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COVID-19 UPDATE #50 – 5th July 2021

It has been several weeks since our last update, which is reflective of a period of stability as the country tries to reach the ‘exit door’ from the pandemic. It can, of course, feel like one step forward two steps backward at times, but we do have a feeling of momentum at present albeit, however – no long-term certainty as yet. I sincerely hope that you are managing ok in these ongoing challenging times.
I am bringing some updates and reminders to you in this digest which I hope you will find of value. Do let us know if we can help in any way.
The number of cases in Scotland has been on the rise this month and requires everyone to remain vigilant. It seems clear that the demographics of these cases point towards the younger generation and given that the majority are currently without any vaccination that is perhaps unsurprising. The cases in the Scottish Schools Estate have forced many schools to close early for the summer break. Our own local school has had a cluster of cases, and it has been close to home this week when my own son picked it up at his school causing an enforced family isolation. Thankfully he seems on the mend and the others in the family have avoided infection.
In many of our discussions with Scottish Practice Principals over the last month, we hear of exhaustion and it is clear that the toll of the pandemic has impacted the mental wellbeing of the profession. We hope that we are reaching the final sprint now and that everyone can bounce back higher. 
Take care of yourself and your loved ones. If we can help in any way do get in touch. I am out of the office now for a two-week break, the first since March 2020, but my colleagues are happy to help in any way.
I am now sharing my 50th Covid-19 digest about the Scottish Dental Sector. I hope you find this digest of value. As always – if you have any specific concerns or questions we will be delighted to hear from you.

POLITICAL UPDATE

After a period of inactivity caused by the Scottish election we now have a newly formed government, led again by SNP. As per the SNP manifesto, they have now extended their pledge to give free dental care to all young adults under 26 within 100 days of the election. This in practical terms would require the new regime to be implemented by late August, and leaves very little time to implement. Once again we find ourselves facing a major policy change to the SDR with very little forewarning on how it will be administered via the SDR. We hope to see more detail emerge over the coming weeks. It seems that this policy also took the CDO by surprise after he articulated that he could not foresee the parliament accepting any removal of patient charges at the pre-election SDA Summit. Perhaps an indicator that the civil service is by definition faced being reactive to their political influences.

CLINICAL UPDATE

We continue to see unprecedented demand for dentistry at present and the cosmetic and short-term ortho treatments in particular. As we reach the end of the furlough support scheme we anticipate that the incidence of redundancies may increase and impact the disposable income of the nation. This is clearly a viewpoint shared by a number of the patient finance providers who are retreating from the market citing increased credit risk as to the underlying reason. We are aware of a number of providers who have exited the market completely and the remaining providers struggling to maintain resources and capital adequacy. Medenta who were benefiting from the reduction in competitors has now had to close the door to new practices as their owners (Wesleyan) seem to be overexposed. Hopefully, this will right itself in due course and those reliant on the finance schemes can leverage the opportunity that exists at present. In the meantime, we do encourage strong financial controls to be exerted on high-value treatment cases to avoid any bad debt risks in your practice. 
Obviously, the PPE and fallow time restrictions have bottlenecked practices over the last year. Many have invested in ventilation systems to minimise the risks and fallow time impact. The CDO recently announced that the NHS shall provide grant funding for this equipment. More details to emerge, but the salient points of the support are that £5M has been set aside to be paid as grants towards ventilation equipment. It will be available retrospectively to practices who have already invested since March 2020 but it is not clear if it will extend to the likes of portable equipment or Hepa filters as had been advised in the SDCEP guidance. We will update you on information when made available. The letter is shared for your interest below.
CDO Ventilation Letter June 2021

FINANCIAL UPDATE

NHS Support
It has now been confirmed that the present financial and PPE support levels for Covid will continue at least until March 2022. It has not been ruled out for further extension but it is clearly the hope and desire that activity levels will be back to normal by that point. As part of the ongoing eligibility for this support, it had been previously announced that a sliding scale support level would be introduced for those practices operating at below 20% average pre covid levels. This activity measurement was delayed from Spring 2021 until July 2021 and has now been effectively cancelled entirely as announced in the CDO letter below. 
CDO Letter – Activity Measurement

As you can see from the letter it would appear that the vast majority of practices are at least operating at 50% of pre-pandemic levels. This is also our observation from the practices we are in touch with and we see some almost at full capacity. However, it seems that many have chosen to remain at remarkably low or non-existent levels. A cynical view would be that those practices are, by design, choosing to ‘game the system’ and receive full support while avoiding treatment delivery. We applaud the common sense approach being taken now to remove the unnecessary ‘blanket’ measurement of the profession and to divert limited PSD resources towards contacting these underperforming practices to help them to increase volume, and hope that anyone found to be exploiting the support is sanctioned appropriately. 
The initial consultations around the SDR re-write or replacement are continuing, but are not expected to deliver any short-term changes.
A recent briefing paper was produced by the SDA with a possible solution to the funding model going forward. This is shared below and they are very keen to have your comments, feedback, and suggestions to take forward. Please do contact them to contribute if you can. 
SDA SDR Proposal

In recognition that the current support scheme is not fit for purpose for maternity and sick pay matters there has been a tweak made to the SDR announced in the PCA below;
PCAD20212 – Amendment SDR 149

With the introduction of a fixed payment rather than the test period being impacted by the covid support this was designed to apply a fairer approach. With regret there are some clear losers with the new scheme and any new entrants are not presently given the choice to pick the methodology which gives them the best result. The BDA is collating everyone’s examples and if you or a colleague is aware of an adverse position emerging you are encouraged to contact the BDA to take this forward for re-design.
On the subject of the BDA, I am sharing the recent summary of BDA Scotland’s activities via the PEC below for your information.
BDA Scotland Report

CJRS/Furlough/ NHS Bonus
The flexible furlough scheme is still available to Scottish Dental practices. That said you should be aware that as we now are in the final stages of this scheme it is tapering off until its full removal in October 2021. From 1st July employers need to contribute 10% of the wage cost with HMRC providing 70%. Then during August and September, this will become a 20/60% split.
We are now seeing HMRC’s investigation teams commence some review of the furlough claims but as yet there has been no indication of any joined-up approach between NHS and HMRC. The claim reviews are at this stage being limited to clear errors or abusive scheme operators and professional advisors who promote them. There have been three convictions in England of professional advisors operating fraudulent schemes and in some cases charging 25% of the claims made for furlough and bounceback loans. HMRC has confirmed that they will be fair-handed with all genuine employers who have done their best to operate the complex scheme and that no penalties are likely to be levied. However, they have also confirmed that if deliberate misappropriation of the funding is identified they will seek maximum enforcement possible with 100% penalties applied and zero mitigation available. They will also seek criminal convictions for the abusers where appropriate.
The claim deadlines remain tight and must be submitted by the 15th of the month following to be eligible.

SEISS
The 5th and final grant invites for SEISS are now arriving and for anyone previously eligible, you can expect to be invited once again to apply. This is not an indicator of actual eligibility and you need to assure yourself of your status based on your own circumstances. If you are finding it difficult to assess and would like some guidance please do let us know. The key criteria in addition to the prior conditions are that you continue to be adversely impacted by Covid in your profession either financially or in terms of restricted ability to trade. This tranche of funding is paid on a sliding scale for those impacted less or more than 30% versus previous earnings. You should compare like for like income levels to pre covid period and retain detailed notes to defend your claim in the next five years if selected for review and/or challenged.


I hope you found this digest interesting. I look forward to catching up with you after my break. Do take care.
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 continues to work remotely but is 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 any way. 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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