Admit the problem

And reach out to the profession for opinions on the way forward

09 April, 2021 / insider

Everyone I meet says the same thing. We’re in a rut; Groundhog Day. Lockdown 2.0 has been hard for everyone. But, there’s now some hope. The vaccination roll out is happening and, despite some supply issues, two million people have been vaccinated in Scotland so far. We have stages from the Scottish and UK Governments indicating a way out.

However, I have grave concerns about dentistry. Since our small change of funding process and PPE supply in November, we have heard only that the measures of activity were not to be introduced until June instead of March due to the second lockdown. That was, until the last full week of March.

A letter from the new Minister for Public Health and Sport, Mairi Gougeon, mentioned the previous suggested measures of activity which were paused. It also mentioned a continued intention to move to a New Model of Care. It suggests there will be a medium-term financial change for 2021/22. It says the chief dental officer (CDO) will be in a position to provide details in the summer. It doesn’t give any indication of a way forward in terms of clinical treatment.

On Friday 19 March, at a Scottish Government briefing, the Health Minister suggested that dentists were able to work at pre-pandemic levels. The BDA have asked for clarification of this statement, as the profession is entirely unaware of a change of this magnitude. Throughout all of this, the CDO has not communicated with dentists.The silence surrounding any further expansion of dental services and how the profession is likely to move towards normality should be no surprise. Throughout the pandemic, the Scottish Government has communicated changes in dentistry with the public at the same time as the general profession. It is frankly ludicrous that our profession has not been given an ability to plan, in any way, for the care of our patients. I am grateful for the financial support. I understand that it was never meant to last this long, and the Government will need to create some more structures to cope with longer
term support.

Once again though, we are being told that this is to allow us to plan for 2021/22 yet the CDO won’t give us more information until the summer. It’s impossible to plan for a financial year when you don’t get information until several months into that period. Any introduction of activity measures must be related to an ability to expand clinical activity. There has been no mention of how clinical activity can be increased. There seems to be a complete lack of understanding of how clinical activity relates to the restrictions in place and that those restrictions are based on social distancing of patients in practices rather than the procedures which can be done.

Similarly, there is no mention of how they may actually measure activity and how, if we can’t perform as much work, it is inevitable that registrations will decrease. We can’t see new patients unless we sacrifice the care of our existing patients in favour of getting new patient registrations. We are not in the business of selling mobile phones or insurance and giving our best deal to new customers. We should not be forced into this by measures of registration.

The single most important element which is being forgotten is dental care. It seems the cure, in the case of transmission avoidance measures in dentistry, is getting worse than the disease, if we’re talking about dental health. We have done no real dentistry for a year. We’re now operating at somewhere between 20-30 per cent. It will be interesting when practices NHS/Private split is recorded for 20/21. Will there be a huge shift from where we were, in terms of NHS commitment? Will it show that patients are voting with their feet and paying for their care? Will COVID have created a two-tier system which will mean that timeous dental treatment will only be possible privately?

Regardless of NHS/Private split, the volume of care which is normally required cannot be delivered with the current SOPs by the current workforce in the current infrastructure. Let alone the additional work and complexity of work, which is very likely to be required following such a prolonged period without routine care. So, what are we to do? It is impossible to increase the workforce or infrastructure quickly or in such a volume that would meaningfully allow dentistry to provide the throughput as before. The cost of this would be astronomical and the timescales involved huge.

I wonder if this is this reason for the silence. Is the realisation of the impossibility of continuation of COVID measures and the lack of any idea of how to deal with the problem the reason? Or is it simply that those who are dealing with this most difficult of situations don’t have the courtesy to reach out to the profession at large and admit the problem they have? Can they not ask for help; guage opinions on how to move forward? I have alluded before to my grave concern for what happens when normality resumes. My bigger concern is now that normality may not be being considered as an option. That a New Model of Care is in some way going to incorporate processes currently in place to manage a pandemic which is coming under control through vaccination. Is dental care and its delivery going to be sacrificed on the precautionary principle? How are we going to care for all those who rely on us?

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