FGDP(UK) Dean Ian Mills looks forward to the future re-opening of dental practices, and supporting a safe return to work with practical guidance from the Faculty.
In many ways, it doesn’t seem that long since my last blog, but in terms of COVID-19 it seems a lifetime away. Hours spent on phone calls, emails and videoconferences have made the time pass quickly, but in many respects, we don’t seem to be that much further forward. There is still widespread confusion, frustration and anxiety within the dental profession, as we try to navigate our way out of this crisis. Hopefully that is about to change, as we gradually start to look forward and put plans in place for the future, and I am delighted that the FGDP(UK) will be at the forefront of this. But first things first…
Over the last week, I have been using the 'F word' repeatedly, and I don’t necessarily mean the one you may be thinking of! Although it has been close on more than a few occasions. In fact, I’ve been using lots of 'F' words throughout this COVID pandemic. ‘Frustration’, ‘fear’, ‘feckless’ and ‘fuming’ spring to mind; but so do ‘food’, ‘family’, ‘fellowship’ and ‘fitness’…ok, I may be fibbing about the last one!
I have even learnt some new 'F' words, which I now use on a daily basis; ‘furlough’, ‘fallow’, ‘FFP3’ and ‘fit-test’. I now struggle to complete a sentence without using at least one of these words. If we invented a dental version of just a minute, based on avoiding these four words, I fear that even Giles Brandreth would struggle to talk about COVID for sixty seconds without falling foul.
But enough of this facile foolishness, the real reason behind this blog is to reassure members of the profession that there is a huge amount of work going on behind the scenes, across many agencies and organisations as we look towards a return to work. The 'F' words most frequently used over the last week have been ‘future’ and ‘forward’, and I take that as an encouraging sign. Firstly, it suggests that we are no longer in the acceleration phase of the pandemic and we can now begin to look forward; and secondly it provides a strong indication that we are all beginning to think ahead to the future. Granted, none of us know what the future holds and, understandably, there is still a huge amount of anxiety within the profession, none more so than for those who work in general dental practice.
There was one significant 'F' word which has still not been addressed and that is ‘financial’. One can completely understand the anger and frustration of those working in mixed and private practice, who get the sense that Government doesn’t give two 'F's about the future of private dental practice. I desperately hope that is not the case, as in my opinion that would be foolhardy in the extreme and cause misery for countless patients, not to mention placing the NHS under intolerable pressure.
When we look towards the future, our decisions tend to be shaped by our knowledge and past experiences. In the current situation, we have very little knowledge or experience of dealing with such a pandemic, let alone how we facilitate a return to normal. This is undoubtedly hampering our decision-making process, and without reliable evidence or relevant clinical experience, we must rely on common sense, which sadly is not always that common.
As a profession we desperately need clear, practical guidance based on a common-sense approach. Safety must be at the centre of all we do, but as I have stated in previous blogs, we cannot eliminate risk, we can only reduce it. We must bear this in mind as we return to practice and accept that some of the protocols which we may need to implement in the first few weeks and months, may not be deemed necessary and indeed applicable in the long term.
This lack of certainty leads to heightened anxiety, and can make the future look daunting. I was recently directed to a podcast by the Edinburgh-based, Devon-born explorer Mollie Hughes, where she detailed her mental approach to overcoming major challenges. On her recent expedition to Antarctica, where she became the youngest women to ski solo to the South Pole, she explained that she was only able to succeed because she focussed on the very next task in hand. She revealed that if she had looked too far ahead and considered the prospect of 58 days of skiing alone, with headwinds of 58 knots and temperatures of minus 45°C, she would have given up. She took one day at a time, and didn’t look too far ahead, otherwise “it was too big to contemplate”.
This is an approach many of you will be familiar with, as it is frequently promoted by goal-setting coaches, who like to illustrate the concept by referencing the quote “How do you eat an elephant?…One bite at a time.”
As I look ahead at the situation facing dentistry, I think Mollie’s advice is particularly apposite. If we look too far ahead the situation may be too big to contemplate. My friends and colleagues are talking about temperature checking, zoning reception areas, reduced patient flow, enhanced PPE, air ventilation systems, fallowing surgeries! The whole situation is overwhelming. How can we work like that? How is it possible? How can we survive?
In my opinion we need to concentrate on the immediate task ahead, and focus on getting our practices reopened and able to deliver safe and effective care. Our priority has to be safety but this will undoubtedly come at a price. We need to accept that we may not be able to provide comprehensive care for all; patients may need to accept that certain treatments will not be available in the short term; and we must all accept that he cost of delivering oral healthcare will be much greater than ever before. The NHS must accept that a target-based system is no longer appropriate, if indeed it ever was. NHS commissioners need to recognise that the cost of providing oral healthcare is going to spiral with the double whammy of markedly reduced activity and massive increase in fixed and variable expenses. The previous system of remuneration is unsustainable, and this has to be recognised.
As I have already stated, the financial situation for mixed and private practices has been horrendously difficult over the last few weeks, and I fear this may not get much easier over the coming months unless something is done and urgently. Reduced activity and rising costs will need to be passed on to the patient, and this is likely to lead to a significant increase in patient fees. For some, this will be acceptable, but for others it will not, and patients may look to access NHS care. The NHS will not be in a position to accommodate the additional demands on an already impoverished service, and if the situation is ignored, there will be further problems ahead.
Which I guess brings me back to the importance of implementing a sensible, pragmatic way forward as we look to reopen our practices. We have to get the balance right between the operational aspects of providing safe care and the financial implications of doing so. There are risks with each and we must now turn our minds to the immediate challenge of minimising both these risks. This is no easy task, but I am delighted to announce that the FGDP(UK) in conjunction with the new College of General Dentistry has convened a COVID-19 Forward Planning Task Group to provide practical guidance based on the latest available evidence to support a return to work. The task group has wide engagement with representatives from various organisations and their aim is to produce sensible guidance which balances both safety and practicality for those working in general dental practice. In so doing, I sincerely hope that the Faculty will be able to produce guidance which will instil confidence within the profession and enable them to see a way forward through this difficult period …..one bite at a time!
But to finish with, I feel a few more 'F' words might be appropriate. And I’m not necessarily talking about ‘fillings’, ‘forceps’, ‘fissures’, ‘fractured cusps’, ‘failing crowns’, ‘fixed appliances’, ‘Fordyce spots’, ‘fraenal attachments’, ‘facial myalgia’, or ‘fusobaterium nucleatum’. I am of course talking about ‘friends’, ‘family’, ‘fellowship’ and ‘faculty’. These are the things which will get us through the next few months…that and financial support…and of course my furosemide, felodopine, and Famous Grouse!
Ian is hosting a webinar on Preparing for the Challenges Ahead on Tuesday 5th May, 2020 at 6pm. Register to join at https://register.gotowebinar.com/register/3507236890456162061.
Read more posts by Ian at www.fgdp.org.uk/deans-blog.