We need to work together to tackle the growing dental surgery backlog and adapt to changes following the pandemic.
I cannot remember a health-based pilot that has continued for as long as the Oral Surgery Pilot. Now in its fifteenth year, it has been a success in supporting dental practitioners, reducing the pressure on the secondary care sector, and delivering a highly skilled, efficient, cost effective and professional service to patients.
The pilot has provided many positive benefits but as time has moved on, it has become a victim of its own success. Several different options have been sampled over the years, and changes have been made to try and improve the service provided to patients.
Covid causing major referrals spike
Covid has presented us with major, lasting changes. The secondary care sector is currently working to maximum capacity dealing with oncology cases which have piled up during the lockdowns. We are working hard to balance the vital needs of medically compromised patients with the continual trauma which arrives at hospitals daily.
"At present we receive more referrals per day than the number of patients we have the capacity to treat."
Patients who were not seen during the pandemic are now beginning to filter back to dentists. The result of the gap created by Covid means that we are seeing many more decaying teeth, unattended during the pandemic, which now require extraction. Untreated orthodontic cases are also now being referred in an increasing number.
Extremely clinically vulnerable patients who took shelter at home during the pandemic are now looking for a dentist. This complex landscape of treatment needs has resulted in a significant increase in the number of referrals per day. At present we receive more referrals per day than the number of patients we have the capacity to treat. The current waiting list for NHS patients has increased from six weeks, to over eight months.
Patients must be our priority
When faced with such a huge backlog, we have no alternative but to prioritise treatment to clinically vulnerable patients, orthodontic cases, and emergencies. Unfortunately, pain in a tooth is not always classed as a medical emergency if it can be improved with pain relief (1). Similarly, routine extractions, are not covered by the oral surgery pilot as these are deemed level one cases as per the commissioning document (2). The pilot only covers level two and level three treatments, and patients should be registered with the referring practitioner under the NHS. Private, non-registered patients are not covered.
Balancing our caseload has left little capacity for routine oral surgery cases, such as wisdom tooth extractions which usually make up a large proportion of our work. Even orthodontic cases are experiencing a long waiting time. The secondary care sector is now in a position where patients are being informed to consider seeking treatment elsewhere due to the waiting list time. The knock-on effect is that practitioners are now referring an increased number of patients to the High Street Oral Surgeons.
"We are doing everything we can in the High Street Oral Surgery practices to maximise capacity."
We are doing everything we can in the High Street Oral Surgery practices to maximise capacity. We are working hard to bring the number of sessions back to pre-pandemic levels to see as many patients as we can. Every appointment slot we make available is very valuable and in the current landscape it is frustrating when patients do not attend their appointments or even let us know that they need to cancel. On referral, practitioners often emphasize the importance of not wasting health care appointments, we need our patients to work with us to be able to get on top of the backlog.
The number of patients currently on the waiting list is over 3000. I have given up counting as each month the numbers are increasing, is causing me additional distress. Despite these soaring numbers, if a practitioner needs a patient treated, they can ring and speak to a surgeon explaining the situation and we will do everything we can to find a treatment slot for the patient.
If we all work together, patients, practitioners, and surgeons, we can guarantee that the patients most in need of treatment can be prioritised for care, whether private or NHS.
Martin W. Curran
BDS FDS(RCPS) MFGDP
Oral Surgeon and former BDA NI Branch President
(2) https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/09/guid-comms-oral.pdf Page 18