The impact of Covid-19 has led to unprecedented measures being put in place, not only in relation to restrictions on movement, but also government financial support to businesses, employees and the self-employed during these times of crisis. The dental profession is no exception; to date the following procedures have been put in place.
Suspension of all routine treatment
All dentists in England should review the advice recently published by NHS England. This includes:
1. All dentists in England should review the advice recently published by NHS England. This includes:The suspension of all routine, non-urgent dental care, including orthodontics, until advised otherwise.
2. All practices establish a remote urgent care service, providing telephone triage for their patients with urgent needs during usual working hours, and whenever possible treating with advice, analgesia and antimicrobial means, where appropriate.
3. NHS regions must set up “local urgent dental care systems” to manage patients with emergency dental problems, where each system provides urgent care to separate patients who either have suspected or confirmed Covid-19, or live with someone who has, and those deemed particularly vulnerable or at significant risk from the disease.
Recent guidance from NASDAL (National Association of Specialist Dental Accountants and Lawyers)
NASDAL have given an update as to the current state of affairs for the dental profession after almost a month of lockdown. Key elements of the guidance are:
- Local council grants (which are taxable) of £10,000 are available directly from local councils for dental practices based upon their relevant rateable values.
- Self-employed support grants (which are taxable) worth 80% of the trading profits of self-employed persons, up to a maximum of £2,500 a month. Trading profits will be assessed (in the first instance) by reference to the three previous years’ profits. It will be available for 3 months, but may be extended.
- NHS income payments 2020/21 will be provided for the first three months of this new financial year based upon one twelfth of the annual contract value, reduced by a “fair amount of reduction” to reflect the absence of direct treatment costs e.g. laboratory fees. The payment is to provide much needed short term cash flow for a practice, and is not the payment of the 2020/21 contract. A new arrangement is to be drawn up for the rest of the financial year.
- Furlough scheme to offergrants to cover 80% of the usual monthly wage costs of non-NHS employees (excluding bonuses), up to £2,500 a month per employee, plus associated Employer National Insurance contributions and pension contributions (to minimum automatic enrolment employer pension contribution) on that subsidised furlough pay. Furloughing an employee must last for a minimum of three weeks. The Scheme will be in place for four months starting from 1 March 2020, but may be extended. Staff who take, or who are required to take, holiday during any period of furlough should receive holiday pay at their full rate of pay.
- Private practices may get support through local council grants and self-employed support grants, and may benefit from the ability to furlough employees. This will, however, in many cases fall short of normal levels of income for a practice.
Mixed practices – Associates’ remuneration
- Private associate fees: payments would not usually be made to associates when a practice is receiving no income.
- NHS associate fees: to be paid at the same level as pre-crisis period, although some principals have reduced that amount to reflect the anticipated, but as yet unknown, fall in payments to be paid to the practice by the BSA after the crisis period.
- Associate plan income: income received under a typical capitation plan will generally belong to a principal, although associates may be contracted to share in that income and the associated fee per item from patients. Whilst income continues to be paid to the practice under the plan, the fee per item may not; and whether an associate will continue to share in the income in those circumstances will, except where arrangements have already been made, be a matter for the principal and associate to agree.
- Furloughing: practices who wish to claim in respect of furloughing staff must ensure that this is in relation to the proportion of private revenue only, and in respect of non-NHS staff. The furloughing procedures should be on the basis of the gross private/NHS split of revenue of the practice. A proportional part of the salaries should be apportioned, and staff members allocated, with their agreement, to the private or NHS side of the business; a process that can in practice present its own problems. The NHS staff should receive their normal pay.
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