A horrendous mess, but everyone's working tirelessly to improve the situation

News Published: 
30 March 2020

 FGDP Dean Ian Mills says working together is the only way for general dental practice to get out of the hole it's in due to coronavirus.

It’s Sunday 29th March, and Spring is here. As I look out of the window the sun is shining, the birds are singing and for a brief moment, I am able to forget what is going on in my world, and yours. That is, until my phone pings, with another message, tweet or email reminding me of the crisis facing the world, the UK and my own tranquil bit of North Devon.

To say the last week has been eventful would be the most ridiculous understatement in the history of understatements. It has been a horrendous week for everyone, and the fact that I will focus on issues affecting general dental practice should not be seen as an indication that we ought to receive special attention, or are in some way deserving of more sympathy. It is simply that this is the area in which I work, and I am unable to write about the experiences of an ICU nurse, a paramedic or a consultant working in emergency medicine. Having said that, I have just registered my willingness to be redeployed, and my next blog could provide a very different perspective on working within the NHS. If those responsible for recruitment and assessing competencies have any sense, I will be writing to you about the importance of tea-making for key workers!


Our colleagues working on the frontline in healthcare and other associated services deserve our unconditional support, respect and admiration, and we are very fortunate to have a National Health Service with such dedicated staff. We should also recognise the incredible work which is being done by many within dentistry, whether that be those who are looking after their patients, staff and practices; those who may be supporting colleagues interpret and implement the guidance; or those advising NHS managers and other organisations to produce that very advice and guidance. They may not be seen as heroes, in the same way that an ICU Consultant is, but they are still playing a crucial role within our own area of healthcare, and I for one am very grateful to all those who have helped support me over the last week.


As you may be aware from by previous blogs, I am a partner in an 8-surgery mixed NHS-and-private practice. At the start of last week our practice was still functioning, albeit in a compromised, confused state as we awaited updated guidance from NHS England. We were still seeing patients for urgent and emergency care up to and including Wednesday 25th; that was until we were instructed by our Local Area Team to desist seeing any further patients at the practice. This we did, with a sense of relief, but also with some degree of guilt. Several patients in pain had to be cancelled and all we could offer them was empathy plus the 3 As - Advice, Analgesia and Antimicrobials.


Having previously worked in Maxfac for many years, I was familiar with the unofficial clinical pathway for toothache if requested to see a patient in pain in A & E – commonly referred to as the 3Ps! It is often stated that many things in life are cyclical, and it is interesting to see the 3Ps being rebranded as the 3As, and then being endorsed by the NHS. It would appear that the Oral and Maxillofacial community have been key influencers in issues other than the use of FFP3 masks!


By Thursday 26th my practice was operating as a triage centre, but one which was following a clinical pathway which led patients into a blind alley, with no way out. Not an ideal situation, but at least we had plenty of staff available to console anxious and frustrated patients, who had no means of access to urgent care. While our new call centre swung into action, the partners were able to cast their attention towards the financial implications of practice closure. To furlough or not to furlough, that is the question.


As I write this blog, there is still considerable confusion as to how a mixed practice should navigate its way through the complexities of the financial situation. As a practice, we have made what we believe to be a pragmatic and reasonable decision in order to protect our staff, our associates and the future of our practice. Whether that will be acceptable to the NHS, the HMRC or the bank, we will just have to wait and see.


I am sure we have all found the decisions of the last few days incredibly difficult and highly emotional. I am incredibly proud of the way our staff have pulled together and worked as a team. Dental staff may not be considered as NHS staff when it comes to pensions or occupational health, but they demonstrate the same level of loyalty, commitment and compassion as their colleagues on the frontline. As GDPs we may not have been saving lives over the last week, but we have been looking after our patients and trying to save livelihoods….and not just our own.


Some may feel that it is distasteful for the BDA and others to be focussing on the financial support package for NHS and private practices, while the country is fighting a pandemic. The truth of the matter is, if the financial package is not resolved, and quickly, dental staff will not get paid and practices will become insolvent very rapidly. Jobs will be lost, and highly skilled members of the dental team will leave the profession, never to return. If we are not careful, the viability of many dental practices will be irreversibly undermined, which will in turn have a massive impact on the oral health of our nation for many years to come.


In my role as Dean of FGDP (UK), I have spent an inordinate amount of time on the computer, on the phone, and on Skype / Zoom over the last week, discussing the issues which we are currently facing and considering how FGDP can help. I have had meetings with BDA, LDC, LDN, NHS England, CQC, FDS England and many local colleagues, and I am struck by the commitment and hard work which is being put in by so many of our profession, at such a time of need.


Two things have struck me during the many meetings and discussions over the last week. Firstly, it would seem to me that everyone is working tirelessly to try and minimise the impact of this pandemic: dentists, dental care professionals, professional representatives, regulators, commissioners, NHS managers and Chief Dental Officers. This may not always be apparent, but I can assure you that many of our colleagues are working night and day to try to improve the situation.


The second point which I feel needs to be highlighted, is the lack of tolerance and understanding which is being shown. The “be more kind” movement appears to have lasted as long as a pack of toilet rolls on a supermarket shelf. We are quick to jump to conclusions, but slow to reflect and admit we were wrong. I fully appreciate how anxious and frightened many of us are, and how angry we are at the apparent lack of support, but the outpouring of vitriol on social media towards colleagues is completely unacceptable.


We are in a horrendous hole at the moment, and as I see it the only way out is if we work together. I was frustrated at the delays in releasing updated guidance from NHS England; I was dismayed at the confusing messages around PPE and incensed at the assertion that all dental practices had received supplies; and I was appalled at the lack of financial support for mixed independent practices. However, I am fully aware of the problems which the country is facing and how difficult it is for all of us; which is why I will be working with NHS England, the BDA and the other Dental Faculties to try and find a way out of this mess.


We are in the midst of a crisis and we only have a finite amount of time, energy and resources. To spend our time fighting with each other, will simply create an even greater problem. The FGDP needs to be a critical friend and provide constructive criticism and support to our NHS partners. But by the same token, NHS managers and CDOs must be willing to accept criticism and understand that although the dental team may not be facing life and death situations, they find themselves with a huge amount at risk. Despite our current worries, many have shown a willingness to support the NHS and volunteer for redeployment. A truly admirable response, and one which is befitting of a proud and caring profession, which puts the patient interests first. One can only hope that government will recognise the value of the dental profession and act responsibly to support general dental practices and ensure access to oral health care is maintained when we finally return to normal.


Read more posts by Ian at www.fgdp.org.uk/deans-blog.