BDA - an update on NHSE guidance

5 Apr 2020
Sophie Kwiatkowski
A 10 minute read
by Sophie Kwiatkowski

Update 3rd April 2020

Hello to all our lovely clients! From all of us here at PFM we hope you are keeping well and safe, and finding ways to keep busy inside!

We have spent the week waiting for further announcements from NHS England and the government as to how the headline funding assistance released last week will work in practice. At 7pm on Thursday 2nd April the BDA posted an update, which we have covered in this release.

There are also a few other updates that have emerged this week, which may be of interest.

Keep safe and if you have any questions, please email your usual point of contact, and we will be here to help you!

This is what the BDA have posted as advice to Principals based on the NHS guidance released. Also included in the detail below is narrative from the webinar on 03.04.2020 with Chief Dental Officer for England, Sara Hurley and NHS Director of Primary Care and System Transformation, Matt Neligan.

NHS dental services provision - General Dental Practitioners

England:

NHS England wrote to practices on 25 March 2020 confirming that 2019-2020 reconciliation is to be based on figures from March 2019 to February 2020. Figures for March 2019 will be used instead of March 2020. For practices that have under-performed, there will be claw-back in the normal way.

They have said that if March 2019 was an unusual month for your practice for whatever reason they are hoping that these can be worked through with local commissioners, but a “common sense” approach has been taken.

For 2020-2021, 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
  • Furloughed workers scheme and NHS contractual payments in England and Wales

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

  1. The government furloughed workers scheme. This allows employers to lay staff off, pay them 80% of their pay, and claim that 80% from the government.
  2. The NHS will, subject to certain conditions, continue to pay dental practices in England and Wales their NHS contract value.

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 duplicitous. This caused a lot of concern for NHS practices, especially those whose contract value is a relatively small proportion of their income.

On Thursday 2 April 2020, NHS England clarified this by stating that the caveat about not applying for wider government assistance applies only to NHS dental income. So mixed practices can claim for furloughed workers 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.

What should mixed practices do?

  1. Determine what percentage of the practice income is NHS, and what percentage is private.
  2. Practices can then claim pay for furloughed workers to the level of the proportion of private income, and will have NHS income for the remainder.
  3. Consider what to do with each member of staff. Staff can either be furloughed workers or eligible for redeployment. A member of staff cannot be part furloughed workers and part eligible for redeployment.

This will present difficulties with staff. The NHS money is conditional on staff being available to help in other areas. Which staff should be furloughed? Which staff should be on NHS money and subject to redeployment?

At present, there are no set rules. We therefore suggest practices and staff follow the following principles:

  1. All employed practice staff should receive at least 80% of their pay (up to a maximum of £2,500). This is a government aim and is a condition of the continued NHS payments.
  2. Over the course of this crisis, the proportion of money claims for furloughed workers as against total staffing levels should be in the same proportion as private income as against total income.

For example, say a practice income is £1m a year. Say £400,000 of that income is from private patients and £600,000 is from the NHS. The private income is therefore 40% of the practice income. Say the annual wage bill is £300,000. Say this crisis lasts 3 months (25% of the year).

During that three-month period, the wage bill is 25% of £300,000 = £75,000. The practice can claim 40% in respect of the £75,000 (£30,000) wages from the furloughed workers scheme. As employers can only claim 80% of the wages, the amount the employer can claim, and should pay staff, is 80% of £30,000 = £24,000. The remaining £45,000 should come from the continuing NHS contract payments.

Keep good records of what you claim.

  1. The question of who goes on furloughed leave and who is on full pay and subject to redeployment should be subject to agreement between the practice and staff. Remember that redeployment is likely to be voluntary in any event. Practice managers and owners should meet with staff online to discuss options.
  2. If employed staff are going to be at home regardless of whether they are furloughed or subject to redeployment, there is an argument that both should receive the same percentage of their pay (as none are working). That percentage will naturally fall between 80% and 100%.
  3. You are able to rotate staff so that some are furloughed for three weeks and then put on possible redeployment leave for a period of time before being furloughed again. Please note three weeks is the minimum length of time that staff can be furloughed for.
  4. Some staff will have good reason to be furloughed workers. But the BDA asks everyone to remember that there is a global pandemic and the skills and knowledge that dental staff have may be very helpful. All staff should therefore consider carefully whether they are in a position to contribute in some way to the national effort. There are a variety of roles, clinical support, that dental practice staff can undertake.

Self-employed, non-dental staff (such as hygienists and therapists) should use the government help for self-employed people.

The BDA have also updated their advice for associates. We have put this guidance below for your information:

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). 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 duplicitous
  • 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.

There are few hard and fast rules. We ask practice owners and associates to follow the following principles in working out pay for associates:

  • Those who have been performing NHS dental services should continue to receive the same income had this crisis not happened.
  • Agreements to start or end associate-ships 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.

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.

  1. Can practices share NHS income so that private dentists also get some money?

The rules of the scheme are that the money should go to NHS dental performers in the normal way. That said, practices and associates could agree together that the NHS contract payments should be shared amongst all associates, including those whose work is predominantly private. It would have to be a matter of agreement with all parties.

2. What if NHS dental performers do not want to be redeployed?

Depending on your area, practices are likely to have to put the names of all dental staff, including associates, on a spreadsheet to be sent to the local area team or health board.

Staff and associates can say that they are not available or if they are vulnerable or living with vulnerable people.

At present, it appears that redeployment is voluntary. If the number of infected people rises significantly, then it may become less voluntary.

Many dentists and dental staff are volunteering. Some are enjoying learning new skills and working in different environments.

Volunteering is not paid separately; it is assumed that those volunteering will still be paid by the practice.

Practices should also state what the routine number of hours a week that dentists and other staff work. This could simply be the typical number of hours spent doing NHS work. But there is nothing to stop associates and staff members of mixed practices agreeing to work more hours if they want to help the effort.

3. What if associates believe they are not being paid the money they should be?

The BDA is launching a pay dispute service. Our aim is to help associates and practice owners reach a fair agreement on NHS pay that is based on the NHS conditions for continued contract payments.

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 will do our best to help parties resolve any disputes in a fair and constrictive way.

Other announcements this week:

  • The Scottish Government issue a revised funding package for NHS dentists. This will provide 80% of the average income from items of service and patient contributions.
  • For those of you that wish to volunteer to help with the wider COVID-19 response, you can register your interest using this link
  • No expectation of UDA claims for triage work performed. Where emergency dental work is undertaken, UDA claims need to be recorded in the same way as they usually would be.
  • Private practices that have questions regarding financial support are for the Department of Health to answer. For any private practices asking if they can help the NHS, sadly a performer number is required, but you can still apply online as a volunteer to help the community effort.
  • The Care Quality Commission (CQC) have announced that they are prepared to take action against dental practices who are still seeing patients for routine treatments.