Why we will have to adapt
Few businesses have escaped the impact of COVID-19; in the wake of this pandemic, dentistry has an uncertain future
he profession watched with concern as healthcare workers battled coronavirus across the globe. In early March we were preparing for the Scottish Conference of LDCs. By 17 March, the situation had changed dramatically, and we entered the delay phase of COVID-19.
For dentistry, this meant an overhaul of normal activity, with conditions imposed on all aspects of care. We were instructed to cease aerosol-generating procedures (AGPs) and nonessential treatment. We cancelled routine appointments for vulnerable groups, care home visits, Childsmile visits, routine examinations. Practices were at a virtual standstill. Only extractions and non-AGPs were permitted. We prioritised those in pain.
By 23 March, we were advised that all routine dentistry should cease. Practices divided into teams to allow social distancing. We aimed to manage patient symptoms in the short term, with one dentist and one nurse triaging calls. Should one team fall ill, another would step in. Urgent (acute) care hubs were established across health board regions, staffed initially by the public dental service. Protocols were produced for referring patients to hubs after robust triage and appropriate AAA (advice, analgesia and antimicrobials).
A redesign of health and social care will be needed
On 24 March, all face-to-face care ceased. In Greater Glasgow and Clyde, direct-dial numbers for the emergency hub, with clear triage protocols, were issued to primary care [GDS]. Since then, in line with feedback from emergency hubs, referral pathways have been regularly updated to streamline care. Most practices could divert calls and use remote access to practice management software to support patients from home and keep their teams safe.
Alongside these dramatic changes, we faced a threat to our financial sustainability, to practices we have devoted careers and lives to building. We awaited proposals for financial support from the CDO, with slow progress initially. We were directed to other sources of Government help, but eligibility, particularly for practice owners, was not clear. These were very challenging weeks. Principals were under a great deal of stress, unsure if they would be able to retain staff and pay them. We appealed to our CDO for guidance.
The initial financial package did not consider practices with a high proportion of fee-paying patients. A revision was issued on 2 April, with a more uniform approach. Many were relieved at the prospect of being able to manage fixed overheads throughout the crisis.
In Greater Glasgow and Clyde, our chief of dentistry (CoD) updated us regularly, and the local dental committee shared this information with GDPs. Many GDPs were redeployed to hubs. The Chief Dental Officer (CDO) and CoD appealed to us to register on the national portal.
Throughout, communication and motivation were vital to safeguarding mental health. Social media groups proved invaluable for sharing information, especially on issues such as furloughing staff, where information was lacking. CPD platforms and webinars were set up to allow us to engage with each other and fulfill GDC requirements while at home, though unfortunately there is no financial remuneration for this during COVID-19.
At the time of writing, our activities remain restricted to giving support to patients with advice, and referral to hubs where necessary. We try to check up on our practices, maintain our equipment, and support each other.
Morale has been challenged, but we believe sustained. We reflect on how lucky we were before. When a team member says they are missing ‘a normal day in surgery,’ it reassures us we must have been doing something right.
Our return to practice is now uncertain. Although, a plan to ‘remobilise’ dentistry was developed last month, in the words of Jason Leitch, our National Clinical Director, in a webinar organised by GDPs on 8 May: “We do not know what a return looks like in six months, because we don’t know what the virus will do. Local communication is crucial, and we have to tell the truth. No practice is ready for coronavirus because we don’t know enough about the virus. We have to be cautious.”
He reassured us that PPE will be crucial. Guidance on its provision, cost and supply will have to be revised. A redesign of health and social care will be needed, with consideration given to funding models. Mr Leitch also intimated a potential move away from ‘shopfront’ dentistry, perhaps to a model that maintains some independent status, underpinned with Government support, but said that the block of funding allocated for dentistry is unlikely to change. He and CDO Tom Ferris have advisory roles, with Health Secretary Jeane Freeman and Minister for Public Health Joe Fitzpatrick confirming the Scottish Government position.
We hope to find a way through the pandemic with more reliable and widespread testing, and development of a vaccine. One thing is certain: a return to pre-COVID dentistry is not likely, and dentistry will have to adapt.
Dr Clare Murphy BDS is a member of the Greater Glasgow & Clyde Local Dental Committee and of the Scottish Dental Practice Committee.