Contents

• 1. Background and definitions
• 2. Principles
• 3. Key considerations
• 4. Redeployment pathway
• 5. Workforce landscape
• 6. Key stakeholders
• 7. Competencies and mapping potential roles
• 8. Indemnity
• 9. Remuneration considerations
• 10. Induction
• Appendix 1: Transferable competencies
• Appendix 2: Questions and answers for volunteers
• Appendix 3: Self-assessment competency checklist

Publications approval reference: 001559 / C0301

20 April 2020, Version 2

1. Background and definitions

The dental workforce in the UK constitutes over 33,000 dentists and almost 58,000 DCPs registrants in England.* With the coronavirus (COVID-19) pandemic and the postponement of elective dental care, this multi-skilled workforce could be used for increasing surge capacity, as well as ensuring effective resilience across the health and social care system. The dental workforce has a wide range of skills and experience that can be used to undertake activities that will help clinical colleagues and the wider workforce during COVID-19. This document sets out the principles of safe redeployment and healthcare delivery as critical care units prepare and deliver increased activity during surge** and super-surge*** in the coronavirus pandemic.

*Gallagher, J. The Future Oral and Dental Workforce for England. Liberating human resources to serve the population across the life-course. 2019.

**Surge: increased activity supported by reducing other routine activity (eg elective/non-urgent surgery and outpatient appointments. This will operationalise operating theatres, recovery wards and similar areas to provide critical care for an increased number of patients.

***Super-surge: increased activity which requires ‘normal’ wards to be converted into critical care units. This will require additional resources to be provided to hospitals: hardware (eg ventilators and monitors), oxygen, consumables and staff. Extra beds may be created through partnership with independent sector hospitals or setting up new field hospitals.

It is expected that the clinical dental workforce can be used to free other roles within the health and social care system and help maintain the delivery of other non-coronavirus related essential services. Strategically redeploying the dental workforce based on needs will maximise the effectiveness of the existing healthcare workforce, as well as increase capacity where the need is the greatest. Some of the dental workforce may still be required to maintain urgent and emergency dental care access. It is crucial that this is maintained, to reduce pressures on emergency departments.

For non-clinical members of the dental team, there are numerous, valuable local community volunteering efforts that will help vulnerable members of society. These dental team members have a wide range of skills that can be used during this time of crisis to support the wider workforce.

While the list in this document is not exhaustive, it provides potential job roles where the clinical dental team may be able to redeploy their skills within their competency. Redeployment will be locally determined. Individual trusts will have their own induction and job specifications and the demand for certain roles will vary depending on locality. The GDC has made clear that it fully supports members of the dental team taking on roles outside normal dental practice, but individuals must ensure they work to the limits of their competency, in accordance with GDC standards.

2. Principles

Safe for staff and patients

• Redeployed dental team members should work to the limits of their usual framework of competence and experience but may have to work outside their usual teams and hierarchies.
• Competencies have been mapped to specific roles, requiring support during surge. Individuals should undertake a self-assessment to ensure their competence meets the required role. Please see Appendix 3.
• Dental team members should not be removed from roles which would leave urgent dental services understaffed.
• The hospital dental workforce should place themselves firstly at the disposal of their trust’s medical director for redeployment. Universities remain open therefore Academic dentists should be directed to the most effective role by their Dean/Head of School in the first instance. Those available for redeployment should let their hospital colleagues be put at the disposal of their trust’s medical director.
• Redeployed dental team members may be at increased personal, physical or mental health risk because of their lack of experience in their new working environment. Induction and orientation will be key, as well as assigning a designated contact person.

3. Key considerations

1. Dental professionals will register their note of interest via the online questionnaire.
2. There will be no obligation for any member of the dental workforce to provide services. This will be on a voluntary basis.
3. Expressions of interest will be triaged based on multiple factors including recognised competencies, level of experience and geographical location.
4. Consideration to competence and supervision will feature as part of any assessment.
5. Once triaged appropriately, the information will be shared with relevant regional teams.
6. Regional teams will recruit staff according to demand/operational needs.
7. Regional teams will provide necessary and identified training needs, based on local requirements.
8. Dental team members will be used to meet surge demand, within their scope of practice.
9. Dental team members will be expected to inform their indemnity organisations of any changes in their roles. You may be asked to carry out activities which are not currently part of your remit.
10. Individuals will need to know what roles they will be expected to carry out and how they will be deployed. When they are already employed, volunteers will need to know how to notify their employer and be made aware of the employment protections they will receive in respect of the leave.
11. Finances: compensating individuals for some loss of income and expenses is an important factor in ensuring that enough volunteers come forward. Maximising success will be aided by identifying and agreeing an appropriate rate of compensation and a simple means for individuals to claim. Those volunteers from a wholly private or mixed NHS background should not be disadvantaged by volunteering. Arrangements for remunerating individuals will take into account support that NHS England and NHS Improvement have provided to the sector.
12. The government has committed to indemnity not being a barrier for staff who work in alternative settings during the coronavirus pandemic. Existing state schemes – the Clinical Negligence Scheme for Trusts (CNST) and Clinical Negligence Scheme for General Practice (CNSGP) – or emergency clinical negligence indemnity arrangements will cover staff working in alternative settings. The Coronavirus Act 2020 gives the Secretary of State powers to provide indemnity for clinical negligence liabilities arising from NHS activities carried out for the purposes of dealing with, or in consequence of, the coronavirus outbreak, where there is no existing indemnity arrangement.
13. As part of redeployment, consideration should be given to previous experience and site familiarity. Focused induction should occur as a priority so the redeployed workforce is prepared.
14. It is likely that there will be high sickness rates and staff will be stretched beyond their usual working practices. It is also recognised that working outside usual systems is stressful and sometimes extreme circumstances will impact on wellbeing and staff morale. Local support mechanisms should be developed as a priority.
15. The trust or organisation to which dental team members are deployed will be required to undertake appropriate identity checks and provide a contract in line with current local arrangements. The contract will need to reflect working hour protections, pay arrangements, annual leave entitlement and inductions that are provided to new staff.

4. Redeployment pathway

5. Workforce landscape

The dental workforce constitutes a mix of both public and private sector professionals. Most of the dental workforce works in primary dental care (85%)* in general dental practice. The earnings for most dentists, dental therapists and dental hygienists are mainly from self-employment. Others work in salaried positions within the community and hospital dental services, as well as in postgraduate training roles. This salaried cohort can be rapidly redeployed locally as deemed appropriate by trusts as they are already employed. Currently, there are 11 dental schools in England. There are 11,000 dental practices in England of which approximately 8,348 hold NHS General Dental Service contracts.

*General Dental Council, Preparing for Practice, Dental Team Learning Outcomes for Registration,2015.

Table 1: General Dental Council registered clinical dental workforce in England**

**General Dental Council. Registration Report March 2020.

6. Key stakeholders

• British Dental Association
• Care Quality Commission
• Dental Schools Council
• Dental professional bodies
• Department of Health and Social Care
• General Dental Council and General Medical Council
• Health Education England
• Indemnity organisations
• Public Health England
• NHS Business Service Authority
• NHS England and NHS Improvement
• NHS trusts
• Royal colleges and specialist societies

7. Competencies and mapping potential roles

Registrants will need to make a considered judgment about whether they are trained and competent (Responding to COVID-19: providing treatment in uncertain times, GDC 26 March 2020).

Local induction and training may be required for use of systems, templates and algorithms.

The expectation is for the dental workforce not to be deployed to roles that require additional training in the form of new qualifications or would require a high level of supervision.

Table 2: Key for training and supervision

Table 3: Competencies and mapping of potential roles

8. Indemnity

Arrangements are in place to indemnify healthcare workers and others for clinical negligence arising from the NHS work they already do, through state indemnity schemes operated by NHS Resolution on behalf of the Secretary of State for Health and Social Care.

During a pandemic, existing indemnity arrangements will continue. The Clinical Negligence Scheme for Trusts (CNST) will also cover dentists and DCPs who are redeployed to work for NHS trusts, and the Clinical Negligence Scheme for General Practice (CNSGP) will cover dentists and DCPs who are redeployed to work for general practices undertaking normal NHS contracted work.

These arrangements should cover existing dentists and DCPs for the vast majority of NHS services. However, we recognise that there will be a need for changes to working arrangements during this emergency period. We do not want indemnity to be a barrier to such changes. Through the Coronavirus Act 2020, the government has therefore introduced additional powers to provide indemnity coverage for clinical negligence liabilities that may arise when healthcare workers and others are working as part of the COVID-19 response, or undertaking NHS work to backfill others, in the event that existing arrangements (CNST, CNSGP or individual arrangements) do not cover a particular activity.

9. Remuneration considerations

Members of the dental workforce who are not on a trust payroll or part of the GDS contract will need reassurance that their roles will be remunerated.

Foundation dentists, although employed by primary dental care practices, are salaried and will continue to be salaried by dental practices throughout any deployment process.

NHS England has agreed to continue to make monthly payments in 2020/21 to all practices that are equal to one-twelfth of their current annual contract value. As part of the funding package, the NHS encourages dental practices to support the redeployment of professionals and staff working in general dental services to underpin the wider NHS response, as is happening across the rest of the NHS.

For staff who are not currently employed in the NHS (private-only dental providers or returners), the time for which they are redeployed into acute or community settings within the NHS will be paid at the appropriate pay scale for their role, reflecting the skills and training required for their specified COVID-19 role. The actual amount will be confirmed by the COVID-19 employing trust. Your contract will reflect standard terms and conditions such as working-hours protections, pay arrangements and annual leave entitlement.

For staff in UDA-funded dental practices, further guidance will be provided separately to recognise the nature of various funding streams that underpin most NHS dental practices.

10. Induction

Health Education England has developed training and induction modules to help the healthcare workforce respond to COVID-19. These modules are useful to aid upskilling of the workforce and prepare for redeployment. Please see online training modules here.

All deployed workforce members will also be provided with orientation and induction at a local level, to ensure they are fully prepared and supported in unfamiliar settings. Employers and service providers remain responsible for making sure the redeployed workforce is competent for its role and is appropriately inducted, trained and supervised.

Appendix 1: Transferable competencies

The dental workforce must be allocated to tasks according to their competency and skill set, as set out below. All GDC-registered dental team members should have achieved the following competencies on registration.

*General Dental Council: Preparing for Practice, Dental Team Learning Outcomes for Registration, 2015.

**General Dental Council, Preparing for Practice, Dental Team Learning Outcomes for Registration, 2015.

Appendix 2: Questions and answers for volunteers

General

In what ways can I support the coronavirus (COVID-19) response?

The coronavirus (COVID-19) outbreak is unprecedented and is affecting all aspects of society. In addition to redeployment, you can assist with the response to coronavirus in many ways by:

• following guidance outlined on www.england.nhs.uk/coronavirus
• offering assistance to vulnerable members of your local community at  https://www.goodsamapp.org/NHS

Might my practice environment be used during the response to COVID-19?

A dental practice is a clinical environment that potentially may be of benefit in some local areas. There are, however, no current plans to use dental practices as part of the response to COVID-19.

Can I help without being directly in a patient-facing role?

There are opportunities to work in roles such as NHS 111. These roles will be available first to individuals who are at increased risk of a severe response to coronavirus, such as people with co-morbidities.

In what geographical location might I be expected to work?

There is likely to be increased demand across the entire NHS in England, and therefore you will be offered opportunities as close to your requested area as is reasonably practical. There may of course be an element of travel involved. If you are redeployed, your travel expenses will be reimbursed. In some cases, local accommodation will be offered.

Will I be tested for coronavirus before my deployment?

No, we expect that testing capacity increases, we will be offering tests to all NHS staff members of their household members who develop COVID-19 symptoms. If you develop symptoms you should report this to your employer and appropriate testing will be arranged.

​Will I be sent to multiple different locations?

To minimise the need for training and induction, it is highly likely that once you have begun in a particular team, you will remain as part of that team until demand subsides and you can return to normal clinical practice.

I am working in an education/research role. Can I still help?

Of course. You are a highly skilled and knowledgeable member of the healthcare workforce. You will have the opportunity to work within your own clinical competence but potentially outside your traditional comfort zone.

Will I be provided with personal protective equipment?

You will be provided with the appropriate personal protective equipment, as recommended by PHE/NHS England and NHS Improvement to safely fulfil each role you work in. The safety of NHS staff and patients is of utmost importance and current guidance is available at COVID-19: infection prevention and control.

Can all members of the dental team offer services?

Assistance and support are required in a wide variety of both clinical and administrative roles. All members of the dental team will therefore have a vital role in providing an effective response to COVID-19.

When is this likely to start?

There is no exact or defined date as to when this additional support is needed. This will vary and depend on the specific demands of a local area, at a particular time.

If I change my mind about volunteering during my service, can I withdraw?

Yes. However, we would encourage you to committ to a minimum period in discussion with your local placement. If you change your mind and don’t want to work anymore, you should tell your line manager. A professional approach would be expected – for example, not leaving before you had completed your shift.

Training

Will I need to learn new skills?

This depends on your current experience and skills. You will be assigned a role and task closely aligned with your current competencies. If there is a need for training, this will be provided, via an induction and orientation programme.

Who will I go to if I have any concerns/questions once I am redeployed?

There will be a central point of contact at the location you have been deployed to.

Personal health

What if I am pregnant?

The government has advised that you should be particularly stringent in following social distancing measures. This does not specifically mean you cannot work. You should, however, have a risk assessment undertaken at work and where possible work from home or work more remotely, potentially in a non-clinical role without face-to-face patient contact.

Please visit this link for more information on what measures to follow.

What if I have a chronic disease?

The government has advised individuals with particular conditions to stringently follow social distancing measures. Please see the list of conditions/diagnoses outlined here. This does not specifically mean you cannot work. You should, however, have a risk assessment undertaken at work and where possible work from home or work more remotely, potentially in a non-clinical facing role.

Please visit this link for more information on what measures to follow.

What if I develop symptoms of coronavirus (COVID-19)?

If you develop symptoms of coronavirus, you should report this to your employer and appropriate testing will be arranged. If at work at the time of developing symptoms, you should immediately inform your line manager and withdraw from work.

What if someone in my family develops symptoms of coronavirus?

If someone in your family/household develops symptoms of coronavirus, you should report this to your employer and appropriate testing will be arranged. Please visit here on how to manage this situation.

What if I become ill while I am working?

If you become unwell while working, please notify your designated point of contact.

What if a member of my household is a vulnerable individual?

Given the increased risks of coronavirus, in certain groups (see here), we would advise against returning to patient-facing clinical work if you are a carer to someone in an at-risk group. However, there is a range of opportunities in non patient-facing roles that we are in urgent need of support with. This includes assistance with clinical triaging via the NHS 111 pathway.

Contractual and remuneration

I am self-employed. Can I still help?

You are indeed a valuable, highly skilled and trained individual. Your services will be invaluable in providing safe, effective and timely care to patients.

For staff who are not currently employed in the NHS, the time for which you are redeployed into acute or community settings within the NHS will be paid at the appropriate pay scale for your role, reflecting the skills and training required for your specified COVID-19 role. The actual amount will be confirmed by the COVID-19 employing trust. Your contract will reflect standard terms and conditions such as working-hours protections, pay arrangements and annual leave entitlement.

For staff in UDA-funded dental practices, the proportion of their time that is non-NHS employment (measured as a proportion of their time pro rata to the percentage of practice revenue that does not come from NHS funding) can be recompensed in the same manner as above.

Please visit here  for regular updates on remuneration.

I work part-time. Can I still help?

You will be able to help in a part-time capacity and may even have the opportunity to increase your working hours if desired. A workforce rota will be designed to suit the availability of all staff. Please discuss your availability with the designated point of contact. Do discuss with your employers under what circumstances you should temporarily suspend your external commitments, to provide more clinical support in your employing organisation. The balance between supporting frontline NHS services directly and delivering the business-as-usual work of the national bodies should be carefully balanced in each case.

Will I have an employment contract?

The site at which you are deployed will provide a contract to reflect standard terms and conditions such as working-hours protections, pay arrangements and annual leave entitlement.

What will happen to my UDA commitments?

As outlined in the communication from the Chief Dental Officer for England on 25 March 2020, your employer will continue to receive payment from NHS Business Service Authority via the usual mechanism. Please see the Letter of preparedness.

How long will I be expected to help?

You will be needed for a limited time, but at this stage the exact length is unpredictable. You are free to stop working at any point, and redeployment can be for short periods. You can choose how much time you contribute. Assistance and support from the wider healthcare community will be necessary until the surge in COVID-19 has been effectively and safely managed.

Will I have a rota/need to work specific hours?

It is likely you will work specific hours and as part of a wider rota. This will of course be planned and designed in such a way that it meets the surge demand on the system. You will be asked for your availability and, where possible, will be given shifts aligned with your stated availability.

Scope of practice

What roles might I be expected to do?

We recognise that dental staff have many competencies that are transferrable to the medical environment. There are many possible roles that you might be expected to take on, depending on where you work. This may be in a hospital, ward environment or within a local GP practice. You will not be asked to fulfil a role that you do not have the training or support to safely perform.

Below is a list of potential roles that the dental workforce could undertake. Note this is not an exhaustive list but is used to demonstrate some of the potential roles that could be undertaken.

Dental nurse – decontamination measures, administrative jobs, talking to relatives, helping with feeding, moving patients, donning PPE, bedside support, equipment preparation, acting as ‘runner’ between teams, turning and washing patients, providing bedside comfort.

Dental therapist – all of above but also wound dressing, suture removal, patient observations and monitoring, history taking.

Dental technician – administrative jobs, talking to relatives, bedside support, equipment preparation, acting as ‘runner’ between teams, providing bedside comfort.

Foundation dentist and GDP – decontamination measures, administrative jobs, talking to relatives, helping with feeding, moving patients, donning PPE, bedside support, equipment preparation, acting as ‘runner’ between teams, turning and washing patients, providing bedside comfort, wound dressing, suture removal, patient observations and monitoring, history taking, radiography.

Dentist with sedation training (past two years) – all of above plus phlebotomy and cannulation. In some cases, it may be possible to administer sedation to relieve anaesthetists.

Will I be asked to work in a role I am not familiar with?

As far as possible, we will aim to match dental staff to the most suitable roles in line with their capabilities. In some situations, you may need to be placed in a less complementary role. However, where this is necessary, you will be supported adequately to take on these roles and should only work within the limits of your competency. Training, induction and supervision will be given. If the pandemic worsens, it is likely that healthcare professionals will have to work outside their normal field of practice.

When deciding the safest and best course of action in the circumstances, you should consider factors which include:

• what is within your knowledge and skills
• the protection and needs of all patients you have a responsibility towards
• minimising the risk of transmission
• protecting your own health.

Can I reject a role if I am not confident it aligns with my skills?

As the COVID-19 pandemic progresses, it is likely that doctors will have to work outside their normal field of practice which has been acknowledged by the General Medical Council. A similar arrangement may be required for dental care professionals. Defence organisations advise that any professional faced with clinical responsibilities outside their clinical competence should clearly outline their concerns to the clinical/medical director managing the service. If further advice is required, please contact your indemnity defence organisation.

I am working in an educational or research role. What are the next steps for me?

If you have an honorary clinical contract, your organisation will contact you to discuss whether you are prepared to postpone your educational/research activities in the short term (unless working on education or research in relation to COVID-19) to provide more clinical support in the workplace. Those with teaching expertise may be able to help provide induction for new staff – for example, environmental orientation, the use of PPE, managing high-flow oxygen of ventilated patients (if appropriately trained to do so).

Indemnity

Where dentists and other dental care professionals are redeployed to help in delivering NHS services for the purposes of dealing with the coronavirus outbreak, they should be reassured that they will be covered for any clinical negligence arising from their NHS activities (irrespective of where the NHS services are provided – in hospital, a clinic, on GP premises, etc):

• the Clinical Negligence Scheme for Trusts, if they are engaged by an NHS trust to provide NHS services
• the Clinical Negligence Scheme for General Practice, if they are engaged by a GP practice to provide NHS services (ie a GP practice, whose main business is providing NHS primary medical services)
• if the NHS services they provide as part of the response to the coronavirus outbreak are not covered under the CNST or CNSGP, they will be covered for clinical negligence arising from the provision of such services under the new powers of the Secretary of State in the Coronavirus Act 2020.

These arrangements will cover existing dentists and dental care professionals.

Where do I go for more advice and support about indemnity?

We recognise that dentists and DCPs may also want access to medico-legal advice and support, and it is the government’s intention to ensure this is not a barrier to their return. NHS England and NHS Improvement are working with the Department of Health and Social Care, NHS Resolution and providers of such advice and support to ensure it is available to dental practice staff.

Appendix 3: Self-assessment competency checklist

This self-assessment competency checklist can be completed and taken to your allocated placement to help guide the allocation of suitable roles.