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COVID-19 Update – 5th September 2020

We hope this digest finds you in good health and you are looking forward to a restful weekend.
Today we are sharing with you our 35th Covid-19 digest in relation to the Scottish Dental Sector. The fact that it has been almost a month since our last digest is perhaps indication of the slowing down of financial announcements of any major significance to the Scottish Dental Sector. We will however continue to provide digest of the major issues as emerging and hope you find it of interest/value.

POLITICAL UPDATE

We are now in week 8 of the government’s Phase 3 recovery plan. With the return of educational settings and relaxation of some social restrictions we are seeing clusters of infection emerging locally. It seems the continuation of localised lock-down actions will be adopted rather than any national return to full lock-down. We have seen local lock-downs in Aberdeen and Glasgow over the last few weeks, both of which have had minimal impact on the Phase 3 level of dental provision given the restrictions already in place. 
The closely scrutinised ‘R Factor’ of re-infection appears to be on the rise and was reported as high as 1.4 last week. It seems likely that ongoing monitoring will continue to dictate whether we can move in to Phase 4 in due course. There are a large number of variables influencing this measure, and with the move in to Autumn/Winter periods the normal ‘coughs and splutters’ are likely to continue to raise anxiety in the population.
Let’s hope the transition to the next phases can follow without too much ongoing delay.

CLINICAL & GENERAL UPDATE

With the CDO’s permission many NHS and mixed practices are now in the position to deliver urgent dental care and AGP’s under their own practice roofs. This helps to remove the frustrations of the limited availability of care within the 56 Urgent Care Centres. Whilst this is seen as a positive given the recent poll undertaken by the Association of Dental Groups which found 25% of households had undertaken some form of ‘DIY dentistry’ in lock-down, the commercial reality of this remains that without any patient charges in the latest SDR that most practices will be adversely impacted due to the additional overhead costs required.
As most will have seen, the recent supplies of PPE for NHS services to practices has created further problems with the news of the 3M FFP3 respirators supplied being ‘out of date’ by up to 10 years! It has been uncovered that these items were re-certified at least twice. The first re-certification appears to have been performed directly by 3M and the second by Inspect. The stock-piled PPE was originally set aside for usage in a major Flu epidemic. 3M have issued a statement to the effect that these items degrade over time and they would not normally re-certify their safety levels. Despite this the Scottish Government and the CDO have communicated that the items are safe for usage but have not produced any meaningful proof to our knowledge. They are in direct conflict with the BDA’s advice not to risk their usage at this time. We are aware that many of our clients are choosing to continue to use their own procured items at their own costs, but this situation remains far from ideal. I share below an update from Lee Savarrio earlier this week on the matter; 
GGC Chief-of-Dentistry-Update-2-9-2020.pdf

Many GDP’s have played their part in the wider healthcare provision during Covid-19 in a number of differing manners. A further opportunity to do so is set to emerge shortly with practices being given the chance to opt in to a fee per item vaccination programme for seasonal flu vaccinations. More news to follow in due course. 
This year’s intake of VDP’s was delayed to the 1st of September and has been re-modelled slightly to recognise that the access to clinical sessions is limited at present and will seek to ‘front load’ the study days as much as possible. There has also been a supply of phantom heads to training practices to allow additional in house clinical skill development opportunities. In addition we have seen the 2019-2020 cohort of VDP’s receiving some financial support to help them transition to Associate positions without the ability to build their own list at this time. 
Last month a Short Life Working Group made recommendations in their report entitled ‘SBAR Ventilation, water and environmental cleaning in dental surgeries relating to COVID-19’ which I share below for your reference.
NHS SLWG Ventilation Advice

This was very quickly challenged via a rebuttal document issued by the BAPD which again I am happy to share for your reference;
BAPD Rebuttal – SLWG

FUNDING UPDATE

NHS Funding
The current emergency SDR and Phase 3 funding package are largely unchanged at this point, with only minor amendment made to increase the GDPA payments in an effort to recognise the increased costs associated the with delivery of local urgent care.
The minutes from the Scottish Dental Practice Committee meeting held on 5th August include some Q&A access with the CDO and are shared below for your information.
SCOTTISH DENTAL PRACTICE COMMITTEE MINUTES

Some interesting observations to note include; 
– Recognition and further acceptance that the CDO’s jurisdiction is limited to NHS dentistry only (1.3)
– Acceptance that there is a lack of fairness and parity in regard to the payment of the Business Support Grant at local council level. Advice to those practices who may have lost out to submit Freedom of Information requests (1.4)
– An implied acceptance that the SDR will require careful analysis and re-write to be fit for purpose in the long term. The re-write in progress resulting from the Oral Health Improvement Plan having been paused in the meantime is not necessarily the guaranteed direction this will now take and further advice/consultation would be sought as matters move forward (1.8) 
– I interpret this communication to be suggestive that we may not expect a stable SDR in the short to medium term future until the environment further normalises. We hope that some stability can emerge soon though as we continue to have numerous conversations with practices who are considering a departure from NHS provision as a result of the lack of clarity being provided at this time.
Despite the gradual return to AGP’s it remains the case that very little lab work is being undertaken at this time. Growing concern over the viability of the labs supporting the profession continues. Unless we see an upturn in activities it seems almost inevitable that we may see some lab failures, which is never likely to be in the best interests of the profession. A rallying call has been made by the British Association of Private Dentistry this week. Their statement was as follows;

“The BAPD recognises the vital role that our dental laboratories play in the provision of dental treatment for our patients and it is crucial that they are supported financially during the COVID-19 crisis. With fewer laboratory-made devices being prescribed because of practice closures, the effect on cash flow for small businesses such as dental laboratories, who rely wholly or in part on NHS/mixed service practices, has been devastating, with reports of redundancies already and now business closures becoming a distinct possibility. We urge our membership to support their dental laboratories in any way they can during this difficult time.” – British Association of Private Dentistry (BAPD)

Flexible Furlough Scheme (FFS)
It appears that most practices have managed to navigate through the transition to flexible furlough. As previously covered in much detail we saw the requirement of employers to pay the NIC and Pension elements directly come in to play last month. From this month onwards the addition of 10% of the wages will commence and the scheme will conclude next month with a further 10% requirement. We have undertaken all the furlough claims free of charge for our clients throughout and will continue to do so as part of our ongoing Covid-19 support efforts. Please do bear in mind that the level of admin and additional work involved in these claims has created an exponential increase in time taken to accurately process the payrolls involved. With that in mind if you can endeavour to supply the required information as early as possible this will aid the payroll team greatly. If you are in need of any advice on your adoption of FFS we are happy to assist free of charge regardless of whether we process your payroll so please do get in touch if you feel in any way lost with your interpretation. 
One key thing to remember about FFS which could be easily overlooked is that within the small print of the scheme there is an allowance made for anyone taking annual leave between 1st July and 31st October in that you are entitled to claim furlough support for the holiday taken meaning that you receive some contribution to the costs of their time off. Please don’t miss that opportunity. The employee has to have been on furlough at some point before 30th June to be eligible.
For anyone undertaking their own calculations you are signposted to HMRC’s latest guidance at this link
Further guidance has been released in regard to the ‘Job Retention Bonus’ payment of £1,000 per employee payable in January 2021. It has now been confirmed that anyone furloughed at any point during Covid-19 who is retained on the payroll up to and including January 2021 and paid a minimum of £520 per month will be entitled to the bonus payment. The claim portal for the payments will open from February 2021.

SEISS Phase 2
The Self employment Income Support Scheme extension opened for claimants on the 17th August. I remind you that a claim must be made prior to the deadline of the 19th October to avoid missing out.
We have helped a number of eligible claimants to rectify HMRC errors in the last two weeks when they were told they were no longer eligible despite having been eligible for Phase 1. If you find yourself in that position you are advised to challenge the system decisions as it is almost 100% certain that if eligible for Phase 1 you remain eligible now for Phase 2 as the demonstration of ongoing adverse impact in the sector is easily achieved.
As previously discussed in my earlier digests, even if you are in receipt of Covid support from NHS or your practice, as long as your private income levels have been impacted then HMRC and the BDA have confirmed there will be no risk of duplicating support and you should ensure you avail yourself of this valuable support payment. 

Kickstart Scheme
The first guidance in relation to the Kickstart Scheme was released earlier this week and can be read at the following link 
This scheme is designed to help young people to get placements in a workplace for a minimum of 6 months to aid their employment prospects.
The funding stream involves the government paying £1,500 of initial setup costs and then 25 hours per week at minimum wage levels for a 6 month period towards the employment of these young people. It is in it’s early stages and some deeper analysis of it will be appropriate but it would seem potentially useful funding to subsidise recruitment in to nursing and admin posts within a practice. There is no barrier to commencing an apprenticeship during the placement if relevant.
There is a very strict eligibility process for candidates which requires the candidates to be in receipt of universal credit and to apply via the scheme.
This is potentially useful if you are considering recruitment or would simply like to assist some young people at minimal cost to you. However to access the scheme directly will require you to create 30 positions which seems unlikely for all but the major corporate players in the Scottish Dental Sector. However there is an option to partner with other practices/employers to jointly achieve 30 positions and for one party to act as the representative of the collective. The representative can claim a further £300 towards their admin costs. The suggested bodies include Trade Organisations and we would anticipate emergence of options if this is something you may be interested in.

BDA Update
As if there was not enough to contend with at the BDA at present their website was attacked and a potential loss of sensitive personal data occurred. Any BDA members have been advised to ensure they adopt password amendments to avoid any arising impact.
As well as this adverse event they have had to deal with the resignation and public spat with prominent Dentist Tony Kilcoyne. If you would like to follow the communications from both sides of the events you can find the coverage online at the following link. It is an unfortunate distraction at this time, but the allegations of toxicity in the leadership cannot be easily dismissed. Time will tell if an external review will be conducted to put this matter to rest.

And Finally
Once again love and best wishes to you at this time from all the team at Dental Accountants Scotland. 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 and have a lovely weekend.

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