How will we cope?
The issue is how we effectively treat patients and ensure we have businesses at the other end
We are living in uncertain times, which requires resolve and fortitude. At the time of writing this, nearing the end of March, I’ve re-written practice policy and processes six times in seven days. The pace and degree of change is startling. The world is changing, maybe for a short time, maybe full stop. How will we cope?
COVID-19 is at the forefront of everyone’s mind. It is challenging Government, the NHS, society at large, and sports fans everywhere. The sport I am missing dreadfully. I’m not able to watch it and not able to play it. As the Chief Medical Officer, said though, exercise is important for body and mind – and my mind is pickled right now.
The biggest problems facing dentistry just now are not the processes we are forced to use. Dentists adapt to rules and regulations. We work using the SDR, or a private equivalent, daily. We adapt, usually in small ways; now in big ways. People I’m speaking to are managing the changes. Not easily. I’m not suggesting the last week and a half has been simple. At the time of writing, nine days ago we were working normally. Now, there is no face-to-face contact with our patients at all. Yet we are finding ways to do it. We are clever, resourceful people and are demonstrating incredible resolve in the face of adversity.
The two biggest problems, I think, are how to effectively treat our patients and how to ensure we have businesses at the other end? I’ve been telephone triaging patients, prescribing antibiotics and reviewing if they haven’t worked. I know it’s what we have to do. Viral load is likely to be important with this disease and it is why dentists are at greater risk. Our patients still need to be seen and treated. I feel powerless to help and worse, I’m unsure if and when they will get help because PDS is unable to cope. This is mostly due to the lack of appropriate PPE; dentistry is down the pecking order for FFP3 masks, but we have to fight for our patients to be dealt with appropriately. If nothing else, to ensure they still support us at the other end when we get back to treating them.
Will they understand why we have been unable to help them, and will they forgive us?
Speaking of support; the other problem is financial. The uncertainty around the financial package is critical. Various measures to support the employed, SMEs and (again at the time of writing) to support the self-employed are coming. We are caught in the middle of this. The offer from the Chief Dental Officer (CDO), has, I have heard, emptied the coffers of the dental budget. I appreciate that the budget is cash limited. However, there must be ‘extraordinary’ funding available from the Scottish and UK Governments for this particular crisis.
The last letter from the CDO stated they are tirelessly working on additional funding and that we should explore other methods. However, there is a serious question of whether ‘furloughing’ of staff is compatible with the CDO offer. We need some clarity. I appreciate that that could be difficult and with the pace of change in the clinical setting, finances may have been a secondary concern.
President Macron said: “As France shuts down; no business, no matter how small, will be allowed to fail.” Boris Johnson and Rishi Sunak have put in place some incredibly bold measures to keep people employed and businesses going. We have heard what an amazing job the NHS is doing and rightly so. NHS staff are putting their lives on the line, caring for people and times will get tougher. It is essential that dentistry is able to carry on. If we do not receive some clarity on the package soon, businesses could start to go within the next month.
The biggest problem from where I sit is understanding what options are available to us and how we communicate this to our staff. At the moment, I can’t confirm to them what we’re doing, how many I need, if I can ‘furlough’, and what if anything we can afford to pay them. I do understand that we don’t want to be in a position where people are profiting from the situation. On every level that is wrong. However, our sums suggest we will get around 60 per cent of normal income. There will be some savings on lab costs, materials and consumables but that won’t kick in immediately. We can possibly get relief of rates (it’s just a cashflow benefit; not actual, as it’s rebated). We might get one-off grants from councils but that won’t give us much more than a month’s cushion. The announcement of ‘furloughing’ grants gives people an expectation that they will get at least 80 per cent of their salary. If I ‘furlough’; surely, I have to pay those still working at least 80 per cent too?
I hope there is additional funding, maybe with caveats of evidence of bills and other income? Maybe some method of ensuring we cannot collect more than 100 per cent of last year’s income? I don’t think it would be unreasonable to ask this and I’m quite sure if we thought we could get that kind of support we would be very happy to pass that on to our staff and associates. Uncertainty leads to instability and chaos in our routine-orientated lives. The happiness of my patients, staff and associates is waning because I can’t confirm how I’m going to do my job for them as a dentist, owner and employer. I see fear in their eyes of the threat of the virus, of pain without care, the threat to their jobs, their livelihoods and the increased risks associated with working at a time of a global health crisis. As soon as I get clarity, I can give peace of mind to all who rely upon me. Then I might be happy, or at least a good deal happier. Be safe, stay home.
Arthur Dent is a practising NHS dentist in Scotland. Got a comment or question for Arthur? Email firstname.lastname@example.org