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COVID-19 Update – 31st July 2020

Today we share with you our 34th Covid-19 digest in relation to the Scottish Dental Sector. The frequency of these updates has reduced as the volume of changes and governmental releases slow down. We will continue to provide digest of the major issues as emerging and hope you find it of interest/value. 

POLITICAL UPDATE

At this afternoon’s First Minister’s mandatory 3 week review announcement Nicola Sturgeon confirmed, as expected, that Phase 3 would not end today. She confirmed that it is now expected that Phase 3 will continue beyond the next review date of 20th August. Of course this is not the news we hoped to have as the current phase enforces so many limits on dentistry and places the sector under ongoing significant commercial pressure. The First Minister made it clear that Phase 3 will only end when it is felt there is not a significant threat to the Scottish public and that we have yet to reach that stage.
The announcement however did provide some guidance on the return of AGP usage in NHS settings and confirmed that for NHS patients aerosols may begin from 17th August for urgent dental care. We will now await the further guidance from the CDO on this remobilisation and the funding support which may accompany it. In the meantime Tom Ferris has been quoted at the following link on the next steps. 
Simultaneously alongside the announcement, a new updated guide on the Phase 3 relaxations was published, and I have pleasure in sharing this guide here.
Phase 3 Road Map Update 30 July 2020

CLINICAL & GENERAL UPDATE

As most practices are now adjusted to their current level of provision it is clear that there is an ongoing supply chain stress being experienced. The fit testing process allied to the (non) availability of all sizes for the full dental team continues to create challenges at this time. Given these logistical challenges the fit testing of the dental teams for the return of NHS AGP’s is likely to strain matters further and with the limited time available some rapid clarity of expectations and provision is desirable. 
I sincerely hope that you are not finding the additional PPE requirements too physically and mentally challenging. We have all been craving scientific evidence to support the fallow time requirements imposed at present and we await a fully detailed report in that regard in the next month. SDCEP’s guidance, as per Prof Jan Clarkson, is felt to be around 4-5 weeks minimum away from publication.
In the meantime a CoDER Working Group report was published this week entitled ‘Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents – A Rapid Review’. I share this document for your information below;
‘Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents – A Rapid Review’

Within the executive summary of this guide the key observations are made as follows;
• This review reports on national recommendation for AGPs and their mitigation from 58 countries.
• There is a highly variable level of details provided across international resources.
• Just over half of the documents (56%) provide a definition of AGPs. 
• 98% of countries state that AGPs can be provided for non-COVID patients. 
• 94% of countries recommend the use of a face mask and goggles or a face shield for non-COVID patients.
• Surgical masks are advised by 21 countries (33%) for non-COVID patients while 44 countries (70%) recommend the use of FFP2/N95 masks and 12 countries (19%) recommend the use of FFP3 masks.
• 82% of documents recommend the use of a pre-procedural mouthwash for non-COVID patients.
• 48% of documents suggest a fallow period after the providing AGP treatment for non-COVID patients, with times ranging from 2 to 180 minutes.
• Most countries making recommendations for COVID patients advised the same mitigation as for non-COVID patients.
• There is a lack of evidence provided to support the majority of recommendations in the documents.

Obviously the frustrations abound with the lack of evidence available which we all hope is remedied before too much longer.
Also circulated this week was an update from the CDO in regard to the usage of 3 in 1 for examinations after some debate over whether an effective exam can be undertaken without its usage. This letter is shared below in case you have not seen already.
CDO update – examinations 27 July 2020

The BAPD have today launched their website and you can support their efforts by becoming an Associate or Founder member at the following link

FUNDING UPDATE

NHS Funding
The current emergency SDR and Phase 3 funding package are unchanged at this point but we will await some direction on the return of AGP’s in August to see how it may well be amended.
The Scottish Government has confirmed that it will accept the recommendation of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and award dentists in Scotland a 2.8% pay increase for 2020/21, backdated to April. This is slightly higher than last year’s uplift which was 2.5%.We should expect a letter of confirmation to be issued soon.

Flexible Furlough Scheme (FFS)
We have helped many of our clients with the implementation of the FFS this month and the part time working optional ability has been welcomed by many practices (even if the complexity of its operation is not!)
As a reminder you can now utilise the FFS for your ongoing grant support. Your claims are limited to employees who have been furloughed at some point from 1st March onwards and each claim must not exceed the total number of employees on any prior claim.
For anyone undertaking their own calculations you are signposted to HMRC’s latest guidance at this link
I draw your attention to a key element in your commercial interests within the guidance. It is pasted in my digest below as follows;
“Employees can take holiday while on furlough. If an employee is flexibly furloughed then any hours taken as holiday during the claim period should be counted as furloughed hours rather than working hours. Employees should not be placed on furlough for a period simply because they are on holiday for that period.”
This is a fundamental relaxation in your favour and allows you to claim furlough support for any holidays taken during the FFS period assuming the employee is flexibly furloughed and further mitigates your employment costs rather than paying 100% of their holiday taken. As you can see you have no need to document the holiday as additional furlough days so as long as you have a FFS letter in place with your employee you can simply include the hours taken as holiday as furlough time for grant submission. This may be helpful for the holiday periods and allow your team to benefit from the ‘Staycation’ opportunities at a lower cost to the practice.
Should you find yourself with an employee requiring themselves to self isolate on return from overseas in the months ahead some guidance has been issued this week. It has now been confirmed that registered healthcare professionals do not need to self-isolate if based in England. Unfortunately in Scotland this does not apply and therefore if your employee is a GDC registrant they are not exempt from the self-isolation requirement, unlike your English colleagues. 
The guidance also extends to how the employee is to be paid if they are found in this position. This is confirmed as follows;
– SSP is not payable for self-isolation on the return from holiday 
– The employee can be furloughed if they qualify (i.e. if they have been furloughed in the past, no new claim entrants allowable.) This requires joint agreement in the same way as furlough in ‘normal circumstance’
– If no furlough support is available the employee should receive either paid holiday (if they have allowance remaining) or if no allowance they would receive unpaid leave. This process should be undertaken by mutual consent

We still await the full guidance on the ‘Job Retention Bonus’ payment of £1,000 per employee payable in January 2021, and expect this in the next 14 days.

HMRC Time To Pay (TTP)
As previously illustrated all self assessment payments on account due by tomorrow (31st July) have been automatically deferred until 31st January 2021. You can take full advantage of this deferral and no action is required. We have been in touch with all our clients to set out the options and are aware that many have elected to pay in the normal timeline rather than defer. I remind you that no interest is payable on early payment from HMRC or chargeable on a deferred amount.
There is no impediment to pay your deferred payment on account in instalments and you may like to pay monthly instalments from now until January if it suits your cashflow plans.

SEISS Phase 2
The Self employment Income Support Scheme extension is set to open for claimants on the 17th August and if eligible you should make your claim prior to the deadline of the 19th October.
You will be contacted directly by HMRC if they feel you are eligible and you can claim a total of 70% of your average monthly trading profits capped at a total of £6,570 and paid in one lump sum payment.
A self declaration of being ‘adversely impacted’ by Covid-19 on or after 14th July is required for this phase of funding. Examples of being adversely impacted can be found at this link. It will be very easy to demonstrate adverse impact in the Scottish Dental sector given the current restrictions. The only thing to look out for is where 100% of your self employed income comes from the NHS. In that case you are likely to risk double funding from public sources. On the assumption you have some private income, regardless of quantum, you are entitled to make a full claim and HMRC have confirmed that this will not be considered a duplication of funding.

And Finally
From the 1st August onwards the government are launching their ‘Eat out to help out’ campaign. Participating restaurants will offer a 50% discount (capped at £10 per head) Monday to Wednesdays in August. After a long break I hope you manage to enjoy a nice social meal with your loved ones, support the hospitality trade and save money!
On a personal note after working round the clock 7 days a week since the 13 March I am looking forward to a short family staycation next week and will catch up with you on my return.
Once again love and best wishes to you at this time from the Dental Accountants Scotland team. I hope you manage to stay safe and well. Have a restful and enjoyable weekend whatever you have planned.

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 feel free to 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 on 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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