Covid-19 and the Dental Laboratory Profession and Industry. By David Smith

COVID-19 AND THE DENTAL LABORATORY PROFESSION AND INDUSTRY

By David Smith

Last week I wrote an article for the DLA about my thoughts on the effects on this pandemic on our profession and industry. I asked for comments from some of the social media sites for experience from other technicians.

Their struggle to survive, re-group and protect jobs and businesses made me want to include more of their experiences for this piece in the Dental Technician magazine.

I remember watching the Steven Soderbergh film ‘Contagion’ some time ago, a very accurate reflection of an epidemic, so similar to what we are now experiencing, with the line “No one would have believed a tiny living piece of protein could inflict so much damage upon our way of life, our health, our economy; so small 1 million viruses would fit into a full stop.” Prophetic!

I am not going to pretend that the effect on us, dental technology, is no greater than the effects on everyone else, but if we can understand why it is affecting us in this way and why it is taking so long for our industry to return to a level of work that makes us less vulnerable and more sustainable, we can begin to make plans to try and survive, as intact as possible with the least amount of financial and employment harm.

Many of you wrote to me explaining your strategies for survival, the effect on your business and employees, and mixed views on our future; I shall attempt to include these.

Let us start from our perineal problem. We are invisible. Often it suits us to be so, in this case, it does not. While government was planning to protect vital business within healthcare, because they did not have sight of us we were not included in any planning. While they were planning with NHS dentists to ensure they were protected whilst Covid made normal work behaviour impossible, the health department and treasury ignored us and the effects on us in any of these schemes. I know we will think this was possibly intentional, it is more likely we were simply overlooked and even if a plan was considered it would be too difficult to implement. If there is any disappointment, it is dentists who did not think to mention that a part of their team was missing.

So, we are left to the mercy of NHS plans for safe dentistry in each of the UK countries and private work, braved by dentists, trying to offer a safe private service to patients, which is economically viable for all concerned.

Most dentists are not NHS staff, but independent contractors. NHS will continue to pay dentists even where it is not possible to provide normal service.

“The first thing I always forget is how many laboratories employ family members. Their plight affects whole families.”

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. In Wales, the government will pay 80% of the NHS contract value. There are similar arrangements in Northern Ireland and Scotland with difference in continuing care and capitation payments. In return, dentists are expected to be available to help the NHS. The government only expect a 20% service from dentists to receive their contract payments.

Of course, dentists working in private dentistry have no such ‘cushion’, so will be keen to open their surgeries in order to earn an income. Here the main issue will be protecting patients, their staff and themselves. Strict PPE and Covid guidelines have been issued to dentists, they are again slightly different in each country and they change constantly and are quite restrictive. I will not go into detail here as it will probably be out of date by the time you read this. Suffice to say it means that running a surgery in any type of financially profitable way and meeting all the criteria is particularly challenging. The cost per patient is going to be much higher and patients are going to have to foot the bill. Eventually so will the NHS!

I was discussing with a dentist the effect on the laboratories, she was not even aware of how serious it is for us but was quick to understand the problem. She said the vast majority of what she does now is emergency work, pain relief, extractions. The odd denture and crown preparation she has done took so long to get her PPE on, then off! the time to prepare then clean down the surgery there was no money to be made from doing any of this type of work. She can work for just two days a week and with no check-ups, some emergencies and phone consultation and still receive her contract value.

So with no incentive for dentists to do NHS dentistry involving laboratory work and the cost of private dentistry increased significantly by increased PPE costs and the patient turnaround time, especially with work involving aspiration, it is understandable why we are suffering reduced work flow with little sign of this changing until safer working practices are developed.

During the period of furlough, larger labs have been able to cut back on staff costs and not had to make large scale redundancies. The new Job Support Scheme starts from 1 November. It will only be available for employees who work at least one third of the time. The payments are not as generous, and employers will have to find 56% of salaries with government now only providing 22% and the employee will only receive 78% of normal salary.

It is hard to imagine dental laboratories being able to afford to keep staff employed in these circumstances, with no end in sight as to when normal volumes of work will return. This is a particular shame as the Dept of Health have protected NHS dentists but have not offered any help to dental laboratories who do their work. This despite much lobbying by the DLA which has managed to shout our dilemma to many politicians.

Of course, one day, when we have control of the virus, there will be a mountain of dental work to do. How many technicians who have lost their job will want to return having found they can earn a living doing much simpler work for the same money?

So for many dental laboratories and dental technicians it is about surviving as long as possible until a new viable normal returns.

I have already explained the dilemmas for large laboratories. For smaller laboratories I asked many how they were coping and how they saw their future. The first thing I always forget is how many laboratories employ family members. Their plight affects whole families.

‘I have probably 40% or less of my normal work. C&B only lab, fortunately small only myself and my daughter who is furloughed. I do not want to make her redundant and will take less money to keep her if necessary. The bounce back loan is keeping me afloat. I’ve had no grants and furlough is the only thing I could claim. I am worried for my future and the future of the few surgeries I work with.’

‘I have a mixed NHS and Private prosthetics only lab employing 12 staff including myself, my wife and my eldest daughter.’

‘Only still going because lab based at home and no employees apart from my wife and myself, my wife on furlough while available, but as directors only minimum wage!’

Small C&B lab here, with normally a 70% private/30% NHS split. 52% of clients have sent no work since March. Last month's turnover was about 35% of normal. The majority of cases coming in are private.

Of course there is no incentive for NHS dentists to do more than 20% of their normal work and even less to do any including lab work. Little wonder that most of the work we are receiving is coming from private dentists.

My turnover is down 85%. In the two full months coming back since lock down I've literally just covered rent and bills. Work has picked up a little this month but that could be due to picking up extra clients due to other labs closing their doors this is not the way I envisaged my business going if things don't change or pick up massively I've got 4 to 6 months before I'll have some big decisions to make. Touch wood it doesn't come to that.

Many expressed their thanks for the support from associations. Big thumbs up for the DLA for constant updates and support

Over the next six months I believe dentists who had a high percentage of private work will continue to see slow growth. Denture work is a much easier procedure than crown and bridge work with Covid so I think that will recover much quicker.

Unless the government change their support of NHS dentistry I see very little lab work being generated from this sector.

For those who survive the future is very bright. There will be a shortage of labs and technicians as those who have lost their jobs will find work in other sectors and not want to rush back. Only by increasing lab prices, significantly, will we be able to pay salaries that will attract people back. Education will have taken a significant blow and the reduction of people coming into the profession will drop significantly.

Thank you to everyone who contacted me. I hope this is a fair reflection of what you told me.