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COVID-19 Update – 17th June 2020

With our First Minister shortly to update the nation on the entry to Phase 2 of recovery it seems that for all practices the return to surgery (at least one surgery perhaps) is now in touching distance.
A number of fully private practices have already returned and are finding the restricted processes, social distancing and additional PPE requirements to be a challenge. It is hoped that the phased return to a ‘new normal’ can be accelerated through swiftly and the ongoing financial challenges can be mitigated as much as is possible in these novel times.
I hope you find today’s digest of continuing value and interest. 

Bouncing Back Higher Webinar Series Update

Thank you to everyone who made it along last Tuesday evening for my presentation on ‘Business Planning for the Phased Return’. As the event was over subscribed we have made it available on demand and it can still be watched by registering at this link
We also have a further two events in the diary which I invite you to enrol for at the links below;

1.  How are practice valuations impacted by Covid-19? – In conjunction with Paul Graham – Christie & Co – June 23rd 7pm

2.  Business planning best practice for the new normal – In conjunction with Software of Excellence – July 7th 7pm

We look forward to seeing you at these events. 

For our client only support session last Friday we welcomed along Catriona Ramsay (Aberdein Considine) who, as an employment lawyer, covered off some of the key HR issues to consider at this time. Everyone who made it along found it to be of value and Catriona has provided her slides and contact details below for me to share. 
Presentation Slides
Aberdein Considine Literature

Political Update

The hotly anticipated briefing this Thursday (18th June) is expected to report that the Phase 1 measures over the last 3 weeks have been successful in their aim to reduce the rate of infection and the country will be allowed to move in to phase 2 of the plans. As the CDO/NHS have now re-indexed the NHS recovery plans to align with the national road map this makes matters somewhat easier to track as we progress.
Based on a movement to Phase 2 from the 18th onwards the return to practice date seems unlikely before the 22nd of June. Although it was made clear that this will not be a mandatory return date rather it will be the date when authorised to do so. The continuing NHS support will be maintained regardless of whether the practice was to re-open on that date or not.
The recently formed collective ‘Scottish Dental Practice Owners’ have taken great strides with a strong working group in place to attempt to create a common voice for the profession and their efforts are applauded. I am able to share their letter of 10th June addressed to the Cabinet Secretary for Health and Sport below and will look forward to the response in due course. They have also managed to get some column inches in the Daily Record and create some focus on the financial challenges at this time as well as TV news coverage this evening. I hope the exposure helps to mobilise some further support for the profession.
SDPO Letter 10th June

CLINICAL UPDATE

We have had a number of conversations in the last week with returning practitioners. The return to practice is proving to be challenging commercially, clinically, and mentally for all involved. The additional PPE required creates a communication barrier between you and the patient and the normal chairside connection that you have sharpened over your career is hampered. This can cause you to lose your confidence/stride. Allied to the dexterity issues that might cause pressure too and the heat of the PPE the experience can be challenging. I encourage you to look after your physical and mental wellbeing as much as you can during the next stages and be careful. The journey may take some time and adjustment along the way but I wish you good health throughout.
I was pleased to note that the British Endodontic Society has provided funding to enable clinical research in to fallow time efficacy and I hope this delivers some positive news to allow implementation of a sensible, evidence based, approach going forward.
NES have produced a FAQ document on the return to practice webinars being run at present which contains some useful pointers. I share this document below;
Returning-to-Practice-webinars-FAQs-1-1

My fellow Director, James Wilson BDS MAAT, himself a Private Practice Principal for 25 years, is presenting a webinar for NES on the 23rd June on the financial considerations of the return to practice and you may like to enrol if available.

FUNDING PACKAGES UPDATE

NHS Support Scheme

As previously covered in my prior digest I confirm that the NHS support package at its present level will be maintained at least until the end of Phase 2 of the recovery period. Realistically, given the staggering of patients, fallow times and reduced surgery numbers along with the limited service offering in the phases 2-4 there is likely to be a long term support measure required in place throughout. However, at this stage we have no certainty provided beyond phase 2. The ongoing viability of the NHS provision will require this support and I would hope it will be maintained at similar levels until the phase 4 recovery period concludes. 
On this basis NHS issued a revised and abridged SDR yesterday in draft format which I share below.
https://hubs.ly/H0rzJKc0

I must admit it was a strange reading experience to review this SDR when effectively all activity measures have been reduced to a £nil payment. The SDR is therefore interpreted largely as a NHS monitoring exercise to assess the level of treatment delivered in this period. It can also be interpreted as a reminder of the treatments which NHS practices should be delivering directly (non AGP) before referral to the UDCCs take place.
The revised SDR should be read alongside the accompanying PCA which I share below.
PCA(D)(2020)9 15th June 2020

The memo reinforces the position assumed for each phase of recovery in relation to NHS treatment, and importantly reminds all practices of the requirement for your own Health Board ‘sign off’ before re-opening which I know that most have already commenced in readiness of a ‘green light’ this week. 
I sincerely hope that the next stages are communicated in a considered manner to eradicate the confusion for mixed practices as we progress. I also hope to see the news emerge from official sources to the providers in the first instance rather than the unfortunate experience of your English Colleagues who were treated to the news of their return by the BBC resulting in a mad scramble to prepare and some ongoing unrest.
I have had some correspondence shared with me this week from the Office of the CDO in relation to the support package and it’s linkage to Hygienist function in the practice setting. You may or may not recall from my earlier digests that in the original letter from the CDO covering the support offered that there was a statement that “there should be no consequential loss of workforce” as a result of their support. We were never treated to a wider definition of ‘workforce’ and to which of the dental team members this should be applied to, albeit the subsequent correspondence did refer to the support package being purely in relation to the NHS proportion of practice activities.  
I provide the following extract from the CDO’s office;

Thank-you for your email of 5 June 2020 highlighting financial support for dental hygienists during the COVID-19 period and cessation of routine dental care in Scotland.
As you have noted NHS dental services have received financial support.  We advised dental contractors providing NHS dental services of the details of this package in the Memorandum to NHS: PCA(D)(2020)7 of 2 April. 
A practice which is predominately NHS will receive funding that should allow it to cover additional costs of continuing to pay staff, including self-employed dental hygienists.  The additional funding was provided on the understanding that dental practices retain staff that would otherwise provide NHS dental care.
I would advise then that you may wish to discuss your situation with the practice owner(s).

Yours sincerely,

Amy Jarvie
Policy Officer
Chief Dental Officer and Dentistry Division
Scottish Government
St Andrews HouseRegent Road
Edinburgh
EH1 3DG

This correspondence is of potential relevance to any NHS/Mixed practice with a Hygienist function within. I appreciate that the engagement of hygiene in this setting is relatively unusual and the scaling function is typically undertaken via Principal or Associate input, however in any practice structured in this way I would highlight that some caution may be required to avoid any possible NHS clawback downstream.
To expand on this scenario slightly, although there remains a high degree of ambiguity on the definition it would seem that the office of CDO is of the interpretation that all DCP’s engaged in delivery of NHS services whether employed or self employed should be considered as being supported by their package. This potentially leads to the possibility of a conflict between the Hygiene team and the practice and/or list holder whom their items of service were routed through if they have not been supported during lockdown. I do not wish to create or enflame any conflicts in this regard but I would advise that your own splits are appraised in full and where appropriate you may well wish to pass on some of the support to the individuals involved. There is no cast iron certainty in this regard, and the administration involved and calculations required are likely to be unwieldy but where possible and fundable it would be in the best interest of all if a suitable retainer could be extended to augment these practitioners and their SEISS support funding. 
The long term viability/structure of the hygiene function is something which will require deep dive scrutiny once AGPs re-emerge and the spectre of self employed vs employed hangs over the existing status of the position too.There is therefore a lot of water to flow under the bridge in this part of the dental recovery before the new normal might emerge, but I felt I should flag this issue in tonight’s digest and should anyone wish to discuss their own circumstances and how best to progress we will be delighted to assist. 

Flexible Furlough Scheme (FFS)

Further guidance was released late on Friday evening in relation to the FFS which will launch from the 1st of July and run until the end of October.
In typical government style it was released across more than one stream and in actual fact takes the reader to digest 7 different areas of guidance to navigate!
The scheme lives up to its name and does provide a significant amount of flexibility. However it is by no means simple! It will require careful planning and application to avoid non compliance and there are a number of considerations to make in how you utilise. The written agreements for any new furlough arrangements will be very important to cover the required audit trail and the administration and calculations involved is potentially daunting. My enduring advice is to undertake a commercial review of what you would like to implement and keep matters as simple as you can going forward. In an effort to de-mystify the scheme and to avoid you having to dig through the 7 difference sources I have prepared a FAQ guide and share it below. It still runs to 9 pages! If in doubt, you should take HR advice and as always I am happy to provide a generalists opinion on your proposed strategies if I can add value. Do feel free to contact us to discuss.
JRS/FFS – FAQ’s 16 June 2020

And Finally

Vernon Coleman, the well known author and renowned highlighter of medical issues recorded a 16 minute summary of the plight of UK Dentistry entitled ‘The Dentistry Madness’. recently and has shared at this YouTube link. While it is aimed to being challenging and sensational it is well worth a view if you have yet to see it. The description of the new patient journey experience is frightening and if we didn’t know it was based on the factual position of current reality we would think it a work of fiction worthy of the bestseller lists! 
Once again love and best wishes to you at this time from myself and the full Dental Accountants Scotland team. I hope you manage to stay safe and well.
As a recurring reminder – our full team are now working remotely but ready and willing to continue to do all we can to support you in any way possible. Please accept my ongoing apology for any delayed reply to your emails while we work harder than ever to support you during this crisis. The level of correspondence required has severely tested my words per minute typing skills! For any urgent queries you may have please continue to call my mobile 07375 700468 (day or night) or book a zoom online consultation here and I will be glad to support you in anyway. 

Our no fee advice is available to you at this time and we will do all we can as part of your team.
I invite you to keep up to date with information our blog and to like our Facebook page to stay in touch. 

Stay safe and look after yourself and all around you at this difficult time.

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