Goodbye 2020, hello 2021
If the gold standard of care is to be provided, and funded, it will have to adapt to the digital era and embrace minimally invasive thinking alongside the rapidly evolving restorative modalities, says Emma Colvin
What was your experience of lockdown?
It started with getting everything in place to secure staff jobs and the business along with adapting to triaging from home and at the same time home schooling. With the additional spare time, I spent the majority attending webinars; Dhru Shah’s Dentinal Tubules were exemplary. Tubules is an online resource which provides more than just CPD. It is a phenomenal source of inspiration and solidarity. Tubules brings professionals together internationally in an inclusive way that I personally have never experienced in my over 22 years of learning.
The private sector came into its own during lockdown and beyond, everyone helping and reaching out to each other. Initially, this did not appear to happen as much within the NHS sector possibly because we were hopeful that our representative bodies would have had our backs. As a team, we kept in touch by Zoom and organised quiz nights etc.
We do not have a large cohort of staff, so we possibly did not have the pressures other practices had. To say we were not worried about the future viability of the business, at the time, would not be true but after financial advice and assessment we appeared to be stable.
Private treatments returning earlier, allowed us and many practices to bounce back. The full complement of NHS treatments only just returning on 1 November allows this group to be fully cared for again, but one could question the timing i.e., why now and not in summer? Especially when we are experiencing a second wave. Additionally, being able to provide all treatments should surely equate to 100 per cent NHS remuneration, as it does in England.
In terms of my experience of family time during lockdown, it was a very precious time. I have been a full-time working mum since I was 25 years old and I personally saw lockdown with my family as a blessing a time that we most probably will not get again. We spent most of the time outside in the garden, doing HiTT classes lead by our older two boys, when I’d often be told my ‘form’ was not correct and I had to redo my press ups! We live at the foot of the Pentland Hills, so we also enjoyed this beautiful area with our malamute puppy.
How was lockdown and the return to practice handled by the Government, and regulators?
I would challenge anyone who said that practice owners and associates did not go into a mad panic when our Chief Dental Officer announced that NHS GDS COVID payments were to be provided at 20 per cent pre-COVID remuneration. This was a wake-up call for the profession and shone a bright light on the value of our oral health service, in the eyes of those in power.
This decision was overturned by an online petition. However, we now find ourselves undervalued in comparison to our English colleagues who have received 100 per cent remuneration, since June, based on 20 per cent of pre-COVID capacity. In contrast, dentists in Scotland were awarded 85 per cent for 20 per cent pre-COVID targets being met. Additionally, our GP colleagues have received 100 per cent remuneration when working at reduced capacity.
When the pandemic struck there was a lot of confusion. There had been no communication in the months of January and February as to what was being planned in the event of COVID-19 hitting our shores. Similarly, return to work was not handled well by the decision makers. The goal posts were being continually moved and unless you were media savvy, you could be learning things were changing in a few days’ time when you had been formally told – and had planned for – a few weeks.
In June, a publicly perceived two-tiered system was seen to have been created when Health Improvement Scotland announced that private patients were able to access dental care. Whereas the CDO advised a continued limitation to access for NHS patients, allowing only AAA, extractions and oral cancer checks with referral to UDCC’s if an AGP was required.
Many dentists found these centres difficult to access however, this varied across the country. We now find ourselves with: 1) A huge backlog of NHS patients in need, 2) A COVID package that places Scottish dentists at a distinct financial disadvantage to their English counterparts, 3) The prospect of a target driven remuneration package enforced during the most unpredictable era our generation has known, and 4) No formal engagement from the Scottish Government with the SDA, although we are ready and willing to help.
How could things have been handled differently?
Communication. We have learned of decisions through social media before being formally advised. However, often, these decisions had been poorly thought through in terms of disease risk and impact on oral health. Engagement with the profession could have easily been done through online polls and webinars. This would have given the workforce a sense of solidarity with the decision makers with the additional benefit of feeling valued. Additionally, the decisions made on the ability to provide dental care, arguably resulted in health inequality; the private patient benefiting over the NHS patient.
What’s your view on the profession’s representatives — the BDA, and those that have emerged this year?
We continued to find ourselves without a voice and nobody appeared to be fighting the corner for the NHS patients and the Scottish GDS workforce. This being all too obvious when we consider the initial COVID-19 NHS package of 20 per cent offered to us in March and the current disparity between what has been negotiated for our English colleagues, who continue to be remunerated at 100 per cent, when dentists in Scotland are awarded 85 per cent for the same level of activity.
The emergence of new associations is the direct result of this. In May, I was introduced to a new movement who wanted to address the perceived lack of voice. This movement has now organised itself into the Scottish Dental Association (SDA) and the Scottish Dental Practice Owners (SDPO). I am the current Vice Chair of the newly formed Scottish Dental Association. This association aims to represent the profession from practice owners and associates to dental therapists and nurses. I believe that Scotland needs its own association, a Scottish voice. The SDA has proved itself willing to challenge decisions being made and is demanding a seat at the table when the future of oral health provision is being considered.
What do you think of the situation, heading into winter?
The UK is now experiencing the second wave of COVID-19 with scientists warning that the situation may develop to be worse than in the spring. To many it may seem strange to suddenly re-introduce all NHS care at this point – why not in the summer when the virus appeared to be under control and when private patients were able to access everything?
On the other hand, the profession now has access to PPE and we have all developed and restructured our dental practices into COVID-safe environments. The situation within most practices is that they are well equipped to attend to all their patients at reduced capacity. Some practices, however, have seriously limiting issues with ventilation and this must be addressed by the Scottish Government as a matter of urgency. Practices have had to put in ventilation equipment that can cost several thousands of pounds when their income for oral health provision has been reduced by 20 per cent.
The Government is working on a ‘new model of care’ — how should dentistry be provided in Scotland?
Firstly, the Scottish Government needs to consider what value they put on the nation’s oral health. Only from this point can we coherently and successfully create a new model of oral health care. We must move away from a system that effectively rewards provision of treatment rather than promoting oral and systemic health. The workforce is highly educated and clinically trained. Unlike other health sectors, we attend to our patients every three to six months, developing good relationships based on trust and we usually see them when they are well.
We could be intercepting early and preventing diseases from developing, for example diabetes and heart disease. With the appropriate referral pathways, oral and systemic health assessments including blood pressure and blood glucose monitoring, we could help to reduce or eliminate the development of chronic disease and hence the financial burden on the NHS.
Additionally, we need to embrace the idea of working across all areas of society to help address the issue of continued poor health within the most deprived groups. Innovative thinking is required at a national and local level, working together to target oral health problems and the perceived barriers. If the gold standard of care is to be provided and funded, it will have to adapt to the digital era and embrace minimally invasive thinking alongside the rapidly evolving restorative modalities, now available internationally.
Ultimately, a new system will have to take into account the workforce and its morale. How can you get the best, from one of the most intelligent and highly trained workforces, when they feel undervalued and quite frankly mentally unwell because of their working conditions?
How does 2021 look for you and practice generally?
2021 will be a good year; I am an optimist. However, I am conscious of the constraints and threat of targets upon us. My private work is the area where I am free to provide the best level of care for my patients and at the same time embrace all the innovative concepts out there.
I genuinely hope that the Scottish Government embraces the Scottish Dental Association, regarding the future of dentistry in our country. To let this pass would be a hugely missed opportunity. We want to work with them to create a model of oral health promotion and care that other nations will want to emulate. COVID-19 may have just handed us the time to do it.
Emma Colvin is the current Vice Chair of the SDA (Scottish Dental Association). She graduated in 1998 from Glasgow University. In 1999, she married John-James Colvin and they have four boys: the eldest 21 and the youngest 11. Throughout her career, Emma has worked mainly within general dental services in both Scotland and England. She also worked as a senior dental officer in community and hospital in Peterborough In the early noughties. The family moved to England in 2003 and returned to Scotland in 2009 shortly after the birth of their fourth son.
Emma’s postgraduate education has encompassed Guy’s, King’s and St. Thomas’s University of London and a return to her alma mater. She has a Post Graduate Diploma (with Merit) in Conscious Sedation and In 2018 she gained a Post Graduate Diploma in Dental Public Health and a PG Certificate In Implantology.
The couple bought their practice, Bellsquarry Dentistry, from a corporate in 2011. Over the following years they worked hard at developing good relationships with the local community and built the practice up, trebling patient numbers. In 2018, they took the decision to convert to a fully private service for their fee-paying adults. “At the time, It felt like a giant leap in the dark, but we have not looked back, and the conversion of patients was extremely successful; more than we had expected,” said Emma.
“The decision to convert had come from realising that we could only provide the highest standard of care, embrace minimally invasive treatment, and focus on prevention under the liberty of a private service. After working for years and trying to achieve the best outcomes within NHS GDS both for the patient and professional, leaving literally felt like the shackles had fallen off. If I had one word to use to describe the experience, it would be liberating”.
Emma added: “However, we were acutely aware that not all within society can access this level of care just now and therefore we continue to provide NHS care for adults who do not pay. Childsmile had already been fully integrated into our daily practice and continues to be embraced by all our staff. We have also been asked to provide research for the University of Glasgow’s Public Health PhD students because we were recorded as the highest provider of fluoride in Scotland, relative to our size.”