NASDAL: More than half of UK dental practices rely on Government loans

A recent NASDAL (National Association of Specialist Dental Accountants and Lawyers) survey has found that 52% of UK dental practices have relied on either CIBLS (Coronavirus Business Interruption Loan Scheme) or BBLS (Bounce Back Loan Scheme) from the government.

The survey was carried out last month and a sample of 121 practices (with a total fee income of £88 million) was taken from NASDAL accountant member practice owning clients on a random sampling basis. The survey found that:

  • 11% of practices have taken out CBILS loans, mainly private practices
  • The average CBILS loan is £105k (12% of fee income)
  • 41% of practices have taken out BBLS loans, covering all types of practices.
  • The average BBLS loan is £49k (7% of fee income).

The average loan is £32k (4% of fee income) and overall, 52% of dental practices have taken advantage of Government backed Covid loans.

 Alan Suggett, specialist dental accountant and partner in UNW LLP who compiles the goodwill survey, commented, “these findings don’t surprise me and reflect what I have found when speaking to dental clients. The CBILS application process was particularly arduous and difficult and this meant that in my experience, those practices that applied for CBILS loans really did need the funds. BBLS however, required just a couple of ticks and the money was in the account 48 hours later. I suspect that a large number of applicants did so on a ‘just in case’ basis and will be happy to pay the money back in full next year.

“One of the major concerns that NASDAL had when we reported to the short life working group (SLWG) headed up by Deputy CDO England, Jason Wong, was that most dental practices are fundamentally sound businesses and to see a good number in potential difficulty purely because of capital loan repayments, is a real concern. That is why it was key for us that in the recommendations, a government guaranteed loan support scheme to underpin lenders confidence in supporting dental practices and dental laboratories at risk was included.

“When the CIBLS and BBLS repayments become due next year, we will see how many dentists and practices are in difficulty.”

NASDAL COVID SURVEY RESULTS

Number of Practices in survey   121  
Total Fees     £88,418,701  
Total NHS Fees   £35,948,501 41%
Total Private Fees   £52,470,200 59%
Total COVID Support Borrowings   £3,822,000  
Average Support Borrowings (Per Practice)   £31,587  
Percentage of Borrowings to Total Turnover   4%  
         
Number of Practices with CBILS   13 11%
Total Fees (of Practices with CBILS)   £11,896,317 13%
Total NHS Fees (of Practices with CBILS)   £1,941,133  
Total Private Fees (of Practices with CBILS)   £9,955,184 84%
Total CBILS Borrowing   £1,369,000  
Average of CBILS Borrowings to Number of Practices with CBILS £105,308  
Percentage of Borrowings to Total Turnover (of Practices with CBILS) 12%  
         
Number of Practices with BBLs   50 41%
Total Fees (of Practices with BBLs)   £34,481,458 39%
Total NHS Fees (of Practices with BBLs)   £15,198,902  
Total Private Fees (of Practices with BBLs)   £19,282,555 56%
Total BBLs Borrowing   £2,453,000  
Average of BBLs Borrowings to Number of Practices with BBLs £49,060  
Percentage of Borrowings to Total Turnover (of Practices with BBLs) 7%  

Above inflation increase of 2.8% offers some comfort for service in crisis

The British Dental Association has said confirmation of second consecutive year of above-inflation pay awards for dentists must now be built on, as part of wider plan to maintain the long term integrity of the service.

The announcement will see 2.8% uplift on pay backdated to April, with no staging. This will apply to hospital and community dentists, with a final uplift to contract values for general dental practitioners to be confirmed following a consultation on expenses. 

In evidence submitted to the DDRB before the onset of the Covid 19 crisis the BDA made the case that the sustainability of NHS dentistry was already on a knife-edge. With a deal on abatement secured, it has stressed that the viability of the service can only be maintained with parallel action on support for private practice, future NHS contract arrangements and long-term consistency on pay.

BDA Vice Chair Eddie Crouch said: “These are difficult times for colleagues, and that NHS dentists aren’t being handed another pay cut will offer some comfort. Before Covid-19 hit years of pay restraint had already taken their toll. Above inflation increases are starting to repair that damage, and now must be pursued in tandem with other needed action to keep this service afloat.

“We’ve secured needed progress on abatement and pay. We now need to see a concerted strategy to ensure the nation’s dental services – both NHS and private – have a future.”  

Scottish practices to reopen, but face financial oblivion without government support

The British Dental Association has responded to confirmation from the First Minister that services will recommence from 22 June, warning that a combination of higher costs and lower patient numbers could prove fatal for services in Scotland.

Practices will be able to offer non-urgent care. Dates for routine care, including aerosol-generating procedures (AGPs) are yet to be confirmed.   Wholly private practices, which comprise 23 out of the roughly 1,000 Scottish practices, have been open for some weeks now.

Shortages of Personnel Protective Equipment (PPE) are expected place to real limits on patient numbers. While the authorities recently distributed more than three million individual items of PPE to dental practices volumes are only sufficient to enable practices to see around 10 patients a day.

The return of routine dental care south of the border has seen a majority of practices operating at less than a quarter of their former capacity, to ensure social distancing and infection control protocols are met. Barely 8% of English practices report they can maintain their financial sustainability on this basis, and BDA has said long term support will be needed to keep the service in Scotland viable.

The BDA has also pressed the Chief Dental Officer to extend to key worker status to dentists and their teams once they reopen. Access to childcare has proved a major barrier to practices reopening in England.

David McColl, Chair of the Scottish Dental Practice Committee, said: “We finally have a date for the return of face-to-face care, but it arrives after weeks of waiting for clear guidance. Practices should never have been left in limbo, but now face even greater challenges as they reopen their doors.

“Dentists have been looking forward to welcoming our patients back into our practices, but already we are hearing from colleagues who simply can’t afford to reopen, given the limits of the current Government support package. Without meaningful help increased costs and lower patient numbers could prove fatal for practices across Scotland.”

Eklund Foundation for Odontological Research and Education open for applications during May 2020

Applications for grants from Eklund Foundation are accepted on the website eklundfoundation.org from 1 – 31 May. Funds of EUR 200,000 have been allocated for distribution in 2020.

Experimental and clinical studies within all fields of dentistry are welcome, though projects that can be related to periodontology, implantology or cariology will be prioritised. Applicants may apply for funding for part of a project or a project in its entirety. The successful projects will be announced in the autumn of 2020.

The Eklund Foundation was created through a donation from the Eklund family, owners of TePe Oral Hygiene Products, in celebration of their long-standing relationship with the professional dental community. The foundation will now distribute grants for the fifth year running. 

Projects supported in previous years include, for example, studies in periodontology and implantology carried out in Italy, the Netherlands, Serbia, Spain, Sweden, the UK and the USA. More information on previous projects can be found on the website. 

Data reveals 40% of claims costs relate to treatment started over 10 years ago

New data published by Dental Protection reveals that almost 40 per cent of its estimated annual claims costs in 2018 related to cases where treatment started ten or more years ago before the claim was made.

Claims that relate to treatment that started many years ago are also being made for larger amounts, sometimes up to £100k. Of the top 100 largest claims made against Dental Protection members in 2018, 60 related to where treatment started ten or more years ago before the claim was reported.

The majority of these late reported claims involve allegations relating to the management of periodontal disease, but also include allegations about management of caries over many years.

Patient care is now very different to that provided several decades ago. There is increased understanding of the importance of record keeping as well as much better education and training on the screening, diagnosis and management of periodontal disease and caries. However, the claims environment will continue to be challenging with increased public awareness of periodontal disease, changes in patient’s expectations about dental care and claimant law firms actively targeting periodontal claims and long-term care.

While predicting the future cost of claims can be difficult, it is an essential part of what Dental Protection does. It is vital to price accordingly in order to meet the possibility of future claims.

This data supports the importance for dentists to maintain their membership of a dental defence organisation that has a long-term understanding of risk and who will continue to support dentists in years to come.

Raj Rattan, Dental Director at Dental Protection, said: “We clearly live in an increasingly litigious environment and dentists need to be confident that they can request support from their indemnifier in 10, 20, or even 30 years time. Dentists can ask us for support in relation to claims brought against them even where they have since moved practice or retired, as can Executors/Personal Representatives where claims are brought against the estate of a dentist who has passed away.

“At Dental Protection we can confidently say we are here to stay. Our subscription rates reflect the cost of our long-term commitment to protecting you to the highest standard long into the future, not a short-term requirement to generate profits.

“Dental Protection membership provides excellence as standard; supporting not just when a claim or a complaint arises but through our education programmes, to prevent any issue from happening in the first place. To learn more about the nature of periodontal claims and what can be done to reduce the risk of a claim, Dental Protection members can take a free online e-module and also join a webinar on 17 September”.

BDA heralds potential breakthrough on GDPR

Following months of lobbying the British Dental Association has welcomed news that Lib Dem MP Christine Jardine has tabled its suggested amendments [1] to the Data Protection Bill to save primary care providers from needless financial burdens.

The simple change would specifically exempt small NHS providers from the costly burden of appointing a dedicated Data Protection Officer (DPO). The BDA has been working closely with partners at the Optical Confederation, the National Pharmacy Association and the Pharmaceutical Services Negotiating Committee, urging both government and opposition MPs to exempt dentists, pharmacists and opticians from this expensive and unnecessary new requirement.

Primary care leaders have argued that the current draft Bill goes well beyond the requirements of the General Data Protection Regulation (GDPR), which does not require health providers to appoint a DPO unless they process healthcare data “on a large scale”.

Most high street NHS primary care providers do not process data on a large scale, but are set to be covered by this onerous new duty by virtue of being defined by UK legislation as “public bodies”. The BDA has estimated that outsourcing this service may well cost even the smallest practices in excess of £5,000, with some members reporting quotes from potential contractors of over £10,000 a year. Amendments will be considered at the Bill’s Report Stage, which is likely to take place in the second week of May [2].

News comes as primary care leaders have written again to the Department for Culture Media and Sport, urging Secretary of State Matt Hancock to change tack.

BDA Chair, Mick Armstrong, said: “We have been making the argument for a simple amendment that would protect small NHS providers who were never meant to be captured by these regulations.

“We want to thank Christine Jardine MP for her support. This common sense move wouldn’t cost taxpayers a penny, is non-controversial and nonpartisan, and remains entirely consistent with the stated intentions of the GDPR.

“This small change can make a big difference, saving hard-pressed high street health providers from needless pain. Together with our partners across primary care we urge parliamentarians on both sides of the house to offer their support.”

[1] https://publications.parliament.uk/pa/bills/cbill/2017-2019/0190/amend/data_rm_rep_0424.8-14.html

Clause 7, page 5, line 24, after “subsections” insert “(1A),”.                                                  

Clause 7, page 5, line 24, at end insert—

“(1A)

A primary care service provider is not a “public authority” or “public body” for the purposes of the GDPR merely by virtue of the fact that it is defined as a public authority by either—

(a) any of paragraphs 43A to 45A or paragraph 51 of Schedule 1 to the Freedom of Information Act 2000, or

(b) any of paragraphs 33 to 35 of Schedule 1 to the Freedom of Information (Scotland) Act 2002 (asp 13).”

[2] https://services.parliament.uk/Bills/2017-19/dataprotection.html