Friday 24 July
BDA argues it would be more cost effective if government supports private dentistry because closures will add pressure on NHS dentistry
Last night around 50 BBC radio stations across England, from Cornwall to Cumbria and Brighton to Blackpool, carried a warning from the British Dental Association on their 6pm or 10pm (or both) news bulletins that dental practices could go out of business because of the high cost of providing care under pandemic restrictions. Most of the news coverage attributed to the BDA referenced the fluctuating costs of PPE, which have risen tenfold since the Covid 19 lockdown, the difficulties for dentists sourcing it, and the reduction in the number of patients they can now see. Presenters also said that some patients had to pay a surcharge on PPE, from £30 to over a £100, though not NHS patients as these charges are fixed.
Some of these news bulletins, including Radio 4's 6pm news, and Drive Times programmes featured an interview with BDA vice chair, Eddie Crouch, who said that the current situation for dentists isn't sustainable, and pointed out that many practices don't work exclusively for the NHS and rely on cross subsidy from private income, and his worry is that many practices might never open again.
A statement from the Department of Health and Social Care said that while it had helped businesses, private dentistry was independent of government. It said that dentists continue to receive NHS funding, regardless of any changes in PPE prices, meaning that [such] practices have a stable income.
Eddie argued that it would be more cost effective if both private and NHS dentistry were supported because of the added pressure on NHS dentistry if many private practices were forced to close, as people were already struggling to access an NHS dentist.
Some of the regional news bulletins carried interviews with local dentists, including Maezema Malik, who said her fear was that as waiting times to see the dentist become longer, that patients in pain were having to wait longer to be treated.
Check local Sounds for BBC news coverage in your area
Thursday 23 July
BBC Radio Hereford and Worcester: ‘We need to know whether the science behind what we’re doing is correct’
This morning’s edition of the Breakfast programme on BBC Radio Hereford and Worcester looked at the issue of access to personal protective equipment (PPE) and whether patients have to pay a surcharge for this when they see their dentist. The presenter said that this didn’t apply to being treated on the NHS as charges are fixed, but claimed that those for seeing a private dentist could be eye watering, up to £100. A local dentist clarified that dentists were not profiting from this but passing on the charges they have to pay.
BDA vice chair, Eddie Crouch explained why/when level 2 PPE was necessary, pointing out that this was more expensive than standard PPE. Another complication, he said, is that masks vary from one manufacturer to another and if you can’t obtain a particular brand you had to wait to be fit-tested for another and this could be disruptive to delivering service at a practice. However, he said that the biggest cost for dental practices is the downtime needed following aerosol generating procedures (AGPs) between patients as this costs around £200 an hour.
When asked what needs to be done, Eddie said the manufacturer of PPE in the UK is helping to improve the situation but the bigger concern, he said, is knowing whether the science behind what we are doing is correct. In this regard, Eddie said that Public Health England was in the process of reviewing around 4,000 scientific papers, and if it turns out to be correct then we’re in serious trouble, because it will significantly reduce the number of patients we can see on a daily basis. Hopefully, he said, it will show that, perhaps, we have been a bit too risk adverse so we can start seeing more patients.
Not available on Sounds
BBC Radio Kent: If there’s a will in central government, NHS dentistry could be reset into something fantastic
Today’s mid-morning programme on BBC Radio Kent
discussed how dentistry has changed during the pandemic and included interviews with local dentists and also BDA spokesperson, Paul Woodhouse. When asked what he thought of the situation, Paul said that this is the biggest challenge dentistry has ever faced. It’s not just a PPE thing, he said, the rules and regulations around how we are allowed to deal with patients mean that our usual work output is massively, massively reduced, and even those of us who can see patients aren’t seeing as many patients as we would like to during the day. The presenter mentioned that some dental practices were installing special ventilation systems to speed up the process of ‘getting clean air into the room’, and asked him what he thought of those. Paul said there was no evidence that these were doing any good or doing any harm, which models work, and which ones don’t, so some practices may have invested in large sums of money – but there was no way of knowing whether they do a decent job or if it’s a wise investment. Paul said that there was so much uncertainty in dentistry, dentists were clamouring to get back to their usual levels of service but there aren’t any answers forthcoming.
The presenter said that he had just spoken to a dentist who said this could spell the end of NHS dentistry, what did he think? Paul agreed it was a struggle but he said he hopes that this could be an opportunity for NHS dentistry to have a kind of rebirth, like a Phoenix rising. Dentistry is a crucial part of healthcare that is often being neglected, he said, and because of that we have a great chance to reset if central government has the will it could do something fantastic with dentistry, but equally it could be a crossroads that’s just a step too far for us.
BBC Radio Oxford: The sooner that PHE can recommend that dentists can see more patients the better, otherwise many practices will go to the wall
BBC Radio Oxford continued to release segments of an interview it did yesterday (and covered in these reports) with BDA vice chair, Eddie Crouch, who explained to listeners how dentistry has changed dramatically since practices in England reopened to see patients in June. It also quoted the BDA’s concerns that level 2 PPE is difficult to acquire and prices have fluctuated up to 6000%.
Eddie explained that having to leave surgeries fallow for an hour after doing any aerosol generating procedure, even the smallest, was making dentistry uneconomic as dentists used to see be able to see around 30 patients a day, now many practices could only see around eight. He said that while some of the costs can be transferred to [private] patients, obviously they cannot afford to pay the downtime for a surgery which costs around £200 an hour to service. When asked by presenter, James Kitchen, how many practices would go out of business, Eddie highlighted the findings from a survey that the BDA carried out at the beginning of the pandemic, which estimated that one in six practices would struggle the longer the pandemic carried on.
Eddie expressed hope that a review that is being carried out by Public Health England into the standard operating procedures, would recommend that dental practices can see patients more frequently, the sooner the better for dental practices. If there isn’t a change, he feared that many dental practices would go to the wall.
Listen from around 18.07
Wednesday 22 July
Times Radio: BDA says private dentists have received no support from Government
BDA vice chair Eddie Crouch was interviewed on the Times Radio Breakfast show yesterday (21 July), discussing the news that public sector workers are to receive a 2.8% pay uplift. The presenter asked why dentists are getting a pay rise when the government has said the pay rises reflect the efforts of healthcare workers during the COVID-19 crisis when dentists couldn't 'contribute'. Eddie said: "For the last decade it's one area [dentistry] of the health service where we've seen a decrease in funding. Many years of zero pay uplift or below inflation uplift. This is a step in the right direction to help the sustainability of dental practices which are going through the most difficult period in my whole career." In response to the question that dentists couldn't open, so couldn't contribute during the epidemic, Eddie said: "Many of my colleagues have been open, they have been triaging...many are working in urgent dental care centres, many in hospitals were working in Covid wards and doing GAs. It's quite unfair to say we weren't working, we were doing many things, we were redeployed, many colleagues I'm very proud of, as they stepped up to the plate."
In response to the question about the challenges faced by dentists are after being locked down for so long, Eddie said: "Many practices operate not only as an NHS practice, which this award is related to, but many practices are also private or mixed. And it is often the private income that subsidises the NHS services, there has been absolutely no support for my private colleagues, and we hear on a daily basis that many practices are quite close to closing, and that will put terrible pressure on the NHS if it's not supported. It's a step in the right direction to help mixed practices, but we need more support. Because many practices at the moment are not operating anywhere near like where they were in February, and many practices are not generating income from private work that will support them, and that is a real fear.
He said private dentists have received no support from Government, as they are over the threshold for eligibility and can't even get bank loans. He called for an urgent review of the current procedures, to help dentists ensure their practices can be sustainable. He expressed sympathy with those not in the public sector who are facing pay cuts and job losses and says the situation is awful for the entire workforce. He said: "I'm not ungrateful for the fact we have had an uplift at a time when we desperately need it. But I have sympathy for those who've had a pay cut. For many years going back dentists have had pay freezes and this is someway of stepping up the changes back to where we were previously, many colleagues have seen a 25% cut in their income over the last decade because of public sector pay freezes."
BBC Radio Oxford: BDA warns costs could put some dental practices out of business
This morning on the 6am news, BBC Radio Oxford quoted the British Dental Association as saying that dental practices are facing a rise in PPE costs of up to 6,000%; and warned that an unpredictable international supply is making prices fluctuate. The news presenter went on to say that the BDA was concerned that the rising costs could put some practices out of business. In an interview, BDA vice chair, Eddie Crouch said that this is the worst crisis in dentistry that he has seen in his 35 year career. He pointed out that that many private practices received absolutely no support all in the past three months and were reporting that the increased costs linked to the new infection control measures were making their practices unsustainable.
Scotland press: Before Covid-19 hit, years of pay restraint had already taken their toll… above inflation increases are starting to repair that damage
Several news outlets in Scotland cited the pay rise announced yesterday for NHS medical and dental staff, and included responses from the BDA, the BMA, as well as commentary from health secretary Jeane Freeman. BDA vice chair, Eddie Crouch said that the increase in in pay – instead of another pay cut – would offer some comfort to NHS dentists in these difficult times. He said: "Before Covid-19 hit, years of pay restraint had already taken their toll. Above inflation increases are starting to repair that damage, and now must be pursued in tandem with other needed action to keep this service afloat. He called for a concerted strategy to ensure the nation's dental services – both NHS and private – have a future. The response from BMA Scotland chair Lewis Morrison noted that doctors in Scotland have had up to 30 per cent real-term pay cuts over many years and almost all recent pay uplifts have fallen short of being acceptable.
The Scotsman: Dentists want to provide the best treatment for their patients but ... some people could have teeth removed unnecessarily
An article in The Scotsman outlines the graduated return of dentistry and what services that NHS dental practices are permitted to provide for patients. It notes that the Scottish Government's phased return of NHS dental services in three stages was originally outlined in a letter to the BDA from Scotland's chief dental officer (CDO) Tom Ferris on 20 May. This states that the situation is extremely complex: "We need to be mindful of the oral health needs of patients balanced against the wider situation with Covid-19, and the essential requirements that we reduce the risk of community transmission and protect both patients and dental teams," the CDO said. The article points out that we are in the second phase of dental practices opening, which commenced on July 13 and this excludes aerosol generating procedures.
Elsewhere on Sounds radio station, BDA spokesperson and member of Scotland Dental Practice Committee, John Davidson said that dentists want to provide the best treatment they can for their patients but were concerned that restrictions on dental practices meant that some people could have teeth removed unnecessarily.
Sounds recording is unavailable
Tuesday 21 July
BBC Newsline: NHS dentistry hasn't been viable for a long time but I can't manage it any more
The evening news bulletin on last night's BBC Newsline aired the financial plight of dentists as they opened their doors again for patients, providing APGs again if they could source level 2 PPE although dentists' costs exceed health service payments. In an interview, BDA Northern Ireland director, Tristen Kelso described the situation for dentists as a perfect storm, pointing out that Health Service and private dentistry have both been hit. He appealed to Department of Health to cover the cost of PPE, and said the profession is in crisis because of additional costs. He also said that the BDA is calling on the Executive to recognise this and provide assistance to practitioners. "I have been contacted by stressed dentists who simply cannot see a future without extra support," Tristen said.
The segment included interior shots of a practice in Downpatrick, and interviewed practice owner, Ciara Gallagher. She showed some of the PPE that is used by dentists now and explained that level 2 PPE needs to be changed in between patients Ciara said: "Every time we lift a drill we must be kitted up. PPE costs approx. £40 and must be changed for each patient, with an hour between for cleaning. The costs are up and the [patient] numbers are down". Ciara pointed out that it wasn't all about the money when she opened her practice doors yesterday it was about the care she could provide for her patients. That said, Newsline viewers heard that the treatment costs are such that "I have less than I started with". She also stated that NHS dentistry hasn't been viable for a long time but she can't manage this anymore.
In a statement, the Department of Health said that it would deliver 1m PPE level 1 to dentists this week, and the financial support scheme, agreed by the DoH at the beginning of the COVID crisis, was in place for a further month. The presenter concluded that COVID 19 has hit businesses hard and dentistry has a foot in each camp and has fallen through the cracks.
Watch from 8:57 to 11:47
ITV News: Dental practices are down to a fifth of their pre-Covid capacity
Last night's ITV news bulletin carried a warning that dental practices could be financially unsustainable with the high cost of PPE and lack of availability. In an interview with Richard Graham, the chair of the BDA's Northern Ireland Practice Committee explained that all the measures that dental practices have to adopt now means that dental practices are down to a fifth of their pre-Covid capacity. For instance, he said, if a practice saw 30-40 patients per day previously, the most they can see now are 6-8 patients and that's a big loss. Richard pointed out that there are 370 practices in NI and said he would be surprised if all of them are not concerned about their financial viability.
Listen from 1 minute 21 seconds
News Letter: Dentists urge Department of Health to cover cost of pricey PPE
Richard Graham, the chair of the British Dental Association Northern Ireland Practice Committee, warned that 90% of dentists in Northern Ireland may not be able to offer the full range of treatment, such as fillings, unless they have high levels of personal protective equipment (PPE) available. Items of PPE, which pre-crisis cost 35 to 40 pence are now being charged at £20 to £30 when dentists try to buy them. With the reduced number of patients that dentists can see, due to the covid safety procedures, this is making it financially impossible for many dentists to continue in the long term. Richard called on the Department of Health to cover the cost of PPE to ensure patients have a dentist to visit going forward. The Department of Health responded by saying that £1 million of PPE is due to be delivered this month and extra financial support for dentists in Northern Ireland would continue for another month.
News Letter - Leading NI dental figure: We are ‘on a knife edge’ as planned reopening of services falls flat
The Belfast Newsletter: Dental services on a knife edge in Northern Ireland
The Belfast Newsletter reports that dental services in Northern Ireland are facing a 'perfect storm' of being able to see limited number of patients and huge increases in the cost of PPE. Tristen Kelso, the BDA Northern Ireland director spoke to the Newsletter and explained that at the heart of the problem was the difference between level one and level two PPE. Level one was cheap and basic, but level two was required for dentists to perform procedures such as fillings. Tristen noted that as many as 80% of BDA members in Northern Ireland do not have access to the level two PPE. He noted that the Northern Ireland government were only suppling level one PPE and he would be taking the issue up with them this week on behalf of the dental community. He also noted that before the covid crisis a number of dental practices were struggling financially and the additional costs of the crisis could cause a number to of practices to close and would reduce dental access for patients in Northern Ireland.
Monday 20 July
BBC Northern Ireland: PPE costs are such that dentists would be generating a loss
Over the weekend and today, the BBC highlighted how the inability to source level 2 PPE caused the government to do a 'u turn' on closing urgent care centres today since many dental practices either do not have the kit to provide aerosol generating procedures, or they have got caught in a 'log-jam to get fit tested for masks.' In an interview on Friday's edition of The News at One, BDA chair of NIDC, Richard Graham, said it was great news for people who need access to emergency care that the urgent care centres would now stay open until the end of August and this, he said, would also provide breathing space for practices trying to source and purchase PPE. He said that a letter has just gone to all practices giving them delivery dates over the next three weeks for level 1PPE - that was needed from 29 June. He said that although this was a welcome help it doesn't address the underlying difficulties of sourcing level 2 PPE. However, Richard warned that the practices that managed to get the PPE and to get tested for the masks that they can't afford to treat NHS patients because the cost of the PPE is such that they will be generating a loss every time they treat someone on the health service, and that's just not sustainable. He said he would welcome a scheme similar to that in Scotland which is providing all the PPE centrally through government with an additional £3.7min to the dental budget because they accept that these Covid times are unprecedented, and the budget was set at a time when Covid did not exist.
The Stephen Nolan show also flagged up the difficulties for dentists in sourcing level 2 PPE.
https://www.bbc.co.uk/sounds/play/m000l36r listen from 07:57 to 13:35.
BBC Radio Foyle: There will be practice closures and health service patients will be forced to go private but what about those who can't afford it?
This morning's breakfast show on BBC Radio Foyle highlighted that although dental practices could open today it would be not be 'business as usual' and dentists are appealing to the Department of Health to pay for the extra costs for higher level of PPE. In an interview, dentist Meabh Owens estimated that it will take at least a year to deal with patient backlog, since 6000 treatments had to be cancelled during COVID. She explained that a dentist would be paid £9.39 for a small filling on a back tooth, and the cost of PPE alone for carrying out one of these procedures would be £20 to £30, and that's before you pay your staff, the dental nurse, the receptionist, or switch on the light, and simply put, practices won't be viable. She added that health service patients will be forced to purchase private treatment, but what about those who can't afford it? When pressed by the presenter on what would be the worst case scenario, Maebh said she has no doubt that practices will be forced to close because the payments are unviable, and those who are most disadvantaged won't be able to afford treatment. She also predicts that there will be a huge workforce issue as young dentists go to Australia and will never come back and those at the other end of the spectrum, will retire early. She was concerned that dentists don't have a seat on the management board and mentioned that the primary health strategy for NI is 14 years old, when it was recognised that people in NI have the worst dental health in the UK. She expressed concern that in the last five years alone £20m was taken from the dental budget and questioned whether there was a view that health service dentistry isn't worth saving.
Listen from 1:39:14 to 1:50:04
Sky News: Dentists warn of looming dental and mouth cancer crisis after months of lockdown measures
From early Saturday morning and throughout the weekend, Sky News (and hundreds of associated news outlets across the UK, including LBC News) featured an interview with BDA vice chair Eddie Crouch about the impact of the suspension of routine dentistry in March and the 'looming dental crisis after months of delays and patients being unable to get check-ups and repair work" done. The segment highlighted that since practices reopened in June that dentists are still facing significant restrictions on how they can operate, with rooms having to be vacated for an hour after any aerosol generating procedure. Eddie told Sky News that a lack of check-ups means missed opportunities to catch the early stages of mouth cancer. He said: "If people have got ulcers in their mouth that are not going away, really, they should insist on seeing a dentist face to face, that is available at most high street dental practices now because it doesn't involve generating a spray or an aerosol to actually just look at an ulcer in someone's mouth. If they're not picked up early, then my real worry is that the long-term success of treatment for these patients is going to be severely hampered."
Eddie also said that getting the right personal protective equipment (PPE) and the process of sourcing respirator masks has been a challenge, as is maintaining an ongoing supply of PPE, together with the concerns over inflation-busting prices, making the equipment almost prohibitively expensive. However, Eddie highlighted that "the biggest challenge" has been the "lack of science" under pinning some of the guidance. "The science is in sort of a lag behind the virus itself and therefore we're dealing with a very risk-averse process at the moment," he said.
The segment also included an interview with practice owner Maezama Malik, who said her biggest worry is that a patient might have "something minor that could progress in a few months" without them seeing a dentist. She said: "We have to deal with the deluge where patients have had a three-month hiatus and they haven't had their regular check-ups and their hygiene appointments, and the things that could be spotted early. But we're prepared for that, we're doing everything we can to get patients in and to work through the backlog." Maezama said this included finishing treatments that had started just before lockdown, such as replacing crowns and dentures
The Department of Health and Social Care says it has "taken action" to "support patients and businesses". A spokesperson from the department said: "NHS England and Improvement have also put robust arrangements in place to ensure patients can continue to access NHS dental treatment."
BBC Radio 5: Backlog of patients could mean that some cases of oral cancer will be missed
BBC Radio 5, a news bulletin on Sunday Breakfast programme carried a warning from the BDA that because of the backlog of patients waiting to see a dentist that it could lead to some cases of oral cancer not been diagnosed, and with strict restrictions in place dentists see far fewer patients than before the pandemic. The segment also included interviews with two dentists discuss, who discuss in detail how dentistry has changed dramatically for patients and dentists, and air their concerns on how problems can develop when patients miss out on their check-ups, including delays in detecting oral cancers.
Listen from 07:35:45, 5:0
Good Morning Ulster: There is a crisis happening right now in dentistry
In a discussion about changes to dental practices opening today in NI, dentist Alan Clarke said there is a real shift from dentistry that people would recognise pre-Covid. He told Good Morning Ulster listeners that there is a crisis happening right now in dentistry. He explained that dental staff have to adopt the same level of PPE coverage as those working in intensive care to protect patients and staff, and this comes with significant costs, PPE costs approx. £30 per patient interaction. He pointed out that filling brings in approx. £9.50, but this has to cover staff costs, and an hour's settling time, therefore remuneration will not 'break even' for NHS care He said that sadly if no action is taken by the Department of Health, it will cause the system to privatise or practices will go out of business. He said that the practice he works in has provided care for generations for 34 years, in a disadvantaged area and it would be sad if the practice could not continue to provide care.
At the end of this segment, the health correspondent said that the Department of Health was due to meet the BDA later this week to discuss costs.
Listen from 1:31:25 to 1:32:34 for news update, and from 1:36:37 to 1:45:58