Furlough and the future and important read for employees of dental practices

Furlough: what a word! 3 months ago it wasn’t even on our radar, now it’s become one of the most talked about words of 2020. 

Advising on furlough is very difficult for many reasons. At the time of writing this blog furlough has been extended to the end of July in its current form. Then from August to October there is a transition, where businesses will be expected to contribute in someway, whilst being able to bring staff back into the business, part time in a phased way. 

So if you are reading this and furlough has changed again, don’t worry, as this blog is about the teams response to furlough and how to support them back into the business in a positive way. If you are a team member then this blog is definitely for you. My perspective covers all sides of what has been happening and planning for re-opening. However for some readers, my views may be a much needed reality check. 

Firstly we all need to take a moment to digest that Covid-19 has changed life as we knew it. I can’t speak for everyone, and I have no intention of doing so, but please indulge me as I describe my feelings. My first reaction to Boris’ announcement that we must go into a lockdown was one of shock. I cried and could not fathom what was happening. The first two weeks were a total blur, speaking to clients from 7am in the morning until late into the evening, cancelling my carefully prepared diary for the whole of 2020, it crumbled in front of my eyes. 

In dentistry my focus was on supporting clients with furlough, who needs to be on furlough? When? How long for? Oh, the decisions! 

Everyone rallied together within the leadership teams to quickly and safely get the practice of dentistry paused, whilst remaining open to deliver effective emergency triage using the AAA approach. As we all know clinically merely a sticking plaster, and depending on where you are based in the UK you will have different SOPs for patients who really do need to be seen.

The last few weeks have been mixed. You have many team members who are fully settled into furlough life, enjoying the glorious weather, home schooling and family life. You may have furloughed some team members later as they assisted with preparing the practice for emergency triage and rescheduling. If you are in a mixed practice some team members will have been furloughed whilst some are retained as part of NHS contracts and maybe working from home, working in the business or even redeployed.

The self employed team members find themselves in a precarious situation with the practice owners and governmental support. They are left wondering how and when they may be able to return to work. Although some are enjoying some unexpected time off, but with that nagging feeling in the back of their mind it is not relaxing and as the weeks have gone on that restless feeling is becoming stronger.

Then we have the practice manager who you may have furloughed. They may be now back in the business working flat out to support the owners with the phased return to work. This moment has not be prepared for, so with blank sheets of paper, plans are being formulated with different scenarios for different outcomes. The managers know that this is the most significant change to happen within dentistry since the introduction of the CQC. 

Last, but no means least, I want to enlighten you all about the owners and what they have been getting up to, as I can tell you first hand they have been working night and day to understand how they can reopen the practice safely for their team and patients. 

I must stress to you that the dental owners are not putting themselves first. They know as an employer they have a responsibility to all the patients and for every team member, employed or self employed. The pressure on them to get this right is immense and they may be shielding you, but don’t underestimate the task ahead as it is very real.

I want to share 4 key areas that the owners are working on so that you can understand what “new normal” involves. 

HR 

A mine-field at the best of times, but in particular learning the rules of 

The word furlough has been a steep learning curve and continues to be, as the longer it goes on, organising a way through that is right for every team member is going to be a challenge. 

I want to reassure you that owners are planning for the long term future. Short term agreeable changes with every team member will be needed to get through 2020. In addition to furlough there will need to be significant job description changes, agreed contract changes to support new hours, and shift patterns to adapt to. They will want to safeguard everyone whilst they are working and also protect everyones job for the long term. 

Financial planning

In the short term managing cash flow has been the greatest pressure for every practice. Continuing to make payments without normal income streams has meant contingency planning this bridging this gap in income.

The long term future is yet to be fully understood as there are so many variables that are yet to be fixed. Variables are not good in any business. They are a huge stress factor that affects cashflow. You can liken this to your home finances, – imagine not knowing what your bills would be each month! Or what you were going to be paid. You would panic. 

Fixed costs are easier to manage and in dentistry we are facing a bunch of variables which are unprecedented. 

Practice owners and managers are trying to forecast for the future, in order to support all the running costs associated with running the practice. And that includes all the relevant PPE that will be needed to provide any treatment and every team member’s salary.  I make no bones here that staffing costs are significant and these can only be paid through the practice income. The reduction of patients moving forward is the area of most concern, so do not underestimate the task ahead. Every practice will have to make significant changes to the look and feel of each day in clinic in order to survive especially in the short term. 

As team members I implore you to be as flexible as you can. In the media you will have heard the mantra ‘we are all in it together’. We definitely are and that is something that every team member will have to realise. It is not acceptable to think that this is the the problem of the owner. You can not expect them to ‘sort it’. This is a crisis and will require all our efforts to ensure your practice bounces back, and it will continue to need to make turns in different directions. You need to be on board and ready to help the ship alter its course, often and at short notice.

Standard operating procedures 

This area I can tell you is a minefield. What do we use? What do we need? What is the right PPE to keep everyone safe? What treatments can we provide? What is happening with aerosol generated procedures? The list goes on and on. 

It seems there will be a phase of transitioning to be able to deliver all the dentistry we used to do. So when you ask the owners ‘what are we doing?’ The answer often is ‘it is a work in progress as we have not been given clear guidance thus far.’ 

What practices are doing is interpreting the emergency dental centres guidance (UDCs) and using that to create practice standard operating procedures. As a team you need to be flexible, and be up for training. You can take part even in this on furlough. I would encourage you to participate, you need to know how to work within the new guidance and how to work with additional PPE. 

One thing for sure is you will be coming back to changes, but let me reassure you that in my 20 years in dentistry we are a safe and transparent profession. I know we will all strive to get everything right and adopt all the new measures that it will take to give patients and our teams the confidence to deliver and receive treatment. 

Phased working 

In a nutshell phased working is finding new ways of maximising surgery productivity, whilst our treatment portfolio is slowly brought back. This is a huge area and we are starting from scratch. Everything you knew about diaries is going to have to change and for me some of these changes will be forever. Whist the diary changes will be significant this is an amazing opportunity to start the diaries again and build diaries that are zoned and controlled to make sure that work flows better. 

Virtual communication is going to explode into dentistry. Think how many Zoom calls you have been a part of over the last few weeks and then apply that to the patient experience. There is going to a major shift in how we communicate with patients and this it is going to change everything you know at least for the short term, and then be reviewed for the medium and long term. 

Digital clinical dentistry has been developing at such a fast rate and now digital communication is going to match that progression, so be prepared to re learn many aspects of your job. Everyone is going to have to take part in aspects of virtual communication, which will demand practiced verbal skills. 

Fundamentally these changes are necessary to maximise clinical surgery time and provide virtual communication for the rest of the patient clinical care. This clinical care will be from virtual triage through to treatment planning and post operative care. 

Rotas and shifts will be explored to increase productivity and maximise opportunities, which will provide the safeguarding measures in the workplace that are required whilst delivering dentistry at an operational level that covers all the associated practice costs. 

Phased working is going to be the hardest part to deliver. There  are so many areas to be factored in, including availability and mapping skill sets with what is required in the short term, medium and long term. As a team member you must be honest and transparent as the overall vision is simple for me:

This vision can only happen if you as a team member get on board and understand the bigger picture. Owners have been cautious in most cases about sharing too many plans, and then amended versions of the plans. If you have not been told much the reason for that is they have not wanted to overwhelm and worry you which is quite kind of them really. 

Plans do keep changing every day with the uncertainty of when do we open? What can we do? Can we get the PPE we need? When do we train? What hours will we work? Will the patients attend? Can I afford to open? 

I want to reiterate to you as team members that the owners and practice managers need to be able to explore all options and take into account all your individual circumstances to be able to manage a balanced and phased return to work. Whilst it is easy to moan and groan please be positive and supportive. This will help massively in preserving everyones jobs which is a top priority. I am aware that there will be individual circumstances that will need to be considered and given due diligence. These considerations will be given and thought through, so therefore you should help provide solutions, not more problems. We can all do this together, if there is a willingness from everyone to play their part. 

I want to discuss what phasing back to work means. I appreciate this will not be straight forward. There will be a few hurdles to overcome not to mention days where you feel emotional: we all have those days and that is totally fine. 

My top tip is communicate with each other and by that I mean really be into communication, be present within the moment and actively listen, do not go through the motions pretending ‘this does not affect me’. Every decision made has a ripple effect and we need to minimise the ripples as far as we can. The teams that pull together through 2020 will survive and thrive. 

To end this blog I am now going to summarise 7 steps that the managers and leaders may use with you to support a return to work.

  1. Weekly staff meetings – where you attend for updates – How has the last week in practice gone? What to expect? What changes are needed to improve?  You should attend in whatever capacity you can even if you are on furlough.
  1. A return to work interview – This is a really important step in coming back from furlough. Be engaged in this. This is the time to talk about your Covid-19 story and how this has made you feel and what support you may need throughout the coming days and months. 
  1. Re induction – You may not have not been working for many weeks, even months, so the practice needs to go through a re-induction with you. This will cover a checklist of procedures and updates to make sure you understand what is expected or you and that you feel confident with any changes. 
  1. Job descriptions – A review of your job description and changes that are required. I have talked about virtual communication in this blog. I have written a three page job description for this role alone. 
  1. Training – You will be required to undertake training to understand what has changed and your role within these changes. Training may be provided on site, an online webinar or a zoom training session. These training sessions are key to keep you in touch with what is going on and if you are a team member that has furlough extended this is vital for you to keep in touch. This is exactly the same principle as team members who are on maternity leave and have keep in touch days with the practice. 
  1. Contract consultations -Most of you will have some form of consultation over working hours and what the practice needs to remain profitable to protect jobs. Hours may need to be varied and be in shifts to build the business back up in a controlled way and support increase in treatments as allowed. This should be a harmonious process with an understanding that these changes will hopefully be for the short and medium term, whilst we work through the phases of unlocking. Agreed changes can take effect immediately, so be up for negotiation as this will be necessary in order for practices to survive. 

None of us can change what has happened but we can decide how we are going to react moving forward. I want to say that you can do this together. Look after each other and keep communicating in a positive manner. That way we can all get back to work and enjoy the job that you have chosen to do –  and survive and thrive.

Michael 

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