Radical change beckons, but right now concerns are more immediate
As the ‘Insider’ asks, how will we cope? There were already some answers to this question as we moved from March into April. Adaptability, care, resilience. They were words that could be applied to the response prompted in many parts of society by the outbreak of COVID-19; the response of individuals, businesses, and communities.
Certainly, in the short term, those different responses in support of a common cause brought some positive outcomes in the face of the terrible loss that others had already suffered and the overwhelming nature of the disease’s impact on our health service and those who work on its frontline.
How we will cope in the longer term remains to be seen. The effects on people’s health and on the health of the economy are still unfolding. It is difficult to imagine ‘coping’ with the loss of loved ones. Coping with the economic implications will be hard, but necessary.
In terms of fiscal measures, the UK Government responded in a manner that was unprecedented in peacetime history, though anything less would surely have made its position untenable. The extent to which its response will mitigate the effects of the disease on our daily life will only be truly known in the coming months and years.
For the dental profession, like all professions, there are questions. Some of the most pressing are around the ability simply to work and earn a living. Quite rightly, the nature of patient contact shifted rapidly from the implementation of cautionary measures, to emergency treatment only and, finally, towards complete practice shutdown as ‘urgent care hubs’ were readied to deal with emergency-only patients.
“At this time, it feels odd to turn our attention to a subject other than one touched by the COVID-19 crisis”
The everyday care of the wider population – in a community setting – was, necessarily, put on hold. The question about the ability to work in the future arose from the initial steps taken by the Scottish Government to protect dental professionals who treat NHS patients from the loss of income they face over coming months.
As we detail in our feature ‘Revealed: the big gap between NHS and private practice’, the viability of many Scottish NHS dental practices already appears to be in question – with profitability experiencing a significant reduction in 2018-19; down 15.2 per cent compared with the previous UK average (comparison with Scotland-only figures is not possible as this is the first time that Scotland-only statistics have been compiled). This follows warnings last year that dentists had already experienced a 30 per cent real-terms decrease in income in recent years.
In the days that we moved towards lockdown last month, the Chief Dental Officer (CDO) announced a series of actions, both clinical and financial – with the latter including “support measures to maximise sustainability within existing NHS dental resource” and the promise to “work with practices to seek alternative sources of support for small businesses”. However, many were quick to point out that the Government’s direct financial support did not cover the patient contribution. “Practices are going to go out of business,” one practitioner told Scottish Dental.
The CDO was quick to respond: “It is my priority that practices do not financially fail,” he tweeted. “I hear your concerns re. practices with higher level of patient charges. These are initial measures & I am seeking additional funding”. On 30 March, as Scottish Dental went to print, the CDO announced a revised funding package which will provide 80 per cent of the average income from item of service and patient contributions.
At such a time, it feels odd to turn our attention to a subject other than one touched by the COVID-19 crisis. But it is about the future; that of how adult NHS patients will be cared for in the years to come – and how the profession will be recognised for its expertise and dedication. As we also detail in this edition – in our cover story ‘For the generation Childsmile’ – a ‘new model of care’ for adult NHS patients is being developed.
It is early days and the CDO emphasised to this magazine that, before the issue of funding is addressed, “we want to get the model right first – for the patient and the profession.”
But, as much as the profession as a whole will look for reassurance that primary care will be properly funded in the long term, and that the potential impact on secondary care of any changes will be taken into account, right now individual practitioners are understandably worrying about their future, and that of their team members, merely in the coming months.