Stuart Fullerton, an associate dentist based near Glasgow, discusses the ever increasing pressure on urgent dental care centres as lockdown lifts.
Urgent Dental Care Centres (UDCCs) have allowed us to provide essential oral health care since the outbreak of the COVID-19 pandemic in Scotland. Soon after my practice closed, I was redeployed to a UDC and have seen their role change over the course of the outbreak and initial stage of practices reopening.
Expanding role of UDCs
In Scotland, dental practices have been seeing NHS patients again since 22 June, but only for urgent care not involving aerosol generating procedures (AGPs) – this has increased the number of referrals to the UDCCs over the past few weeks. That’s why the first steps of the remobilisation of NHS dental services in Scotland included increasing the capacity of the UDCCs so they could see more patients and provide more treatments.
This week, as phase 3 of the national reopening plan kicks in from 13 July, UDCCs are likely to be impacted. Pressure on the centres is likely to grow as the number of referrals from practices increases and some redeployed GDPs return to their practices. There is a real risk that the UDCCs reach breaking point, and that the backlog of PDS patients from vulnerable groups will continue to grow.
Challenges and uncertainty
I’ve found working in the UDCC during these uncertain times both rewarding and challenging. From the beginning I had questions about workload, commitment, indemnity, the increase in the treatment scope and PPE. But having been stood down from seeing patients since March, I enjoyed being back at work treating and helping patients again.
"Delays in briefing the UDCCs have contributed to the uncertainty."
Delays in briefing the UDCCs have contributed to the uncertainty. For example, our UDCC was informed the night before that the capacity of the UDCC and the scope of treatments available to patients would increase from the following day. We were also told to move to dealing with red, amber and green care set down in the SDCEP guidance and to provide an expanded list of treatments for acute and essential care as soon as possible.
No information was provided on how or where to accommodate the additional patients and treatments. ‘Green’ referrals would now include repair of dentures, recement of bridges and temporary dressings; however, we and other UDCCs were not equipped to offer these services, meaning there would be a delay in providing some treatments to patients.
Before the SDCEP guidance was issued, there was doubt about whether AGPs could be used for certain treatments. Although some references were made to previously published documents, clinicians have been left to use their judgement on how to proceed. Our local NHS Board Chief of Dentistry had asked the Scottish Government for more time to ensure the UDCCs were properly equipped and briefed.
Streamlining the service
Improvements have been made to streamline the service provided to patients in UDCCs. More GDPs were deployed to help in the centres, as demand and referrals increased. The bulk of the work undertaken is still extraction-based, although the scope of treatments offered has expanded.
There is now a comprehensive triage form to help streamline patient care. In some instances, however, the information provided is incomplete, usually because the referring dentist does not have access to a patient’s records or radiographs, and this can cause delays in offering patients an appointment.
I suggest that GDPs should send forms into the UDCCs earlier in the day to enable UDCCs to allocate appointments the same day. Some practices have remote logins for this purpose meaning patients are more likely to be seen that day.
"There is a real risk that UDCCs reach breaking point, as the backlog of vulnerable patients continues to grow."
I am proud of the way PDS and GDS have worked together to set up this system as safely and efficiently as possible. However, from this week, pressure on the centres is likely to grow as the number of referrals from practices increases and some redeployed GDPs return to their practices.
We must continue to improve the service we’re providing to patients during these challenging times. I worry that there is a real risk that UDCCs reach breaking point, as the backlog of vulnerable patients continues to grow.