Tom Bysouth, Chair of the Welsh General Dental Practice Committee, updates us on the work being done to support dentists in Wales during the COVID-19 outbreak.
These are very challenging times in general dentistry and we are doing everything we can behind the scenes to get the best possible outcomes for you, your dental practices and staff.
Every week, new challenges
Throughout March, BDA Wales has been in consultation with the CDO office representing our position on the clinical safety measures for continuing patient care and the financial modelling for business continuity.
The CDO's most recent letter of 26 March 2020 on business continuity and the financial model to be applied, has provoked an array of concerns from worried practice owners and associates alike.
Yesterday, I wrote to Wales CDO, Dr Bridgman, to address these issues and to restate our position on the following key issues.
Redeployment and PPE
Many practice owners currently do not know what the terms for redeployment look like - either for individual staff or for the contractual obligations of the practices. The fact they are committing to the terms on 1 April without this knowledge puts practices, staff and practice owners in a bind.
We fully understand that it has taken time to assemble the estates and systems for the urgent dental care centres. Preparations are now well-advanced in many Health Boards. We appreciate that there has been a huge amount of work done on this and we are grateful to everyone involved.
However, we have flagged widespread reports that there is insufficient PPE of the right calibre available. This is needed so colleagues can safely work at these urgent care centres. A shortage is particularly concerning if these centres are needed to remain open for longer than a few weeks, which is likely.
Our position across the UK is that, without wide-spread testing of patients and knowing their infection status, the distinction between hot and cold urgent-care centres is effectively moot. All patients are potential carriers and therefore any AGP procedure requires full PPE including FFP3 masks.
Despite these various concerns, many dentists have said they want to help on the front line and are awaiting further instructions, training and mask-fitting.
We will continue to campaign for safe working conditions for dentists and their teams.
Financial arrangements for April - June 2020
The Welsh Government has offered 80% of the NHS ACV for the three month period from April to June. We understand the constraint due to reduced PCR and do not contest it.
However, we cannot agree with the directive to maintain 100% NHS staff pay. Here are the reasons why:
- The 20% reduction is significantly more than the DDRB model for costs for materials and labs at 13.5%, so there is at least a 6.5% shortfall in the ACV revenue
- Paying staff at 100% of their NHS earnings will create deficits that may be insurmountable, depending on the overall business model of the practice
- This is also at odds with all other schemes in the UK which are set at 80% earnings
- The practice owner would need to forfeit a large proportion of their pensionable earnings to balance the salary bill and for younger practice owners this is likely to mean more debt and little or no take-home pay
- The removal of 20% of the ACV makes it untenable to pay the labs a retainer. Moreover, we believe that most labs are in the process of closing with furloughed staff on the 80% government scheme.
Our position is that there should be a proportional adjustment across the board for salaries. This is the most equitable and more likely sustainable arrangement. It will help ensure the viability of dental practices in the long-term and be best for the community as a whole. So, we argue, a reasonable starting point would be 80% of NHS-derived salaries/fees.
Mixed-contract and private practices
The situation is more complex in practices that provide NHS and private care and the current directives are extremely challenging. There is not a one-size-fits-all business model, as we well know from the last three years of contract reform.
Regarding the private element of care and income, we have heard of several practice-owners being declined access to the government-backed business loan scheme and instead being offered a high street commercial loan at staggeringly high interest rates. It is unreasonable for practice owners to borrow at such high rates to continue to pay staff for not undertaking private work, and we are making this case to Government.
Practice owners are grappling with the choice to either furlough staff as private practice ceases, so staff can claim 80% of their earnings from one of the two government schemes, or to pay them 80% of their NHS equivalent earnings and forfeit any equivalent private self-employed earnings compensation. We believe the decision should rest with the practice owner and staff members on a case-by-case basis to decide what is best.
We have made it clear to Government that mixed contract practices should be able to operate a mixed business model for financial relief and that the schemes should work in tandem according to need. The Department for Health has indicated that they will be providing guidance on this later this week.
Given what we have heard from practices around Wales, without relief from the thorny directive of 100% NHS staff salaries, the current directive portends possible closures of some practices.
Financial Arrangements - March 2020
The early news from the CDO, that there would be a 4% allowance in March made for end of year reconciliation of contracts, was a welcome move.
We understand the concerns expressed by many practice owners that there will be winners and losers depending on where practices had planned to be with their targets at mid-March.
We are writing to the various Health Boards to advise leniency. Should a practice be adrift to the negative by 1 or 2 % after the 4% adjustment then Health Boards should consider the bigger picture and understand the pressures that practices are dealing with currently.
Working for you
We’re taking every opportunity to campaign on your behalf during this time of crisis. We’re working to get the best possible outcomes for you, your dental practices and staff. See our lives updates page for the latest on the work done in Wales and across the UK and listen to my recent interview with BBC Radio Wales.
Chair of the Welsh General Dental Practice Committee