After two years of pandemic firefighting, many dental practices are still feeling the operational impact of the pandemic. The strict COVID-19 protocols are now a thing of the past, but there are numerous other issues causing significant operational difficulties and uncertainties for many NHS providers. What are the main challenges for providers in 2022/2023 and are there any options for redress?
Recruitment
Recruiting associates to do NHS work has hit crisis level but, nevertheless practices should make sure their advertising is not disadvantaging them. If stating a UDA rate, optimise the advertisement by putting the gross UDA rate not the net rate they will receive. If you were an associate sifting through hundreds of ads the ones with the higher figures would catch your attention.
Low UDA rates
Practices with a lower UDA rate are facing significant constraints on their ability to compete for associates in the recruitment market when for example, they need to replace associates who are leaving or going on maternity leave. Providers should try and negotiate a better rate but there is no guarantee that this will be successful.
Treatment deferrals
COVID-19 and other respiratory symptoms are still causing patient cancellations. Although screening is no longer required practices are required to notify patients to tell the practice if they are suffering respiratory symptoms and to not attend their appointment. This is bound to have an impact operationally.
Staff absences
Likewise, COVID-19 is causing an increasing rate of absences amongst the dental team, creating more pressure on smaller practices with less flexibility and scope for the redistribution of work.
If practice performance is threatened due to recruitment related issues, COVID-19 absences, treatment deferrals or patient cancellations to the extent it's likely to significantly impact on UDA performance, providers can and should make a Force Majeure application detailing the exceptional circumstances they are experiencing. These applications also serve to drive home to the NHS the relentless pressure all these issues are causing to so many NHS providers.
Clawback
Practices, including those that have never incurred clawback prior to COVID-19, may be facing reduced revenue because of clawback from 2021/22. For some, this clawback repayment alongside other rising costs is causing considerable difficulty.
Practices should, if necessary, discuss with their LAT the impact on their practice that the repayment is having and request an extended repayment period. If clawback was not the pre-pandemic norm for your practice, set out the business case for spreading repayments over a longer period to enable you to get back on track and meeting your normal activity levels. You can also contact your LDC for a contact name to address your case to if you require.
Q1 target
Many providers were concerned about being able to reach the 95% in Q1. However, there were also many that didn't consider the 5% activity allowance was of benefit commenting that Q1 is usually the slowest quarter anyway (often coming in under 95%) and decided the 5% allowance wasn't helpful particularly with the accompanying conditions. In preference, providers opted to manage their annual activity as they would any normal year, making up the UDAs over the year to achieve 96/100% by year end or at worst, accrue a small clawback.
Is reducing or terminating your NHS contract a possible option?
Reducing contract activity could provide a solution for some, but it's necessary to plan and discuss this with your LAT. For many the impact of reduced UDAs on practice revenue might create a period of financial instability for the practice. Many of the practice overheads may not reduce, or not by the same proportion as the reduced revenue and it might take time to build a reliable replacement private base. In any event, the commissioners may not agree to a variation - they don't have to, and they often refuse.
Terminating a NHS contract might also be a preferred option by some practices but the implications of taking such action need to be carefully considered. Replacing the lost NHS revenue with an increased regular private patient base could become tougher in a period of rising inflation and economic downturn. For instance, maintaining the monthly outgoings on a private dental plan might not be a feasible alternative to NHS treatment for many patients.
The NHS contract is a practice asset which could impact on the value of your business if you reduce or terminate it. Whilst there is no indication that the demand for NHS treatment will decline it may not be made easy for providers to reinstate or increase UDAs once handed back to the NHS.
Now we are in Q2 and back to normal contractual arrangements but with all the above issues, 'normal' post-pandemic arrangements are posing extreme challenges. Individual circumstances will always play a big role in the decisions taken by practices. We travel in hope that the NHS will recognise the current impact these issues are having on NHS dental practices nationwide and acknowledge the urgency to act to restore the viability of providing NHS dentistry.