlighted above

Please see the guidance for Wales here. Practices in Wales should collate a list of team members’ transferable skills for Health Boards so that they can be redeployed to support essential services which may include supporting out of hours dental services, call handling or other appropriate duties to support the NHS

Please see the guidance for Scotland here. As a condition of receiving NHS funding, there should be no reduction in workforce. The NHS dental workforce may be required to assist with the wider COVID-19 response across the whole health care system in Scotland

Please see the guidance for Northern Ireland here. The expectation is that in return for financial support, dentists and other staff agree to assist in the wider HSC during COVID-19. There is a particular focus on support for care homes

  • What do I need to pay my employees who are self-isolating?

Your normal sick pay policy will apply e.g. enhanced sick pay arrangements or statutory sick pay. You may find it helpful to review your Sickness Absence Policy (M 233-SAA) in iComply

  • If my employee is not sick but notifies me that they will be self-isolating what pay are they entitled to?

Some employees may feel that they do not want to come into the workplace as they are concerned about contracting COVID-19 . In this situation, any payments will be at your discretion. You are able to agree the time as unpaid or to be taken as holiday

  • What happens if my employees need to look after their children following the school closures or other dependants?

Normal time off for dependant arrangements apply and any time absent from work will be unpaid, unless you agree otherwise with employees. Please review Family Emergency Leave Policy (M 233-FEL) in iComply. Please note, dentists and dental staff, who are working in UDCs or have been redeployed into the wider NHS, are deemed as key workers and school facilities will be available for your children. Workers with caring responsibilities can be placed on furlough

  • Does my employee have to provide proof of sickness?

Employers can use their discretion regarding the need for medical evidence. If an employee has COVID-19, or is advised to stay at home, they can obtain an ‘isolation note’ by visiting NHS 111 online, rather than visiting a doctor. For COVID-19 cases this replaces the need to provide a ‘fit note’ after 7 days of sickness absence

  • What should we do if we suspect an employee at the Practice may have COVID-19 or has symptoms?

Follow the guidance being updated here

  • Can we insist an employee self-isolates?

If an employee does not meet the requirements to self-isolate, you are able to ask them to self-isolate. Should they agree to this, full pay would be applicable

  • I have a pregnant team member, what should I do?

The government has advised that pregnant women are high-risk and suggested they should practice social distancing and/or self-isolate for 12 weeks. Please see further government guidance here. It has also been advised that pregnant women who are more than 28 weeks pregnant, or have underlying health conditions, should avoid direct patient contact. We recommend that you speak to your pregnant team members to discuss and agree with them how they would like to manage this, you may wish to consider an Occupational Health referral. You are required to complete a risk assessment with pregnant team members and consider COVID-19 within this. The risk assessment should identify any adjustments that you need to make to protect the team member and their baby, including suitable alternative work and/or working from home. Please see further guidance here

  • Is statutory sick pay now payable from day 1?

For COVID-19 related absence only, statutory sick pay is currently payable from day 1 of absence

  • Can I claim statutory sick pay in relation to COVID-19 from the government?
    Please see government guidance here. Practices will be able to apply to the Coronavirus Statutory Sick Pay Rebate Scheme for repayment of the current rate of statutory sick pay paid to current or former employees for sickness starting on or after 13th March 2020. If you pay more than the current rate of statutory sick pay you will only be able to claim the current rate amount. The repayment will cover up to 2 weeks starting from the first day of sickness, if an employee is unable to work because they either:
    – have coronavirus
    – are self-isolating
    – are shielding
    The online service to reclaim statutory sick pay is not currently available
  • Do I have the right to ask my team members to take holiday?

You are able to tell your employees when to take holiday if you give them twice as many days’ notice as the amount of days you require them to take. COVID-19 is likely to impact upon employee’s pre-book holiday arrangements and we recommend that you discuss this with them

  • I am concerned about my worker’s holiday entitlement, how can I manage this?

The government has confirmed that due to COVID-19, statutory annual leave can be carried forward into the next 2 holiday years. Up to 4 weeks of unused annual leave can be carried forward into the next 2 holiday years. Up to 1.6 weeks of unused annual leave can be carried forward into the next holiday year by agreement. Please see further guidance here

  • Can I stop my staff member from going on holiday abroad?
    You are unable to stop employees travelling, however, they will need to be aware of self-isolation requirements and the sick pay arrangements in their contract of employment
  • Can we change our enhanced sickness policy in case our whole team becomes infected?

Any changes to enhanced sick pay policies will need to be agreed by employees as part of a consultation process

  • I have team members undertaking training courses within the Practice, what is happening with their course?

The majority of training providers have put provisions in place regarding training. We would recommend that you contact the training provider for specific details

  • Can employees work from home?

If you have roles that can be temporarily based from home and team members are willing to do this, we would strongly recommend this option. This may be an opportunity for them to update their CPD, work on the iComply cycle or focus on practice strategy planning

  • An employee has been confirmed as contracting COVID-19, should we close the Practice?
    Follow the guidance being updated here
  • Patients are cancelling and we are concerned that we may have to offer a reduced service, can I lay-off employees?

If you are offering an emergency service only and have the lay-off clause within your signed contracts of employment you are able to utilise this. Please note, this is a temporary measure, unlike redundancy which is permanent. Employees who have been laid off are entitled to £30 per day for 5 days in any 3-month period. To be eligible for statutory lay-off pay employees must have been continuously employed for 1 month. This is calculated on a pro rata basis for part time employees. Lay-off can last longer than 5 days and any additional time will be unpaid. After 4 weeks of continuous lay-off or 6 weeks in a 13 week period, employees are able to apply for redundancy. Please see further guidance here. We recommend that you discuss this potential option with your team members and in the event that this is implemented confirm in writing to your employees. We suggest that this is a last resort and you should consider morale and future retention within the Practice. We are also aware that recruitment is difficult and would recommend that you try to avoid this where possible

  • What payments are my self-employed team members entitled to?

For fully private practices, please check the contract for service in place with the individual team member to determine any payments due. In order to protect self-employed status, our CODE contracts for services stipulate that payment is only due when treating patients. 

For mixed or NHS practices, following the Chief Dental Officer’s webinar on 3rd April and the information published so far, it appears that to receive NHS contract payments practices are required to continue to pay associates at previous levels in relation to the associate’s NHS element of their contract for services

  • Following the government’s announcement regarding the Self-employment Income Support Scheme, what are the requirements regarding earnings?

Please see further guidance about the government support available for self-employed team members here

Self-employed trading profits must be less than £50,000 and more than half of your income coming from self-employment. This is determined by at least one of the following conditions being true:

    • having trading profits/partnership trading profits in 2018-19 of less than £50,000 and these profits constitute more than half of your total taxable income
    • having average trading profits in 2016-17, 2017-18, and 2018-19 of less than £50,000 and these profits constitute more than half of your average taxable income in the same period

HMRC are aiming to contact eligible self-employed team members by mid May 2020 to invite them to claim using the GOV.UK online service

 ____________________________