Will UK dental labs survive the COVID pandemic?
We speak to Matt Everatt, technical director at S4S, about how S4S got through the COVID lockdown and what dental labs must do to survive in the future.
How did lockdown affect S4S?
COVID-19 affected everyone. There was absolutely zero work coming in and we were closed for three months in the end.
We started back on the first of June, a week in advance of dentistry starting back up again.
So obviously that’s a massive dent in our annual performance. Prior to lockdown we were experiencing a really successful few months.
February was incredible and the beginning of March was starting out as the best March we would ever have.
I think the whole of dentistry was dealt a bad deal at the start. Particularly with poor leadership at the helm. There was a distinct lack of presence from the chief dental officer.
The government forgot dentistry for the majority of the lockdown. The announcement that dentistry was starting back up again was first seen in the news.
The biggest issue for dental technicians is that dental labs are just invisible. The politicians and general public don’t know who we are.
We’ve written to MPs seeking help and they tend to think we’re dental practices. So the responses we get are usually quite generic and pretty poor.
We didn’t know how we would bounce back and where we would be post lockdown.
The great news is that we’ve done more business this September than we did last.
We acquired an orthodontic lab in north London and S4S London was launched January time. It was an incredible first three months, then COVID hit.
But again S4S London has bounced back and the figures are actually better than last year.
So the flip side of the industry being in a bad way is we bounce back incredibly well.
To give you an idea, since the first of June, S4S has picked up 704 new dental clients. Which is quite incredible really.
Is that a reflection of the situation with many dental labs closing down?
I don’t know. There probably is some of that.
When we reopened we were of the view that when we reopen we’re going to be safe for our staff and we’re going to make sure that nothing’s changed for the dental practices we work with.
We work with the same turnaround times and offer the same price points.
If we were going to open back up again, it was at the same level of service as in March. I think that has helped.
A lot of the practices opened up expecting delays.
We’re certainly seeing that’s the case with Smilelign, our clear aligner system. Other companies are putting surcharges on things and treatment plans are taking longer, for example. But we’ve managed to maintain that same level of service as we did before.
How tough did lockdown get for S4S?
It was a massive worry.
We were a very healthy business and well-organised business. But looking look at the figures and how long we could survive, the government schemes really saved everyone’s bacon.
Spirits were very high at the beginning. We all kept in touch, making sure everyone was well. We’re very up on mental health and mental health awareness in the lab.
But I think we all got a bit desperate to get back. Lockdown pushed everyone to the limit.
There were people looking to just get back to normal, then there were those really living in fear. Others were unwell and shielding and we couldn’t ask them to come back.
What precautions did you put in place for when the staff came back?
We’re very fortunate, we’ve got a very large lab. We’ve got a good environment for social distancing anyway.
We put in screens so everyone can maintain social distance in areas that are less spacious.
We opened the lab a week earlier than dentists opened their practices so we were able to do that really efficiently and adapted the working environment as and when we brought staff back from being furloughed.
Looking at the positives from lockdown, it allowed us to do a bit of a reboot. We started back up leaner and more efficient.
The aim was to come back and to save every job, and, if anything, to create more jobs. So far we’ve done that.
That’s excellent and different to the narrative from other dental labs. What can you suggest other labs do to, not just to survive this current situation, but to improve coming out the other side?
The biggest issue I read in dental lab groups is that a lot of labs providing predominantly NHS-priced work are barely receiving any cases. And the cases they are receiving are low value with low margins.
I’ve never quite understood why labs offer an ‘NHS price list’. They don’t get paid by the NHS, they’re paid by dentists who have the NHS contract.
The labs that provide these types of products were dealt a huge blow. NHS practices were given a lifeline. They were paid 100% of the contract to do 20% of the work.
There is no incentive for NHS practices to undertake any treatments that require lab work. So again, labs are completely forgotten.
It does now appear that advisers to the NHS and the chief dental officers are listening. They are looking at how to potentially support labs.
But going back to your question. One of the things that we do as a lab is we don’t have a different price list for NHS treatments. We have one price list – that’s what it is.
We have different things on that price list for sure.
I saw yesterday the NHS prices that labs were charging, £35/40 for a full denture. To make any money at those prices you have to produce large numbers. It’s a volume game.
If those labs lose three or four NHS practices or the practices don’t send in any work, labs are going to close and that’s what’s happening.
Those labs that are struggling really have to look at their business model going forward.
We’re all capable of turning out some fantastic work. You’re all capable of doing that and really consider going forward what that means to you in terms of your level of service and prices.
NHS dentistry is going to change. The labs that survive will see the work come back again. It’s just for how long these labs can survive.
Is there anything else you’d like to add?
Clinical dental technicians have to work under the prescription of a dentist and they have to have a patient declared as dentally fit.
A clinical dental technician told me that she has several patients now that have been told by their dental practice there are no appointments at the minute and therefore none of their patients requiring dentures or partial dentures can be declared dentally fit.
So this clinical dental technician is left with these patients in limbo. She wants to make some partial dentures for them, but can’t do it because they can’t get sign off by a dentist.
That patient is left to wait or to pay privately for sign off as dentally fit.
What would you suggest is the solution?
I think, in this instance, we need to change the legislation. So these clinical dental technicians can give the green light to treat these patients without the dentists seeing them.
Absolutely with a caveat that when practices do reopen again, the patient should return as a dental patient.
Are we more neglectful to that patient in removing any treatment to them, than we are if that clinical dental technician provides them with a partial denture for aesthetics and function, then return to a dentist at some point in the future?
I think it is more neglectful saying the patient can’t have anything because the dentist can’t sign them off as dentally fit.
An example I heard of: a patient who couldn’t see a Manchester practice removed their own tooth in the garage and then finally had lots of problems and had to pay privately to see a dentist.
Really, what harm could clinical dental technicians do by offering a service to help these patients in these unprecedented times?
On the whole, there is a real mix in the dental profession at present, more so than ever.
Private dentistry seems to be doing exceptionally well and our labs (S4S, S4S London and Smilelign) have bounced back exceptionally well. Our recruitment agency, S4S Team, is very quiet, understandably.
I do expect there will be a levelling out of the profession.
I expect lots of patients will migrate from NHS dental practices and become private patients. This has to be a good thing.
The NHS dentistry model is flawed and so many dentists are unhappy with the UDA system.
I do think that there are opportunities for us as dental labs to reset and improve our businesses.
Sadly, we have already lost some labs. I do hope the remainder survive these next few months and we see the profession thrive in 2021.
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