Prepare to recover slowly

The drive in the profession to throw out the NHS payment system - can I suggest we put the brakes on that?

10 February, 2021 / insider
 Arthur Dent  

As I sat, pondering the announcement of a second National Lockdown in Scotland, I felt void of emotion.  At least this time round we won’t have multiple changes of rules or guidance in a short period. We won’t have to create new Operating Procedures or re-train our staff, build screens or source bucket-loads of PPE.

This is something we have done before, something we were probably expecting post-Christmas anyway, new variant or not. Even in the first few months of COVID, there was an inevitability that the following winter would bring stress to the NHS systems, regardless of the uncertain outcome of SARS-CoV-2.

Dentistry should remain unaffected, as we have reached a static level of guidance regardless of the effects on the world around us.  This point, it could be argued, should have been reached a few days or weeks into the first lockdown.

However, I am not myopic; I recognise the enormous struggles the profession faced with the uncertainty of transmission and the lack of evidence which resulted in the cautious approach taken. We are in a different place now. Our systems protect us from patients with COVID. We just need to maintain high levels of control to avoid inter-staff transmission.

We have adapted to the vastly different professional and community landscape we find ourselves in. Humans adapt, dentists adapt.  Even if someone rips up the rule book, we will write a new one. However, let’s ask ourselves a question; what are we doing differently? Our processes have altered a little; PPE is the biggest shift. Our control of people entering our buildings is quite high at the moment when there was virtually none before. We have probably changed the material we use to clean slightly.

But what else has changed? We still drill and fill, access pulp chambers and make dentures. I grant you, in nothing like the normal numbers, but the processes are the same. We have not had to change the way we perform dentistry; just get used to doing it with a couple more layers of plastic in the way.

That said, there seems to be a drive in the profession to throw out the NHS payment system. Can I suggest we put the brakes on that? We have been supported (to varying degrees, according to NHS commitment); as has the country by the Job Retention Scheme and Self-Employment Income Support Scheme. We can all see how expensive that process has been, and we can imagine how long it’s going to take to pay for it.

I cannot see the benefit in trying to renegotiate a contract at a time when the Government (UK or devolved or independent Scottish) has no money and will be trying to cut left, right and centre. Now isn’t the time to ask for more money or create an arrangement in which we receive less.

I also think we’re going to be a bit busy (understatement of the millennium). I think there’s going to be a huge backlog of work which will be more complex and time consuming than normal. I don’t think that we are like a hairdresser; after one cut, we are back to normal.  Well, I know that’s not true; the first cut might not be perfect but after a couple we’ll all be back in the usual pattern and the hair just keeps growing.

It will be interesting to see how much dentistry varies from that. There will inevitably be those who have been fine and will remain so. Equally, there will be those who stayed at home and have eaten and drunk their fill, with the associated dental fallout. It will probably inform the debate over recall periods very well, though.

I think the big battle will be how quickly we can get things under control. The longer our restricted practice carries on, the greater the volume and complexity of need will be. In turn, the longer the waiting times will be as we programme this work into our schedules. Some practices may choose to work from a zero point with examinations and others may have lists of postponed treatment plans.

Whichever method, the order books will get longer and longer. This creates clinical and financial problems. Clinically, if people have to wait longer for treatment, that treatment changes and becomes more complex; fillings become RCTs, RCTs become extractions requiring dentures, bridges or implants. People also return for emergencies in between appointments because temporary dressings fail; we are probably all seeing that just now.

From the business perspective, cashflow gets stretched, especially if we wait for the end of plans to submit claims and get paid. This can put enormous pressure on businesses at a time when many are teetering on the brink.

I’m trying to look forward, yet I only see greater travails, not great times. In the meantime, I pray for us to be used in the vaccination programme that will (hopefully) set us free. I hope that it is well organised and voluminous in both its administration and uptake. I hope that dentists get to help out and avoid further burden on our stretched healthcare system.

However, whilst this last year has been tough for most; I see 2021 as a far tougher prospect for dentistry. I fear it will be several years before our patients get back to the levels of clinical consistency that we were at just a year ago. Dentistry, and healthcare in general, is in for a bumpy few years. 

So, the thoughts for the year: use our services to accelerate the vaccination process; prepare our recovery and think hard about the level of work we are prepared to endure and for how long; get fit enough to cope with longer hours and harder work than we have done before. Be prepared to recover slowly; ‘Long-COVID’ is likely to affect dentistry too.

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