Ian Mills, Dean of FGDP(UK), describes the difficulties facing general dental practices during the coronavirus pandemic.
It is Wednesday morning, 18th March 2020. Like many others, I am currently trying to understand the enormity of the situation which is unfolding around me. It is a bit like watching a trailer for an apocalyptic film, but then realising that you are part of the cast.
A few weeks ago, I was wondering what all the fuss was about, and cynically thought that most of the scaremongering was down to media sensationalisation. Surely it was only a bit of flu, and no different to what we have had to face previously. How wrong can you be?
Last week, I was awarding Diplomas to successful Diplomates and handing out awards at our Annual Dinner. This week, I am having crisis meetings in my practice on a daily basis, trying to ensure the safety of my staff and patients, while developing contingency plans for if (when) the situation escalates further. This was not what I had in mind for my planned week of annual leave!
I am a partner in an 8 surgery practice based in North Devon. We have 34 staff and many thousands of patients. Likely many others we are a mixed NHS / private practice with approximately 50% of our income generated by NHS activity. The non-UDA activity is related to additional services which include sedation, orthodontics, oral health education and domiciliary care. At the best of times, running a large practice is challenging, but during this developing crisis the situation is likely to become intolerable for many. Our staff are worried and anxious about their own safety, the safety of their patients and of course the impact which COVID-19 could have on their livelihood. They turn to us for advice, support and guidance; desperately looking for reassurance that we have a plan and everything is going to be okay.
As I sit writing this blog, I am trying to work out what I need to do to protect my staff, patients and practice. I am struggling to develop a coherent working plan, let alone a cunning one based on any level of certainty. I have no idea how this is going to play out over the next few weeks and months, and the current lack of guidance and support from NHS England is stultifying. Over the last few years, I have heard repeatedly that we need to improve leadership skills within our profession. Boy, do we need them now.
When I have previously been involved in discussions around leadership, the initial focus tends to be around people at the top of the profession, those on committees, boards, or in management positions. More recently, the focus has been on the importance of leadership skills within general dental practice, and how this can be important as part of a team. I think I had always recognised this to a certain extent, but the last few days have rammed this home.
When there is little or no support forthcoming from others, we need to step up and take responsibility. This will inevitably fall to the practice owner(s) and practice manager, but like any good sports team, there need to be multiple leaders throughout the organisation willing to make decisions and lead by example. If we continue the sports analogy, the ‘fitness’ of the team, the quality of the players, the team ethic and the commitment to the ‘club’ will all contribute to the results. This is particularly so in the face of adversity.
In my own practice we are extremely fortunate to have a great team, led by a fantastic practice manager. We are meeting on a daily basis and trying to keep our staff and patients up to date with developments. For me, the main concerns are around safety and business continuity.
Compliance with cross infection protocols is something which dental practices take very seriously and are well placed to minimise risk of transmission. We are experts at implementing high standards of care in order to protect our staff and patients, which is just as well given the high risk of exposure to droplets. I am sure we have all introduced some additional measures in terms of increased handwashing, cleaning communal areas, disinfecting door handles, etc. This has been fairly easy to introduce…or at least it would have been if we had ready access to materials, consumables and disinfectants.
As the British Dental Association (BDA) has been highlighting for weeks, the lack of face masks and Personal Protective Equipment (PPE) is particularly acute, especially as we are absolutely in the front line. It has been highlighted repeatedly that our risk is considerably greater than most in view of our proximity to our patients when undertaking treatment, and most worryingly, exposure to aerosols. This is a particular concern as I write this blog, as some evidence would suggest that we are putting ourselves and our staff at risk by continuing to use high speed drills and ultra-sonic scalers.
As yet in England, we have received no updated advice about working practices, nor have we had any offer of financial support from the NHS if we reduce activity. Individual clinicians are being forced to make decisions for their staff and patients without the necessary support and advice. An appalling position to be in, and it has been left to practices to take the initiative, and provide leadership. I fully appreciate the problems and difficulties which the NHS is facing at this present time, but if ever there was a time when we needed its voice of leadership, it’s now.
Like many others, my main concern at the present time is protecting my staff, my patients and my business. To do that, I need clear guidance and advice from experts in the profession, and I need that advice yesterday! I cannot make contingency plans for my business with this level of uncertainty. People are relying on me to make decisions to safeguard their health and their livelihood, but I cannot do that on my own.
The future may look particularly bleak for many of us working in general dental practice, but I am aware that there are many worse off than ourselves. At this difficult time we need to work together across organisations and practices and support each other over the coming weeks and months. The BDA are doing an excellent job in supporting the profession at this time, and should be congratulated. In my role as Dean of the Faculty of General Dental Practice, I will be working to support the BDA in disseminating what information is available and providing whatever support we can to our members and the wider dental profession.
This is a horrendously difficult time for the profession and we need guidance, support and leadership. I am hopeful that a demonstration of this will be forthcoming from NHS England.
Read more posts by Ian at www.fgdp.org.uk/deans-blog.