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Northern Ireland: A dentist's perspective on providing care in the COVID world

Blog Author Philip McLorinan

Blog Date 28/09/2020

Dentist Philip McLorinan lists the ways in which his team has had to adapt to dentistry in the COVID-19 pandemic.

 

You know that first breath of someone removing their FFP3 mask? The one that is almost tangible relief that the AGP is over? It epitomises so much about what our professional lives have become.

 

It’s very different to the sigh of despair I feel when I read another story about patients not being able to get treatment when dental practices are ‘open again’.

 

Our reality

Fallow time means that dentists are having to work between two or more rooms to maximise their activity to get through the backlog of treatment that has built up over lockdown. Protocols imposed have turned a typical 30-minute pre-COVID appointment into one that now takes two hours.

 

Social distancing measures have resulted in reduced numbers of staff being present within the practice at any one time. We’re running on 50% of our normal staff level.

 

The combined effect of social distancing measures and fallow time means that we have reduced clinical capacity and are only able to see a small fraction of patients compared to before.

 

We seem to be busier than normal, which is strange because when we look at the actual items of treatment carried out, our output has been slashed when compared to last year. In the past it was common for us to have 180 patients a day attend our practice for care, now we typically only accommodate 30 patients a day, which is about 15% of previous attendance.

 

We are currently working through the backlog of patients who presented to and contacted the practice during lockdown with problems. We are seeing many patients for whom a simple solution which could have been offered back in February or March has turned into a much more complicated treatment plan, and on some occasions the initial plan has been abandoned and a previously salvageable tooth has been extracted.

 

Whilst dealing with the backlog and the list of abandoned treatments we are also now being contacted by an increasing number of patients who have had issues which they have been self-managing or who didn’t want to bother us with during the lockdown. Their problems are now beginning to boil over and need urgent attention. I am concerned there is a common misconception that ‘it’s business as usual’ in dental practices since restrictions on the care that can be provided have been relaxed. Unfortunately, the reality is very different.

 

We clinically prioritise patients in most need which is challenging because we know that all our patients want to be at the top of the list. We are so used to doing our best, however during the new normal there are times we are not able to do our best for our patients and this is upsetting for us as a team.

 

Working through these outstanding issues is having a knock-on effect on being able to recommence ‘routine check ups’. I fear that there will be a lot of undetected disease which will include oral cancers.

 

A new rule book

Appointment books vanished overnight and are now being rebuilt. Staff rotas changed radically to comply with requirements of social distancing and the furlough process. Training and communication was ramped up to help the team feel safe and to be confident in new procedures and policies to reduce the risk of transmission of COVID-19.

 

Additional time is required during the working day for time away from the enhanced level 2 PPE. PPE is obviously essential in keeping everyone safe, however it is extremely challenging to wear, restrictive in movement, it plays havoc with body heat regulation and seems to suck every bit of moisture from your body.

 

The appointment book had to be reinvented to enable dentists to alternate between chairs with dedicated appointment times set aside for AGPs, non-AGPs, telephone triage, emergencies, additional PPE breaks, deep cleaning – the list goes on.

 

Many of my team are finding that after 3-4 AGPs in a day they are both physically and mentally drained, so we must strike a balance between what our patients want and the wellbeing of the team providing that care.

 

Like the majority of the population, we have worries about financial stability and job security. As a mixed practice we have received some support from the Department of Health in relation to the NHS element of the practice, however the private element of dental practice has fallen between the cracks of government support despite much lobbying.

 

Some light in a dark place

As a practice owner I am so proud of how my team have risen to the challenge. Many were and are still understandably worried and concerned about treating patients safely and like many, they fear taking COVID-19 from their workplace to their homes and vice versa.

 

With the recent announcements of increasing COVID cases, increased level of alert and increased restrictions outside of the work environment, the next few months will be extremely challenging. Our profession will endeavour to provide the best service it can for patients, however it is essential that the teams are aware of their own wellbeing and ensure good channels of communications are maintained. As we have heard many times, we are all in this together.

 

 

Philip McLorinan
Dunmurry Dental Practice