It’s 2006, Los Angeles International Airport. A weary and dishevelled traveller arrives on the red-eye flight from Heathrow. He approaches passport control through a security check, looking forward to catching up with sleep. He’s in LA to attend the surprise 40^th birthday party being thrown for an old schoolfriend who has emigrated to the United States.

Suddenly, security klaxons blast out all around him and he finds himself thrown bodily to the floor. Stunned, he hears screams of “Don’t move,” “Keep your hands where they are” and “You’re in big trouble Mac!”

When he eventually dares glance up, the traveller is looking straight down the barrels of half-a-dozen police-issue handguns which are aimed directly at his face. Stunned, the traveller is handcuffed and bundled out of passport control to a windowless room, where airport security, police and FBI officers interrogate him.

Some time has passed and by now the traveller has fully woken up and bewilderment turns into dread as he takes fully on board the gravity of his predicament. After all, this is post Nine-eleven and the USA is still on high alert.

The question the security services want most answered is: “What are you doing with explosives in your jacket pocket?” Specifically, “Why would you be carrying explosive detonators on your person, into the United States of America?”

Ah! It suddenly dawns to our traveller that there’s been a silly misunderstanding and there’s a completely innocent and rational explanation as to why sophisticated monitoring equipment had picked up the fact that he had tried to clumsily smuggle explosive detonators into the USA, by concealing them in his Barbour jacket pocket.

After having rushed home after a full day at work, collecting his suitcase and driven straight for the airport, he had merely picked up the wrong jacket – the one that had detonators in it. Simple!

But it wasn’t actually an easy task for the traveller – having to try and persuade America’s finest of his explanation – namely that he’d innocently carried explosives on a transatlantic flight into the heart of one of the world’s busiest airport, completely accidentally.

It took hours for the traveller to get the security services to halfway accept the truth – namely that his hobby involved putting on sophisticated fireworks displays for a UK-based pyrotechnics company. He had an identical Barbour jacket which he used exclusively for shielding him against the cold while working on winter fireworks displays. He often carried detonators and other small pieces of equipment in the pocket of his Barbour jacket (now evidence), while setting up fireworks displays which he orchestrated via his laptop. In his haste to catch his flight, he’d picked up the wrong identical jacket before leaving the house.

Despite directing the secret services to the firework company’s website and them seeing the traveller’s face on screen, they wanted fuller verification of his story and attempted to contact his pyrotechnic boss so that he would back up the alibi of the traveller. Unfortunately, time was also against the traveller. By the time the interrogations had reduced from fever pitch to critical, it was night-time in the UK and the traveller had a further uncomfortable six hours before they were able to rouse his boss by telephone in order to satisfactorily confirm his story. I’m not sure of the fate of the jacket, the detonators or whether the 40^th birthday was a success, but I know the traveller was reasonably unscathed after release.

I know that for actual fact because the traveller, Andy George, managing director of dental laboratory Ceroplast Ltd, is sitting in front of me in his office in Worcester.

I’m glancing at a large photographic mural of a beach which dominates one of the walls of his office. “It’s still out of focus” he remarked. That was a barbed reminder that I’d insulted the photograph a few years ago, on one of my many previous visits to the lab. It’s a perfectly satisfactory photograph, for an amateur happy snap, but our relationship, albeit sporadic, thrives on exchanging insults.

 

It’s the first day of September and I haven’t seen Andy face to face for a couple of years or so. At first it looked like I was meeting up with the old irrepressibly enthusiastic Andy – a man whose  boundless energy has always been, seemingly without limit. We’ve been friends for over 30 years and I’ve rarely seen him visibly worried, but today there was a subtle, but definite hint, that he was under some considerable stress.

Like everyone else in general practice dentistry, dental laboratory owners like Andy are facing a particularly precarious and very uncertain future, bordering on the catastrophic. There are fears that the UK dental laboratory sector could be near annihilated in the next few months.  

In July, the Dental Laboratories Association (DLA) which represents laboratory owners issued a press release warning of “Financial ruin for dental laboratories.” While the Department of Health is providing 100% of a dental practice’s NHS contract value if it is providing 20% of its usual activity, “there is no stipulation for the type of work carried out, nor are there requirements for the contract payment to be used to pay the regular costs of a dental practice during this unique period.”

Steven Campbell, President of the DLA, said “Since 8^th June, Dental Technology has been ready to accept prescriptions for custom made dental appliances, but they simply haven’t materialized; as a result, we could be looking at a best case scenario of 40% of the profession being made redundant unless a rescue package is put together urgently.”

The press release continued: “The DLA are asking that if the Government can continue to pay 100% of an NHS contract value, then there should be specific instructions for those dental practices to pay their average bills to their dental laboratory and their dental supply company, either as part of a rescue package or as part of a deal for payment of work in advance. Without this or a specific rescue deal for dental technology in the coming days or weeks, we will be counting the cost of COVID-19 in terms of the nation’s dental health for a generation.”

So here I am, with Andy, on the day that he has to tell yet another member of his technical staff, that he has to make them redundant. “It’s all very sad,” he said. “It’s awful. It’s absolutely awful. And incredibly stressful.” 

A large proportion of Andy’s technicians have worked with him for many years and he now finds himself being reluctantly forced into reducing his workforce of 21 by a third, leaving him with just 14 members of staff including an administrator. I know personally, that this whole process will be tearing Andy apart. He greatly values his colleagues and often showed his appreciation for their dedication and loyalty by organising out of work social events.  I was lucky enough to be invited to a day out go-karting one time.  I came last, along with my wife.  Our skills were recognised with a safe-driving award.   

Today, he later has to hold a three-way Zoom meeting with a technician and a human resources company, DentalHR, which is helping to guide Andy through the complicated redundancy process.

Andy’s usual monthly salary bill for staff totals £40,000. Currently, with the inevitable reduction in income due to dentists not working normally, he is only taking £20,000 in lab fees, which will not be enough to keep the lab going long term, even after being forced to slash his workforce by a third. It barely covers the reduced staff monthly wage bill and overheads.  He is currently having to look into borrowing money from the Coronavirus Business Interruption Loan Scheme (CBILS).

UK dentistry has never faced such economic and logistical difficulties as it confronts now, and it’s the biggest crisis to affect Ceroplast since it was started in 1960 by Andy’s father Alan George and his business partner Denis Davis. Interestingly, Denis was the joint inventor of the Dacol Hydroflask used in denture construction, with Ray Colbeck.

The lab moved into newly converted premises in St Johns, Worcester in 2000 shortly after Andy, who trained in dental technology at Cardiff in the 1980’s, took over the company. The lab now occupies 6,000 square feet over three floors. The lab produces all manner of devices from orthodontic appliances to implant devices.  Apart from state of the art digital crown, bridge and denture laboratories, it also has a large, currently redundant lecture room in which local clinicians and technicians attended verifiable CPD courses, some of which I attended in the days when Zoom wasn’t a household name. On the ground floor, a smart CQC-approved dental surgery with reception and plush waiting room awaits a dentist to continue with  prosthetics work.

 

Today, the once buzzing laboratories are eerily quiet. The only people who are in the building are two senior prosthetics technicians, two crown and bridge technicians, and one technician working in the plaster room. Apart from Andy, his partner Claire is in. She has recently been helping Andy share the task of delivery driving. While I am with Andy, the lab has only received three phone calls from dentists requesting pickups of work.  Andy estimates that the lab’s current output has reduced by 70% compared with production pre-lockdown.

Despite his own concerns for his workers, Andy empathises with the plight of self-employed hygienists, therapists and dental associates. “Hygienists are in such trouble and I’ve heard of associates who have been made redundant because they are only earing a quarter of their normal income. Private practices which have more surgeries seem to be surviving, but associates at the smaller practices which can’t accommodate fallow times as easily, are falling by the wayside.”

Forty percent of the lab’s work comes from the NHS and the drop off in work from NHS practices is particularly worrying. The lab is still seeing mainly private work coming in from independent practices, but proportionately, he is seeing an increase in private denture work. The lab is still seeing some private crownwork coming into the building, but at a much reduced volume. He is really hoping for a gradual increase in all work over the next few weeks. He has not ruled out the possibility that he may be forced to make more decisions about further redundancies if the situation doesn’t improve quickly. He still has a trickle of work coming in from his contract with prisons, but this is only a very small proportion of total income.

 

Pre-COVID-19, UK dental laboratories were also facing stiff competition from overseas labs. This is a trend I personally never understood. I had a long-standing arrangement with the lab for them to ring me up and tell me off about a prep if it wasn’t up to scratch. And Andy would do that – with relish. If the technicians weren’t sure of the margins, they’d send the models back for me to mark up or alternatively scrap, and do the imps again. You can’t do that with overseas technicians and although I was never tempted to even try foreign labs, the practicalities and anticipated uncertainty about quality was enough of a deterrent for me. Apparently, the problem with competition from abroad hasn’t gone away and is another threat to the survival of UK dental laboratories. The ‘labs’ that collect work in order to send it abroad, are apparently still at it.

The worry for Andy for the redundant staff is that they are currently unlikely to find work in labs elsewhere. He has heard of other labs, including dental corporate-owned labs, also offloading staff. One member of Andy’s staff, who had been with the company for over 25 years even offered to work unpaid until things ‘pick up again.’ Andy has been particularly affected by the emotional reaction of the colleagues he has had to let go. “There have been a lot of tears.”

Like most dental people, Andy, until this year a council member of the Dental Technologists Association, is confused by the directions (or lack of directions) given to NHS practices regarding the resumption of normal practice. As far as he is aware, NHS dentists won’t be resuming normal operations until 2021. He is nonplussed by the directions from the CDO and NHS England. “The loss of NHS work is killing us, and we don’t know why there has been this instruction.”

GDPUK also spoke to Steve Taylor, owner of Taylor Dental Technology Centre based in Leyland, near Preston. He is a Clinical Dental Technician and non-executive member of the board of the Dental Laboratories Association. Mr Taylor said: “Hundreds of technicians have been made redundant already. A survey carried out by the DLA shows the potential redundancies at the end of October when the furlough scheme ends could be 1,500 plus up to 2,000.” To put this in perspective, in August, there were only just under five and a half thousand GDC registered technicians.

“If a lab was 100% private, in June they were working at 15-20% of capacity, July it was up to 45% in August they were at about 65% of normal capacity. Ten percent of NHS labs haven’t yet reopened. They are getting no work in at all. They are being asked to do repairs and some additions. I have heard of one NHS lab being asked to do only six units of work since the 5^th of June. The greater the percentage of NHS a lab does, the greater the dilemma. Potentially, when the furlough scheme ends, it’s potentially going to be catastrophic for a lot of technicians and a lot of labs.”

“The NHS dentists have been funded at !00% of their contract value throughout this crisis and within that contract value is a percentage that relates to laboratory work. Obviously they aren’t doing that Band 3 laboratory work and so none of that money is passing on to the labs. Until NHS dentists start doing Band 3 work, labs are in real peril. If that happens, where WILL NHS patients get their work made if we lose 2,000 technicians. That is a colossal hit to dental technology. It will take the sector decades to recover.”

Mr Taylor is Chair of the British Institute of Dental and Surgical Technologists and President of the British Association of Clinical Technicians. He said: “If National Health Dentists want the NHS laboratories to be there if five or six months’ time, they need to be thinking about how they can support them. I am aware of some dentists who have actually passed on some of the NHS revenue intended for lab work, on to labs in order to tide them over and keep their heads above water, which is a fabulous gesture. But in reality something that is going to need to happen on a much more formal scale.”

While NHS dentists are still earning 100% of their past contract values, the NHS is not interested in supporting the labs that have faithfully served those NHS practices. While the DLA has made calls for either a rescue package or for the NHS to instruct practices to pay their usual lab bills to the technicians they use, so far, they appear to have been ignored.

This is not a plug for my friend’s laboratory. This an unashamed plug for UK dental laboratories. Because if we don’t support them in some way or another NOW, there won’t be any UK dental technicians left to complain about your lab tills to.