Already isolated, support for the homeless is on hold

Declan Cairns, co-founder of the Glasgow Dental Initiative, reflects on his experience and highlights the vital community work affected by the pandemic

15 June, 2020 / indepth

What’s been your experience of the COVID-19 crisis and lockdown?

Professionally, it has been a challenge to manage the crisis, both for staff and for patients. Our job boils down to caring for patients, so to be forced to stop providing this service, especially when someone is in pain, has taken time to adjust to. The vast majority of patients have been very understanding of the situation. There will always be a couple insisting on coming down to the practice, but this had to stop. Personally speaking,
I really enjoyed taking the opportunity to press pause and reflect on what has been an extremely busy time after graduating. 

What do you see as being the short and long-term futures of practice?

Short term, it is very difficult to imagine general dentistry returning to the way it was previously, especially in terms of volumes of patients. From a business point of view, materials will cost more, disinfection time in between patients significantly increases, limits to AGPs will impact the complexity of work undertaken and fewer people will be coming through the door.

But it is the impact on the general population’s ability to access NHS dentistry after the lockdown is lifted that I find particularly concerning. GDS practices are businesses which provide an essential frontline NHS service. They will be expected to absorb these costs when treatment resumes, and it worries me that private paying patients will be prioritised in order to try balance out three-to-four months of lost income. Many NHS contracted dentists feel they have to carry out multiple treatments per appointment to justify the time spent for the fee per filling and, in the future, this is simply not going to be possible with the current SDR.

It is the impact on the population’s ability to access NHS dentistry after lockdown is lifted that I find particularly concerning

I would like to see this changed, with a payment system that rewards practices to promote prevention in their local community, and to reduce the strain on NHS services after lockdown is lifted. However, I believe restorative dentistry will struggle to return to anything like normality in the absence of a vaccine.

Do you think the way dentists are educated and trained will be different?

I think the move to online learning will have suited a lot of people, but there is a limit to how much you can learn without actually going and doing it. As a student, I never particularly engaged with the lecture theatre learning style, and much preferred making summaries of slides afterwards in the library, so having an audio version of the lecture that I could revise in my own time would suit me down to the ground.

However, you would be losing out significantly on the skills developed by being on clinic, talking to patients, taking histories and practicing procedures in Op-Tech. Outside of academia, it is essential any DCP masters the practical element of their job, and thorough practice is needed before anyone can feel confident carrying out a procedure on a person. Unless the dental hospitals win the lottery and have students practicing on mobile units in their own home, I think people will still need to complete some practical element of their training before they are allowed to progress.

Tell us about the Glasgow Dental Initiative (GDI)

GDI was formed in 2015 by myself and my colleague, Abdulwahab Aslam-Pervez, focused on improving the oral health of the homeless community in Glasgow. As a charity group we have been advocating our work to dental practices within the area, and this resulted in donations of toothbrushes, toothpaste and other oral health supplies.

The group meet once a week at a soup kitchen on Cadogan Street. Users are given a tote bag with our logo and which contains a toothbrush, toothpaste, OH leaflets and other items such as bottled water, personal care items, and seasonal items, such as gloves and hats etc.

Our focus is to promote trust in the dental team by delivering dental health messages in a positive manner and providing advice on seeking emergency and routine dental care. Our aim is to:

  • Ensure everyone – irrespective of housing status – has access to essential dental supplies (toothbrush, toothpaste, and denture care products when available/appropriate);
  • Build a network of GDI-affiliated practices which donate oral health supplies regularly; and
  • Encourage an empathetic approach to delivering care through educating the profession on the challenges that the homeless encounter in engaging and accessing oral health care.

COVID-19 has meant we have been unable to interact directly with this group until further guidance is released by the Scottish Government. Our challenge is when and how we are going to manage this service in the future to align with Government policy. The removal of this service to an isolated group will bring challenges in future; to rebuild the trust and communication between the volunteers and service users, who have a diverse range of communication skills and needs.

Our peer advocacy service users have built a relationship of trust and communication with our volunteers. This approach promotes the sharing of positive experiences receiving dental care, which is invaluable in supporting those with dental phobia or have a negative attitude to maintaining their oral health. The Groundswell study provides evidence that peer support from people with similar experiences can help break down the barriers many people associate with healthcare workers. Implementing this scheme will enable us to capture those who have been falling through the gap in primary health/dental care provision in the past.

GDI was formed in 2015 to help improve the oral health of homeless people

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