Letter of Preparedness Issue 4 – What does it mean for my Practice?

17th April 2020

The NHS has now released its much awaited Letter of Preparedness: Issue 4 (here) and its purpose was to provide further clarity on questions raised by practice owners and the British Dental Association alike. Despite some useful guidance, there are still more questions than answers.

Updates on Contracts and Financial Arrangements

Mixed Practices

Mixed practices have been a central focus across the sector as many concerns addressed in issue 3 did not specify how mixed practices would be impacted by the proposals provided for solely NHS practices.

NHS relief is only available for the NHS proportion of the practice whereas the private proportion of the practice is entitled to government relief discussed Financial assistance for dental practice owners Practice owners are instructed to use the proportion of gross income that relates to the NHS contract value with the balance being the private share. If practice owners claim relief under the NHS scheme and/or government relief then this must be declared as part of the 2020/21 reconciliation process.

Wholly private practices are still fully able to access the wider government support schemes, as significant numbers have, including the Coronavirus Job Retention Scheme which provides the ability to claim for furloughed employees.

2019/20 Reconciliation and Clawback

The default reconciliation year will run from 1st April 2019 to 29th February 2020. However, practice owners may now agree with their local area teams that they can either run this from April 2019 to February 2020 plus March 2019, March 2020 or average UDA (Unit of Dental Activity) delivery over an appropriate three month period.

Any clawback repayments for 2019/20 contract year may be payable over the financial year but no later than 31 March 2021.

Patient charges

Practice owners are encouraged to keep manual records of telephone triage to assist the NHS with development of contract management arrangements for 2020/21.

Urgent treatments provided with UDC (Urgent Dental Care) systems should adhere to the current regulatory framework for FP17 submission and applying patient charges.

Self-Employed Staff at Dental Practices

Whilst Issue 4 also goes further to provide information on urgent care systems and re-deployment of staff, there are many more questions particularly surrounding self-employed staff which arise and have not yet been considered.

Following the earlier announcement by the Government on 26th March 2020 in respect of self-employed staff, there is much uncertainty surrounding how this ties in with the relief available through the NHS schemes as discussed in our article Covid-19 advice for NHS dentists.

Private Fees v NHS Fees – Self-Employed Staff

For self-employed staff who undertake private treatment, the guidance is clear and they should be able to access a taxable grant worth 80% of their average monthly profits recorded over the last three years up to £2,500 per month. However, there are thresholds to this such as having a 2019 tax return and anyone with trading profits of up to £50,000. Despite being a relief to self-employed staff who work under private retainer, this relief may not be nearly enough for self-employed staff who can earn substantial amounts under their current engagements, in particular given that over half of all dentists earn between £50,000 and £75,000 per annum.

The water is muddied further where associates exclusively perform NHS work. There has been no guidance issued as at the date of writing this article on whether NHS associates are required to choose between the self-employed relief available as part of the announced schemes and the relief available under the NHS Schemes to practice owners. As a secondary point self-employed staff usually either contract, as an individual or through a limited company, with practice owners and there is no clarity on whether associates who contract through a limited company are considered employees of that company. Furthermore, what reliefs available to them and in that capacity, and whether they cut across the relief provided by the self-employment schemes. In some cases this may lead to double recovery.

NHS Relief v Wider Government Relief

Another key aspect of the relief previously discussed in our article, Issues with the NHS guidance for NHS dental contract holders, are problems surrounding the NHS’ ‘Letter of Preparedness: Issue 3’ – specifically whether the relief available to practice owners generally cuts across the specific relief issued by the NHS. If, for example, an associate who undertakes NHS work claims relief under newly announced self-employment schemes and the practice owner has claimed relief through the NHS schemes, then is the practice owner able to seek relief from the NHS or do they lose the right?

There is also a question as to who will be responsible for this overpayment if practice owners and associates under NHS retainers both recover from under different reliefs and it is later considered to be an overpayment by the government.

Subcontracting of the NHS Contract

Further guidance is needed on the implications for NHS contracts which have already been formally subcontracted. We await further guidance issued on this matter in due course.

In summary, despite the release of the Letter of Preparedness: Issue 4, specific questions do remain for practice owners.

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