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Capital funding: The way forward on fallow time

Blog Author Eddie Crouch

Blog Date 16/11/2020

​BDA Chair Eddie Crouch on why government support is the key to reducing fallow time and getting millions of patients back through dentists' doors.


  Eddie Crouch speaks to BBC Breakfast about the patient backlog


Restrictions on dental practise are with us for the foreseeable future.


Since the first lockdown, we have been reaching out to members to track the impact of the pandemic. Whether that’s support for the self-employed or PPE shortages, the stories you’ve told us have shaped the case we’ve made to governments in Westminster, Holyrood, Stormont and Cardiff Bay.


Now, we have another crucial call to government borne from the vital evidence that members have been sharing with us and it is this: Practices need capital investment from the government to help reduce their fallow time, increase capacity and, once and for all, improve access for all.


We’ve set out the case direct to Matt Hancock, and to each devolved administration. Here’s what you need to know:


The ‘skeleton service’ remains

“The oral health time bomb is ticking and we cannot afford to lose the chance to act on the early signs of decay, gum disease, and oral cancer.”

Across the UK, the overwhelming majority of practices - some 70% - are still running at less than half their pre-pandemic capacity.


Yes, there’s some variation by region, nation, and NHS commitment, but we are light years from business as usual. Furthermore, it’s about the kind of treatment practices can carry out.

All the UK nations report reduced time available for routine care, and a sharp focus on urgent and emergency cases.


Colleagues are firefighting with huge backlogs, and patients are still being left out in the cold.


In England alone, some 19 million NHS appointments that would have taken place in a typical year haven't happened.. Oral health problems bottled up during lockdown are still being managed through a system with little give, and problems that could and should have been nipped in the bud, are being missed.


This low capacity means the oral health time bomb is ticking and we cannot afford to lose the chance to act on the early signs of decay, gum disease, and oral cancer.


Ventilation: the Catch-22

The number one barrier facing dentists in upping their capacity is fallow time. In order to reduce fallow time, practices must have effective mitigation in place.

The recommendations from the new standard operating procedures (SOPs)  are certainly welcome however they offer theoretical savings that only those who are familiar with, and can  meet the air change requirements,  can bank on. Many are simply not in this position.


The reality is that most practices simply don’t hold data on their air change levels, and the majority can’t afford the equipment that could cut fallow times to the new minimum.


“We have a chance to restore services to millions, but without support from Government it won’t translate into access.”

Industry sources suggest a typical practice now faces costs of over £10,000 to get mechanical ventilation in place.


That’s the Catch-22. Yes, the new SOPs could bring back a dose of normality to this service -  but the caveat is that the come with a multi-million-pound bill that dental practices simply cannot afford.


A high proportion of practices tell us they will struggle to maintain their financial sustainability over the next 12 months. NHS contract holders have support in place, but the threat of a reimposition of arbitrary targets looms large for many. Private practices meanwhile have been left to go it alone.


Too many feel they are on borrowed time.


On paper we have a chance to restore services to millions, but without support from Government it won’t translate into better access for our patients.


A solution that pays for itself

COVID-proofing comes at a cost, and the surveys, the kit, and extensive building works cannot be borne by practices alone.


If mechanical ventilation now represents an official solution, then it falls to the authors of new guidance to help get it in place.


Capital investment has always been thin on the ground for dentists. Practices in England haven’t seen a penny from central government in well over a decade. In Scotland there is a record of support for decontamination units. But real support is now needed in every UK nation.


Private practices provide vital access to services - without which NHS dentistry would not cope. Dentists providing private care face the same challenges as their NHS colleagues. So it is our view that, in the interests of public health, capital funding must be open to all. The same principle applied recently to the funding for care homes, which also operate in a mixed economy, should apply to dentistry.


And government would quickly recoup any costs.


In England alone, the pandemic has blown a more than £0.5 billion sized hole in the dental budget. Patient charge revenue has plummeted and will need topping up by Treasury contributions.


Investment here would pay for itself and help get millions of patients back through our doors.


 Eddie Crouch


Eddie Crouch

BDA Chair