BDA Chair Mick Armstrong outlines the case he made to Parliament's Health and Social Care Committee and why dentistry faces an existential crisis in the wake of COVID-19.
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In a word, that's the impact that COVID-19 has had on both the nation's oral health and its dental services.
I had the opportunity to speak for the profession to the Parliament's Health and Social Care (HSC) Committee on 16 June. The watchdog was tasked with looking at the impact of the pandemic on England's healthcare services.
The effects on general practice - both NHS and private - has been devastating and is probably existential.
We all know dentistry was not in a great place to start off with. With oral health inequalities that show no sign of closing, rock-bottom morale and retention problems, the pandemic has made a bad situation so much worse.
I set out to tackle these difficult questions at the HSC Committee head on. Here's a summary of the case I made.
Tackling the backlog
Primary dental care was virtually non-existent during lockdown. And if we look at official figures it amounts to around eight million courses of treatment that went undelivered.
"12,000 dental practices were effectively replaced by a few hundred Urgent Dental Centres."
12,000 dental practices were effectively replaced by a few hundred Urgent Dental Centres. They've done a sterling job in very difficult circumstances, treating the most urgent cases, but it's clearly no replacement.
My practice alone has cancelled 6,000 appointments and we will be cancelling another 3,000 until September just to deal with our urgent case backlog.
In West Yorkshire we've had more than our share of access problems for over a decade. Sadly, these
problems will now be visible in every community in this country.
Dental practices that did reopen and return to work on June 8 are simply in no position to tackle the backlog, let alone new cases.
Back to work – and in need of more support than ever
Yes, some practices have resumed face-to-face care. However, those that have are running a tiny fraction of their pre-pandemic capacity.
Social distancing, decontamination, fallow periods all add up to a radically reduced patient volumes.
For NHS and private dentists that time comes at a cost. In my practice we'd normally offer 150
appointments a day, it's now 10-15. This affects patients and make business unsustainable.
Pre-COVID you could protect a patient and staff with PPE at a cost two or three pounds. Now it costs over
40 pounds per patient.
We've shared with MPs the feedback from our members. Private and NHS practices are on the brink, with only 8% confident that they can maintain their financial sustainability long-term.
The support for private practice that was missing during lockdown (business rate relief and financial support) is needed now more than ever. PPE that's in short supply needs to be made available to all through the Government's chain.
It is now asking the impossible to keep doing dentistry in small numbers - and we will need long-term investment.
Finding a new model
This cinderella service needs to see change. The very model dentistry is based on has been demolished in the face of fewer patients and higher costs.
All practices now need support.
"NHS contract holders need to know that activity won't be the only measure of performance, now we've entered a world where activity is all but impossible."
Private practices, left out on a limb, represent more than half the total spend on dentistry in the UK. If they fail their patients simply have nowhere to go. NHS contract holders need to know that activity won't be the only measure of performance, now we've entered a world where activity is all but impossible.
The HSC Committee Chair Jeremy Hunt pledged to revive the inquiry into dentistry that we secured last year, in the face of mounting access problems across England.
We've already written to thank him. We could only cover a few bases in this latest session, but we need to cover the fundamentals and soon.
The time has come to tackle the big questions: How will a future service operate? Who it will treat? How it will be funded?
As we told Matt Hancock, that conversation needs to begin now.
"A page must be turned. We need leadership and we need a plan with clear lines of communication and influence."
Throughout the session, MPs consistently brought up leadership and yes, we've seen problems from the get-go. We had one working day to prepare before we were told we could open. There was a plan for dentistry ready to go for a week before it was released, but it appears "the system" and political will yet again got in the way.
A page must be turned. We need leadership and we need a plan with clear lines of communication and influence.
I said it to the committee and I'll say it again - this profession needs the chance to make our case. And we expect to be heard.
Mick Armstrong, Chair