business

NASDAL: Uncertainty reigns

The National Association of Specialist Dental Accountants and Lawyers (NASDAL) has called for clarification over a number of key financial issues affecting the profession.

Alan Suggett, specialist dental accountant partner in UNW LLP and NASDAL Media Officer said, “We quite understand that matters of patient safety and all things clinical taking are precedence in the current situation. However, dentists and practices need resolution on a number of financial and contractual issues. We cannot ignore the fact that dental practices are businesses. Indeed, a recent Dental Protection survey showed that more than one in two (53%) dental professionals said financial worries were having the biggest impact on their mental health in the face of Covid-19.

“A new NHS contract in line with the Prototypes must be introduced. The CDO (England) letter says “…mechanisms for the full 2020/21 contract year with the intention of reintroducing a link to delivery of activity and outcomes”. For the foreseeable future an activity-based NHS contract will be unworkable. Now is the time to implement the vision of the late Sir Jimmy Steele and achieve preventative dental care within a viable financial framework for NHS practitioners. Until this happens, our clients must attempt to make plans and financial forecasts with no idea of what the new NHS contract financial landscape will look like”

Other issues lacking clarity include NHS contract payment abatement, and duplication of government support e.g., SEISS, Bounce Back loans, and Small Business Rate Relief grants.

Johnny Minford, of Minford Dental Accountants commented, “in regard to SEISS, a number of difficult questions arise for dentists carrying out both the NHS and the private work. Many dentists earn more than the £50,000 threshold, but some don’t, for a variety of reasons.

The self-employed grant (SEISS) is paid if an individual’s taxable profit is less than £50,000, after capital allowances, but before pensions or superannuation. However, HMRC is unaware of any income under the NHS contract provisions. There is therefore a risk that the NHS Covid payment rules may be breached when the receipt of SEISS, in addition to NHS Covid earnings, exceeds pre-Covid income levels.

A recurring theme from the NHS is ‘reasonableness’. It is vital that NHS practitioners keep notes and records of the factors leading to decisions taken, and why they were made. This will give the best protection against comeback.”

Alan Suggett went on to add, “the fact that UK dentistry and healthcare are devolved, has further added to a sense of confusion. We would like the CDOs of England, Wales, Scotland and Northern Ireland, and the appropriate devolved administrations, to realise how vital clarity of financial matters is to NHS contract holders, and communicate this in a clear and unambiguous format as a matter of urgency. As a non–partisan association, NASDAL are happy to engage with and assist these parties with this vital task. The CDO (England) has stated that ‘all parts of the UK will be aligned’. However the differences in the systems of delivery of NHS dentistry mean that this cannot be achieved without an integrated plan dealing with technicalities.”

IDEX 2020 moved to new dates in September

The 17th International Istanbul Dental Equipment and Materials Exhibition (IDEX), originally due to take place in the Spring, has been postponed until 10-13 September at the CNR Expo Center in Istanbul. The decision to go ahead with the show was made by the Pozitif Trade Fairs and DİŞSİAD (Turkish Dental Bussinessmen Association).

Reaching a business volume of 500 million dollars in Turkey, the dental industry will gather professionals from all over the world at IDEX. The exhibition will display products from more than 1.000 domestic and international brands. With 30,000 visitors expected from 80 countries, the exhibition aims to create a trade volume of more than 150 million dollars.

Organised by CNR Holding subsidiary, Pozitif Trade Fairs, in association with DİŞSİAD, the exhibition is known to draw industry professionals from Europe, the Middle East, Africa, Asia, Russia and CIS countries, the Far East, North and South America, and Oceania.   

Companies from Russia, Germany, Italy, the UK, Austria, Hungry, India, the UAE, and the USA will be present as the products of more than 1.000 brands from 14 countries will be showcased. State-of-the-art products, from orthodontics to implants, imaging devices, dental equipment, dental cements, and cad/cam, will be introduced across the 35,000m2 show floor.

In addition to the aisles packed with products from around the world, attendees will also have the chance to explore the industry and its challenges on a global scale via the programme of seminars and workshops on offer. Industry developments will be shared as professional international speakers discuss the dental industry’s latest innovations and share their opinions about the future of the sector.

For more information, click here.

Dental Protection offers support to dentists deciding to re-open practices

Dental Protection has reassured all members working in England who choose to return to work that they will continue to be supported. While the situation with NHS practices reopening is clearer due to a general acceptance that the Chief Dental Officer (CDO)’s guidance will be followed, the position regarding private practice has been less clear and has left those dentists – many of whom are facing financial difficulties – concerned about when they can return to work and whether they would be protected if they choose to do so.

Dental Protection has said members operating in the private sector who decide to return to work can be reassured that the indemnity provided by Dental Protection will continue to meet their regulatory and legal obligations, as long as they are in active membership and paying the correct subscription for the work they will be undertaking.

It added that members will have access to support and advice if needed, and if a complaint or claim should arise from the decision to re-open, members can request assistance.

In an email to members, the organisation said that the decision to re-open rests with the individual practice owner and that while Dental Protection cannot make such decisions for dentists, it can advise members of what they should consider when making the decision, such as:

  • The GDC statement that ‘Practitioners providing NHS services will of course need to adhere to the directions given by  the CDO; other practitioners will want to take that into account in making decisions.’
  • The CQC’s stated position that it ‘cannot require providers of dental care services to close, unless we find clear evidence of a breach of our regulations that requires consideration of the use of our powers under the Health and Social Care Act 2008 and associated regulations. It has also said that ‘The decision to offer dental care services is one for the provider to take.’
  • The need to adhere closely to central Government guidance on social distancing and to the most recent dental guidance documents from various agencies including PHE and the prevailing CDO guidance.
  • If you operate in the private sector, you should review existing protocols and standard operating procedures (SOPs) and take these into account when developing your own protocols, individually or within groups, and ensure practice protocols/SOPs meet the standards set in the prevailing guidance. 
  • Undertaking a thorough clinical risk assessment of the operating environment and of the patient journey.

In the event of a complaint or claim regarding the decision to re-open or the care that was provided, Dental Protection also it would be important to be able to evidence the following:

  • Written SOPs consistent with the widely accepted evidence-base and at least as robust as those issued by the NHS
  • Evidence of understanding and adherence to the SOPs and protocols by all team members
  • Clinical records which, in additional to usual record keeping requirements, clearly show the process of care, the rationale of the clinical intervention(s), the PPE used together with details of the relevant guidance considered in clinical decision making.

Raj Rattan, Dental Director at Dental Protection said: “Our team at Dental Protection includes experienced clinicians, associates and practice owners, and we understand the myriad of challenges facing members during the current crisis, including the welfare of their staff, their patients and themselves. We also recognise the financial pressures they may be facing, which is why we have offered members the equivalent of two months’ subscription relief. As a profession, we may not know what the future looks like, but I can assure you that Dental Protection will be protecting members as the situation evolves.”

Further information is available at: https://www.dentalprotection.org/uk/articles/information-for-members-considering-re-opening-their-private-practice

Dental services to resume in England from 8 June

In a letter sent to all dental practices in England, chief dental officer Sara Hurley and the director of primary care and system transformation Matt Neligan have confirmed that dental services can resume from 8 June, so long as necessary infection prevention and control requirements are in place and PPE is available.
 
The British Dental Association (BDA) has welcomed news the government has given the green light for the restoration of routine care services in England, but has cautioned that practices will need to move at different rates depending on availability and fitting of PPE, their ability to enact ongoing social distancing measures and time to implement appropriate cross-infection control.  

The BDA notes that this could see varying levels of treatments made available with immediate effect, with individual practitioners exercising their professional judgement on the pace of change. The BDA has also expressed the view that steps should be taken to integrate dentistry into the wider government strategy on PPE supply led by Lord Deighton.

Dentist leaders have also warned the whole business model that the service is based on could change unalterably upon reopening, with social distancing and cross-infection control reducing capacity and potentially access levels by as much as two thirds. The BDA is continuing to press for the NHS contractual framework to reflect the new reality and for additional support for private dentistry, including a business rates holiday – already offered to leisure and retail sectors – to be expanded to dental practices, alongside other support to mitigate against reduced patient numbers.

BDA Chair Mick Armstrong commented: “A return of high street dentistry we will be welcome news to millions of patients left with few options during lockdown, but key questions remain. It is right to allow practices to decide themselves when they are ready to open. Dentists will be keen to start providing care as soon as safely possible, but we will need everyone to be patient as practices get up and running. Dentist can open their doors but won’t be able to provide a full range of care without the necessary kit. Longer term practices can only stay afloat with ongoing support, while social distancing continues and the costs of providing care are sky high. Opening the floodgates risks raising false expectations, unless government is willing to step up and help.”

Gabriela Pueyo, General Manager of Bupa Dental Care, which has been operating a number of Urgent Dental Centres across the UK on behalf of the NHS, said: “We are delighted that we can begin to re-open our 400+ dental practices in England from Monday 8th June  after the government announcement today. This is a vital move to prevent long term damage to our patients oral health and dentistry as a whole. We are busy preparing practices, including introducing a new Patient Charter and additional measures to continue keeping patients and staff safe.”

The letter confirming the reopening of dental practices on 8 June begins with a thank you to all for contributions during the peak pandemic period and the commitment to supporting the national response. It states that the goal for patients and professionals is to resume the safe and effective provision of the full range of care in all practices, as rapidly as is practicable and that NHS England has been working with the British Dental Association, wider professional representative groups and the dental industry to reach this consensus on the commencement of reopening services.

It also touches on financial and contractual arrangements and offers advice for the sequencing and scheduling of patients. The letter can be read in full here.

A prompt to prepare from OCDO England

The Office of the Chief Dental Officer (OCDO) England has issued a ‘promot to prepare’, offering considerations applicable for safely reopening primary dental care settings. 

While the risk of Covid-19 transmission to staff and patients arising from clinical proximity and the unique aerosol generating procedures involved in dentistry remains a key factor in the temporary suspension of routine dentistry, dental care cannot be postponed indefinitely. Therefore, a sustained reduction in Covid-19 transmission risk will provide an opportunity to safely resume some elements of dental care. 

In preparing for the resumption of routine dental care, practices may wish to consider patient priorities, practice pace, proximity and levels of protection required for the safe delivery of dental care. The prompt to prepare considerations released have been produced by dental practitioners for use in primary care settings to provide guidance, which is due to be published by recognised professional bodies. Dental teams are advised to ensure that they regularly update their knowledge and understanding of the published Covid-19 Public Health England guidance and its application in a dental setting. 

The guidance is laid out in what has been termed a ‘Consideration Pathway’. Practice considerations outlined cover patient flow and practice floorplans, communal areas, supplied and equipment. To ensure safety of staff, training, screening, work schedules and guidance on health and wellbeing is considered. Factors explored for patient care include communication, care plans, and travel to and from the practice. 

“In preparing for the activation of the broader public health conditions that both herald and safeguard our ability to resume routine dental care, ‘prompt to prepare’ offers considerations applicable to primary dental care settings,’ explained Sara Hurley, chief dental officer for England. “There will be inevitable changes with regards to pace, proximity and levels of protection that are required for effective risk management and the safe delivery of dental care. This is the time to review and make the appropriate adjustments to protocols, procedures and practice infrastructure for the safe and effective resumption of routine dental care. Further guidance will follow, these will cover urgent dental care and alternative (non-AGP) evidence-based care planning.” 

BDA blasts GDC as ARF remains unchanged during Covid-19 crisis

Following today’s announcement from the General Dental Council (GDC) that it will not make changes to the Annual Retention Fee (ARF) levels or introduce an emergency payment scheme to allow registrants to pay by instalments, the British Dental Association (BDA) has published an open letter to the Chair of the Council, Bill Moyes.

With the profession now facing grave financial uncertainty the BDA has lamented failure by the regulator to show flexibility to colleagues, some of whom have seen their incomes fall to zero. It has also called for much-needed transparency in the process for setting the ARF. The GDC retains a budget operating surplus and significant reserves.

BDA Chair Mick Armstrong said: “Despite recognising the dire financial circumstances in which many practices and individual registrants find themselves, the GDC has not seen fit to provide even token support, citing no fundamental change to the work it does and the little financial impact the move would have on registrants. Greater transparency into the reasoning behind this decision would have been the very least response registrants should have received. But the message we are left with is ‘we need all the money and whatever we could do won’t really help you much’.”

Meanwhile, a spokesperson for the GDC said: “The real solution to these issues is to achieve a safe return to treating patients – a goal we all share, and all have a part to play in. But while that remains uncertain, we still have to carry out our legal duties and we need to ensure that we have the financial resilience to do so. Our free reserves provide only limited cover and it would not be prudent to run them down. We know that the decisions not to reduce the ARF further, or to introduce an emergency instalment scheme, will not be welcome ones and they were not reached easily or lightly. But we continue to believe they were the right ones to take.”

GDC Chair Dr William Moyes issues ARF statement

The Chair of the General Dental Council, Dr William Moyes, has issued a message to all dental professionals regarding annual retention fees as the Covid-19 pandemic continues:

The impact of the Covid-19 pandemic continues to have a significant effect on our lives. I am very aware that the effect of the suspension of routine dental care and services is severe and that it has prevented you providing the patient treatment and care you want to – and in some cases has caused financial difficulties. We have been asked whether the GDC could respond by making changes to the Annual Retention Fee (ARF) paid by all dental professionals or by introducing an emergency payment by instalments scheme.

The Council has thought carefully about the options available to us, but we have decided not to make changes to the ARF levels or to introduce a payment scheme. These are not decisions we have taken lightly, and I know they won’t be welcomed by some of those we regulate, so I want to be clear about the reasons why we have made them.

The work we have to do, which is laid down in law, has not fundamentally changed. We are required to remain financially stable and to meet our statutory obligations to ensure the public are protected and confidence in the professions is maintained.

Nearly all our incomes comes from the ARF collection. By revising our regulatory approach and increasing our efficiency, we have been able to secure greater value for money and reduce the ARF – and we hope to continue along this path. But we don’t want to make changes now that we can’t sustain, and which might lead to inefficiency and increased costs in the future. We are looking hard at the way we deliver our services, both during the current emergency and beyond. One example of that is that we have rapidly developed ways of running hearings remotely. That could eventually lead to a permanent reduction in our costs, and if it does, that reduction will be reflected in the fees we charge in future. 

For the time being though, significant uncertainty remains about the months ahead and it is just too early to predict what is going to happen – to the sector as a whole or to the GDC. So, it would be imprudent to make changes which might not be sustainable, or which have the potential to add further risks or cost to what we do.

In looking at the options available to us, we were also aware that even changes with very significant negative impacts on the GDC would make only a small difference to the level of the ARF. Only the government is in a position to provide financial support to the professions and they have chosen to do so both through NHS contract arrangements and by more general support to employers and businesses. I am very aware that the benefits of that have been felt unevenly, particularly by those outside the scope of NHS contract support, but the level of the ARF is not an effective way of addressing that issue.

I very much want to see a return to healthy, safe and successful dental services, as I know you do too and I look forward to your being able once again to offer your patients the full range of care and treatment they need.

– Dr William Moyes, Chair, General Dental Council

Henry Schein Dental helps dental professionals expand access to care with telehealth offerings

Henry Schein Dental UK has announced the expansion of the company’s service portfolio with the addition of a teledentistry offering, developed by Medpod Inc. Medpod is an expert in digital health and a trusted health care solutions partner with extensive clinical research and medical technology expertise.

The new offering is a clinical decision tool that allows dentists to provide critical patient communication and monitoring as the Covid-19 outbreak continues. The cloud-based software platform gives providers the ability to conduct remote consultations for patients so that they can continue to operate their practice, while delivering virtual care to patients who may not have access to a physical office visit, or choose not to visit a clinical setting as a safety precaution.

“Oral health and overall health are closely connected, and we want to ensure that patients’ oral care is not neglected during this global pandemic and have therefore expanded our solutions offerings to teledentistry,” said Patrick Allen, Managing Director of Henry Schein Dental UK. “As we continue to practice social distancing to slow the spread of the coronavirus disease, access to remote patient care is critically important. By incorporating a teledentistry solution into the practice, it can help to monitor the health and welfare of a patient, during this challenging time, while also maintaining a close, personal contact. This new offering reinforces our commitment to deliver the solutions our dental customers rely on.”

With Medpod’s cloud-based software enabling teledentistry, dental practices can offer remote consultations, triage dental emergencies and any further investigations to be performed in person, and ensure post-procedure follow-up via a web-based platform on any smartphone, tablet, or computer. This also allows dentists to determine the patient’s level of discomfort, prioritise cases, and makes it easy for patients to access their dentist in a more effective way than a phone call. For dental practitioners, Medpod’s software offers live, two-way video communication, and integrates live-streaming of HD audio/video, and a highly flexible user interface into one easy-to-use, care delivery and patient management system.

For more information, please visit http://www.henryschein.eu/medpod or send an email to medpodeu@henryschein.com.

UNW welcomes senior manager to dental business unit

Newcastle-based chartered accountancy and business advisory firm UNW has welcomed the appointment of Mike Blenkharn as Senior Manager to its specialist Dental Business Unit.

Mike, who has a degree in Accounting and Finance, and qualified as a chartered ACCA accountant in January 2016, joins the firm with over 10 years’ experience in working with dental professionals. Before moving to UNW, he was Healthcare Manager at Dodd & Co. Chartered Accountants, where he was involved in advising the majority of the firm’s dental practice clients. Alongside his dental accounting experience, Mike brings with him a wealth of experience in NHS contracts, net pensionable earnings, tax affairs, exit strategies, and retirement planning.

The appointment of Mike adds to UNW’s growing team, with the firm now employing over 115 people at its Citygate offices, underpinning its success in the marketplace across all sectors. UNW’s Dental Business Unit, led by partner Alan Suggett, is a leading national advisory team that acts for over 500 dentists across the UK.

Alan Suggett, Dental Business Unit Partner at UNW, said: “I’m delighted to welcome Mike to UNW. Adding another experienced accountant to our dental team, to work alongside Liam Richardson and me, helps us to further stand out, even amongst NASDAL accountants. We are now best placed to not only continue delivering excellent service to our dental clients, but to help develop our growth plans with confidence.”

“I have known Alan for many years through NASDAL, so was well aware of the focused and professional approach that UNW takes in providing the best service to its clients, as well as in developing its people,” commented Mike. “Despite the unusual time in which I have joined the team, the firm has been extremely welcoming, and I look forward to working with our substantial client base.”

Inside Pandora’s Box: Pandora Dental explores the way forward for dentistry during the pandemic

Pandora Dental, an association of independent dental surgeons founded in recognition of the need for evidence-based best practice and guidance during the Covid-19 pandemic, has hosted a webinar titled ‘Dentistry in Crisis: The Way Forward’, disclosing its findings so far in regards to current concerns and proposed solutions moving forward.
 
Dr Mark Cronshaw, Pandora Dental’s President, led the webinar, first of all mentioning that his own practice in Cowes on the Isle of Wight has been closed since March. As well as a lack of available tests and there being some time before a vaccine is available, Cronshaw discussed the cross infection hazards prevalent in dentistry – not only via everyday means such as speech, but the heightened risks posed by procedures that spread blood and saliva, including AGP.
 
Pandora began as a WhatsApp group between several dental professionals that has grown to a membership of 160. The organisation has explored several solutions to allow dental practices to reopen safely, including revised PPE protocols, conducting risk assessments, revising clinical procedures, ensuring clean air, and adopting a number of other novel approaches that may be found. One such novel approach provides a thermal and photosensitive solution in which UV-C reportedly kills the virus in 10-20 minutes (https://www.bbc.co.uk/news/business-51914722). Hypochlorous acid was also offered as a possible cleaning solution.
 
While Pandora is run by dentists primarily for dentists, hygiene therapists, nurses, managers, receptionists and other dental staff, the association is extending its support to the UK government, regulators, dental laboratories, manufacturers, distributors, educational organisations, specialist financial services, and the press. Some progress has already been made as Pandora has led research groups, preparing reports for various bodies, such as the DoH, RCS, and PHE. Pandora has also sourced PPE, negotiated discounted equipment purchases, and supported its members by assiting with business interruption insurance queries. In addition to developing links with government, preparing SOPs, consulting with indemnity providers and gaining support from several academics, the association is leading a media campaign to increase the awareness of solutions that will enable practices to resume.
 
Key concerns raised over the current state of the profession, according to Pandora, are that patients may be too anxious to attend appointments with Cronshaw mentioning how the media has played a role in implying dentistry may be ‘dangerous’ when it comes to the spread of the disease. Another major concern is over a potentially stressed and unhappy workforce, with a poll conducted by Pandora between 5-7 May finding that more than 49% are now considering leaving dentistry altogether, compared to just 12% prior to the outbreak. Stress, finances, limited treatment options, enhanced PPE and increased protocols were all given as reasons for those considering leaving the profession. However, with correct PPE and enhanced cross infection control measures in place, 84% answered that they would feel safe to return to work.
 
Other concerns raised include the logistics of access to essential supplies, the economics associated with compliance, future costs for the NHS, and the ‘time bomb’ of patients currently undiagnosed and going untreated for diseases such as mouth cancer.
 
Going forward, Pandora Dental is looking to change perceptions by equipping the public with the right knowledge so that they feel comfortable returning to their dentist. In addition, the organisation will work to make sure that staff are fully prepared for their return to work, possibly on 1 June, while also providing help with risk assessments and audits, defining treatment decisions, and ensuring unity across the industry, from nurses, hygienists and lab technicians to managers, receptionists and industry partners.
 
Speaking as part of a small panel, Professor Mike Lewis noted that air cleaning systems were of particular interest to him, as they will ‘remove other particles, including those from cleaning chemicals, as well as the virus’. He described them as ‘a must’.
 
Meanwhile, Dr Adam Nulty, who has been overseeing Pandora’s scientific research, explained that the group is working to create a positive, pragmatic approach to resuming practice, stating that they will keep their evidence simple and easy to understand. He added that the approach taken will ultimately not be too much of a stretch above existing protocols.
 
‘We are working with the entire industry,’ concluded Cronshaw,’ and would like to spread our message to remain positive.’
 
For more information, visit http://pandoradental.org.uk/