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COVID-19 Update – 22nd May 2020

After what was has been a lovely warm two days for most of the country, we hope you have managed to get some fresh air and recharge your batteries somewhat.
We are today sharing our 25th Scottish Dental Sector Covid-19 update with you. We will continue to share any important news and advice for the Scottish Dental Sector, and will maintain contact at least once a week going forward. We have elected to send a second update this week due to the significant movement in opinions/guidance over the last 24 hours which seem worthy of digest.
We hope you continue to find value and support in my digests, and as always if you need any bespoke and free advice at this time the whole team at Dental Accountants Scotland are here for you. Please head over and ‘like’ our Facebook page to keep in touch with our news. 

POLITICAL & CLINICAL UPDATES

I have chosen to merge these two areas given the overlap of news this week. 
The much anticipated announcements from the First Minister have delivered a high level road-map for a 5 phase recovery period in the weeks and months ahead. Clearly the whole country was awaiting the detail behind this announcement as the gov.scot website fell over instantly when access was opened! To save you the job of retrieving the 46 page document I share this below.
Scottish Government Road Map

Within the document there is a useful table from page 37-45 which gives a high level overview of the phased relaxation of measures anticipated as matters progress. The next legally mandated review date for the country is a week today (28th May) and subject to there being no regression of the current position we will enter Phase 1 of recovery. This phase will last a minimum of 3 weeks and any progression beyond Phase 1 will be subject to satisfactory achievement of the R factor being below 1 and in sustained decline.
On closer review it is indicated that the movement to Phase 2 (which at earliest is 4 weeks away) will be required before dental practices will re-open to see patients with urgent care needs. At this stage only Urgent Care Centres will provide any urgent AGP procedures. 
You may have been aware that the CDO issued a letter in connection with the mobilisation of the NHS service provision yesterday afternoon. If you have not read this then I am happy to share below;
Return to Practice Plans – CDO

The road-map and the CDO guidance are clearly aligned in their approach/timetabling (as you would expect.) NHS practice provision is not to be delivered anywhere other than the UDCs at this stage and the centres involved are being resourced upwards in an effort to expand the breadth of service delivery. This is most welcome to the profession as there is a clear need for patient treatment and it is not being adequately serviced at present.
The CDO’s guidance also takes a phased approach and it is indicated that the entry to Phase 1 has already commenced with the increasing of capacity at the UDC’s taking place at present.
Phase 2 of the NHS plan is split in to two parts. 2a being resumption of face to face urgent care treatment (non AGP) and phase 2b being the introduction of routine care and exams (still non AGP). Cross matching this to the wider road-map it would seem that phase 2b in the CDO guidance is phase 3 in the government road map. Not sure why the different numbering system was used by the documents, but perhaps it was an effort to show independence of mind (or a more cynical interpretation might be lack of alignment.)
For planning purposes, you could decipher this timeline at best/earliest being;
– Now – Increase of capacity at UDCs – 4 weeks from tomorrow (19th June) – Re-open of practice settings on a single surgery basis for urgent care only– Uncertain time (target pre 31 July) – Resumption of normal dental care (non AGP) in practice setting
This provides an element of framework to plan around, however interpreting the financial impact of this is still out of reach somewhat until further update is given on the revised funding support from the NHS during this period as clearly the SDR will not be fit for purpose during such restrictions. 
The final phase (CDO=3, Scottish Government = 4) will see the return of AGPs to a practice setting, but based on the above timelines this may be some way off yet I fear.
The ‘elephant in the room’ at this stage is how/if any of the guidance on the table at this point applies to the private dentistry setting. You may have been following the English situation in regard to their interpretation of the CDO and CQC guidance issued originally to close all practices and the crowd funded legal challenge over jurisdiction. This allied to the BAPD vote of no confidence in the CDO (Press coverage) makes for a volatile environment there. It was very interesting indeed to see that the CQC guidance was ‘watered down’ somewhat this week as a reaction. The matter has now reached a similar stage in Scotland and the release of the opinion from Neil Taylor (Taylor Defence Services) & Senior Counsel on Monday has set out the position as they see things clearly that a private provider has the right to determine their own opening strategy at this point. TDS’s document can be read below for your information. 
TDS Opinion

I am aware that some practices have chosen to re-open yesterday as a result of this guidance, and while the intentions will no doubt be honourable in these practices it is perhaps more appropriate to ‘hold firm’ to allow the various relevant parties to set policy. 
Things are clearly moving quickly from a number of directions and many providers are looking for clarity of which instructions are binding at this point. The governance for delivery of NHS services does fall within the CDO’s scope and for Private services with Health Improvement Scotland. It is my strong advice at this time that you remain closed until approval is received from these bodies as the professional risk of ignoring their instructions may have severe consequences.
For mixed practices considering opening for private treatment only you are advised to consider the inherent risk of the removal of NHS support if they ruled the conduct contrary to their instructions. Whilst your indemnity cover and theoretical ability to open exists based on the TDS advice I would suggest that you may face funding removal and protracted legal wrangling to litigate your entitlement. Given the fragility of the sector during this period I would suggest that it may be a fatalistic move at this stage to be too ‘cavalier’ in your interpretation of the rules. 
We expect the SDCEP clinical guidelines and toolkit to be released this coming Monday (25th) and it would be prudent to await its guidance before restarting in a practice setting. The decision however is one of a personal nature, and one which I would not make on anyone’s behalf, but I do encourage a degree of patience until matters settle in the next week or so. This does not prevent you whatsoever from planning and preparing for re-opening to achieve a state of readiness. You might like to consider your SOP in the meantime. 
We have heard tonight that GP contracts/support have been issued by the NHS which involved additional payment for PPE. This may be a strong indicator of the direction of travel for this potentially expensive cost in the period ahead for dentistry also.

FUNDING UPDATES

COVID-19 STATUARY SICK PAY (SSP)

Although a relatively minor support element you may recall at the start of the outbreak that the Chancellor announced that the government would underwrite the first 14 days SSP payment for anyone on sick leave due to Covid-19. I would like to let you know that the portal for claiming this will be launched on the 26th May and will be accessed via this link

NHS SUPPORT PACKAGE

The CDO’s letter share above makes reference to an intended re-working of the NHS support package to support the recovery phases and recognises that the SDR will not be fit for purpose during this period. With the previously in progress Oral Health Improvement plan changes being considered it seems likely that the SDR in its current form may not return and may require flexible support re-writing throughout the recovery stages and beyond. We will keep a watching brief on any reforms on your behalf and comment where appropriate. 

OTHER MATTERS

GDC (ARF)

The lack of flexibility shown by the GDC this week in regard to the ARF payments has been very disappointing to the whole profession.
Often in the ‘firing line’ over the years the GDC could argue that they would be ‘damned if they do/damned if they don’t’ in the eyes of many in the profession. However, it is felt that they have missed an opportunity to show some empathy to the plight of their registrants by steadfastly refusing to offer a reduction in the ARF or any deferred payment terms.
The ARF had already been reduced to £680 in line with their costed two year strategy ‘Right Time-Right Place – Right Touch’ and it seems that they feel there is no further flexibility available. This apparent lack of compassion is unlikely to narrow the disconnect felt by a large proportion of the profession unfortunately. I cannot help but wonder why a monthly payment plan option could not have been offered as a small concession and would have been a gesture of support.

TECHNOLOGY IN ACTION

I have witnessed a great, and indeed rapid, adoption of the use of technology in the sector during lockdown and this can only be a positive opportunity to leverage matters for the benefit of practice activities going forward. I have personally managed to ‘cram in’ more meetings with our clients in each day than ever as many use Zoom for the first time and my travel commitments are lessened. It is great to see people in good strength and spirits ‘face to face’ during the social distancing period, but I do miss the hand shakes or hugs from everyone and look forward to the point where we can do so once more!
From a practice perspective I was pleased to hear of the use of Itero scans already on file being used for denture construction. This allowed a broken denture to be replaced during lockdown with no face to face contact. The possibility of scanning the whole patient base in future as a means to cover this type of eventuality seems a prudent and worthwhile option.
I was also made aware of a ‘Covid-19 Special’ deal today from Dental Monitoring in relation to their ‘Smilemate’ service. They are offering a reduced monthly charge of £140 versus the £275 normal charge at present. The system allows digital images to be shared remotely by the patient/potential patient and automates some treatment planning and communication. With the functionality for digital appointment booking the system looks to be worth reviewing and you can locate their web page here Smilemate

AND FINALLY

As this is Mental Health Awareness Week, I sincerely hope that everyone’s wellbeing is maintained and the anxiety and stresses of the current challenges are not causing you any mental concerns. Please do reach out at any point for a chat with myself or any of the team. It’s good to talk! 
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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