Sunday, 17 March 2019

Tax and Finance: Top Tips for Dentists

Becoming a dentist isn't just about clinical skills... managing your finances is a hugely important skill. Luckily, a new resource is out there to help out...

This book, written by Kalpesh Prajapat and specialist dental accountants Lovewell Blake LLP, gives an overview of basic financial information and how it relates to you as a dental professional. For me, trying to manoeuvre my first tax return as a dental associate was disastrous: it took me hours and I did it all wrong. It would have been incredibly handy to have this resource back then!

It is highly recommended that you engage with a qualified financial expert when becoming self-employed and completing your tax return.

Here's just a few tasters from the book. 

What does it mean to be self-employed?

As a dental associate you are a contractor from the 'Provider' (if an NHS contract) or the practice owner or principal. You will hold an agreement with the provider/practice owner/principal to carry out a certain number of Units of Dental Activity (UDAs) as well as how the fess are shared in private treatments. You will be responsible to managing your own tax, national insurance, professional indemnity and annual retention fees. 

How can you become Tax Efficient?

Being self employed as an associate you must plan financially to pay your tax bill every year. It is recommended that you save this money aside every month but methods to help manage your money include:

  • Having separate personal, business and savings accounts
  • Making the most of tax-free savings e.g. ISAs
  • Investigating other assets e.g. bonds 

When should I seek advice from a Professional?

You may need assistance when planning and managing your finances. Professionals that can help you include:

  • Accountants
  • Financial Advisors
  • Lawyers
Accountants and lawyers may be members of National Association of Specialist Dental Accountants and Lawyers (NASDAL) which may be helpful for specific dental aspects of work. I think it's worth getting advice and assistance whenever you feel out of your depth... the risk of getting tax returns wrong is a hefty fine from HMRC so better to get it right!

For more information you can purchase the book here

Do you have any questions? Let me know in the comments below!

Sunday, 24 February 2019

Who are NHS England?

You may have heard of NHS England but what do they actually do? Before my fellowship with them this year I only had vague ideas about the role of the organisation. So what have I learnt that they do and how does it relate to dentistry?

A bit of History

Before 1948 and the introduction of the NHS, all dentistry was provided privately. For the first 2 years after the NHS was introduced, dentistry was provided free at point of service, but spiralling costs associated with high numbers of extractions and full dentures lead to the introduction of patient charges in 1951. 

Dentists were paid a fee per item of service which was considered to be complicated and confusing. This was in place until 1992 where a blended style of contract was introduced where there was a payment for capitation and also for quality and continued care. Most recently, the contract changed again in 2006 where our current UDA system came into play as I am sure you're aware where banded treatments simplified the payments patients made if they were fee paying and also for the first time allowed for there to be fixed NHS dentistry budget. Dental Contract Reform has been in place for the last few years where again the contract is going to be changed. 

The commissioning of dentistry has been overseen by NHS England throughout this time - initially known as the NHS Board. Commissioning decisions are now overseen by local teams rather than one central body who hold the budget and providers will be accountable to contractually. 

NHS Structure

NHS England (NHSE) is part of the Department of Health and Social Care (DOHSC) and its responsibilities are set out in the Health and Social Care Act 2012. These are:
  • Planning of NHS services
  • Budgeting of NHS services
  • Day to day delivery of NHS services
  • Responsible for commissioning of NHS services (I will explain this in a future post about the Commissioning Cycle)
  • Hold contracts with doctors and dentists
NHSE are under the Secretary of State of Health and their team at DOHSC (currently Matt Hancock) but are arms length bodies similar to Public Health England (PHE) and Health Education England (HEE). 

The Secretary of State annually publishes the NHS Mandate which sets out the goals NHSE have to work towards in the upcoming year. 

NHSE and Dental Commissioning

Budgets for paying for and commissioning health services are broken down into different teams within NHSE:
  • Clinical Commissioning Groups (CCGs) are given the budget (60% of overall budget) for hospital, urgent, mental health and community services. They co-commission GP services with NHSE
  • Specialised Commissioning e.g. cancer care, secure mental health
  • Dental
  • Optometry
  • Military and veteran health services
  • Health and justice
  • Public Health Commissioning (although the majority of this is commissioned by PHE i.e. local health authorities)
NHSE not only commission the service, they also contract manage and monitor services as well as holding the NHS dental performers list (which was contracted out to Capita in 2014). 

Engagement with the Profession

It is important that commissioners communicate and engage with the profession. For dentistry, there are formal routes that they do this regularly:
  • Local Dental Committees (LDC)- although hosted by the British Dental Association (BDA) are funded from the Levy collected from NHS GDPs through NHSE
  • Local Dental Networks (LDN)
  • Managed Clinical Networks (MCN)

I will blog about these separately. As well as these regular engagements, NHSE can engage with the profession during procurement processes or via professional bodies such as the BDA or other specialty-specific bodies.

I hope this clears up the role of NHSE and how it relates to NHS dentistry!

Do you have any questions? Let me know in the comments below!

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