More like a Mike Leigh film than Disney
If there's not to be a genie, can we hope for the best and plan for the worst
Here I sit, trying to write this piece with news of ever-increasing infections, restrictions and new dental (not) guidance. I feel we are at a tipping point in dentistry, and society, and I’m getting more anxious by the moment. The stakes for a profession in limbo could not be higher.
The players: Coronavirus; an evil and all-pervading baddy that actually isn’t that bad (it’s not Ebola!). Our hero; the dental profession, divided, at odds with its controllers, railing against the ongoing uncertainty in the world and its own head. The backdrop; a system broken, the UK Government fighting with its own demons – headed by a bumbling blond idiot (or is he?), an economic disaster, teetering on the brink of the abyss. A bold Chancellor trying to save our jobs but not mentioning the ultimate cost of it all. A race to a vaccine that will save us all from the baddy.
I joke only because if I did not, I would cry. I have lost my patience with the situation. My frustration is bubbling over. I want to hit something or someone, but it won’t help. My overriding feelings are of deep concern for my patients, my colleagues and my profession. I want someone to tell me what the **** is going to happen.
The biggest frustration is the uncertainty. I know that no one really knows what is going to happen. However, for dentistry in Scotland, we have undergone a huge period of change and there is simply no reassurance that our leaders are even thinking about things. I know they are; aren’t they? But we are not being told. We have been waiting for the SDCEP review which came out on 25 September, but it’s not guidance. I think that was the strongest message in there – this is not guidance. Why not? Isn’t that what they do?
The Scottish Government has never confirmed the financial support period. So how do we plan? It could stop next week. I believe it won’t, but I can’t be sure. If it changes, does it benefit us, does it benefit some? Will we be lucky? Should it be down to luck? Is anyone else thinking measures will help but only those of us with viable jobs. Is that everyone? Hygienists, therapists; are they another of the collateral casualties of this virus? With less than a month or so more of the high-level furlough support, does the profession have the ability to retain its workers? They will be needed in time to deal with the backlog, but can we keep them until we can deal with it?
The whole of healthcare, especially dentistry, is based on having sufficiently high throughput of patients to generate income or deal with the need/waiting lists or both. There is not a huge glut of capacity to deal with extra work I’m talking about in normal times. At the moment, our throughput has been massively reduced; 20 per cent less? The new SDCEP document may see a jump in our capacity but they said this may get us to 60-70 per cent of normal. I honestly don’t see that – without a major financial incentive to do more, especially in NHS work. However, at 60 per cent of normal and six months of backlog, the waiting list is only going to get bigger. Can we catch up? How do we catch up? Even if we went back to normal tomorrow, I think it would be years before we get there.
So, if we are to get a change to our current situation, can I make a plea? Can we aim to reach as high a capacity as is possible? Use the hospitality industry as a model for our waiting areas. If you can sit in bars and wait for a pint, surely we can all sit in a socially distanced waiting area with our masks on? Can we accept that we normally have very good cross infection control measures which do not particularly need to change, with the exception of chlorine solutions for surfaces? Can we accept that we exist in a profession which has inherent risk and that the biggest risk is not dealing with people’s teeth? The chances of someone with Covid being at a dental surgery at the moment is tiny and the chances of them passing that on to others is very much smaller.
This is feeling a lot more like a Mike Leigh film than Disney, but if there’s not to be a genie; can we hope for the best, plan for the worst and try to see as many patients as possible? Minimise our backlog because that, in the fullness of time, true cost of this pandemic. For the Scottish Government: please tell us what we can do in the next phase, make it simple, make it realistic and give us some incentive to do as we humanly can. Tell us that we will remain in that pattern, with whatever support you can muster until a point far in the future where we have our herd immunity or a vaccine or a rapid test to check our patients pre-AGPs. Who says I’m not an optimist? I pray for some certainty.