Winter Update 2021 - Tough Times

Once again I hope you are all well and have been safe and well during the tough times we have and continue to experience. Whilst we all make efforts to move on with our lives, we are regularly reminded of the risks of Covid and its variants and unfortunately, it continues to pray on our actions.

As we reach the end of the year, and look forward to the Christmas break, I felt it important to update you on the developments at the practice and the challenges we have and continue to face. Today i recieved an email from a patient dismay about the waiting times to see a dentist on the NHS, and he asked the question - What is your NHS commitment?

The pandemic made many take stock and reevaluate their personal and professional lives and as a consequence, we have experienced a huge change in our teams. As some patients may be aware when they have attended the practice there are a number of new faces behinds the masks and the changes have occurred from the receptionist all the way to the dentist.

These changes are probably very similar across many professions, and my words may echo with some of you more than others.

Whilst no doubt many people have their reasons for changing jobs and professions, the changes in dentistry as a whole have slowly developed over many years and are now at a crisis point. The reduction in the workforce was highlighted earlier this year when a staggering 47% of qualified dental nurses left the register with the general dental council and left the profession. This workforce is not being replenished at any rate close to this level of loss and the impacts will continue to be felt.

S3 Dental practices provide a mixture of NHS and Private dental care, and the chronic underfunding of the dental service nationally has created a situation where dentists have found the service unworkable financially and also clinically.

The cost of the NHS dental service is fixed by the NHS and the government and since 2006 when the last dental contract reform happened, the patient charges have gone to the NHS. It is a misconception to believe that the dental practice benefits in any way from these dental charges. It is in essence additional taxation put upon NHS patients.

The cost of living has steadily increased, and whilst we may hear constantly that there has been additional investment and funding to the NHS, this rarely trickles down to dentistry and secondly is almost always below levels of inflation. This combination of steadily devaluing and underfunding the NHS dental service whilst increasing the amount of money patients pay for their dental treatment has meant that the system is near critical failure.

We have attempted to restore our dental services during the pandemic, but nationally dental practices continue to be hampered by the safety measures we must take to protect patients and frankly a system that currently devalues its workforce.

As dentists and nurses continue to leave NHS dentistry AND dentistry as a whole - either due to health concerns or frustration, we as a practice as faced with the problem of not having enough clinical staff to service our existing patient base.

Earlier this year and throughout the pandemic the government has been keen on dental practices to prioritise new or existing patients who have dental problems over existing routine examinations to patients who regularly attend our practice. We acknowledge AND recognise that there is a significant percentage of our patient base that has not had a dental check-up on the NHS in over 2 years.

Dental examinations are important screening tools for dental disease and conditions such as oral cancer, and early identification of problems - especially which can be asymptomatic and do not cause any pain is important to prevent future problems. It was also incredibly disappointing to hear the minister responsible for dentistry to dismiss and downplay the role of dentists in the identification of oral cancer, as a way of downplaying the huge problem with getting access to a dentist - either on the NHS or Privately.

For our patients, unfortunately despite our commitment to continue to offer NHS care, there are problems ahead. The lack of dentists available to work on the NHS means that whilst we are under orders to prioritise patients with pain, we are not able to see the volume of patients we previously saw who require an appointment within the confines of the current system and safety measures.

During this last year we worked hard to get some balance and routine, but the red tape and restrictions kept in place meant that progress was hampered serverely.

We are working hard to recruit dentists & nurses to provide NHS care and have been advertising for over a year now, but unfortunately, this is a national problem and there is no foreseeable solution to this. With a combination of Brexit and Covid, dentists from the EU who have previously supported the system have either returned to their home countries or cannot get past the red tape to move to the U.K.

NHS dentistry since 2006 has been target-driven, which means that NHS dentists were under obligation to provide a contracted amount of dental treatment on as many different patients as possible and funded according to this performance. Now understandably and perhaps rightly so, the NHS and specifically dentistry needs to ensure that the funding it provides to dental practices provides value for money, and if as a practice we do not meet that target then we should not be paid for it.

In reality, this is not a black or white issue, the cost of operating a business and keeping staff employed throughout a year is a fixed overhead irrespective of our contractual performance. It is likely that S3 Dental and many other NHS dental practices will be expected to repay money to the NHS for “work not done”, but it is also very likely that this money will not be offered to dental practices in the future. This then creates the dynamic whereby you cannot rebuild the NHS dental service because it is no longer funded. Essentially the system is self-devouring and now rapidly reaching crisis and breaking point.

Unless something changes drastically, for the foreseeable future, we are advising patients that they can expect a waiting list to be seen for dental examinations and routine care on the NHS. NHS England is aware of the national crisis in dentistry and current guidance is still to prioritise urgent care over routine appointments. We are actively seeking dentists to provide NHS dental care, but this may be an ongoing problem for the next 18 months.

The clinicians working at S3 Dental have had the pleasure of looking after our patients for many years, but with the pressures being applied through the NHS currently, the role has become increasingly difficult for them to fairly provide patients with the clinical care they need.

For patients who are not willing to wait for NHS guidance to change regarding NHS examination and wish to have their dental examinations sooner, we are able to offer a limited number of dental examinations on a Private basis to patients. Patients contacting the practice for an appointment will be advised of the day-to-day situation, but we may also need to contact some patients directly to postpone routine examinations previously booked.

During this pandemic, Dr. Charles Brandon, Dr. Junade Mirza, and at the end of this year - Dr. Amy Anfilogoff will have moved on from S3 Dental, and I would like to thank them for their service at S3 Dental and I am sure they will be missed by their patients. Unfortunately at this stage, since no replacement clinician has been found to take over their NHS duties, any patients who had NHS examinations booked will likely need to have their appointments postponed until a time we have clinicians able to provide NHS care. Dr Atif Bhatti, Dr Assad Chouhdry and our new addition - Dr Saara Majid will continue to offer NHS care within their capacity.

Whilst the Omicron variant continues to run rife, our team is also subject to the same rules of isolation and we need to ensure patient safety as our top priority, so this is also complicating matters significantly.

Dentists and Nurses work as a team, and cannot work without each other. This is a requirement by the general dental council and part of the indemnity obligations we have. Should either dentist or nurse be legally required to self-isolate, the appointment diary becomes further congested and frustrated.

I ask those patients who need to have their appointments rescheduled, postponed, or delayed for their understanding of the current situation, and please be mindful of the difficult situation if contacted by the reception team - they are simply conveying the instructions given to them by the NHS service and decisions made on the basis of our appointment availability.

If you would like to discuss your options and how the changes impact you, you are welcome to contact us, but please avoid calling the practice directly, as we will not be able to respond to the volume of queries we receive and our phone lines need to be functional for urgent appointments. We can handle non-urgent queries via email at hh@s3dental.co.uk OR via Whatsapp on our practice telephone number - 01444440123.

Finally, i would like to wish you all the best of health this Christmas season, and my personal condolences to those of you who have lost family and friends this year.

Please look after yourselves and stay safe.

Merry Christmas & Happy New Year

Dr Sami Butt BDS MFDS RCSEd Cert.Ortho

Principal Dental Surgeon - S3 Dental