17. NHS England contracts and abatement: what do I need to know?
Abatement is an agreed reduction in the NHS contract payment for any variable costs associated with service delivery. The NHS has said it will honour contract payments, but it is reducing that overall figure to take off the costs not spent. Practices need to know this abatement figure in order to understand their NHS income. The abatement is applied to the whole contract not at the individual performer/associate level.
Abatement to be applied to most contracts from 1 April up until 8 June will be 16.75%. This figure is based on an approximate assessment of variable costs that will not have been incurred when practices were closed to face-to-face care (such as laboratory costs and materials). The abatement for this period will be enacted through reconciliation over the period to 31 March 2021. We expect it to be reclaimed by commissioners gradually over the second half of the financial year.
For practices that have operated as urgent care centres during that period, there will be no abatement for the time they have been providing urgent care. That different approach recognises the extra costs for UDCs, on set-up, protective equipment and potentially staffing.
For the period from 8 June onwards, when practices have begun to provide face-to-face care again, 100% of contract value will be paid, with no abatement. This recognises the additional costs of providing care during the current period, again for example in terms of PPE. Practices are expected now to be making all possible efforts to be delivering as comprehensive a service as possible to patients.
Practices will not be measured on the delivery of Units of Dental Activity during this period. However specific assurances will be requested that individual practices are open for face-to-face care, are adhering to contractual hours with reasonable staffing levels for NHS services in place and are performing the ‘highest possible levels of activity’, with no undue priority being given to private activity over NHS activity.
Practices will need to deliver at least 20% of usual volumes of patient care activity to receive their full contract value. Importantly, we have agreed with NHS England that the definition of patient care activity includes all clinical contact that dentists or dental care professionals have with patients either face to face, by telephone or video consultation counted by the BSA via completed courses of treatment or via the COVID-19 triage portal.
The period to be assessed will be all clinical contact that dentists or dental care professionals have with patients either face to face, by telephone or video consultation from 20 July to 16 September 2020. This will be compared to the number of courses of treatment only, provided by the contractor in the equivalent period in 2019. Remote advice and care is included in the calculation for 2020 but not for the equivalent period in 2019. If practices are unable to meet the 20% threshold, then they will be required to revert to payment based on UDAs.
This above arrangement is temporary and we are working with NHS England to establish a revised mechanism for the later part of this financial year as activity gradually increases.
Practices are required to ensure that all staff continue to be paid at previous levels. This includes not just to dentists and dental hygienists, but also dental therapists, dental nurses, non-clinical and administrative staff. All practices will be asked to provide assurance over their continued engagement of staff, and to give an explicit declaration that they have not gained any windfall profits.
This abatement is not routine and will only apply in this pandemic when face to face activity within a practice has to cease. In a non-pandemic situation if a practice has to close because of fire or flood then force majeure provisions apply and UDAs may be carried forward. This would not have been helpful in a pandemic situation where during the abatement period there are no UDA targets.
The issue of abatement affects general dental practitioners providing NHS services. It does not affect Community or Hospital dentists.
18. When does the furloughed workers scheme close?
The furloughed workers scheme closed to new entrants on 30 June. Now only practices will only be able to furlough employees that they have furloughed for a full 3-week period prior to 30 June.
Another change to the scheme is that practices can now bring furloughed employees back to work on a part-time basis. If your practice qualifies to claim under the scheme, you now have the flexibility to decide the hours and shift patterns of their employees – with the government continuing to pay 80% of salaries for the hours they do not work.
19. How can I change the terms of employment contracts?
Practices may wish to alter the terms of employment for their employees. This might include: changing the hours that staff work, including breaks, changes to terms about clothing and uniform, and changes to pay or other benefits. There are two ways in which practices can change the terms in an employment contract, either in agreement with the member of staff or through dismissal and rehire. Advice should be sought on both options, members can find out more about the options available to them in our
toolkit for returning to face-to-face care.
20. How can I negotiate changes to associate contracts?
Changes are best made by agreement with the associate concerned. Where changes are agreed, those changes can take effect quickly and easily. However, associates may be unwilling to agree to those changes unless there is a benefit to them. Associates are more likely to agree to temporary changes that will be reviewed after a period of a few months. We believe it is in both parties’ interests to negotiate sensible changes. We ask practice owners to make temporary, rather than permanent changes; at least until the situation becomes clearer. And we ask practice owners not to try and force changes that are too onerous or disadvantageous to associates. Members should seek
advice from our practice support team before they take action on contract changes and review more information on the options available to them in our
toolkit for returning to face-to-face care.
21. Do I pay employed NHS staff if they're not working?
If an employed member of staff refuses to return to work despite risk assessment indicating it is safe to do so, there is no right to continued payments from NHS England and this is considered an employment matter for the practice.
However, NHS England have said that if employed members of staff have asked to stay off work for caring responsibilities, or because official guidance says they should not be working, they should be eligible to receive NHS income.
Contract holders can claim under additional government support schemes in relation to their proportion of private revenue. Therefore if appropriate for workforce needs, practices might wish to consider whether to furlough staff unable to work for these reasons and bring into work those able to do so (in proportion to the practice NHS commitment).
22. Will there be clawback due to the shutdown?
At present, we do not believe there will clawback, however we are seeking clarification on this. We are also waiting to find out the contract terms on which the NHS will pay dental practices to reopen and start providing NHS dentistry. We advise you to review the section on NHS dental services provision on our
Financial Impact page for the latest on this.
We're answering many calls from members on staff and associates pay, members can access
our answers to these questions here . We also recommend that members watch our
advice webinar on financing and furlough .
23. What are you doing about business interruption cover?
We are taking urgent legal advice in respect to insurers not paying insurance claims made by dentists in regard to business interruption during the COVID-19 pandemic.
We have instructed law firm Brown Rudnick LLP to examine insurance policies affecting dental practices. It is now working with our members to gather relevant evidence on the full range of polices in the sector. This legal advice will shape the guidance that we will be offering a profession that has been blindsided by a lack of effective insurance during a period that has seen routine care suspended and cash-flow for many practices fall to zero.
The Financial Conduct Authority (FCA) has begun its own legal process to weigh up policies covering almost every business sector in Britain. We were the first trade union or professional body to directly engage with the FCA following the failure of most polices to pay out for losses incurred during the pandemic. While we welcome the news, we have expressed concern that the FCA's ‘one size fits all’ approach will fail to address the specific needs of our members. We are pushing for clarity on whether challenges affecting dentists will be taken into account by the court.
Members can watch a recording of our webinar with law firm Brown Rudnick LLP on the legal issues relating to business interruption policies and the pandemic.
24. Dentists can't access business rate exemptions, what are you doing about this?
New measures were introduced in the 2020 Budget to give business rate exemptions to retail businesses. Dental practices were not included in this. We believe that in the context of the business disruption caused by the COVID-19 outbreak, it is essential that this exemption be widened to include dental practices. We've made representations to the Government to that effect and we will update you on any progress made.
25. What support can mixed practices receive?
We have been pressing the Government for clearer answers on the support available to mixed practices. We welcome
confirmation from both the Treasury and NHS England that mixed practices can make full use of the furlough scheme in proportion to their private activity, without endangering their NHS funding. This is now known to be the case in all four nations and will be a relief to many mixed practices.
For the most up to date information on what options are available to you, we recommend you see our
financial impact page. We also recommend that members watch our
advice webinar on financing and furlough . This is kept as up to date as possible. But for the absolute latest, see our
live updates page.
Members with mixed practices, we've put together a tool to help you calculate how much you are entitled to claim as part of the furlough scheme. Watch this demo video to help you use our furlough calculator.
Self-employed people who earn less than £50,000 a year are able to claim money from the Government's Self-Employment Income Support Scheme (SEISS) . Most associates earn more than £50,000 a year and will not be eligible. Associates who are eligible should have been contacted directly by HMRC by now. There is a question about associates who do a mix of NHS and private work. Those associates should still be receiving NHS income from their practice. If they claim their loss of trading profit from the SEISS, this could be deemed as duplicative relief and could fall foul of NHS rules. The BDA is seeking clarification on this point and will update members as soon as we have further information.
26. Can I avail of multiple forms of government assistance?
Yes. We have lobbied all four governments for a clear answer on this and at present we know:
England: The Treasury and NHS England have confirmed that mixed practices can make full use of the furlough scheme in proportion to their private activity, without endangering their NHS funding. This will be a relief to many mixed practices, and comes after consistent campaigning on your behalf.
Northern Ireland: A full list of the business support measures that have been put in place in response to COVID-19, and the Department of Health have stated that they expect dental practices in NI will be eligible for support from both UK-wide and NI Executive sources.
CDO has acknowledged the need for financial assistance for the private portion of mixed practices' incomes. The Welsh Government has now introduced
two grants to support businesses in Wales through the Coronavirus pandemic. Grant Number 2 is relevant to eligible dental practices should their rateable value be £12,000 or less.
Scotland: On 9 April, the Scottish Government clarified that mixed dental practices that receive NHS support funding, can also
apply for support from other government sources to cover the private element of their income. These latter claims should be proportionate to the amount of private dentistry delivered.
Members with mixed practices, we've put together a tool to help you calculate how much you are entitled to claim as part of the furlough scheme. Watch this demo video to help you use our furlough calculator. We also recommend that members watch our
advice webinar on financing and furlough .