BDA Chair, Mick Armstrong sets out the case for action on preventative measures to ensure dentists’ wellbeing is safeguarded during and after the Coronavirus pandemic.
Dentists have long lacked adequate support. It’s why we successfully fought to secure coverage from the NHS Practitioner Health Support Programme and why we’ve provided our members access to our Health Assured service.
However, this pandemic has raised the stakes. So we’ve made our case direct to the Health and Social Care Committee’s latest inquiry into workforce burnout and resilience across healthcare. As far as we are concerned, the answer is not about a cure, it is about prevention.
What is the key driver of burnout?
Failed systems breed stress. From our own investigations, levels of burnout were highest among dentists with greater NHS commitments.
Our research has shown that occupational stress is a key driver of burnout and mental ill health. More than half of dentists have reported that their job is very or extremely stressful, and 44% confirm that their stress exceeds their ability to cope with it.
We made the case for dentistry to this inquiry on behalf of our members and to ensure that all dentists have a viable future.
Has stress increased for dentists during lockdown?
We do not yet have enough robust data on the impact of the pandemic on stress and burnout among dentists. However, from research conducted during the lockdown period, there was consistent feedback regarding pressure and heightened stress caused by the situation.
One dentist told us: “I am suffering so much stress, anxiety and uncertainty. No-one knows what we should or shouldn't be doing. There is no authority taking responsibility and telling us what to do”.
While some of the immediate concerns may have now abated, the profession is still facing grave uncertainty and pressure, with the future of their practices and careers an unknown quantity.
Wellbeing services must include support for dentists
“Dentists must not be forgotten when wellbeing services are being rolled out.”
We’ve demanded more support for dentists and have pressed just how crucial the impact of the pandemic has been on frontline staff. Dentists must not be forgotten when wellbeing services are being rolled out.
Since May 2020 we have experienced a surge in dentists accessing our Health Assured support service. The majority of calls cited anxiety, employment, work-related stress, low mood and work-related demands as their reasons for getting in touch.
Dentists working in hospital services are also experiencing a period of heightened anxiety and uncertainty, with many being redeployed during the pandemic.
Some have courageously taken on clinical roles way beyond their usual skill set, working on COVID-19 wards, and dealing with death and the loss of their patients.
Some initiatives have been put in place to support the mental wellbeing of these staff. We want to ensure that dentists will continue to be supported in the longer term to help them cope with the emotional and physical impact of this work.
The ongoing impact of COVID-19
We are also very aware that working with the higher levels of PPE, an essential requirement for all dentists now, results in physical and mental exhaustion and is having a detrimental impact on dentists’ wellbeing. We are concerned that this will increase burnout and expedite the number of dentists wanting to leave the profession. If higher level PPE is now a fixture of our reality, this is something that must be addressed.
Clearly the impact of the pandemic itself has given rise to concern about the health of dentists and their families. This has been particularly heightened for those groups which have been identified as at increased risk, for example, BAME dentists. Oral health inequalities were continuing to grow even pre-COVID-19, and now that has become an even greater challenge to tackle.
Frustrations at limited patient care
Many colleagues have expressed frustration at not being able to care for their patients as well as they feel they could. One described feeling powerless in these extremely stressful and frustrating times. Certainly, these aren’t new feelings, but COVID has pushed them to their limit.
Managing patients' expectations has become very challenging. The backlog persists and the restrictions placed on practice means fewer patients can be seen. This remains true across high street, community dental and hospital dental services.
We know our members feel a deep sense of responsibility to their patients. There is a lot of frustration resulting from this inability to provide timely care, often to very vulnerable patients with high needs.
With these waiting list issues now widespread, HDS dentists are also concerned that they will be expected to increase out-of-hours provision to reduce the backlog. This will have a clear and obvious impact on their wellbeing.
What do we need for dentistry going forward?
Although NHS practices have been supported financially through the pandemic, those reliant mainly on private income have been left out in the cold. We’ve repeatedly asked the Treasury to extend the criteria for schemes such as the self-employed support scheme and the business rates relief scheme, to help keep the private sector afloat.
Leaving private dentistry to fend for itself will have a detrimental impact on the sector. If private practices go out of business, the pressure on the NHS will be ever greater, and patient choice will be adversely affected.
“Burnout is driven principally by the systems we’ve endured for over a decade.”
Fundamentally, while COVID-19 has added to the pressure, burnout is driven principally by systems we’ve endured for over a decade. It requires a wide-ranging response reflecting both duty of care to practitioners and supporting patient access to services. In short, we need a contractual framework that puts patients and dentists before tick-boxes and targets.
The target-based system has proven unworkable during the pandemic. We’ve long called for a system focused on prevention-based care, lowering stress for clinicians, and ensuring the best patient care. We now have an opportunity to make headway.
For those working in employed roles in the CDS and HDS, as well as in dental academia, we'd like to see advice and guidance for appraisals. We’re keen to find out more about job planning processes that encourage dentists and their managers to actively include wellbeing into these considerations and their working practices.
This would help to integrate a preventative approach to burnout and mental ill health and would hopefully promote healthier and sustainable working lives.
Mick Armstrong, Chair