Our chair Mick Armstrong outlines the seismic impact of the COVID-19 pandemic on dental services.
The repercussions of the COVID-19 pandemic could devastate the UK's dental services. Our findings, based on evidence provided by thousands of our members in response to the government's Health and Social Care Committee's request, have laid this bare.
This investigation into the impact of COVID-19 on healthcare services was initially limited to just ‘core’ NHS services - cancer, maternity and mental health. But we persevered and did not let up until the committee made the right decision to include us.
Too often we become the "Cinderella service" (overlooked and undervalued), but colleagues know the truth. Whether you are NHS or private, working in a community clinic or on the high street, you are a core part of this nation’s health service.
Here are the five core issues we have outlined in our case.
1. The access problem is going from bad to worse
The need for dental services is not going to disappear. In fact, current inability to access care means it’s likely we’ll see more demand than ever for NHS and private dental services in future.
As we all know, access to NHS dental services was fragile prior to the pandemic. Our analysis of the government’s GP survey last year showed that levels of unmet need for NHS services in England amounted to over 4 million people, or nearly 1 in 10 of the adult population.
"Currently a maximum of eight patients a day per surgery can be treated in Urgent Dental Centres, compared to a pre-pandemic capacity of over 30 at NHS practices".
In addition to the backlog of need accumulated during the lockdown, there will now be further build-up due to ongoing measures to limit COVID transmission when dental practice resumes.
Currently a maximum of eight patients a day per surgery can be treated in Urgent Dental Centres, compared to a pre-pandemic capacity of over 30 at NHS practices.
Should that maximum remain in place it would mean a drop in access for tens of millions of patients.
2. An oral health gap is set to widen
Loss of treatment and preventive services is already having an impact - and it is hitting those from disadvantaged and vulnerable groups the hardest.
These are the high needs patients, the ones who will face greater difficulty in accessing or travelling to urgent care hubs, who are the key targets of the public health programmes that effectively ended on lockdown.
Recent Public Health England data revealed a more than ten-fold difference in severity of dental decay between five-year-olds in rich and poor communities. With routine care shut down, that gap is set to widen.
Preventive programmes, including fluoride varnishing and supervised toothbrushing for children, were targeted particularly at disadvantaged groups, who will feel the greatest effect of their cessation. Post-pandemic the answer lies not in cuts, but doubling down on prevention.
3. All are struggling – but private practice is uniquely exposed
If patients are going to get care, they are going to need practices to come back to.
In early April 2860 practice owners responded to our survey on the financial risks they face. Over 70% told us they would struggle to remain financially sustainable for any more than 3 months. The more private work respondents undertook, the bleaker the prospects.
In the month after we did this survey, examples began to surface of bankruptcy and closure, with associate dentists losing their jobs.
We’ve worked hard to ensure that the government has put in place financial mitigation packages for NHS contractors. But they are refusing to listen when it comes to official support for so many colleagues in mixed and private practice.
"The fact is if private dentistry – and private dentists – are left to go to the wall then the whole system will come crashing down".
It doesn’t have to be this way. Dentists are among the only businesses on the high street still paying business rates. Bookies have won a reprieve, so why not dedicated health professionals? There’s no logic to leaving private associates earning just over the government cap of £50,000 not knowing where their next paycheck is coming from.
The fact is if private dentistry – and private dentists – are left to go to the wall then the whole system will come crashing down.
Private care accounts for more than half the nearly £8 billion spent on dentistry in the UK. It subsidises equipment training and premises in mixed practices. Standing alone, private dentistry provides quality care for millions who will have nowhere to go if these businesses go under.
4. Dentistry is suffering beyond the high street
It’s not just GDPs. Many hospital dentists have been redeployed to the front line, working in intensive care units or geriatric departments. These dentists have done their bit, and many will carry a lasting burden on their mental health.
Colleagues working in intensive care units will have seen the devastating effects of COVID first hand. All NHS staff and volunteers who have worked in this environment require long term support.
The pandemic will also only add to the backlog facing community dentists - the UK’s most vulnerable patients were already facing two year waits for extractions under GAs. It is inevitable that treatment will be delayed further given the pressure that is already building on hospital theatres and ward staff.
5. We’ll need support to survive the ‘new normal’
If government does its bit, practices could see out this pandemic. But ministers have a responsibility to ensure colleagues can survive and thrive in a radically different world. The whole dental service is dependent on primary care functioning effectively.
Lower patient numbers and higher level PPE both carry costs, which are incompatible with the model on which high street dentistry previously operated. It's a world where failed contracts and targets based on activity will have even less meaning.
Ministers need a clear plan - a plan developed in tandem with this profession - to establish how dental care will operate in uncharted territory.
Last year we secured a hearing into dentistry from the committee. However, a snap election put paid to the next stage of this, preventing further scrutiny of a service already on the brink.
Now we have our chance, against the backdrop of a crisis none of us have experienced in our working lives.
We expect to give evidence shortly, but there'll be no trip to Westminster for us. Instead - via Zoom - we hope to tell the committee that the government owes it to our patients to ensure this service, our service, has a future.
Chair BDA Principal Executive Committee