Nigel Jones explores whether NHS dentistry will return to the way it was before the pandemic – and questions if anyone wants it to.
It’s hard to think of a single aspect of NHS dentistry that hasn’t been changed, if not wholly transformed, by the impact of Covid-19.
Everything from the number of patients you can see to the types of treatment you can carry out, from activity targets to the level of PPE you need, have undergone radical changes over the past 15 months.
It seems as if for many of those months we’ve been talking about and hearing the phrase ‘the new normal’. Now, with the vaccine programme going well and a government timeline for reopening society, it feels like that normality is within sight. The big question for NHS dentistry is, does anyone want it to go back to normal?
Activity targets and access issues
At Practice Plan, we’re certainly hearing from dentists who aren’t keen to return to the pre-pandemic levels of patient volumes.
With reduced activity targets and the extra safety protocols needed to treat patients, many NHS dentists have been seeing less than half their normal number of patients, and therefore they’ve experienced a different, slower-paced way of working.
We’ve had feedback from dentists who say they are feeling intimidated at the thought of returning to normal patient volumes and potentially returning to the ‘treadmill’ way of working many say is necessary to reach their targets.
Activity targets have already been raised since practices first reopened in June 2020 and are likely to continue rising. However, I’m not convinced they will keep increasing to the point where they are back at the levels seen before Covid-19.
The safety measures currently in place will probably be needed for a long time, even if the vaccine rollout keeps gaining momentum and the virus is brought under greater control, which will impact the ability to provide pre-pandemic levels of access for the same level of funding.
Patients may well struggle to adapt to this kind of scenario, as we’ve historically seen in areas where access to NHS treatment is difficult and there have been huge queues of patients trying to secure an NHS dentist.
These kinds of scenes in the media are politically damaging and successive governments have always sought to prioritise access.
Removing dentistry from the sidelines
There is an argument that the government will want to return to the status quo when, after all, under the pre-pandemic contracts they were in the comfortable position of spending less – thanks to rising inflation-beating patient charges – while remaining largely in control.
However, the world has changed to such a degree that the government may be forced to accept there is a need for urgent transformation in the way NHS dentistry is delivered.
They now have the opportunity to think about the idea of integrated care and radically reappraise how dentistry fits into wider healthcare rather than allowing it to sit on the sidelines.
Unlike many other areas of healthcare, more than 50 per cent of the population regularly attend their routine dental check-up. Which, especially when you consider that the majority pay for that service and may experience discomfort or pain as a result, is a sign of how much patients value dentistry.
It seems that the government could certainly reassess how that power could be harnessed for the benefit of the wider NHS. However, it hasn’t suited previous governments to move in this direction and there doesn’t seem any indication that strategy will change.
The logical step of a core service
One change that seems to have moved from the background to the foreground of discussions is the introduction of a core service.
I suspect this core service would be a combination of specific treatments being available, perhaps along the prioritisation outlined in Professor Steel’s 2009 review, and targeted patient groups being eligible for NHS care.
Providing urgent care and helping people out of pain is always a priority for NHS dentists, and a core service may prioritise emergency care, especially as they now have the success of the urgent care centres created during the pandemic to build upon.
That kind of core service could further evolve to focus on different patient groups in the future, with priority groups likely to be children, adults on income support and adults in vulnerable situations, such as care home residents.
This does seem to be a logical step forward and there are examples from across the world of dental services equivalent to the NHS operating in a similar way.
Although there are precedents, it feels logical and there is growing support for the transparency and clarity that would come with such a development, it doesn’t make it a certainty – far from it. The threat of a core service attracting core funding is a very real one that could be a barrier. However, I’ve been hearing about the potential of a core service for the past 30 years that I’ve worked in dentistry, and I think it’s more likely now that at any time that, as a result of the pandemic, something like this could happen.
Enough dentists to meet demand?
One further factor that may impact the ability of NHS dentistry to return to normal is potential issues in recruiting enough people into the profession to meet the demand from patients.
While the number of registered dentists has steadily increased over the years, there has also been a rise in part-time dentists, so the number of clinical hours may actually have decreased.
On top of that, many dentists are choosing to retire early, Brexit may discourage overseas professionals from working in the UK, Scottish graduation will be delayed for a year and, for the first time, it seems that many dentists I speak to are no longer encouraging their children to follow their career path.
And it’s not just a shortage of dentists that may prove a challenge. Other members of the team, such as dental nurses, who have had a tough role during the pandemic, may well be looking elsewhere for less stressful work and better pay.
These issues are combining with the impact of covid safety measures to reduce the availability of dental care at just the very time when most patients are more anxious than ever to be seen, and the lockdown-induced virtual world has turbocharged the demand for cosmetic dentistry. This has all contributed to an imbalance in supply and demand, that may continue for some time and, perversely, puts the dental profession in a position of some strength to both influence the future shape of the NHS as well as turn their vision of the ideal practice into a reality.
And that position of strength needs to be used not just to retain the existing dental workforce but to answer the question of how the next generation of dentists can be inspired and encouraged into the profession.
So, it’s not just a question of whether dentistry can return to how it was before the pandemic. It’s a question of whether we want it to.