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COVID-19 and dentistry: Eight lessons that must be learnt

Blog Author Eddie Crouch

Blog Date 02/12/2020

​COVID-19 is far from over. But BDA Chair, Eddie Crouch, tells us what lessons must be learned on vaccination, access and the essential role of dentistry.

 

My predecessor spoke to Parliament’s Health and Social Care Committee this summer on the ‘existential’ challenges facing dentistry during the COVID-19 pandemic. Those challenges remain, and MPs have now launched a joint inquiry recognising that lessons must be learnt for future phases of the crisis, and for any future pandemic.

 

The COVID-19 pandemic was unprecedented and the Government had a duty to act, sometimes without waiting on a clear evidence base to emerge. However, mistakes have been made and some of the choices made since March have had a devastating impact on our patients and the sustainability of dental practices.

 

Here are the lessons we must learn from this crisis:

 

1. Dentistry is an essential service

“Choices made at the outset effectively categorised dentistry as a ‘non-essential’ service.”

We reluctantly accepted the case for lockdown, but choices made at the outset effectively categorised dentistry as a ‘non-essential’ service. This must be avoided in future. The shift to an urgent dental care model – operating at less than a thousand sites, as opposed to over 12,000 practices UK-wide – appeared to have been largely predicated on a PPE shortage, rather than the best interests of patients.

 

And we’ve seen the results. In England during May less than 3% of patients were able to access NHS dental care compared to the same period last year. By our reckoning over 19 million NHS appointments were lost between March and October. And as practices continue to operate with severely reduced capacity, this backlog continues to grow.

 

Dentistry isn’t an optional extra. Our teams are made up of key workers, providing an essential service to millions. With appropriate standard operating procedures in place and reliable supplies of PPE, we would hope and expect that there will be no suspension of face-to-face care during further phases of COVID-19, or in any future pandemic.

 

2. Restrictions require corresponding support

Social distancing and other infection control measures have had a huge impact on the ability of practices to deliver care and maintain their bottom line. But corresponding support has been absent or uneven.

 

Private practices were left out on a limb during lockdown, while almost all their neighbours on the high-street got support on business rates. NHS contractors were offered support, but now face real questions on what will be maintained in the months ahead, while restrictions remain in place and patient numbers haven’t recovered.

 

“Investment in ventilation is an obvious way forward.”

Fallow time is a case in point. Most courses of treatment involve aerosol generating procedures. We believe that if you accept the precautionary principle that this may put patients or staff at risk, you accept the obligation to provide support.

 

That’s why, we see investment in ventilation as an obvious way forward. This restriction has seen patient numbers fall to the floor. Capital funding for dental services has been non-existent for decades. While point of treatment lateral flow testing and access to a vaccine could reduce these challenges, investment is still required to future proof this service. If governments are going to make rules for healthcare that carry consequences, support needs to follow.

 

3. Private dentistry exists

All four UK governments have singularly failed to even recognise the ‘mixed’ economy on which dentistry is based.

 

We’ve made our case direct to the Chancellor. The private sector now represents 60% of spend on dentistry in the UK, and with the exception of the furlough scheme and access to credit, it has pretty much had to go it alone while trying to provide vital access to patients.

 

The return of VAT to PPE in November has been viewed as a tax on safety for private colleagues, who are ineligible to access free PPE via the Government’s NHS hub.

 

If officials are going to develop plans to maintain patient care and support this sector, they have a duty to consider where the most money is now being spent. Private dentistry must not be ignored.

 

4. Activity-based contracts don’t work

“The pandemic has aggravated deep seated problems in a service that was already facing a crisis.”

The pandemic has aggravated deep seated problems in a service that was already facing a crisis.
The target-based NHS contract in England and Wales was unfit for purpose before COVID-19 hit, but has proved utterly incompatible now with the Government’s wider policy response. The same has been observed of the Item of Service models in Northern Ireland and Scotland.

 

In England, the low remuneration for time consuming urgent care (1.2 UDAs) relative to a quick routine check-up (1 UDA) now means, any move to re-impose this failing system would force dentists to deprioritise those most in need to meet arbitrary targets to avoid steep financial penalties.

 

Future proofing these vital services requires an urgent move towards a reformed system.

 

5. Don’t leave IT on the back burner

I’m proud of how colleagues adapted to the brave new world of remote triage. But they weren’t done any favours by the lamentable IT systems most of us are working to.


Remote consultations and triaging will clearly form part of the response to any future pandemic.


However, the long-term failure to ensure effective digital integration among NHS providers has been plain. Dentists’ inability to access electronic prescribing and summary care records has significantly reduced time available for direct patient care.

 

We’ve asked Government not to wait on the next calamity to provide an appropriate, integrated digital infrastructure for dentistry.

 

6.  Keep dentists in the loop

We’ve read elegant slogans draped on Downing Street lecterns, but colleagues have lamented the lack of communication as far as this profession is concerned.

 

For those on the front line messages have been late, or open to interpretation. This resulted in widespread frustration: dentists working against the clock following an eleventh-hour call to reopen and patients unclear on what levels of service they could access.

 

Failure to manage patient expectations has been the number one criticism of the Government’s COVID-19 record. 73% of practices in our latest survey expressed dissatisfaction, ahead of all other measures, be it PPE availability, quality of guidance and even financial support.


Many colleagues in England remain justifiably angry that they first heard about practices reopening on 8 June via the BBC news’ ticker tape during a Downing Street press conference.

 

As this crisis moves to its next phase - and in any future pandemic - the Government has a responsibility to keep us in the loop.

 

7. Be prepared on PPE

We alerted authorities to the shortage of key PPE in early February, as key supply chains from China began facing widespread disruption. Our concern that dentists would soon have to ‘down drills’ was viewed as an overreaction. Little over a month later that is precisely what happened.

 

For much of this pandemic, members have reported access to kit and testing as the number one challenge they face. We now have more robust, home-grown supplies of PPE. But any future failure on stockpiling, supply chains and overall preparedness would result in a return to an unacceptably limited urgent care model in any future pandemic.

 

8. Take a logical approach to vaccines

“We remain concerned that dentists – in both NHS and private settings – will not be given priority to the COVID-19 vaccine.”

A rapid rollout of a COVID-19 vaccine could be a game changer, and Government advisors have recommended that all health professionals should be near the front of the queue.

 

However, we remain concerned that dentists – in both NHS and private settings – will not be given priority to the COVID-19 vaccine. As we’ve seen in England, where NHS contractors in England have been excluded from the free flu vaccination programme. Given volunteers are being sought from across the workforce to deliver the vaccine, we need to avoid a surreal situation where dentists administering the vaccine are likely to be ineligible to receive it.


Crucially, any failure to prioritise dental teams in the COVID-19 vaccination programme will further hinder access to dental services for patients, a logical approach is needed.


We have seen what life is like without dentistry, and for the majority of the population now seeking routine care that situation remains. The mistakes of the past cannot be revisited.

 

Eddie Crouch 


Eddie Crouch
BDA Chair