While dentistry has faced unprecedented challenges over the last couple of years, practising dentistry on an island comes with its own additional set of complexities. Twenty of the Orkney islands are inhabited. With an ageing population and an increase in the number of people relocating to rural areas during the pandemic, the new Local Dental Committee (LDC) in Orkney will be vital to support the evolving needs of the community.
The LDC has been set up to ensure we can provide the best possible service for the people of Orkney and champion best practice in remote and rural dentistry. Effective representation and political engagement are vital to addressing local concerns. This has been the driving force behind establishing Orkney's first LDC.
Local solutions for recruitment and retention issues
Many of the challenges we face in rural and remote dentistry are the same as those faced by health boards nationwide, but with additional complicating factors. The issue of recruiting and retaining staff is a prime example of this.
In Orkney, we have taken a very long-term view on recruitment and retention, actively managing that process. As a result, our clinical team is largely made up of dentists we have engaged with from very early on in their careers. Challenges in recruiting dental staff have largely been overcome by incentives and on-going communication with dental students from Orkney; for example, all our VTs to date have chosen to stay on with us following training. Our LDC may help us share these approaches to support other areas.
Challenges in recruiting dental staff have largely been overcome by incentives and on-going communication with dental students from Orkney.
Retention of support staff is currently the single biggest threat to our service. The current level is far below the Public Dental Service Agenda for Change support staff rates. The Scottish Government need to recognise the discrepancy in rates for this work. We struggle to compete with other support work opportunities, particularly within a small community with a limited recruitment pool and no financial incentives to encourage relocation.
We have fought hard to retain funding incentives for clinical staff, and although we have since had assurances from government that these will not be removed, we are already seeing that they are being eroded away on a small scale. We're hoping that the LDC will help us to address this urgent issue and to ensure that we retain the financial incentives that are in place.
Unique challenges to providing dental care
For all people living in remote and rural areas, access to dental care can be a challenge, and Orkney is no exception. When the first general dental practice was set up in Orkney in 2014, we saw a lot of patients presenting with acute issues due to the barriers to access. There's a move towards centralisation in Kirkwall on the main island, but many patients are based on the outer islands. So, we have to consider the economic impact of travelling for treatment, and the carbon footprint this creates. Covid has added additional risks, with patients needing to travel on a public ferry or plane to receive care.
When the first general dental practice was set up in Orkney in 2014, we saw a lot of patients presenting with acute issues.
We hope to look at the possibility of establishing a remote mobile service to visit outer isles, but this will be challenging within the existing NHS framework. The LDC will provide us with a useful platform to seek support and guidance to try and make this happen.
A growing population and limited referral pathways
Changing work patterns have led to increasing numbers of people choosing to relocate to the island, which means that our waiting lists to join the practice are substantial. We currently treat more than three quarters of the population of Orkney and it is going to be a serious challenge in the next couple of years to work through the backlog and ensure everyone can be seen. In addition to the newcomers, we also have an ageing population in Orkney, so we see large numbers of patients with dentures and complex oral health problems.
We often have to deal with things ourselves in-house, as specialist care means patients taking a flight off-island.
While dentists in other areas might send patients to dental hospitals for treatment of some of these issues, we often have to deal with things ourselves in-house, as specialist care means patients taking a flight off-island. There are currently limited referral pathways outside of emergencies due to Covid and health board staffing issues. While we can cover a range of specialisms in-house, this is not sustainable. We want to re-establish that aspect of our model as it is vital to the effective provision of our services. The LDC will be instrumental in discussing and lobbying the board to re-instate a model that works for both us and the hospital services.
Communication is key
Another benefit of the new LDC will be the opportunity to flag up issues specific to island life. We face particular logistical issues as an island location. These include dealing with delivery of equipment, to managing support engineers if something breaks down. We work very closely with the Public Dental Service, and effective communication is essential to this, which the LDC will support.
Living amongst your patients is another unique aspect of operating in Orkney – on an island, you see your patients everywhere, from the shops to outside the school gates. This brings benefits but also challenges, which were highlighted by the interruption of service during the pandemic. Receiving little notice on changes made us appear disorganised and out of the loop to our patients when we had to, in turn, provide them with little advanced notice.
Effective and timely communication with the public is essential to our ability to operate well. The LDC will be instrumental in addressing this, helping us to keep everyone up to date with the ever-changing dental climate.
The LDC adds to the opportunities we now have across different committees to be part of the dialogue about changing how dentistry is provided in Scotland. That's an exciting and unique position to be in, especially for remote island representatives, because service delivery is not designed for island demographics. To have a say in shaping our future, means a great deal to us.
To have a say in shaping our future, means a great deal to us.
Seeing the level of engagement from our clinicians is extremely rewarding and we are proud of all we have achieved to date. To have representation in a formal structure like this is not something we have experienced before, and we hope it will make a real difference.