The post-COVID challenge
If a new funding model does not consider the backlog of treatment the pandemic has caused then a vicious cycle of oral disease could develop, says Mohammed Samad
What was your experience of lockdown?
It has been a difficult time for everyone on a personal and professional level. It has been mentally draining for all in the dental team as there has been so much uncertainty around the dental profession. The team has been unable to get answers over the past few months about the long-term plans for NHS dentistry as there has not been any communications of this.
On a personal level, this has been the most challenging time during my entire dental career; I feel this is the case for everyone in the profession, whether a practice owner, associate, VT, dental lab technicians and all associated staff. The down time has enabled dentists to realise the unreasonable working conditions which, in the past, have been ‘accepted’. The fees imposed in NHS dentistry have never allowed dentistry to be completed to a standard that is expected.
Several colleagues have expressed their reluctance to return to the delivery system which has existed due the undue stress which has been placed of working on the treadmill that is NHS dentistry. Many feel it is not an appropriate delivery system for dentistry in a first world country and needs a major upheaval in order not to leave the dental health of hundreds of thousands of patients in Scotland in the balance.
How was lockdown and the return to practice handled?
The general feedback is the frustration at the lack of communication from the CDO to the profession. There have been a few announcements by the Scottish Government on the remobilisation stages of NHS dentistry throughout the lockdown which always get announced through the media on a Thursday afternoon. This is the first the profession heard and caused unwarranted stress – with the public accusing practices of lying or not doing what the announcements stated.
Practices were then left to explain that they were not made aware of any restrictions and even where an announcement has been made, there are still restrictions in place which were not clarified to the public. There have been huge variations between health boards in respect to the advice practices in each health board must follow.
Confusion has ensued when colleagues are trying to get advice or help from other colleagues due to the variation between boards. Certain health boards and directors of dentistry (DOD) have been amazing in their communication with their local practices – yet it seems other health boards and DODs have left their communication methods back in their offices in March when lockdown happened.
The Scottish Government communication has also been nothing short of illogical and non-existent. There has been no communication to the profession of changes which are being introduced; the profession has been left in the dark time and time again, and yet the Government does not appear willing to engage with a key stakeholder group such as the SDPO [Scottish Dental Practice Owners] which represents around 3.5 million patients throughout Scotland.
Could things have been done differently?
Hindsight is a wonderful thing. Dentistry is an evidence-based profession and there have been numerous letters asking for evidence on the abandonment of dentistry in Scotland when comparing with how
other countries responded to the pandemic in relation to dentistry.
Proper care, which could have been offered, was removed with no real
evidence or reasoning. Yet, now, when cases are on the increase
throughout the UK, we are now being advised we need to see more patients? Again, the profession feels this does not make sense. Again, the profession wonders if the decision to prematurely move into phase 4 has been made in haste without any real consideration to the real impact this will have on practitioners.
What’s your view on the profession’s representative organisations?
The BDA has been around for several years; it is regarded ‘as the sole
negotiator’ between the Scottish Government and the profession. There are many dentists who are not members of the BDA and still the Scottish Government does not take this into account. People have time to contemplate the current state of affairs and groups have grown to represent a wider area of the profession.
SDPO was formed so that practice owners have a united voice and can express any concerns in organised and professional manner. There is no desire for competition with any of the bodies and organisations, yet simply a desire for various bodies and organisations to be heard. We hope that all voices are appropriately heard and there is input from various aspects of the dental profession moving forward.
One body (BDA) cannot represent the whole of the dental profession
ranging from associates, assistants, VTs, nurses, therapists, hygienists, auxiliary staff, hospital dentists, community dentists, and laboratory technicians. A representative body from each of these sectors must be involved in order to be fair and representative.
And now, heading into winter?
It is a difficult situation for every dental practice throughout Scotland – and the UK for that matter. The underlying difficulty that has been expressed by every practice owner I have spoken with is a feeling of the public have been given a blanket statement without making them aware that dental practices are not back to ‘business as normal’. The CDO has communicated this to the profession, yet a simple clarification on the day of the release would have allayed the profession’s fears.
Meeting targets to get paid a certain amount? Well, it certainly does
look like a target-based approach which is already in place in other countries in the UK and looking at the feedback from the profession working with that system, it is clear to see that a target driven system is not beneficial to patients. We were once told during the pandemic that the Statement of Dental Remuneration would not be returning, yet it has been reintroduced back into the profession.
What is going to happen moving forward is anyone’s guess. We had Oral Health Improvement Plan as a proposal, but this has now diminished with COVID. It has been admitted that there is no clarification on the long-term proposal of NHS dentistry which is a huge worry for all involved.
How should dentistry be provided?
The Government aimed to make Scotland one of the world’s leading countries in dental health. We are far afield from this goal. There have been
various ideas within the profession of how best to provide a state funded
dental model. It is widely accepted within the profession that a state funded model does not allow for high quality dental care to be provided, yet over the past nearly 20 years, there has been no deviation from this system by the Government.
Practitioners have made it known for a long time that the current model was poor in the set-up, but grievances are also in place from within the profession due to the lack of engagement by the Government to help develop a new funding model. Various funding models have been suggested by the profession, but they seem to be falling on deaf ears. Ideas from a basic core service, to vouchers for dental treatment to insurance-based models have been looked at as is the case across the world where variations of these types of systems are in place.
Dentistry should be developed in such a way that it is rewarding for the profession and allows them to educate patients and not simply be there to treat the disease. Prevention is the best cure as the adage goes.
How does 2021 look for you and practice generally?
We are looking to get through week- by-week currently; the goalposts
change continuously, and reshuffling is inevitably required. 2021 will be
challenging, regardless of the funding model or the COVID situation. Parts
of Scotland are on high-risk status, so at the time of this being published
the status may have changed and the Government’s plans for remobilisation of dentists may have also changed.
The backlog of patients and treatments we will have is unthinkable. Taking
into account the eight months of check-ups which have not been seen,
appointments that were booked in which have been cancelled, treatment
which was open, and three-monthly hygienist appointments that have
been cancelled – these all need to be completed first before the practice
stops chasing its tail.
Unless we become dental practices doing 12-hour shifts, seven days a week, it will be years before we have caught up. Oral health has taken a massive impact during this time. The initial advice to promote prescription of painkillers and antibiotics for simple treatments that could have been completed in-house was not received with pleasure by the profession.
There are various stories of people attending emergency dental hubs with simple problems and yet they are being offered teeth extractions as the sole treatment option which, in normal circumstances, would not have been considered. A potentially vicious cycle could develop with a completely new funding model that does not consider the above. Careful thought is required to allow the profession to work its way through the backlog in an efficient and ethical manner.
Mohammed Samad graduated in 2009 from Dundee University and completed one year of vocational training in Fife before returning to Glasgow to begin his associate career. Approximately 12 months later, he became a practice owner of Carntyne Dental Care. Just months after this, another opportunity arose, and he became practice owner of Toncross Dental Care.
Mohammed’s two practices, which are predominantly NHS, are in the east end of Glasgow; a highly deprived area where there is high dental need and a high prevalence of dental disease. They provide a wide range of services including facial aesthetics, NHS, and cosmetic orthodontics, IV sedation, along a full range of NHS treatments.
They are limited to what can be offered due to logistics and have had to prioritise who can be seen every day. Any ideas of expansions to offer other services have been put on hold until the country is again in a position of ‘normality’. The lockdown has impacted the local community greatly as this is their local practice, and the lack of access has resulted in undiagnosed and untreated disease.
Mohammed obtained his Diplomas with the Royal College of Surgeons in England and with the Royal College of Physicians and Surgeons in Glasgow early In his career to further enhance his delivery of care to patients. He also provides intravenous sedation for patients. He has been offering IV sedation for approximately eight years, having completed approximately 3000 IV sedation cases. He holds the role of IV sedation mentor for dentists and nurses wishing to train In IV sedation with NES.
Mohammed is in the process of completing his Masters In Orthodontics so that he can offer this service in practice to patients who desire such a service. Alongside this, he was previously an external examiner for MFDS examinations for the Royal College of Physicians and Surgeons of Glasgow for a number of years and has now been given the honorary position of deputy convener for the MFDS Part 2 exams for RCPSG.