Many National Health Service (NHS) dental practices now face an uncertain future, according to the British Dental Association (BDA), which says that the latest lockdown has left patients unwilling to keep appointments or seek care, leaving dentists incapable of meeting unworkable activity targets recently imposed by the government. Based on YouGov polling:
- 46% of adults in England indicate they would be likely to cancel a routine appointment if they had one booked during the new lockdown.
- 45% are now less likely to seek routine care when due for a checkup, compared to before the new restrictions.
- 16% would be less likely to seek dental care even with an urgent problem like acute pain or swelling.
- 79% of practices have seen an increase in the levels of cancelled or missed appointments since the start of 2021.
- 43% of practices have seen a much higher than usual rate of no-shows compared to earlier in the pandemic.
Also, more than three quarters of practices report issues with staff availability since the start of 2021, with 39% citing COVID-19 infections as having a high impact, 53% citing staff self-isolation, and 42% citing problems in securing childcare owing to a lack of clarity on key worker status.
Imposed on January 1, the targets will see practices in England face steep financial penalties if they fail to hit 45% of their pre-pandemic NHS activity targets between January 1 and April 1, 2021.
The BDA criticized the imposition for forcing practices to prioritize non-urgent care, which would better enable them to hit their targets. In light of the BDA’s survey findings, dental leaders have urged the government to abandon these targets and let practices focus on urgent cases without the threat of sanctions.
According to the BDA, 41% of practices or 2,732 in total are currently operating below 36% of their targets, facing a “cliff edge” and the potentially ruinous return of most of their NHS funding for January 1 to April 1, 2021.
The BDA has stressed that ongoing support for all practices, both NHS and private, is needed now more than ever. Dentists are still among the only businesses on the high street not receiving business rates relief, which has already been extended to bookmakers and vape shops, the BDA said.
“Practices are open and safe, but with lockdown back, patients are voting with their feet,” said Dave Cottam, chair of the BDA’s General Dental Practice Committee.
“Cancellations are surging, while increasing number of staff are sick, self-isolating, or struggling to secure childcare. Targets that were always hard to justify are now impossible to deliver, leaving scores of dedicated NHS practices set to go to the wall,” Cottam said.
“To their credit, Ministers have taken a pragmatic approach during this pandemic. From facemasks to furlough, when the facts change, so have the policies. Dentistry cannot be the one exception,” Cottam said.
Other dental organizations share the BDA’s concern about the new targets.
“Many patients have been unable to access dental care for over a year, with their dental problems getting steadily worse, and oral health inequalities exacerbated by coronavirus restrictions,” said Ian Mills, dean of the Faculty of General Dental Practice UK (FGDP).
“The dental profession is acutely aware of the present backlog of unmet dental need, which requires treatment as soon as possible,” Mills continued.
“However, the recent imposition of UDA-based (Units of Dental Activity) targets in England to remedy this, just as the pandemic becomes worse than it has ever been, is at odds with the government’s message to stay at home to protect the NHS and save lives,” he said.
“The dental profession has worked assiduously to create a safe environment for dental treatment to be delivered, but there are justifiable concerns that significant increases in patient throughput, in order to meet UDA targets, could potentially compromise staff and patient safety,” he said.
“The UDA was an ineffective measure of activity before the COVID pandemic, and we consider it even less appropriate now. Circumstances will vary by practice and by patient, but the priority should be on safety, the treatment of those with acute needs, and essential maintenance of oral health,” Mills said.
“Positive tests for COVID-19 and COVID-related deaths are at record levels, emergency departments and intensive care units are under severe pressure, and hospital staff are stretched like never before,” said Matthew Garrett, dean of the Faculty of Dental Surgery of the Royal College of Surgeons England.
“Dental teams have robust infection prevention and control protocols in place, which can reduce the risk of transmission if rigorously applied, but we cannot eliminate it altogether, not least given the risks inherent in patients travelling to appointments,” Garrett said.
“Encouraging greater throughput at the present time may not be in the best interests of patients with routine oral health needs, nor does it support the NHS and the national coronavirus response,” he continued. “However, the public should be reassured that dental practices are safe places to visit if they need to access urgent care.”
“The risk-based approach we set out in our guidance is adaptable to each national alert level, aiding the revision of practice protocols to ensure they remain appropriate over time,” said Mick Horton, trustee of the College of General Dentistry and its lead representative in the group that developed guidance for safe treatment during the pandemic.
“Though dental practices remain open in the latest national lockdown and patients are permitted to attend, the high prevalence and transmission rates of coronavirus at present, which underpin the rule to avoid non-essential travel, are important factors to consider in risk assessment,” Horton said.
“Practices which conclude that the responsible course of action at present is to postpone certain appointments should not be penalized for serving the greater good,” he said.
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