COVID-19 and corporates: A sector in recovery?

By David Westgarth, editor, BDJ In Practice

Key points

  • Associates relying on their ‘safety net’ to recover
  • Plotting a route out of the pandemic underway
  • Mixed fortunes ahead
  • Future remains uncertain

Introduction

As the embers of COVID-19 burn away, some of dentistry’s focus has switched from tales of what it was like working in an urgent treatment centre and being re-deployed to the frontline to the here and now. What can we do to fix the situation? What does my immediate future look like? And the million-dollar question, when will things return to normal?

In truth, few answers are readily available. The situation remains precarious, especially so for associates. The first-hand accounts in this associate-themed issue shine a light on how difficult it has been for many, yet most point to their corporate employer as a watermark of help, support and continuity throughout.

According to LaingBuisson1, as of August 2018, the UK corporate dentistry market was represented by an estimated 2,495 dental practices, equivalent an estimated 21.3% of all high street dental practices in the UK. There are estimated to be in the region of 205 corporate dental groups currently in business, defined as incorporated companies or sole trader/partnerships operating three or more dental practices. Spending on high street dentistry supplied by corporate groups in the UK was estimated at £1.81 billion for 2017/2018, some 25.5% of total UK high street dentistry spending.

In short, that’s an awful lot of dental practitioners and patients relying on the corporate market to make as full a recovery as possible. With practice owners anxious about the financial buoyancy of their businesses and associates potentially facing a situation where they had no income and felt that they had no control or influence over their destiny during the closed period, it is not difficult to see why so many are seeking a return to practice.

Impact on corporates

Just how hard was the corporate sector hit by the pandemic? Dr Eddie Coyle, Clinical Director, Colosseum Dental UK, suggested speed was of the essence to survival.

‘Our teams quickly adapted to safeguard the quality of patient care we could provide within the strict guidelines’, he said. ‘We were heartened by the acts of kindness many of our teams displayed, in their local communities, supporting vulnerable patients and offering support to the wider NHS effort. We can all be very proud of how we reacted.’

Julie Ross, Chief Operating Officer of Portman Dental Care, said it wasn’t just the corporate sector that felt the impact of COVID-19.

‘The whole of the dental profession has been affected’, she said. ‘Portman has had a strong central team working to guide the practice through and provide the information that was needed at the start of the pandemic, and the structure and training that was needed to reopen and deliver care.’

Sarah Ramage, Clinical Director at Bupa Dental Care, pointed to the global problems faced throughout healthcare providers.

‘As with the rest of the dental industry this has been a time of significant change for our customers, people and operations’, she explained. ‘There have of course been financial implications, practices have not been able to see as many patients as before and there is also the added challenge of the global demand and increased costs for PPE.

‘We have had to adapt quickly first to providing only remote and emergency dental care, and then returning to face to face care, with just a few days’ notice. The health, safety and wellbeing of our patients and staff remains a top priority and we have made huge efforts to ensure everybody feels safe and comfortable in their working environment while adhering to government and CDO guidelines.’

Nyree Whitley, Group Clinical Director at {my}dentist, added support for NHS providers has been invaluable. ‘Our revenue is mostly through NHS contracts, so we’ve been able to access government support where appropriate’ she told BDJ In Practice. ‘There’s no doubt that it’s been a really difficult time for everyone involved, and that includes patients. Our focus is now on resuming services as quickly and as safely as possible.

‘We’ve had access to significant private funds throughout the pandemic too, and that’s helped to ensure we do slightly better than tread water. That’s given us the opportunity to support our practitioners who have a large focus on private dentistry. That’s an area of the business that grew 25% last year, and with similar numbers not being possible this year, we’ve looked at ways to support those practitioners.’

Associate support

It is that support of associates Nyree mentions that perhaps intrigues me the most. When you start to unravel the layers of support associates need – including financial – you begin to realise why some clinicians view corporate dentistry as a safety net.

‘We’ve placed safety firmly at the heart of everything we have done throughout these last six months’, Nyree explained. ‘There has been so much information coming from the government relating to guidelines, some of which needed to be broken down and made sense of! Our employees are understandably keen to know where they stand, so communication has been vital. Regular broadcasts to all staff, Q&As and a multitude of information on our intranet has been available, and we’ve had regional Clinical Support Managers hosting local webinars, which have proved to be hugely popular.

‘The last thing we wanted to do was to leave associates feeling like they were cut off. They will be the bricks in the re-building process the profession will undergo. Health for many took on a dual meaning – financial and actual. There isn’t a rulebook on how best to respond and best practice because things have simply moved too quickly. We have urged our teams to be careful with the misinformation relating to COVID-19 and in dentistry that is circulating – it’s important we’re clear and firm with patients that every step we have taken has been backed up by evidence.

‘We’ve also been able to pay them. Even before the abatement figure was agreed upon, our associates have been supported financially. I’m very proud we’ve been able to do that, and while it is clear many practices are struggling, I find it difficult to see circumstances where a practice owner would not follow suit.’

According to Sarah, communication is also something fundamental to Bupa’s support for their associates.

‘Communication has been so important throughout the crisis, so our senior leadership team have been very focused on finding ways to communicate throughout this period’, she added. ‘A key tool has been the establishment of a specific website that could be accessible from anywhere that had all the pertinent information available at any time. For a few months, we had weekly calls alternating between calls for all our people and calls specifically for our clinical team. The frequency has slowed a bit as the pace of change has reduced, but we wanted to make sure at all times that our teams had a direct line of conversation with updates on the strategic developments which impact them and their operations more specifically. We record these and stream them online to allow those unable to join to watch back at their own leisure.

‘We also share a written follow up pack – we appreciate that days in surgery can vary hugely and no two days look the same. To enable two-way feedback, we have also put in place a specific mailbox and addressed issues directly with the person or used this valuable feedback to ensure we were providing the right information in the rest of our communications.

‘The welfare of our associates and practice teams has remained at the forefront throughout the crisis. We wanted to support them through this challenging time, so we also set up a specific advance fund for our private clinicians as most were unable to access government schemes.

‘We also set up an Emergency Support fund to support all our colleagues experiencing severe and urgent financial hardship as a result of COVID-19 and allowed people to cancel holidays and rebook them later in the year after the national lockdown was over. We also shared health and wellbeing resources, and financial management resources to help them with the challenging situation.’

Sarah’s observation about health and wellbeing struck a chord with Eddie.

‘Looking after our teams’ health and wellbeing has always been our top priority – in the good times as well as the difficult times’, he said. We have been – and continue to be – determined to support our associates throughout the pandemic. Of course, we’ve kept our teams fully informed with news and updates throughout, and as a leadership team, we’re always available 24/7 if our associates want to pick up the phone to us.

‘We acted quickly and swiftly to put together a Clinician Aid Package – an interest-free loan our clinicians could request to see them through these difficult months and beyond.  

‘The leadership team were delighted to be back on the road in July, visiting our clinic teams and associates to thank them for their hard work in recent months, and to listen to them to find out what further support we can offer them. We’ve sought this feedback more ‘formally’ too in the form of a survey – as I mentioned, our top priority is to look after our teams and their wellbeing, and we take this responsibility very seriously.’

Catherine Tannahill, Director of Clinical Dentistry at Portman Dental Care, suggested their employees also had multi-faceted support throughout the early stages of the pandemic.

‘Associates working within Portman have been thoroughly supported’, she stated. ‘We have communicated effectively throughout the pandemic and provided careful guidance and training for the return to work. Associates working within Portman should have felt that they were encouraged to resume services safely and effectively, with the PPE and support teams in place.

‘Generally, many associates will have had to continue to pay their GDC subscription, their indemnity fees and have little or no help from any Government funding. We have provided a Hardship fund for those who found that they were in need.

‘Allied to the financial support, we know it is important for our associates to continue to develop their clinician knowledge and high level of expertise. We’ve delivered online webinars from our specialists working within the group, effective training for our SOPs, and constant communication and listened to concerns and worries associates have informed us about. Our top priority has been ensuring the safety of our patients, clinicians and colleagues and we’ve been very clear about the fact everything we’re doing is focused on this.’

Motivation

No income, high levels of stress and no immediate daily routine has the potential to stress anyone. With NHS practitioners effectively sidelined throughout lockdown, some practitioners I have spoken to felt their motivation slipping. ‘Digital overload’ was applicable to life without COVID-19, and with it came an avalanche of webinars, Zoom meetings and endlessly talking to screens.

So how do you keep a workforce motivated throughout a pandemic? While Julie suggested strong communication, listening to feedback and looking at ways to ensure Portman’s clinicians can maintain their income, others took a slightly different approach.

‘We have recognised and praised our clinical teams for the incredible efforts, and proactive work they have done to continue operating’ Sarah said. ‘Our practices have come quite far in the process of the return routine care where appropriate and in line with policy and direction from CDO’s.

‘As well as doing everything we can to support them through this challenging period – both in terms of keeping them safe, comfortable and keeping practices busy with patients, open, transparent, honest communication has been critical. Throughout the pandemic we have run COVID-19-specific virtual teams to share information and news and to make sure they had a forum to give us feedback, and thoughts and ideas on how we can improve the handling of the pandemic, and the next phase.

‘As we move towards more business as usual work, we are planning to improve our ongoing clinical processes and continue running webinars to ensure our clinicians have an opportunity to keep up to speed with latest clinical developments.’

For Colosseum Dental, the focus has been away from digital.

‘Seeing our teams face to face always helps to show we’re listening, and we care’, Eddie explained. ‘We’ve continued our other activities such as recruitment and M&A – after all we’re still a growing business! We have the support of our investors and we’re in this for the long-term. That hopefully provides the reassurance for our associates that we intend to be a stronger proposition than prior to COVID-19.’

Nyree also believes the personal touch works best.

‘Personally, I have tried to get out and about as much as possible. There are so many frustrated voices relating to current guidelines and restrictions, and it’s important they are recognised. We’ve added additional training courses for staff at no extra cost. The local webinars have given teams the opportunity to say to regional staff ‘this is what we’re doing and this is what our proposals are based on’. If you operate on the basis that no question is too silly, you’ll get plenty of buy-in. One of the unintended consequences of the situation we’re in is how much engagement there has been right across the business. It’s definitely brought us together.’

‘The new norm’

This is one of those phrases that I think we’re going to hear a lot more of as time goes by. In a previous discussion on challenges the community dental services face in their COVID-19 recovery, Jenny Harris suggested a return to normal wouldn’t necessarily be of benefit to the profession.2 Indeed, in the last issue of BDJ In Practice, Keerut Oberai highlighted that now is the time for regulatory change.3

So what does Portman’s ‘new norm’ look like?

‘The doors are open, and the reception areas are too’ Catherine said. ‘There will be more remote triaging and virtual consultations – that is here to stay, as patient love it – and more efficient and effective treatment planning so that patients can reduce their risk by minimising the number of visits required. Discussing treatment plans and gaining consent for treatment can be done remotely and we find that patients are more relaxed and receptive in the comfort of their own home.

‘We have ensured that we have the right cleaning protocols in place and comfortable and an ongoing supply of PPE, rolling out mask fit testing by training our own regional fit testers across the group.

‘Our fallow time reduction protocol was recently rolled out across the group, with training and opportunity for checking following the recent ventilation documents which supported our early decision to invest in Air Purifiers for every treatment room.’

According to Sarah, the new buzz phrase ‘social distancing’ will play a major role in their new norm.

‘We have strict social distancing measures in place, enhanced protection for patients and colleagues through the adoption of enhanced levels of personal protective equipment and more stringent protective and disinfection procedures within the practices, including temperature checks for everyone’, she explained.

‘We will also continue to utilise teledentistry to triage and manage patients where appropriate and work to expand capabilities of this service to deliver appropriate care to patients. We feel this works well in the here and now and is sustainable throughout a time of uncertainty.’

While there are some material differences to how {my}dentist practices will look for obvious reasons, Nyree believes their reputation as the largest corporate stands them in good stead. ‘We’re fortunate to have solid foundations to build on’, she said. ‘Our clinical leadership team will take on greater significance in the COVID-19 world we live in. The long-term career development, the network, the mentoring, the ability to branch out into specialty training – they will remain available for all of our associates, and we’ll continue to support them in their clinical and career development.’

As a business, Eddie explained that they will continue to adapt and try to stay ahead of the curve to safeguard top quality patient care and to look after their teams, adding: ‘Associates may need to offer more flexibility in their work patterns, such as working longer days and over weekends to meet patient demand. There will continue to be changes in how we operate based on research and new information, product development and innovations.’

Crystal ball gazing

The problem I foresee with many of these adaptations is their sustainability. No-one really knows how long COVID-19 will affect dentistry, and no-one can assertively answer when – or if – things will begin to resemble normality. According to Nyree, that could pose a significant problem for patients.

‘The simple answer is no-one knows when or if things will ever be the same again. There are going to be some areas of dentistry that aren’t going to see normal – some by design, some by desire and others because of the pandemic. Areas like teledentistry – as Sarah and Catherine have both alluded to – will take on greater significance to provide both patients and practitioners with viable, safe options for consultations. It will be our job to support that development. If there’s a further de-escalation of safety measures and some of the enhanced PPE measures in place falls, away then practices will start to look and feel the same on the surface.

‘My biggest concern is access. Prior to the pandemic, access problems were well-documented. I have little doubt that the last six months will have been a huge setback to any progress made in areas where access was a problem. UDC’s were slow to start up when dental services were halted. Patients have had to rely on emergency appointments only, and the demand for those has been sky high. On top of that, ongoing courses of treatment have remained open, so disease that was prevalent prior to lockdown has had six months and counting to develop.

‘The you have to consider who is going to treat this backlog. We have seen a number of people leaving for a number of reasons. Some were shielding, some have taken early retirement, some have re-located to less urban areas and some practices have simply closed due to financial reasons. Factor in the potential number of missed oral cancer cases and you have something approaching a crisis that the entire profession will have to face up to in the months and years to come.’

I asked Julie the same question.

‘It’s difficult to say if things will ever go back to how they were pre-COVID-19, even if the awaited vaccine is effective’, she told me.

‘Some changes are positive, such as the remote triaging and consultations and others just need getting used to, such as the enhanced PPE. We are working with the attitude that this is how the profession may need to continue into the future and therefore using this as an opportunity to further improve and enhance our services across the group to provide the best experience and area for our patients. If things change it is our duty to be across those.’

When asked when normal may return, Sarah agreed that some of the changes resulting from COVID-19 may be here to stay.

‘It is likely to be some time before practices can return to offering full routine care in the way that they were before, and it may be that certain elements will remain changed for the long term.

‘Protection for patients and clinical teams will remain a priority and guidelines will continue to be adjusted depending on the how our knowledge of the virus develops, but we will of course continue to take these changes in our stride, and offer treatment to our patients as best as we can with a high standard quality of care.’

A double-whammy rocky road

With COVID-19 and a deep recession, it’s perhaps understandable why many practitioners have fears for their jobs. If even one corporate were to fold as a result of the economic climate, the impact would be catastrophic. Is the pandemic and recession a cause for concern for the longevity of corporate dentistry?

‘At Colosseum we plan for the long-term’ Eddie said. ‘This includes making ourselves the best we can be to ensure top quality patient care and creating a great place to work for our practice teams. There will always be a demand for dentistry.’

Whilst Julie believes there is no doubt that a recession is coming and the resulting concerns that this may have for their patients’ ability to finance their dental care, at this juncture, there is a choice.

‘We can choose to join a recession or to continue to deliver a great standard of care and customer service that should ensure our patients continue to put their trust in Portman and invest in their dental health.’

With the virus still in its relevant infancy, Sarah sounded a more cautious tone.

‘We are still learning so much about the virus and its impact, so there is much uncertainty about how it will affect both how our industry operates as well as how it will affect the rest of the world’, she explained. ‘We are working to prepare for every eventuality to ensure we can continue to care for patients. What is clear is that our clinical teams have shown incredible levels of adaptability and resilience and we will continue to support them with changes we may have to adopt as the situation evolves.’

According to Nyree, {my}dentist’s outlook is grounded in their solid foundations.

‘We have {my}options that provides patients with private access at an affordable cost, and we expect this will only grow. NHS contracts provide our associates a comfort blanket and the opportunity to grow their careers. Patients will look for value for money through the recession, and we’re confident we can provide that.

‘With the focus still very much on prioritising patients we see, there’s an inherent sustainability built into the NHS that means with current support, it is easier. I have some concerns about the private sector. While they require the same amount of PPE as their NHS counterparts, the expenditure is greater. It can’t go on forever, and these concerns need to be heard.’

A viable employer?

It isn’t inappropriate to suggest new graduates coming through the system and doing away with their training wheels may look upon corporates in particular as a risky option. And while Eddie couldn’t offer reassurances to new graduates, he did reiterate his belief there will always be a need for dentistry, and it remains a great career option.

While Catherine agreed that dental care is not something that will ever not be needed, she believes patient tendencies and demands will secure the future of the workforce.

‘The expectations of patients are much higher and post-COVID-19 we anticipate that patients are more aware of the importance of their health and their dental health. We have also noticed an increased demand for more aesthetic treatments as time spent on camera when working or talking to loved ones via Zoom and Teams has made people more aware of their own appearance. Dentistry is a great lifelong career, with opportunity for career development and experience within Portman. We have talented and supportive clinicians within the group who are able to provide career guidance support and advice.’

In Nyree’s eyes, dentistry remains a fulfilling and positive career choice, adding that those in it have perhaps had the time to reflect on why they decided to join the profession in the first place. ‘There could well be a move of dentists to corporates, with more associates seeking the safety nets we provide’ she suggested. ‘You have to get the balance right between stability, job security and progression. Yes, the future is going to present a challenge, but approached in the right way I believe associates can be part of the recovery the profession seeks.’

‘Despite the recent pandemic, we remain positive about the future of dentistry and continue hiring across all our geographies so we can care for our patients’, Sarah said.

‘We would encourage new graduates to continue to look for windows of opportunity to join a large, stable and supportive dentistry provider. Due to the size and scope of our business, we’ve multiple ways in which clinicians can join us to further their career, with a wide variety of self-employed Associate positions available, as well as our newly launched Employed Dentist roles.

‘We’ve designed this employment option to give dentists a greater choice and stability in a difficult market. Some of the advantages of taking an employed position with us include salary, paid holidays, GDC registration covered by us, free indemnity insurance, no charges for lbs and full suite of market-leading employee benefits.

‘As a large dental provider Bupa is in a strong position to adapt to changes in the dental industry and invest in what the future of dentistry will look like, providing varied career pathways for dentists to satisfy their ambitions as they continue to develop their skills and interest over time.’

Whichever way you want to slice it, corporates and their associates have a huge role to play in the successful re-building of dentistry. Not, as these opinions reflect, in the way we once knew it, but in a stronger, more efficient way.

References

  1. LaingBuisson. Dentistry UK Market Report: Fifth Edition.
  2. Westgarth D. COVID-19 and Community Dental Services: The challenges ahead. BDJ In Pract 2020; 33: 14–19.
  3. Oberai K. Regulation in dentistry: An opportunity for change. BDJ In Pract 2020; 33: 18–20.

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