New model of care?

Let’s stop talking about change and start talking about patient care, and what dentistry can do to treat everyone as soon as possible

21 June, 2021 / insider

I want to get over COVID-19. Not that I’ve had it. I want us all to get over it. I want to stop writing about it. I’m getting frustrated with the delay to my life and everyone else’s. Midway through last month, Glasgow was told it had to remain in Tier 3. The hospitality sector was dismayed once again, and the Delta variant was driving a fresh increase in cases. However, the early information suggested that this variant, although potentially more transmissible, does not seem to lead to more serious illness and the vaccine appears to be useful in limiting its effect. So, are we going to see more stringent restrictions again? If cases are rising, then surely that will be the case?

Or perhaps not: rather than confirmed cases, should we not be asking about hospital admissions, ICU admissions or deaths? In the first flush of the pandemic, we were told we had to stay home, stay safe and protect the NHS. Now, the Nightingale hospitals are being stood down. The vaccine programme has passed 20 million double doses. The only ones left to get the first dose are those aged under 40 and healthy. So, should we not be starting to think about accepting new cases and concentrating on the more serious numbers? Does it matter if we have cases, although controlled, if hospital admissions are controlled and serious illness is suppressed?

At some point the pandemic stops and endemic starts. I’m sure there’s a technical line for this, but the real test must be when the collateral damage is worse than the disease. And here we are with dentistry. We are still in the mire of this pandemic and there has been no change since November. We have been told a ‘New Model of Care’ will be prepared for and that the current financial support is not fit for purpose and will be replaced with a new transitional arrangement. This will allow practices to plan, we are told.

The real test must be when the collateral damage is worse than the disease

Well, we are now more than six months on. We have no information about patient care, about transitional financial arrangements, about a new Health Minister, about how we are going to care for our patients and the backlog, and about what’s going to happen to practices when furlough ends in September. If we can’t deal with the communication of some of this information, let alone the detail, then what hope do we have?

We are a profession which is becoming factionalised. The BDA, SDPC, SDA, SDPO, CDO and SG are all acronyms for a lack of communication and consistent thought. I like to think I have a decent handle about what’s going on in the profession: I don’t. I’m reading

the stuff that’s coming out and I see no assessment of the issues, no understanding of the massive unmet need which is growing and will overwhelm us. No understanding of the workforce nightmare we face with a year group delayed and a large chunk of senior dentists waiting for the end of financial support measures to retire. Not to mention the DCPs who are on furlough or the self-employed equivalent who, if there is no change to provide an incentive or ability to work more, could drop from the profession.

All the time we are talking about a ‘New Model of Care’, Core Service and financial models including salaries. The SNP and new Government have committed to free dental care for all over the course of the next Parliament – without any ability to enhance our capacity to see people. I just don’t get it. We are storing up a huge amount of treatment and unmet need, we are facing a serious drop in personnel power and have no clue about when we will be allowed to carry out more treatment for social distancing and probably PPE supply reasons, despite the fact we can queue cheek-by-jowl in Tesco (other supermarkets are available), day in day out.

I use the same argument that the hospitality sector has been using. Shops with little or no control are fine, but a controlled and regularly cleaned environment, like a dental surgery, can’t be allowed to open up to more care? Not even mentioning AGPs and ventilation; the PPE donning and doffing, waiting room restrictions, pre-screening and one-way systems killing the throughput we need to see enough people to do our regular tasks. Let alone 14 months of backlog.

The ‘New Model of Care’ is supposed to change the way we work, to enhance prevention. Now, I’m all for prevention, but that will not address the current need. Is this really the time to be talking about change? Is it really the time to focus our attention on ‘New Models’, clinical or financial? Regardless of how good bad or indifferent they will be, the profession will take time to adjust to them and throughput will reduce. We can’t afford that.

We need everyone’s attention focused on treating the patients. When we are still in the midst of a global pandemic, when the finances of the Government will be at their lowest and we have a huge backlog across healthcare, could we concentrate on the real problem? How do we treat the patients we have and how do we deal with the backlog of care that we know will be required? Let’s stop talking about change and start talking about patient care and what dentistry can do to treat everyone as soon as possible. We might just save our profession in the process.

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