A question of confidence
It’s been tough. It continues to be so, despite the phased return to practice. Never has there been a moment during lockdown when the profession could feel some sense of security about its future. The same could be said about many other groups of workers, certainly. But the degree of support and reassurance given to the dental profession has not matched that afforded to other health workers. There have been missteps throughout; from the early omission of cover for the loss of patient charge income (albeit remedied relatively quickly) to the more recent lack of engagement with the body recognised by the Scottish Government to represent the profession, the British Dental Association (which in turn empowered a patchwork of Facebook and Telegram-based campaign groups).
The way in which dentistry is provided to the population – essentially small businesses paid by the NHS to carry out certain approved treatments, who are then free to also offer varying degrees of private oral health care – has always diminished its importance in the eyes of the Government. As if good oral health is a financial choice. During the pandemic, this indifference manifested itself in the UK Government ignoring completely the impact of lockdown on private dentistry. Yes, purely private dentists who have had very profitable careers over the last decade without building a reserve to see them through some months rightly garner little sympathy. But the wider indifference ignores the symbiotic relationship in mixed practices between private income and the ability to provide NHS care.
In a letter to NHS dentists on 30 July – which heralded the return of aerosol generating procedures (AGPs) to those practices able to provide them safely, from 17 August, as part of phase three of the remobilisation of dentistry – Tom Ferris, Scotland’s Chief Dental Officer outlined some of his thinking about the move to phase four. This included a restart of item of service payments, including the patient charge. Ferris added: “I am also very much aware that you may have concerns about the long-term viability of item of service within the phased route-map outlined for NHS dentistry and the current constraints this has placed on you.
“The Government needs to be able to respond to developments with COVID-19, sometimes very rapidly. However, a broad review is required outside of the route map to consider how NHS dental services will look in the longer term and developing funding and payment solutions that ensure sustainability of the NHS dental service. A vital aspect of this will be your views and there will be an opportunity for dentists to have their say as we move forward.”
As we report on our news pages, the CDO’s statement follows anger expressed by the British Dental Association over “inadequate” engagement with the profession. But if the CDO is true to his word about giving dentists an opportunity to “have their say” on the long-term funding model for dentistry, then there is still some way to him regaining their confidence. Even now, there is a sense of salt being added to the wound of the past five months. For example, as we also report in this edition, concerns remain over the issue of payment of open courses of treatment. COVID support payments were intended to cover the lockdown period during which practitioners were unable to provide care and receive an income in the normal way. No support was given for the period prior to lockdown, when dental practices could still operate and earn income. However, some treatments that were begun pre-lockdown are due to be paid for after lockdown. One dentist told this magazine: “The proposal that payment for treatments carried out prior to lockdown should be deducted from COVID support payments is ill-founded and unfair. It would leave practitioners unpaid for work that they carried out prior to lockdown.”
Prior to the pandemic, work by the Scottish Government had already begun on a ‘new model of care’ for adult NHS patients. As Professor Jason Leitch, the National Clinical Director, said in the last edition of Scottish Dental: “The excellent work undertaken by the CDO and his team in relation to the new model of care will not be lost as the Government moves through with the remobilisation of the NHS dental services and into a longer-term steady state.” The question is, however, what confidence can dentists have – given their experience this year – in the Government’s ability to develop “funding and payment solutions that ensure the sustainability of the NHS dental service”?