At this crucial moment in the COVID pandemic, Tristen Kelso reflects on the impact of recent changes to operational guidance, and the funding available to dental practices.
It has been a busy and uncertain week for many of us. As Northern Ireland’s Chief Scientific Advisor warned us that further COVID-19 restrictions are likely be recommended before Christmas, dentists have continued to process new operational guidance, while discussions on future funding for Health Service dentistry have continued. Against this backdrop, we’ve been working hard on your behalf.
Voicing your concerns to the Health Committee
This week, we briefed the Assembly Committee for Health on the impact the newly revised Operational Guidance will have at practice level. We emphasised that while reduced fallow-times are now possible, there are a range of barriers that will continue to prevent seeing anything like a return to pre-COVID activity levels.
“Surgeries with no mechanical or natural ventilation will be particularly hit.”
Interrelated factors ranging from fixed levels of funding for PPE, the physical and mental toll of wearing enhanced PPE on practitioners and staff, social distancing measures, and of course the varying ability of practices to achieve the lower fallow-time provisions through having adequate ventilation in surgeries, have all been highlighted.
Under new guidance, fallow-time depends on each surgery’s ventilation status. This is set to become a permanent feature, which when added to environmental cleaning requirements will have a significant bearing on activity levels possible in practices. We made clear that practices which have surgeries with no mechanical or natural ventilation will be particularly hit under new guidance.
Funding dental practices is essential
Our first priority has been to work to bring a degree of financial stability to the GDS. That objective has been achieved to some extent for Health Service committed practices, and we look forward to confirmation of FSS 2 support. This will be in place to the end of the financial year, and we expect details to be shared with practitioners in the coming days.
“The government’s support to practices with mixed or mainly private earnings has been wholly inadequate.”
However, it remains a great source of frustration that the government’s support to practices with mixed or mainly private earnings has been wholly inadequate. We have consistently elevated the concerns of private dentistry to the NI Executive, and to individual Ministers on numerous occasions. However, Minister Swann’s recommendation to Minister Dodds, that a Business Support grant scheme for private dentistry was needed, appears to have fallen on deaf ears. We have repeated these concerns once again in our latest submission to the Health Committee, and will not stop campaigning on your behalf.
For FSS funding to be adequate meanwhile, activity levels must be set at a realistically achievable level. This is particularly important in light of other constraints that apply beyond merely fallow-time, and while we navigate our way through a second wave of COVID. Looking forward, additional funding will be required if activity levels are to increase to meet additional PPE and other significant variable costs. We’ve made this clear to the Department of Health in ongoing negotiations over recent months.
Ventilation and the road ahead
Our message to MLAs is clear. The vast majority of dentists are doing their utmost to provide the maximum care they can to their patients at this time. New restrictions imposed on practices during COVID continue to severely curtail the volume of activity that can be provided, and are likely to do so for some time. Practices must be given the maximum support possible to enable them to continue to deliver the optimal level of care possible to patients in these difficult circumstances, without arbitrary, unrealistic targets being imposed.
We need a baseline audit of practice ventilation capacity to be carried out, so that we understand how practices are equipped to move forward, perhaps when other restrictions ease. This is a process that needs to be worked through.
The issuing of revised guidance should not force vast numbers of practitioners to rush out and spend large sums of money on new equipment. Our position with DoH has therefore been that no conditions based on attaining lower ventilation levels should be attached to FSS 2 arrangements.
Where investment may be required, even in the absence of arbitrary activity targets, then government support should follow. We will continue to input on the practical outworking of the operational guidance on your behalf in the months ahead, and to press for a course of action that supports practitioners, without adding to the pressures they are under.
BDA Northern Ireland Director