Time for a radical rethink
Michael Dhesi, principal dentist at Greygables Dental, on his experience of lockdown and the future of dentistry
What have the past few months been like?
Lockdown was a challenging period both professionally and personally. From the outset, it was always my goal to support patients and the wider NHS as much as possible.
I found that, while myself and other colleagues in urgent care hubs offered an essential service to those in need, there was no adequate provision for the complex clinical issues faced by my own patients in a predominantly private, referral-based practice. These issues included – but were not limited to – complications with dental implants, bone grafting and minor oral surgery.
The advice provided to the profession was not clear or, in my view, from an evidence-based position. This caused significant confusion in the profession. It was also not clear until TDS (Taylor Defence Services) sought the opinion of senior counsel that the Chief Dental Officer (CDO) did not have legal authority to restrict the provision of private dental care in Scotland. It is my understanding that this is a position now also accepted by Scottish Government. Senior Counsel’s opinion came as a relief to me that I was indeed able to care for my patients, as was my desire, so long as I complied with the relevant legislation.
How did you prepare for a return to practice?
As lockdown progressed, I kept abreast of a quickly developing professional landscape with various bodies introducing their respective guidance. It was clear to me that the position in relation to the provision of private dentistry was incorrect and I was involved as part of the TDS team who sought the opinion of Senior Counsel regarding the authority of the CDO to restrict the provision of private dentistry in Scotland.
It was obvious to me that primary dental care would not be returning in its ‘pre-COVID’ form. Dentistry would be much slower paced and enhanced PPE would be essential. It is in my nature to analyse these challenges and seek to overcome them.
I developed standard operating procedures, a patient risk assessment and a patient information leaflet for use within my practice that I was confident allowed us to treat our patients in a safe environment. I also shared this information with more than 120 other practice owners in an effort to help others in their return to practice.
Greygables Dental looks and operates very differently with social distancing, one-way systems and Perspex screens – to name but a few changes in place – to protect our staff and patients.
Could the crisis have been handled differently by the Government and regulatory bodies?
Undoubtedly, all of those in positions of power sought in good faith to provide the best information available to them at any particular time in a rapidly developing situation.
However, it is my view that without reflection on the relative successes and failures of any situation in healthcare we are unable to make improvements for future patient care. There must be an acknowledgement that patients have suffered as a result of the limitations placed on care and that otherwise restorable teeth have been extracted.
It is my personal view that the provision of emergency dental care should never have been restricted and there was no reliable evidence base for doing so. In other countries across the world dentists continued to provide care to their patients during COVID-19.
If there were to be a second wave, I would hope that this is a position Scottish Government could review and seek to allow patients to be cared for by their own dentist in urgent circumstances.
How radically, and in what ways, do you think the provision of dentistry will change?
It is likely that as dentistry will be provided at much slower rate and where that is the case the current funding system will not allow practices to remain financially viable. These are issues the CDO will have to consider in implementing a system that works for the population and practices. If there was ever time for a radical rethink it is now.
There is already a move among colleagues towards dental plans and I think this will be something that will increase.
I suspect that there will be an increase of non-exempt patients utilising dental plans and insurance schemes to fund their dental healthcare.