BDA Northern Ireland director, Tristen Kelso, outlines the crucial lessons the DoH must learn from its handling of the first wave of the COVID-19 crisis.
The response to the COVID-19 pandemic has shown the very best of the dental profession. Across the sector, different strands came together to establish essential emergency care for patients. Dental professionals donated their PPE and oxygen cylinders, volunteered their time setting up and working in the new urgent dental centres (UDCs), and worked out of hours and in new settings. It was unprecedented, unknown and unpredictable. Yet together we made it work.
Lessons that must be learned
However, the early goodwill was quickly undermined by the manner in which the support systems were put in place by the Department of Health (DoH). BDA Northern Ireland has provided the Health Minister, Robin Swann MLA with feedback on the handling of this crisis by his Department.
We want to ensure that crucial lessons are learned from the first wave of the COVID-19 crisis. Our feedback was sought ahead of the Minister presenting his Surge Planning Strategic Framework to the Assembly later this month.
Here is a roundup of the case we made to the Minister on the lessons that must be learnt and the mistakes that must not be repeated.
1. Financial support must be timely and adequate
"The absence of any dedicated support to offset private income lost… has been grossly unfair and could have a detrimental impact in the event of a second wave."
The initial support arrangements conveyed a depressing lack of understanding about the financial realities of general practice.
Along with the introduction of the new support system came a raft of caveats and conditions that undermined the impact of any genuine support on offer. Flaws in the system regarding the fair treatment of various cohorts of practitioners - most notably maternity cases - verged on being discriminatory even if by flaw, rather than design. The lack of an appeals mechanism only heightened anxiety levels and a perception of unfairness across the profession.
This approach was highly damaging to morale among a dedicated profession already under enormous stress.
We have emphasised the need for greater assurances in relation to ongoing GDS funding, as has been achieved in England until the end of the financial year.
Furthermore, the absence of any dedicated support to offset private income lost by mixed/private-oriented practices has been grossly unfair and could have a detrimental impact in the event of a second wave.
The asynchronous nature of restrictions first, financial mitigations later significantly heightened general dental practitioners anxiety levels.
2. PPE costs must be covered
“... when extra costs are imposed as a condition of returning to work, they [must] be covered and not left as a burden for dentists to bear.”
The failure to provide level II personal protective equipment (PPE), or commit to providing additional funding towards enhanced PPE costs ahead of permitting routine dentistry to restart, was a major oversight on the part of the Department.
It led to dentists and their representatives having no choice but to reach out to elected representatives in desperation at what was an unworkable scenario, and to the media. Had adequate support arrangements been put in place earlier by DoH, the sense of crisis and despair could have been avoided.
The Department must reassure us that when extra costs are imposed as a condition of returning to work, they will be covered and not left as a burden for dentists to bear.
3. Wellbeing of dentists must be factored into all decisions
We have emphasised the psychological trauma experienced by practitioners in Northern Ireland during this pandemic.
Dentists have had to contend with a myriad of stressful factors including new restrictions imposed on their practise of dentistry, redeployment, and severe physical discomfort and heat stress from wearing enhanced PPE. Practices endured significant disruption to their established business models all while trying to keep their businesses afloat.
The human toll has been considerable and exacerbated by the DoH approach and this needs to be fully recognised.
4. The CDS must not be taken for granted
Community dentists were instrumental in setting up the UDCs and have worked outside of their normal hours since March. Yet they are still awaiting confirmation of what rate they will be paid for those additional hours worked. Once again, the goodwill shown by dentists has been met with a dysfunctional approach to pay issues, including the extensive delays in applying the DDRB pay uplift.
5. Hospital dentists’ skills must be better utilised
"Respect our dedicated professionals and demonstrate a willingness to address key concerns in a timely manner."
We’ve called on DoH to better utilise the skills of our hospital dental colleagues should redeployment options be considered in a future wave. Fundamentally, employed staff and the continued services of independent contractors must not be taken for granted.
Our concluding message
The points we have made are clear: listen to the profession and consult with its representatives. Respect our dedicated professionals and demonstrate a willingness to address key concerns in a more timely manner.
How practitioners feel they have been treated during this pandemic could have profound implications for the future provision of NHS dentistry under the GDS. It’s in everybody’s interests that we get this right.
BDA Northern Ireland director