This virus is punishing delay and indecision

News Published: 
23 March 2020

FGDP(UK) Dean, Dr Ian Mills, makes the case for greater clarity at a critical moment, as dental practices struggle to make the right decisions to protect patients and themselves.



It is now Saturday 21st March, and things are becoming slightly clearer for those of us working in general dental practice…… slightly clearer, but by no means clear enough to offer much reassurance or spread the growing anxiety.


We have received some clinical guidance from NHS England, which basically reinforced what most responsible clinicians were already doing. Not quite sure why there was such a delay, as this contributed significantly to the confusion, frustration and anxiety which has been prevalent throughout the dental profession over the last week.

For those of us practicing in England, it was good to finally know where we stand in terms of clinical guidance, although there is still confusion with conflicting information emanating from various groups and societies, around such procedures as implant treatment, oral surgery and orthodontics. I am all for clinicians retaining clinical autonomy, and applying evidence-based practice based on the contextual situation, but there are times where we need clear, prescriptive guidance to remove confusion and allay anxiety, and that time is now. The situation has been compounded by publication of recommendations from various societies, BAOS, BAOMS, ADI which all conflicts with NHS guidance that we are perfectly safe to continue to see routine patients as long as we avoid Aerosol Generating Procedures (AGPs), wear a paper mask and cross our fingers.


We certainly need to avoid the escalation of panic based on hasty guidance, but when there is a paucity of research we need to rely on expert opinion, patient preference in light of the level of risk and potential consequences. I would suggest the level of risk for dental professionals is now unacceptably high and, in my opinion, we need to revise current NHS guidance to reflect this. If this is not addressed, and quickly, I fear we will become the infantrymen (and women) of the NHS. 


The announcement from the Chancellor, on Friday 20th March would seem to contain some good news, especially for our staff, which is to be welcomed. The possibility of retaining staff on 80% of their wages is a great relief for all, and will hopefully help many of the key workers within our profession. It is to be hoped that this will ensure that we have a highly skilled workforce ready and waiting to return to work when we finally get back to some semblance of normality. That is vitally important and I am delighted that we will be able to offer our staff some degree of reassurance when we finalise our working arrangements next week.


What is more worrying, is the position of our self-employed dentists, both associates and practice owners; both private and NHS. At the time of writing, we have received no financial commitment from NHS England, and the Local Area Teams appears to be unable or unwilling to offer support or guidance. This is an intolerable position to be in, and although Scotland, Wales and Northern Ireland are better informed, I understand that there are still serious concerns about the detail of the remuneration packages. In the private sector, the situation is even worse with no potential safety net. There is a distinct danger that patients on capitation plan schemes will discontinue their standing order as they have to tighten their own belt, and removal of AGPs will decimate private fee per item. We are in a desperate situation and associates and owners must work together to find our way out of this situation, but we cannot do this alone.


The BDA have stepped up to the mark and their Executive Team led by Martin Woodrow is providing critical support for the profession. I am also very proud of the work which our own team are doing within the FGDP and I would encourage you all to visit our website and read our update.


In my last blog, I spoke of the need for leadership, and it is heartening to see so many of the profession stepping up and grasping the initiative in order to protect their patients, their staff and their businesses. Events over the last week have clearly shown the need for strong leadership, but we have also seen just how important communication is.


As a dental profession, we are frequently reminded of the level of importance afforded to communication by our regulators, educators and commissioners, and rightly so. A lack of communication leads to misunderstanding, frustration, and ultimately complaints; and recent events would suggest that this does not apply solely to patient interactions!


A lack of information creates a vacuum of knowledge and understanding and leads to fear and apprehension. We have seen that over the last week, and many of us will have relied on the FGDP, the BDA and other membership organisations to fill that vacuum. We are also faced with the challenge of too much information via the internet, social media and “fake news”, which can cause even greater levels of anxiety.  I was therefore delighted to facilitate a videoconference on Friday evening for a group of local practice owners from rural North Devon. It was a fantastic opportunity to share knowledge, experiences and worries with like-minded colleagues who are all facing the same problems. It was a huge success and I am sure many similar groups are springing up all over the country. As a practice we are planning weekly meetings on a Friday evening, from the comfort of our own homes, with a WhatsApp group established for sharing information and ideas throughout the week. We are communicating with each other frequently, openly and generously, in order that we can help each other, but in turn help our associates, our staff and our patients. 


The other area where communication is key is with our staff. These are unsettling times for everyone, and it is important to keep staff well informed and up to date with the current situation and how that will affect them. Like many we are using a group chat to supplement regular meetings, and this has proved highly popular. WhatsApp (other group messaging services are available) has been a very effective tool for distributing information, involving staff and also a great source of humour. Clearly a large number of individuals have a lot of time on their hands judging by the cartoons, videos and memes currently doing the rounds. One can only imagine how this will escalate as people have more time on their hands. I fear the Singing Dentist is going to have competition!


It is easy to focus on our own problems within dentistry and forget those who must be in a much darker place. We may be facing financial hardship, risk of transmission and various other issues, but most of us have a reasonable support network around us, even if that is increasingly on-line. Many old or vulnerable individuals do not have this network and they are being placed in a horrendous situation as they are being forced to withdraw from society and deal with this on their own. This is a very worrying situation for us all, but it must be especially frightening for many of our older patients. In my own practice we recognised this and came up with the idea of trying to help within our community. We have a large cohort of old and vulnerable patients, a database to allow us to identify them and a bunch of staff and clinicians with time on their hands. We have therefore started to contact all our patients over seventy years of age, to check that they are ok, and offer to help or support in any way that we can in terms of shopping, picking up medicines or just having a chat.


Many of our vulnerable patients are being adequately looked after by family, friends and neighbours, but they all appreciated the contact and communication from our team. It is great to see that our orthodontist has led the way in supporting the local community. Zena will be working with a local farm shop to help deliver food to the vulnerable on Wednesdays instead of shuffling teeth!  We are part of a caring profession and in times of despair, it is important to help each other and look out for those less fortunate than ourselves.


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