A practice owner in Lancashire tells us how he set up two urgent dental centres and how the pandemic has exposed cracks in the funding of NHS dentistry.
It’s been a hell of a month! Easily one of the most stressful and bizarre of my career. At the start of March, I had five busy practices with 60 staff working in them. Now I have only two practices operating as cold urgent dental centres (UDCs) with six dentists working across them every other day.
Setting up UDCs: Leadership at a local level
The suspension of routine dental care on 23 March thrust us into a world of uncertainty. At first, it was unclear whether we’d receive the funding that we needed to stay in business and support our staff, and we had no idea what to tell our patients. The pressure was immense, as 60 people turned to me looking for answers that I didn’t have.
In terms of patient care, it was clear that UDCs needed to open as soon as possible to safely provide urgent care to our patients. But official guidance was slow to come. It was very frustrating to see nothing from the Chief Dental Officer (England), while new guidance was being issued in Wales and Scotland. It was a big relief when moves were made locally to fill this gap.
"We then worked together to create a regional Standard Operating Procedure to make this possible."
Our Commissioner and Local Area Team reached out to local practices early on asking for UDCs to be set up. Two of our practices were chosen to become UDCs based on their location. We then worked together to create a regional Standard Operating Procedure to make this possible. We based it on the guidance being issued in other UK countries, which meant that we weren’t starting from scratch when the guidance was finally issued.
We had difficulties sourcing PPE, managing staff rotas and adjusting to new ways of working. But we worked with the local Emergency Dental Service and have provided safe urgent care to our patients using non-aerosol-generating procedures (AGPs). I’m happy to see that a hot UDC, set up with full PPE and designed to allow for AGPs, has now opened in our area to treat the patients that we can’t.
Cracks in the system exposed
It’s very hard to know what will happen next. So far, the demand for urgent care is lower than expected. We know that some of our patients are in need of care but are too afraid to come in. We hope this will change in the coming weeks.
In the meantime, it’s important not to forget that we faced challenges before COVID-19. March is often a make-or-break month for dental practices. Here in Lancashire, we were already struggling with very low UDA rates. Associate and operating costs are rising too. We’re working hard to meet some of the highest rates of dental need in the country. I worry that the funding package unveiled by the NHS may not be enough for some already struggling practices.
"This pandemic has exposed for all to see, that the current system of NHS dentistry funding is not fit for purpose."
This pandemic has exposed for all to see, that the current system of NHS dentistry funding is not fit for purpose. I hope that one of the lasting effects of this national crisis will be a reassessment of the way NHS dentistry is funded – we need a system which prioritises prevention and better serves the areas of highest need.
Important lessons about NHS Dentistry funding
When you’re part of the NHS, you’re part of a family. Despite the challenges, we’re working to support each other and provide for our patients. At a practice level, we did our best to open for urgent care quickly and safely. Our Local Area Team and Commissioner worked to make this possible and, after an agonising delay, we got word that NHS practices would continue to receive funding, despite the suspension of routine care.
I’ve always been proud to provide NHS dentistry. Now, I’m prouder than ever. I worry everyday about the impact this outbreak is having on my staff, patients and business. I hope that in the long term we will learn important lessons about how NHS dentistry is funded, so that we can reduce health inequalities and improve the sustainability of the service.