Local dental committees call on government to tackle dental crisis

Local dental committees (LDCs) are warning that the survival of NHS dentistry is at risk. Their second online annual conference takes place on Saturday 12 June, and dentists will be looking for answers. Key speakers at the conference will be Ed Waller – director for primary care strategy and NHS contracts at NHS England and Improvement – and England’s chief dental officer, Sara Hurley. 

LDCs want to know how the government and respective NHS bodies are going to tackle the recruitment and retention crisis as a damning report from Healthwatch England reveals that some dental patients within the NHS are being put on a three-year waiting list.  At the same time,  a BDA survey reveals that nearly half of dentists are likely to change career or seek early retirement in the next 12 months if the current Covid restrictions remain in place.  

Motions at the conference will also raise a plethora of workforce issues that are crucial to delivering NHS dentistry.  These range from seeking clarity on the admission of new EEA graduates onto the GDC list of registrants to a call for urgent action by the government and commissioning bodies to tackle the additional recruitment challenges faced by rural communities and those far from dental schools.

Conference will hear that dentists are exhausted from having to wear enhanced personal protective equipment and will be wondering if this is still necessary as lockdown restrictions ease, and as an evolving evidence base calls this into question.  A motion will say that this adds to the strain of working for a relentless target-driven NHS system that demands back-to-back aerosol generating procedures.

LDCs will iterate support for the development of properly funded robust and effective programmes to support the delivery of oral health services to the homeless and socially marginalised groups in society.  In keeping with this, a motion will be urging policy makers to develop programme frameworks that enable sustainable care for these groups. These are just a few of the topical issues, among the anticipated 32 motions, that will be aired at conference.

In a shift of gear, guest speaker Steve Mulligan, GDP, clinical tutor, will share some of his insights into sustainable dentistry. Steve will draw from his experience as a GDP at the coal face, and his research at Sheffield University into the emerging challenges of single use waste and dental material-based environmental issues.

Shawn Charlwood, Chair of the BDA’s General Dental Practice Committee said: “Just about everyone – dentists, MPs and Healthwatch England – are calling on the government to take action over the dental care crisis which has worsened throughout the pandemic.

“It’s unacceptable that patients are being told they have to wait for years before they can be treated. We need a well-trained, highly motivated workforce to deliver this care but the government is driving dentists away from the NHS in their droves.

“After a decade tinkering around the edges a contract that isn’t fit for purpose, we need reform that offers dentists a supportive environment where they actually want to work. And it needs to be in place by April.

“If NHS dentistry is to survive in more than name, the government has to grasp the nettle and invest in dentistry now.”

Chair of this year’s LDC conference, Stuart Allan, said: “Once again the LDC annual conference will drive home what we know already – that the long-term sustainability of NHS dentistry is in question.  A chief executive from Healthwatch who was recently interviewed on the BBC said the government must heed the dental professionals and patients because they have the answers to fixing a broken system.  We’ll certainly have some of those at our conference.  We hope the government is listening?”

Dentists warn of exodus from service, as access crisis deepens with 30 million appointments missed

The British Dental Association has urged government to set out a clear route map for reform and relaxation of COVID restrictions, as new survey data points to an exodus from the service as the access crisis continues with nearly 30 million appointments lost since the first lockdown.

According to a new survey of dentists in England:

  • Nearly half (47%) of dentists indicate they are now likely to change career or seek early retirement in the next 12 months should current COVID restrictions remain in place. The same proportion state they are likely to reduce their NHS commitment.
  • Working in high level PPE mandated under current infection control procedures is having a devastating impact on dentists’ morale, with nearly 9 in 10 (88%) indicating it is having a high impact on their morale. 78% cite financial uncertainty as having a high impact, and their inability to provide pre-COVID levels of care.  Two thirds cite hitting NHS targets imposed by the Government on 1 January 2021. Since the new year the workforce report the highest levels of stress compared to any point since the onset of the pandemic.
  • Nearly two thirds of NHS dentists estimate they will not meet controversial imposed targets, where they will face penalties for not hitting 60% of pre-COVID activity levels. Those that have made progress have done so unsustainably. 62% say their practice had to invest in new ventilation equipment, without any government support, 41% say they were forced to refocus on routine over urgent appointments, with similar numbers saying they have reduced private work, or reduced or eliminated annual leave.
  • England remains the only UK nation where government has not committed to or embarked on exploratory work to provide capital funding for ventilation systems to enable practices to increase patient numbers while keeping to infection control restrictions. While securing new kit has been the number one strategy deployed by dentists to meet NHS activity targets, nearly 70% of practices say they now face financial barriers to further investment.
  • Nearly half of dentists (47%) lack confidence in terms of the business outlook for their practice should current standard operating procedures remain unchanged.

BDA analysis of Freedom of Information data indicates that nearly 70% of appointments – or 28 million courses of treatment – that would have been delivered in NHS services in England in the year from March 2020 have been missed.  The BDA estimates by now the figure is likely to have exceeded 30 million. While numbers have increased MPs had expressed concern in January that the current interim system of targets would “prioritise volume over need” and indeed urgent treatment delivered has fallen since the new year.

While dentist leaders have welcomed recent government commitments to reform the widely discredited activity-based contract at the heart of NHS dentistry, they have warned needed change could be fatally undermined by further reductions in capacity through colleagues leaving the service or reducing their NHS commitment. The BDA believe contractual and legislative change needs to be in place before 1 April 2022, the beginning of the next NHS financial year.

With the vaccination programme making real headway the BDA has also underlined the need for a clear timetable for revising high intensity infection prevention and control procedures – including heavy duty PPE and maintaining lengthy gaps between appointments – given the huge impact on both productivity and the workforce.

MPs are set to tackle these issues in a Back Bench Business debate led by Bedford MP Mohammad Yasin later today (Tuesday 25 May 2021).

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “The pandemic has wiped out access for millions and taken a hammer blow to the workforce, with many now looking for the exit.

“Practices have managed to hit punitive targets but at a terrible cost. Churning through appointments against the clock in heavy-duty PPE now risks an exodus from this service.

“Fixing NHS dentistry will be impossible if dentists are left unwilling to work in it. We need a clear road map that lifts restrictions, provides needed support to all practices and makes a decisive break with a broken contract.”

Michael Copeland at Wesleyan Group, the specialist financial services mutual, said: “The BDA’s findings paint a worrying picture of a frontline service under significant pressure.

NHS England’s March hike in the UDA levels that dentists need to hit to avoid funding clawback – from 45% to 60% – prompted significant concern from the sector. This research shows that fears of falling short will become the reality for many – putting their finances under further pressure during a critical period for practices’ recovery, and potentially putting the viability of their entire businesses at risk.

“In these conditions, it’s not surprising that many are considering stepping back for good. As well as putting strain on the country’s ability to provide the required volume of dental care, it could also mean that some dentists take the retirement plunge before they are fully ready – feeling as though they have no other option in such an unfavourable environment.

“For those considering early retirement, moving into wholly private practice or changing career, reviewing how it will affect your personal financial situation is an essential first step. Speaking to a professional adviser who understands your circumstances can help put an effective and sustainable plan in place.”

 

The British Dental Conference and Dentistry Show will take place 25th-26th June 2021 at Birmingham NEC

CloserStill Media, organiser of the British Dental Conference and Dentistry Show, have taken the decision to postpone the British Dental Conference and Dentistry Show (BDCDS).

The 2020 event will now take place on Friday 25th and 26th of June 2021 at the Birmingham NEC, hall 5.

Martin Woodrow, Chief Executive of the BDA, commented: “The BDA believe that moving the show to June 2021 puts us in a much more comfortable position to run an event that really serves the profession. We’re really looking forward to delivering another excellent conference and exhibition this year, where we can all reunite and celebrate the tremendous work dental teams have carried out across the country.” 

The event organisers, have been focussing on how they can support the profession as they navigate through the third national lockdown and resume some normality during a very testing time for dentistry.

Alex Harden, Event Director, commented: “We want to thank all our customers and partners for their support, open discussions and encouragement. As everyone has been reminding us, great things happen when the community comes together and connects at BDCDS. We will be working with our partners to finalise the details and will share more information about our plans in the coming weeks.”

The BDCDS is the UK’s leading two-day exhibition and conference for dental professionals, providing clinical, leadership and practical training via an extensive educational programme and hands-on workshops. It is the UK’s largest event of its kind, attracting over 9000 unique delegates and over 400 exhibitors.

CloserStill Media specialises in global professional events, within the healthcare and technology markets. The healthcare portfolio includes some of the UK’s fastest-growing and award-winning events, such as the Clinical Pharmacy Congress, The Dentistry Show, The Pharmacy Show and Acute & General Medicine.

CloserStill delivers unparalleled quality and relevant audiences for all its exhibitions, delivering NHS and private sector healthcare professionals from across occupational therapy, pharmacy, dentistry, primary and secondary care with more than £16m worth of free training.

The British Dental Conference and Dentistry Show 25th-26th June 2021 –Hall 5, Birmingham NEC, co-located with The Dental Technology Showcase.

For all the latest information, visit www.thedentistryshow.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com.

England: Priority access to Covid-19 vaccine for dentists

Following last week’s authorisation of the Oxford University/AstraZeneca vaccine and updated guidance around increased spacing of second vaccine doses, we are beginning to see an acceleration in the vaccination programme across the UK.

The British Dental Association (BDA) has repeatedly sought reassurance about prioritisation for dentistry, from NHS England, the Office of the CDO and separately across the devolved nations. NHS England’s initial priority, in line with JCVI advice, is for those aged 80 and over, together with care home staff and residents. Frontline health and social care staff are included in the next priority group. NHS England has confirmed that dentists and their teams, both in the NHS and in the private sector, are included in that group of frontline staff and therefore sit in the JCVI’s priority group two.

On Wednesday, having been contacted by some of our members, Craig Whittaker MP challenged Prime Minister Boris Johnson on priority access to the Covid-19 vaccine for dentists and their teams. Mr Whittaker echoed the BDA calls for confirmation that dentists are in vaccination priority group 2 together with all other healthcare workers. The Prime Minister confirmed that all dentists in patient facing roles and members of their teams are eligible for the Covid-19 vaccine. The BDA will continue to push for clear guidance and clarity on timings of the vaccination for all dental teams.

The BDA is aware that some dentists have been approaching their GPs to highlight their status as frontline staff. There are reports of variable responses from GP practices and others involved in vaccination programmes to these approaches from dentists and teams. The BDA has continued to raise that concern with NHS England and understand that clarification will be forthcoming, confirming the position of dentists and teams to those organising vaccination programmes.

Timeframes for vaccination of the primary care workforce will still inevitably, to some extent, depend on local operational arrangements, logistics and availability of vaccine stocks. The BDA anticipates NHS contractors being contacted directly and that up-to-date CQC registration details will be important for private practices.

England and Scotland enter new lockdowns; dentistry ‘unaffected’

On Monday 4th January, Scotland’s First Minister, Nicola Sturgeon, announced that from midnight (5th January), the country would be put into a full lockdown as Coronavirus cases continue to surge. Just hours later, Prime Minister Boris Johnson spoke to the nation in a pre-recorded televised announcement, confirming that England too would enter a new national lockdown – one that resembled more the one from March/April 2020. The new lockdown, which sees schools once again closed in another government U-turn, will reportedly not affect dentistry – on the surface at least.

The original lockdown during the Spring of 2020 saw dental practices closed for almost three months. They were able to reopen from 8th June, although it was a slow start for many as the profession grappled with new SOP measures in efforts to prevent the spread of Covid-19. Patient numbers remain much lower than pre-pandemic, in part due to increased fallow time.

As Scotland enters its latest lockdown, the British Dental Association (BDA) has ‘received confirmation from the Chief Dental Officer that the national lockdown from 5th January will have no impact on dentistry’. The Association has ‘argued that the full range of NHS treatments should not be available while the new virus strain continues to spread significantly. However, the Scottish Government’s position remains unchanged’ as: essential travel includes leaving home for healthcare and dentistry is deemed essential healthcare, meaning it can therefore continue under the revised restrictions announced by the First Minister. The BDA also states that ‘aesthetic treatment is not essential healthcare (and not available on the NHS) and should not be undertaken’.

Scotland’s CDO, Tom Ferris, also reiterated, via the BDA, that if a patient attends a dentist with a concern then the full range of clinical dental care should remain available to the dentist in order to manage the patient’s condition.

Meanwhile, CDO England, Sara Hurley, issued an update immediately following Boris Johnson’s announcement of England’s latest lockdown measures, confirming that ‘dental services are to remain open and see patients’.

Hurley noted that dental professionals are defined by the Government as critical workers, adding: ‘Dentistry is an essential medical service. It is a priority for the NHS. Patients are entitled to travel for medical appointments, include dental. I have included some useful resources in this bulletin for NHS practices to spread the word that dental services are open and seeing patients, please use them.’

The Government guidance on the national lockdown states: ‘The majority of public services will continue and you will be able to leave home to visit them. These include the NHS and medical services like GPs and dentists.’

The BDA also reiterated that ‘services should be carried out in line with the current standard operating procedure (SOPs) . Remote consultation, triage and risk assessment remain key prior to patient attendance for face to face dental care. Social distancing measures remain in place and PPE levels as stated for low, medium and high risk assessed patients remain.’

While dental practices remain open for business unlike last Spring, there will most likely be an impact felt as more patients opt to stay home rather than attend appointments, among other factors. Therefore, the BDA has issued an open letter to Health Secretary Matt Hancock, urging the government to abandon NHS targets that will be ‘impossible to achieve under the new national lockdown, and which risk putting hundreds of practices out of business’.

In addition to patients’ reluctance to continue with dental appointments, the BDA believes that ‘the NHS targets will force dentists to prioritise routine check-ups for the “worried-well” over a time-consuming urgent backlog’. MPs are set to debate the imposition of these targets at a Backbench Business debate on 14 January.

BDA, FDGP(UK) and College of General Dentistry join forces to investigate discrimination in dentistry

The British Dental Association, Faculty of General Dental Practice UK and College of General Dentistry have joined forces to conduct a survey into discrimination in dentistry.

The survey is aimed at all dentists who have ever practised dentistry in the UK, and at dental students studying in the UK, and asks about their morale and career satisfaction as well as any experiences they may have had of being treated unfairly whilst working or studying.

Feedback from the survey will be anonymised, and the data and experiences captured will be used to identify and raise awareness of the ways in which discrimination is experienced in dentistry, and how these affect individual practitioners.

In recent months, the three organisations have convened a programme board to promote joint working on issues of equality, diversity and inclusion (EDI) in dentistry, as well as a joint working group to investigate racial inequality in particular. The survey results will help these groups take forward evidence-based actions to address the underlying issues, and to promote greater understanding in the profession of the experiences and concerns of their fellow dentists.

The survey is available at https://www.smartsurvey.co.uk/s/racismindentistry/.

Onkar Dhanoya, Chair of the BDA-FGDP(UK)-CGDent Equality, Diversity and Inclusion Programme Board, said: “Dentistry is a caring profession by nature, but the experiences of some dentists suggest that as a profession we don’t always treat our colleagues as well as we do our patients. Only by listening can we better understand others’ concerns in order to address them.”

Russ Ladwa, President of the BDA, said: “Discrimination is unfortunately still a feature of our society, and dentistry is far from immune, but this survey is an important step towards understanding and addressing the issue in our profession, and I encourage all dentists to complete it.”

National dental organisations have come together with a reminder: Antibiotics do not cure toothache

National dental organisations have come together to support the World Health Organisation’s Antibiotic Awareness Week, which runs from 18-24 November.

The Faculty of General Dental Practice UK, Association of Clinical Oral Microbiologists, College of General Dentistry, British Dental Association, British Association of Oral Surgeons, Association of Dental Hospitals and the dental sub-group of the Scottish Antimicrobial Prescribing Group are repeating the message to patients that “antibiotics do not cure toothache”, and reminding dental teams that antibiotics should only be used as an adjunct to definitive clinical management of the cause, and only where indicated.

Since the start of the Covid-19 pandemic, the dental profession has focussed on preventing the transmission of SARS-CoV-2 to their team, patients and the wider population. During the first national lockdown, the provision of general dental services was severely restricted and limited to the referral of urgent and emergency cases and the provision of advice, analgesics and antimicrobials where appropriate.

As a result of these constraints, a marked increase in antibiotics prescribed in NHS general dental practice has been reported. In England the number of prescriptions was up 22% during April to June 2020, and in Scotland there were steady month-on-month increases from April, peaking at a 50% rise in July, when compared with the same periods in 2019.

It is estimated that dentists account for around 10% of all oral antimicrobial agents prescribed in healthcare, and a clear link has been established between the consumption of antimicrobial agents in human medicine, animal healthcare and agriculture and increasing rates of antimicrobial resistance.

While antimicrobial resistance continues to be a long-term problem, a government review reported that 700,000 people worldwide are already dying of antibiotic-resistant infections every year, and estimated that by 2050 the annual global cost could be 10 million lives and £66 trillion.

Prudent prescribing of antimicrobials can slow down the further development of antimicrobial resistance, and all healthcare prescribers play a vital role. The dental profession has shown its clear commitment in addressing antimicrobial resistance by significantly reducing the use of antibiotics in dental practice over the last decade.

Last year alone, dentists in the UK reduced their prescribing of antimicrobials by 9%, and the organisations say it is vital that the profession maintains and builds on this success. They are encouraging all dentists to continue to play their part in reducing the development of antimicrobial resistance by ensuring appropriate prescribing of antibiotics when managing their patients during the Covid-19 pandemic and into the future.

Guidelines for antimicrobial prescribing in dentistry are available at https://www.fgdp.org.uk/guidance-standards/antimicrobial-prescribing-gdps and https://bnf.nice.org.uk.

Posters and leaflets for patients are available at https://www.fgdp.org.uk/antimicrobial-prescribing, and a Dental Antimicrobial Stewardship Toolkit, developed by FGDP(UK), the British Dental Association and Public Health England, is accessible at https://www.gov.uk/guidance/dental-antimicrobial-stewardship-toolkit

NHS England: Contract uplifts confirmed

Following consultation with the BDA, the Department of Health and Social Care has confirmed that contracts will be uplifted by 2.5% in England. The uplift will be paid in November and backdated to 1 April.

The BDA stressed, when the Chancellor announced his deal back in July, that an above inflation award represents a bare minimum any government can offer NHS workers’, adding that the ‘uplift does not begin to cover the huge increases in expenses practices have faced with PPE and meeting new cross-infection guidelines’.

Foundation Dentist salaries will be updated by 2.8%, as will Educational Supervisors’ grants. FD service costs have been frozen, which the BDA has strongly objected to.

This is the second consecutive year of above-inflation pay awards for dentists. The BDA remains clear that this must now be built on, as part of wider plans to maintain the long-term integrity of the service.

The BDA continues to campaign on behalf of NHS dentists.

BDA: Dentists facing uphill struggle, as missed appointments top 14 million

The British Dental Association has warned dentists face an uphill struggle to restore services unless government is willing to support costs for new equipment that could radically expand patient access, as the number of missed appointments hits over 14 million.

Official data on activity seen by the BDA indicates treatments delivered by NHS dental services in England are at a quarter of pre-Covid levels, and have only begun to inch above typical demand for urgent care, which is currently receiving priority. Over 14.5 million fewer treatments have been delivered in 2020 compared to the same period last year.

Dentists have been required to maintain 60-minute windows between patients after an Aerosol Generating Procedure (AGP) to minimise risks of viral transmission, contributing to this dramatic fall in patient volumes.  Recent recommendations by the Scottish Dental Clinical Effectiveness Programme (SDCEP) – which are widely anticipated to inform official guidance across the UK – could reduce this ‘fallow period’ to as little as 10 minutes where dentists can demonstrate a sufficient number of air changes per hour (ACH) in their surgeries.

The BDA has stressed that if practices – both NHS and private – are required to make changes to adhere to new official advice, then government will need to provide financial support.

Progress will require many of the UK’s 12,000 practices to undergo an on-site survey by ventilation engineers. With practices already struggling to remain financially sustainable the BDA has stressed the government must show willingness underwrite this work and offer commitments for capital funding for necessary equipment.

Practices will likely require mechanical ventilation, fitted internally or externally, with ducting as required, with those with surgeries without natural ventilation like windows facing significant challenges. It has been over a decade since dental services In England received any form of direct capital investment. Corporate provider MyDentist recently announced a £1.25m fund to reduce fallow time to 20 minutes in the 600 practices in their group.

The BDA anticipate many patients with untreated decay will end up requiring more extensive and costly interventions as result of limited access to dental services. Oral cancers – which kill more Britons every year than car accidents – are also going undetected in the absence of routine check-ups.

BDA Chair Eddie Crouch said: “Dentist are facing an uphill struggle to restore services and get on top of an ever-growing backlog. New rules could offer some hope, but only if government is willing to show leadership. If practices are going to get more patients back through their doors, it will hinge on support to invest in new kit.

“Until we see commitments, dentists will be fighting a losing battle, as early signs of decay are missed, and oral cancers go undetected.”

British Dental Association members launch legal action over data breach concerns

Members of the British Dental Association (BDA) who may have had their personal details leaked online are preparing to take legal action against the organisation amidst concerns that more should have been done to protect their data.

Sort codes and account numbers, as well as private e-mails and correspondence are thought to have been stolen by hackers in a digital attack which took place on July 30th.

An investigation is currently underway to determine the full extent of the breach, with the BDA – a trade body representing dentists and dental students across the UK – now reaching out to members that may have been affected.

Hundreds of site users have since expressed their concern over the breach, and several members have now instructed law firm Simpson Millar to begin investigations and to start legal proceedings.   

Robert Godfrey, Head of Professional Negligence at Simpson Millar solicitors – who is also handling hundreds of data breach claims for hacked easyJet customers – said the data breach was ‘deeply concerning’.

He has been approached by site users and believes anyone affected by the breach could have a valid claim for damages against the BDA for the distress caused by the ordeal.

He said: “We have had members of the BDA site contact us who are quite rightly very concerned. We are actively investigating potential claims on behalf of people directly affected by this serious breach. This is a clear violation of GDPR and data protection rules.

“I am confident any person whose details have been accessed could have a valid claim. It is clear there has been of breach of the residents’ right to privacy and the BDA is ultimately responsible. There is a clear entitlement to compensation for any upset, injury and cost of support and disruption to their lives.

“Many will be anxious and fear they will be targeted at home or work in the future.

“There is no doubt that the affected people are going to need support in this difficult time both from their family and friends. There are around 35,000 dentists in the UK, so this breach can be expected to have had a significant impact on a large number of people.

“The BDA are a professional body who have a very clear duty of care to ensure that the members of their site, who hand over their confidential information to them have their data secure and protected, are not exposed such as has happened in this breach.”

Mr Godfrey added: “We would strongly suggest that those who are contacted by the BDA should seek legal advice about their options as a result of this breach.” 

 

Those seeking advice are urged to contact Mr Godfrey of Simpson Millar on 0800 260 5010.