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Coronavirus: the financial impact

This is a challenging time for dentists. Here we have collated advice on the financial impact of the COVID-19 outbreak and the mitigation measures being introduced. Each section covers the UK as a whole, then offers nation-specific information where it has been issued.

Page last updated: 05 November 2020

 

On this page you will find:

 

1. Useful links for GDPs

2. Business support measures promised by Government

3. Business interruption cover

4. NHS dental services provision

5. NHS provisions for sick pay

6. Associates in NHS practice

7. Associates in mixed practice

8. Salaried services (HDS, CDS etc)

9. Private practice

10. Associates in private practice

11. Private capitation schemes

12. Practice owners: advice on paying staff

 

NHS advice on COVID-19

 

NHS advice on self-isolating 

 

Government response in England, Scotland, Northern Ireland and Wales.

 

Stay at home guidance for households with possible coronavirus (COVID-19) infection 

 

Public Health England Guidance to health professionals 

 

Guidance on infection prevention and control for COVID-19 

 

Guidance and support for employers and businesses 


NI HSCB communications

 

2. Business support measures promised by Government

The following support measures are available from the Government:

 

  • The government’s Coronavirus Job Retention Scheme, also known as the Furlough scheme, will remain open until the end of March 2021. Under the scheme employees will continue to receive 80% of their current salary for hours not worked, up to a maximum of £2,500. Flexible furloughing will continue to be allowed, in addition to full-time furloughing. See our guide to this scheme in our section below on Practice owners: Advice on paying staff.

  • Government-backed loans of £330 billion have been made open to all businesses and will be available until 30 November 2020.

  • Business interruption loans, with the Government paying the first 12 months' interest.

  • Bounce Back Loan Scheme (BBLS) enables smaller businesses to get access to 100% taxpayer-backed loans after concerns have been raised about slow and difficult access to the coronavirus rescue schemes. The scheme offers businesses loans up to £50,000 within days of applying. No capital or interest repayments are due for one year. The Government will pay the interest for the first 12 months.

  • £10,000 extra cash grants have been made to some of the smallest businesses, some dental practices with rate exemptions have already received this.

  • Local Authority Discretionary Grants are available for small business who are not eligible for the Small Business Grant Fund or other government initiatives. We are looking into whether dentists are able to apply for these.

  • The Government will refund up to two weeks’ SSP per eligible employee. Statutory Sick Pay (SSP) is also payable from the first day of sickness. You do not have to wait three days before starting to pay SSP. SSP is payable for those who are self-isolating in accordance with UK Government guidance.

  • Limited measures were also announced to support the self-employed, but a £50k cap was placed on these, limiting the amount of dentists in private practice that can avail of it. We will continue to campaign to help associate dentists, please see the relevant sections below. Dental hygienists and therapists are likely to qualify for help under the Government’s self-employment income support scheme.

 

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3. Business interruption cover

Business interruption insurance covers a business for loss of income during periods when they cannot carry out business as usual due to an unexpected event. It aims to replace certain losses sustained by the business during the period of the disruption.

 

The Association of British Insurers have warned that only a small number of companies in the UK will have cover which allows them to claim on their insurance for the impact of the Coronavirus pandemic.

 

We understand that insurance companies will not cover additional risks, which were not factored into the pricing of the policy. And we acknowledge that these are unprecedented circumstances. However, we are very concerned that many of our members will not be covered for closures due to COVID-19.

 

We have taken legal advice in respect to insurers not paying insurance claims made by dentists in regard to business interruption during the COVID-19 pandemic. We were also the first trade union or professional body to directly engage with the Financial Conduct Authority (FCA) following the failure of most polices to pay out for losses incurred during the pandemic. 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.

 

The High Court hearing on business interruption insurance concluded on 30 July, but a judgment is not expected until later in the year due to the huge amount of material under review, the possible impact of the decision and complexity of the arguments.

 

Much of the legal argument has centred on causation and the requirement for the loss suffered by the insured to have been caused by the "insured event" (for example the occurrence of a notifiable disease within a 25 mile radius of a premises).

 

The insurers said that, regardless of the events insured against, no policy was ever designed to provide cover for a national pandemic, and as a result of the national lockdown, businesses would have suffered losses anyway. However, the FCA argued that the national lockdown only occurred because of each and every individual case of COVID-19, which can each properly be described as a cause of the insured's losses.

 

We know that this is an important issue for many dentists and we will update you when we know more.

 

 

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4. NHS dental services provision

General Dental Practitioners

England

With the pandemic impacting the end of the 2019/20 financial year, NHS England previously set out three possible methods to calculate UDA activity for 2019/20 to make sure that practices were not adversely impacted by the reduction in patient care. Those three possible methods were:

 

  • Option 1: March 2019 to February 2020 would be used to decide UDA delivery for 2019/20
  • Option 2: April 2019 to March 2020 would be used
  • Option 3: April 2019 to February 2020, plus an average UDA delivery over an appropriate three-month period in 2019/20. 

Since year-end reconciliation, NHS England has now identified that these three options did not work well for a small number of contracts. The NHS Business Services Authority has now written to indicate that in exceptional circumstances, the period from 21 March 2019 to 20 March 2020 can be used to calculate UDA delivery. Under this exceptional method, the 16 schedule months of March 19 to June 20 are assessed to calculate activity for the specified 12-month period of 21 March 2019 to 20 March 2020.

 

A review of all contracts has taken place and those impacted will be contacted directly by NHS BSA by 25 October.

 

For 2020-21, NHS England will revise contracts so that:

 

  • NHS contract payments to practices are maintained
  • Contract delivery is maintained
  • All practice staff required to be available in other NHS areas
  • Practices must pay staff at same level.

 

NHS contractual payments and abatement

 

We’ve put together a guide for members on associate payments during the pandemic in England . Our video of essential advice on abatement also tells you what you need to know about abatement in England.

 

Abatement is an agreed reduction in the NHS contract payment for any variable costs associated with service delivery. The contract value paid to an NHS practice is intended to cover all the costs relating to the delivery of that contract. For example, if you have not been practising for three months then your laboratory bills, consumables and corresponding costs would have reduced in that time. This reduction in your expenses for the period in which you were not providing face to face care must be reflected.

 

The NHS has said it will honour contract payments, but it is reducing that overall figure to take off the costs not spent (abatement). 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).

 

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.

 

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.

 

A letter of clarification from NHS England reiterates practices' obligations around passing on payments to staff, including associates. It recommends the use of Net Pensionable Earnings as the best way to do this, which has been our stated position for some time. However, it also recognises that other methods of payment can be appropriate where agreed.

 

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.

 

Furloughed workers scheme and NHS contractual payments

 

There have been two different state schemes to help dental practices with an NHS contract:

 

1. The Government furloughed workers scheme, which has been extended until the end of March 2021.

 

2. The NHS will, subject to certain conditions, continue to pay dental practices in England and Wales their NHS contract value.

 

Clarity for mixed practices on financial support

 

One of the conditions of the NHS payment is that practices benefiting from this continued NHS funding will not be eligible to seek any wider Government assistance to small businesses which could be duplicative. This caused a lot of concern for NHS practices, especially those whose NHS contract value is a relatively small proportion of their income.

 

On Thursday 2 April 2020, NHS England clarified that mixed practices can claim for furloughed workers for part of the time, in respect of private income and still receive their NHS income. NHS England has said that it will be asking of evidence of the portion of NHS/private income used in any applications for additional support. The amount of money claimed under the furloughed workers scheme should be in proportion to the private income of the practice.

 

 

Wales

 

From 1 July 2020, NHS practices in Wales will receive 90% of their contract value. This will then move up to 100%, potentially from September. In return for this 90% of contract value, practices will work within the scope of the de-escalation plans, at present in the amber phase, and work through the back-log of patients as best as possible on a prioritisation of needs basis.

 

Practices can be in heightened amber and only offering non-AGPs, or be in low amber and be offering AGPs as well, as long as they are set up and signed off by the relevant authority.

 

Key to this offer of 90% is the move away from the UDA system, and its replacement with the UDAS, (units of dental assessment). This is a move from payment based on activity, toward payment based on patient need and number. And filling out the Assessment of Clinical Oral Risks and Needs (ACORN) risk assessment form is an important part of that.

 

We support the protection of the contract value and the move away from the activity treadmill and we welcome confirmation that there will be no patient number target up until March 2021. This new model may stay after March 2021, and we all can shape it. However, we appreciate that many questions remain and can only be answered with time. We are working to keep you as up to date as possible.

 

Is sticking with the UDA model an option?

 

Yes. You can stay with the UDA model if you wish. In making any choice, we encourage you to consider social distancing, provision of AGPs and patients throughput. UDA numbers will also be ghosted in the background, so practices will be able to see a comparison.

 

Please also note that there could be clawback if you stay with the UDA. Your UDA target would be 75% of the original. This target did not count for April, May and June. So when deciding whether to stay with the UDA model, you should factor in how much activity you can complete going forward, and whether it will allow you to meet your UDA target.

 

If you feel it is best for your practice to stick with the UDA system, letting your Health Board know would be a good place to start.

 

Northern Ireland

 

During this period Financial Support Scheme (FSS) payments totalling 80% of a GDP’s average monthly gross Item of Service income are being administered each month with no changes to allowances or registration fees. Crucially, GDPs are allowed to access wider Government support in direct proportion to their percentage Health Service/Private split. Duplication of support is not permitted.

 

The Department of Health have issued a FAQ on the Financial Support Scheme (FSS) for General Dental Services (GDS) in Northern Ireland. It provides an outline of how dentists in a range of situations can expect their payments to be calculated. We advise you to review this document, particularly if your circumstances changed during the 12-month period used to calculate the amount of support given.

 

We continue to regularly engage the Health Minister and the Department of Health on Financial Support Scheme issues. We're seeking clarity on long term financial support and assurances that abatement will not be applied on FSS payments as the cost of delivering dentistry increases and patient throughput remains low.

 

We continue to lobby the Department of the Economy regarding meaningful wider business support measures available, and which can be accessed by dentists.

 

Scotland

 

The Scottish Government has issued a letter from the Chief Dental Officer and a memorandum to dentists with details about the return to dentistry. We have welcomed the additional funding outlined in the CDO's letter – an extra 30% to the General Dental Practice Allowance and a 30% increase to the GDPA cap. However, we argue that this support did not go far enough.

 

We advise you to review this summary of the sources of financial support currently available to dentists in Scotland during the crisis. We are continuing to press the Scottish Government for additional funding mitigation measures for mixed dental practices.

 

The Scottish Government issued a revised funding package for NHS dentists on 30 March. This will provide 80% of the average income from items of service and patient contributions. This is what we asked for – a more equitable funding solution. This should hopefully provide much-needed reassurance to many dentists.

 

The Scottish Government subsequently issued a memorandum setting out more details about the funding package. In addition, Practitioner Services has published a Q+A to answer some of the queries it has received from dentists.


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.

 

We have written to the Cabinet Secretary for Finance to seek additional funding for private dentists to help them remain viable, and copied the letter to all other MSPs and all MPs in Scotland. This complements the BDA's UK-wide approach to seek additional support from the Chancellor.


For information on paying staff during closure and the options open to NHS practices in Scotland, please see section 12 below.

 

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5. NHS provisions for sick pay

There are provisions for long-term sick pay in all four nations. In all four schemes, there is no pay for four weeks, then NHS dentists are paid an amount based on their normal pay for the next 22 weeks.

 

The pay is due if a dentist cannot work due to sickness. At this stage, we have asked the relevant authorities to see how they are going to interpret this provision.

 

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6. Associates in NHS practice

COVID-19 is a global issue. We ask all our members to behave responsibly. Associates should work with practice owners to agree cover for emergency work and other dental work that can be carried out. There will, of course, be members of the dental team who are particularly susceptible to the dangers of COVID-19. In these unprecedented circumstances, we ask all associates and practice owners to work together constructively. 

 

Side letters to associate agreements

 

We have prepared side agreements for associates and practice owners and England and Wales to help ensure that their associate contracts reflect the current situation:

 

The side agreement, put simply, says that both associates and practice owners should adhere to guidance issues by NHS England and the Health Board in Wales. This includes guidance on paying associates and guidance about the dental services that need to be provided.

 

We believe that the commercial relationship between associates and practice owners in Scotland and Northern Ireland is different because associates in Scotland and Northern Ireland have their own NHS contracts.

 

England

The NHS has said that it will continue to pay NHS contract payments to practices.

Neither England nor Wales will be paying 100% of the contract payments. In England, there will be an agreed and fair reduction for any variable costs associated with service delivery (e.g. in recognition of reduced consumable costs and lab bills). In Wales, the Government will pay 80% of the NHS contract value. 

 

There are a number of conditions that apply to the continued NHS contract payments. Those conditions include:

 

  • All staff, including associates, continue to be paid at previous levels
  • Practices don't seek other assistance which would be duplicative
  • All available staff may be required to be redeployed.

What should practices pay associates?

 

The starting point is that practices should continue to pay associates the NHS contract payments they would have received had COVID-19 not happened.

 

We ask practice owners and associates to follow the following principles in working out pay for associates:

 

  • Payments to associates for March 2020: To calculate end of year figures for the contract year 2019-2020, NHS England is going to use activity figures from March 2019 instead of figures from March 2020. It therefore makes sense for practices, where possible, to pay performers for March 2020 based on their March 2019 activity. That won’t always be possible or pragmatic. Where March 2019 figures are unavailable or unrepresentative, practices should pay associates based on their average UDA performance over the last few months. Where practices believe that the March 2019 figures would be inappropriate or unfair, they should discuss this with their commissioners, who have been asked to take a reasonable and common-sense approach.
  • Those who have been performing NHS dental services should continue to receive the same income had this crisis not happened. A way to consider this may be simply to look at the amount on the pay statements, look at what you paid on average after deductions for lab fees and licence fee, and use that figure.
  • A recent letter of clarification from NHS England reiterates practices' obligations around passing on payments to staff, including associates. It recommends the use of Net Pensionable Earnings as the best way to do this, which has been our stated position for some time. However, it also recognises that other methods of payment can be appropriate where agreed.
  • NHS England has said that it will be asking NHS dental practices to complete declarations showing what money has been passed onto associates. We are waiting for details on how these reconciliations will work. We are hopeful this may help associates who have not received money due to them. We will continue to represent your interests in discussions with NHS England, and are continuing to push for legislative change to ensure that appropriate earnings are passed on to associates.
  • Agreements to start or end associateships are, generally, likely enforceable and should be kept. In most cases, if a practice has agreed that an associate can start an associateship, the associates should start and should receive the NHS contract payments.
  • NHS Maternity pay, Parental leave pay, Adoption leave pay and Sick Pay should be payable in the normal way. Dentists returning from maternity leave whose 2019-20 figures may not be representative of their normal monthly activity should be treated fairly and a pragmatic solution should be agreed. Dentists who are in the high risk groups and may not be able to work assisting the practice with telephone triage or able to be deployed should be treated fairly.
  • There is nothing to stop parties agreeing something different.
  • Parties should act fairly, professionally, with patience and understanding. It is a difficult time for everyone.

NHS contracts and abatement

 

We’ve put together a guide for members on associate payments during the pandemic in England . Our video of essential advice on abatement also tells you what you need to know about abatement in England.

 

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.

 

The abatement to be applied to most contracts from 1 April up until 8 June will be 16.75%. 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.

 

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. 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 from 20 July to 16 September 2020. This would 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.

 

Since 25 March, there have been conditions attached to practices continuing to be paid. Included in that was a requirement on practices to ensure that all staff, including associates, non-clinical and others, continue to be paid at previous levels. This continues to be a requirement now. Associates should therefore continue to receive their previous NHS earnings.

 

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. Our view continues to be that the most appropriate starting point for payment of previous earnings to associates is net pensionable earnings.

However, we know that some contract holders have taken account of the abatement figure in making a calculation of associate pay. The confirmation of the final abatement percentages may therefore need to result in some payment adjustments, for example where practices have assumed a higher figure than 16.75%.

 

We know that some associates are still not being paid previous NHS earnings. We continue to discuss this with NHS England and the Department of Health and Social Care to see if there could be a temporary change to the Statement of Fees and Allowances to ensure payment. We are also working with external counsel to explore all other possible legal angles to try to make sure associates are treated fairly. We will keep you updated on that activity.

 

A letter of clarification from NHS England reiterates practices' obligations around passing on payments to staff, including associates. It recommends the use of Net Pensionable Earnings as the best way to do this, which has been our stated position for some time. However, it also recognises that other methods of payment can be appropriate where agreed.

 

NHS England has said that it will be asking NHS dental practices to complete declarations showing what money has been passed onto associates. We are waiting for details on how these reconciliations will work. We are still hopeful this may help associates who have not received money due to them.

 

We will continue to represent your interests in discussions with NHS England, and are continuing to push for legislative change to ensure that appropriate earnings are passed on to associates.

  

Reopening and NHS associates 

 

Associates should continue to be paid in line with the letter of 25th March, unless ALL of the following occur:
  

  • The practice is reopening for work and has put in place a safe system of work and
  • The associate has refused to work at the practice that is reopening (either for some hours or all hours) and
  • The associate has not made reasonable efforts to engage a locum to cover the absence.

We have produced side agreements for associates and practice owners to use to adapt their existing associate agreement to the current NHS arrangements.

 

Practice should continue to pay self-employed associates their NHS-related payments, if they self-isolate because they have symptoms, test positive for COVID-19 or are contacted by the test-and-trace service.

 

NHS England have also confirmed that sick pay should be paid to performers who are extremely vulnerable, those who are pregnant and in the third trimester; and those in particular list of vulnerable people (e.g. Type 2 diabetes); and who are not receiving NHS contract payments because they cannot work. We are currently waiting to see if these changes are going to be backed up by changes to the SFE.

 

If an associate is still working on redeployment, the practice should still receive income in relation to that associate's NHS notional activity and associates should continue to receive their NHS income if they are not receiving pay for that redeployment. Their redeployment must also be on the approved list for this to apply, e.g. contract tracing. 

 

Helping associates

We have been keen to help associates who have issues with the money they have been receiving from their practice owners.

 

Our advice lines are open to Extra and Expert members and we will try to help them discuss the situation with their practice owners.

 

Where we are not able to help the parties reach agreement, and if the local area teams or health board is informed that the practice was in breach of the conditions of the continued contract payment, action may be taken.

 

We do our best to help parties resolve any disputes in a fair and constrictive way. We also  continue to represent your interests in discussions with NHS England, and are continuing to push for legislative change to ensure that appropriate earnings are passed on to associates.

 

Northern Ireland

During this period Financial Support Scheme (FSS) payments totalling 80% of a GDP’s average monthly gross Item of Service income are being administered each month with no changes to allowances or registration fees. Crucially, GDPs are allowed to access wider Government support in direct proportion to their percentage Health Service/Private split. Duplication of support is not permitted.

 

The Department of Health have issued a FAQ on the Financial Support Scheme (FSS) for GDS in Northern Ireland. This provides an outline of how dentists in a range of situations can expect their payments to be calculated. We advise you to review this document, particularly if your circumstances changed during the 12 month period used to calculate the amount of support given. We continue to push for further improvements to the Financial Support Scheme on your behalf.

 

We continue to lobby the Department of the Economy regarding meaningful wider business support measures available, including support for the self-employed and any monitor impact wider business support has on DoH measures. We are seeking to ensure that DoH support is fair and balanced for both NHS and private practices.

 

Corporate bodies and practice owners with NHS contracts continue to be paid during this time, on the condition that they pass on income due to associates. If you encounter issues, we will take them up on your behalf. See more about logging an associate pay dispute with us.

 

Scotland
It has said that dentists will continue to receive 90% of their average monthly item of service income (net of patient charges for fee paying patients) and they will protect NHS commitment status.

 

Associates’ NHS income is usually paid to the practice. Our view is that practices should pay that money, minus license fee, to the associates in the normal way.

 

The Scottish Government recently issued a letter from the Chief Dental Officer and a memorandum to dentists with details about the return to dentistry. We have welcomed the additional funding outlined in the CDO's letter – an extra 30% to the General Dental Practice Allowance and a 30% increase to the GDPA cap. However, we argue that this support did not go far enough.

 

 

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7. Associates in mixed practice

England

We have received clarification from HMRC over the position of associates under the Government’s Self-Employed Income Support Scheme who are also continuing to receive NHS income.

 

The various NHS financial support mechanisms across the UK have sought to protect NHS earnings during the pandemic. However, one of the conditions attached to ongoing payments to contract holders in England is that associate NHS earnings continue to be paid at previous levels.

 

Meanwhile, self-employed associates earnings less than £50,000 are eligible to claim under the SEISS. This allows individuals to claim a taxable grant worth 80% of average monthly trading profits, paid out in a single instalment covering 3 months’ worth of profits, and capped at £7,500 in total.

 

Given that associates in England are potentially in receipt of NHS earnings as well as separately being eligible for the SEISS, we have been in contact with HMRC so that we can give clear advice to associates. HMRC have clarified to us their view on the SEISS as follows:

 

  • NHS England has put out clear guidance that dentists will be fully remunerated for the NHS work they would have otherwise undertaken during the outbreak, subject to some basic requirements.
  • As regards non-NHS activity, the Government has set out a range of UK-wide measures which will support private income for dentists. If they meet the criteria, private dentists who are self-employed could be eligible for the Self-employment Income Support Scheme (SEISS) and those who are employees and receive a salary through a PAYE scheme could be eligible for the Coronavirus Job Retention Scheme.
  • The SEISS eligibility criteria does include that the dental practitioner has been adversely affected by COVID-19. If part of the dental practitioner’s income stream reduces, but another part remains the same, it is still legitimate for them to claim the SEISS. Dental practitioners will receive the full grant based on 100% of their trading profits, even if only 50% of their profits have fallen. If the NHS continues funding the dentists for their work, it would still be legitimate to claim the SEISS if the rest of their trading profits were adversely affected. 

We have also discussed the matter with NHS England. Their expectation is that NHS contract holders should be paying associates in line with previous earnings, consistent with their existing advice.

 

In summary, if associates fulfil the criteria for the SEISS scheme, continue to receive NHS payments, but have seen any drop in their overall income (for example due to a reduction in private earnings), they can make a claim for a SEISS grant.

 

If associates are eligible and want to claim the first grant under the SEISS, the claim must be made on or before 13 July 2020. The scheme is being extended and associates may be able to make a claim for a second and final grant in August 2020. 

 

For more information on NHS contracts and abatement please see the Associates in NHS practice section.

 

We have also set up a process for resolving disputes where earnings are not passed to associates on and we are discussing with NHS England a regulatory mechanism to ensure that this happens.

 

Northern Ireland

HMRC has indicated (see above), that if associates fulfil the criteria for the SEISS scheme, continue to receive FSS payments, but have seen any drop in their overall income (for example due to a reduction in private earnings), they can make a claim for a SEISS grant.

 

One of the eligibility criteria for the SEISS scheme is that it is only open to those earning less than £50,000 from self-employed roles. We continue to lobby for the removal of this unfair and arbitrary limit. However, those self-employed associates earnings less than £50,000 are eligible to claim under the SEISS.

 

Associates should note that they are required to make a declaration each month when applying for Financial Support Scheme (FSS) funding if they are in receipt of other government supports. Duplication of support for HSC activity is not permitted under the FSS, and GDPs wishing to claim for support from wider business support schemes must do so in relation to private activity only.

 

Scotland

We are seeking clarification from the Scottish Government on the position of associates in mixed practice. To date, PSD have advised associates: "We consider that you should not claim any aspect of NHS income which you would normally receive, from HMRC. We would advise you speak to your accountant and other professional advisers to determine your course of action.  Practitioners should be aware that we are required to share data with HMRC in order to validate taxation and payments. We anticipate that HMRC will reconcile any payments they make."

 

However, HMRC has indicated (see above), that if associates fulfil the criteria for the SEISS scheme, continue to receive NHS payments, but have seen any drop in their overall income (for example due to a reduction in private earnings), they can make a claim for a SEISS grant.

 

One of the eligibility criteria for the SEISS scheme is that it is only open to those earning less than £50,000 from self-employed roles. We continue to lobby for the removal of this unfair and arbitrary limit. However, those self-employed associates earnings less than £50,000 are eligible to claim under the SEISS.

 

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8. Salaried services

If you are a salaried dentist, working in Hospital Dental Services, Community Dental Services or prison dentistry, for example, your employment status should not be affected by this crisis. You will continue to receive your salary.

 

However, it should be noted that they may be deployed elsewhere within the health service, as the outbreak progresses. For more info on this please see our latest advice on redeployment (see questions 21-25). This may prove quite stressful and members should be aware that they have access to our 24-hour counselling service.

 

If you are a salaried dentist and have an issue, please reach out: 

  • Members employed on national terms and conditions within the salaried/community dental service, in dental schools, in the armed forces or a variety of other employed roles within the NHS, please contact: employmentrelations@bda.org
  • Members working under hospital terms and conditions can contact the BMA for employment relations support: 0300 123 1233 (please quote your BDA membership number).

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9. Private practice

This is an exceedingly challenging time for business in the UK. The COVID-19 outbreak is impacting the incomes of private practices and many are currently in desperate financial circumstances. We are lobbying Government and representing your interests during this difficult time.

 

Business support made available from the Government

Chancellor Rishi Sunak has pledged additional support for business, on top of measures set out in the budget. These include:

 

  • The government’s Coronavirus Job Retention Scheme, also known as the Furlough scheme, will remain open until the end of March 2021.. See our guide to this scheme in our section below on Practice owners: Advice on paying staff.

  • Government-backed loans of £330 billion have been made open to all businesses. We are worried that many dentists are having difficulty accessing these, and are instead being offered commercial loans at very high rates. Please contact advisory services if you are unable to access a reasonable commercial loan. That information will be useful to us in discussions with the Government to help members.

  • Business interruption loans, with the Government paying the first 12 months' interest.

  • £10,000 extra cash grants have been made to some of the smallest businesses, some dental practices with rate exemptions have already received this.

  • The Government will refund up to two weeks’ SSP per eligible employee

  • Limited measures were also announced to support the self-employed, but a cap was placed on these, limiting the amount of dentists in private practice that can avail of it.

This situation is untenable. We’re pushing for a fair and equitable solution for mixed and private practices. Our CEO, Martin Woodrow has outlined why it's so important for us to fight for private practices during the COVID-19 pandemic and how our campaign for support is having an impact.

 

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.

 

This is a stressful time and members should be aware that they have access to our 24-hour counselling service. Dentists who are worried they cannot meet their current personal household expenditure can also apply to the BDA Benevolent Fund for financial assistance.

 

Business rate exemption should be given to dentists

Dental practices were not included in the new measures introduced in Budget 2020 to give business rate exemptions to retail businesses. 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 government to that effect and we will update you on any progress made.

 

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10. Associates in private practice

Self-employed dentists face huge uncertainty in the face of COVID-19. The measures announced by the Chancellor on 26 March to support the self-employed during the COVID-19 outbreak will not support the majority of self-employed dentists.

 

This is an untenable situation. We're working hard on your behalf, lobbying government to provide sufficient financial support to the self-employed during this time of national crisis. We will update you when more information is available.

 

Chancellor Rishi Sunak also told the House of Commons:

  • Self-employed are all eligible for the business interruption scheme
  • VAT has been deferred
  • The Universal Credit enhanced rate is available to all self-employed, which includes housing support
  • Self-assessment tax payments have been deferred until January 21.

Both your safety and the financial viability of your practice are driving priorities for us. Our CEO, Martin Woodrow has outlined how our fight for private practices during the COVID-19 pandemic is having an impact, we encourage you to read it.

 

This is a stressful time and members should be aware that they have access to our 24-hour counselling service. Associates in significant financial hardship may also speak to the BDA Benevolent Fund about their situation and the possibility of financial aid.

 

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11. Private capitation schemes

Most patients will likely continue to pay into private capitation schemes. Some may stop. Practices will continue to get the capitation money. In many cases, practices will continue to pay associates their share of the capitation money.

 

We believe that it is best if practices do continue to pay all (or most) of the capitation money to associates, but on condition that associates remain at the practice for a period of time, say six months after the shutdown ends. We say this because, if associates continue to receive the capitation payments, they are – in effect – being paid to do the routine work as associates with those payments. They should therefore remain as an associate at the practice long enough to carry that work.

 

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12. Practice owners: advice on paying staff

This continues to be a challenging time for dentists and dental practices all over the country. Practice owners under financial pressure have the following options regarding staff payments:

 

  1. Until March 2021, use the furloughed workers scheme, by agreeing employees that they are furloughed workers, as part of government scheme to keep staff employed on 80% pay. 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.
  2. Agree with workers that they work reduced hours for proportionately-reduced pay
  3. Lay off employees on guarantee pay
  4. Consider making staff redundant.

 

The furlough scheme 

The furloughed workers scheme has been extended until the end of March 2021. In the meantime, practices can 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.

 

You may, with staff agreement, designate employees as furloughed workers. This includes employees who are currently self-isolating. People on maternity and paternity leave who return to work are also eligible for the government’s furlough scheme.

 

You can then submit information to HMRC about the employees that have been furloughed and their earnings through a new online portal that HMRC will set out.

 

Employers will not have to top up the remaining 20% of the furloughed workers’ pay. A draft letter to give to employees in mixed practices is accessible for members . Note that template says you will pay 80% of their pay. You may choose to pay more if you wish. If you do, insert the appropriate percentage in the letter. If you have a purely private practice, see the furlough letter for private practices .

 

For the question of how furloughed workers will tie in with help from the NHS, please see Section 4. NHS Dental Services Provision.

 
The key points of the furloughed workers scheme are:

  • You can claim up to 80% of furloughed workers usual monthly wage costs
  • The maximum that can be claimed is
    o   £2,500 a month, plus
    o   Employer NI contributions and
    o   minimum automatic enrolment employer pension contributions
  • 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
  • You can claim for any employees who were on your PAYE payroll, and who had received a payment that had been notified to HMRC by 19 March 2020,whether full-time, part-time, or employees on a flexible contract
  • You can claim for employees you made redundant after 19 March 2020, as long as you rehire them
  • Whilst being furloughed, employees cannot do any work for you
  • Employees must have been notified that they have been furloughed
  • Wages of furloughed workers are subject to usual income tax and other deductions
  • Employees who work reduced hours during this time are not eligible for this scheme. They will have to be paid in the normal way
  • Normal equality laws apply to who you furlough and who you don’t
  • Employees placed on unpaid leave after 28 February 2020 can be furloughed
  • Employees on sick leave or self-isolating should get SSP, but can be furloughed after
  • Employees must be furloughed for at least three weeks. You can therefore rotate who is furloughed as long as those who are furloughed are furloughed for at least three weeks.

Mixed practices and the furlough scheme

 

It makes sense if the proportion of time staff are furloughed is the same as the proportion of private income at the practice. So, if private income amounts to 33% of total income, then each member of staff can be furloughed for 33% of the time and paid in full under the NHS scheme for the remainder.

 

If we assume this lockdown is for three months, then that would be one month as furloughed and two months as NHS. If private income is 50% of practice income, each staff member could be furloughed for six weeks and paid in full under the NHS scheme for the remainder.

 

Mixed practices can use our furlough calculator  to figure out how much money you are entitled to claim from the Government if you were to furlough some of your staff for a given period of time. To make it easier we've also made a demo video on using the furlough calculator.

 

We have drafted a letter for members with mixed practices to give to staff to explain the situation and seek their agreement to be furloughed workers .

 

How to claim for furloughing workers

Claims are made through the Government portal. You will need to sign in to this using the Government Gateway system for your business.

 

Payments may take up to six working days to reach the claimant. You can make the claim yourself, or you can delegate this to an agent who usually runs your PAYE affairs (for example, a payroll consultant or accountant).

 

Before making a claim, you should gather the following information:

 

1. In respect of your business:

  • The number of employees being furloughed
  • The dates employees have been furloughed to and from
  • Details of employees – the name and National Insurance Number of each furloughed employee
  • Your employer PAYE scheme reference number
  • Your Corporation Tax Unique Taxpayer Reference, Self-Assessment Unique Taxpayer Reference or Company Registration Number as appropriate for your entity
  • Your UK bank account details
  • Your organisation’s registered name
  • Your organisation’s address.

2. For each furloughed employee you will need to make a claim. Each claim is made up of up to three parts:

  • A claim for the furlough pay being given over the period of the claim
  • A claim for the cost of the employer national insurance payment made on the furlough pay
  • If the furloughed worker is a member of your workplace pension scheme, aclaim for the cost of the employer pension contribution. This must be paid on to the employee’s pension scheme.

To assist in calculating these amounts, HMRC has provided a Coronavirus Job Retention Scheme Calculator. The calculator will work out each of the above elements which form part of your claim for each furloughed employee.

 

To use the calculator you will need details of each employee’s normal pay level, their National Insurance category, and dates including when they went on furlough, when furloughing ceased (if applicable), pay period dates (i.e. when each pay period runs to, such as the first to last day of each month), and what date employees are actually paid on. 

 

In respect of the pay level, this will be straightforward for individuals who are on regular levels of pay. However, if an employee has variable levels of pay (for example, because bonuses are paid, or there is a regular change in working hours), then it is more difficult to calculate what level of furloughed pay applies. At the current time, the calculator does not support this particular calculation, but there is further guidance to support such manual calculations. Your payroll provider should be able to support you with this.

 

The calculator will set out the amount you can claim for each pay period. You should save the results of this before moving on to carry out another calculation.

 

Once you have this information you (or your agent) can input this into the Claims Portal. Once complete you should receive a claim reference number. It is important that you keep a record of this (such as a screen print).

 

You should tell your employees that a claim has been made using this system. Further claims can be made if furloughing continues beyond the claim period.

 

Staff of NHS practices in Scotland

We have sought clarification from the Scottish Government with regards to the NHS COVID-19 Financial Support Payment and paying non-furloughed employees, and have been advised that this funding does not place a condition on practice owners to maintain pre-COVID-19 levels of (non-furloughed) employees’ pay.

 

NHS financial support measures are intended to ensure the integrity of the NHS dental team and that once dentists are able to restart NHS dental services, practices will be in a position to do so. The Scottish Government has stated that it hopes “the rational response for a practice owner would be to ensure that happens through continuing to remunerate their employees but it is not a specific condition of the NHS funding. As independent contractors, this is a matter for the practice and employees of the practice”.

 

The NHS COVID-19 Financial Support Payment places the following conditions on dentists:

 

  • There must be no consequential loss of workforce, and
  • Contractors must immediately advise their local NHS Board if their associateship agreement or any other arrangement with a practice has been terminated or put into abeyance.

Practice owners have the following options:

 

  • Practice owners may continue to pay their non-furloughed employees as per the employee’s contract of employment/on the same basis pre-COVID-19, or
  • Practice owners can consult with their employees over reducing their pay. Employees will need to agree to this. National minimum wage rules will still apply. Agreements should be confirmed in writing, or
  • Practice owners may wish to consult with staff to reduce their employee’s contracted hours of work. This approach may have implications over employees being able to be redeployed to the wider NHS, which is a condition of receiving the Financial Support Payment. Consideration will need to be given to the future when a practice owner may wish to consult again with those employees about increasing their hours, or
  • Practice owners who have short time working and/or lay off clauses in their (signed) employee’s employment contracts may wish to consider either of these two options. However, as the NHS is paying dentists public money to help keep their practices running it would not seem reasonable to adopt such an approach as it would go against the spirit in which dentists are receiving the Financial Support Payment.

When seeking to make changes to 20 or more employee’s terms and conditions, including pay and contracted hours, there are further consultation requirements on employers and potentially financial penalties if these processes are not followed.

 

Employees do not need to agree to these changes. If they do not agree to the change a formal process will need to followed. In some cases, employers may have to give notice to an employee, to vary the employee’s employment contract, of up to 12 weeks.

 

Reduced hours

You may agree reduced hours working. You could suggest or ask your staff to suggest to you a temporary cut in hours and hence a proportional reduction in their pay. There is no obligation for them to agree, but if you are frank and explain the circumstances and the alternatives (lay-off or even possible closure of the business) then they might be agreeable. However, note that the same rules on staff being able to claim for redundancy (see above) apply if you reduce staff hours on short-time working to 50% or less of their normal hours.
 
Any agreement to reduced hours or short-time working should be put in writing – including the new hours, the rate of pay, the date the reduced hours start and the date for reviewing reduced hours or the date that they return to their normal hours – and signed by the employee.

 

Guarantee Pay

Employed staff will either be entitled to full pay or only to guarantee payments during any period where there is no work.

 

What are guarantee payments?


Guarantee payments are £29 per day (£30 per day from April, or less, if the employee would normally earn less than £29/30 in the day). Employees are entitled to a maximum of five days of guarantee payments in any three months. Practices do not have to pay anything to staff once they have had their five days of guarantee payments.

 

When are employees only entitled to guarantee payments?


Employed staff will be entitled to only guarantee payments if, either:

 

a) The practice has a contractual right to lay off staff without pay. There is a clause in the BDA model contract of employment entitling employers to lay off staff with only guarantee pay.

b) Or, in normal times, they are only paid for the work they do; so they do not get paid normally if there is no work.

 

In all other circumstances, where practices have no work for staff, they will have to pay staff in full if the practice closes or if they need fewer staff.

 

How long can practices keep staff on guarantee payments?


If staff are on guarantee payments for more than four consecutive weeks (or more than six weeks in any 13-week period), they can give the practice a notice to claim redundancy pay. The practice may, if it wishes, issue a counter notice to that. A tribunal would then decide whether there is a reasonable prospect of the employee returning, within four weeks of giving the original notice, to full employment for at least 13 weeks. The provisions are not very simple. Our advice team is happy to advise on individual situations.

 

Redundancy

The Government is keen to avoid redundancies if at all possible. That is why is has introduced pay for furloughed workers. However, practices may be able to make staff redundant. There is a procedure to follow. We provide advice on redundancy . Staff who are made redundant may be entitled to Statutory Redundancy Pay, which can be calculated here.

 

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