Dentistry’s future hangs in the balance
From mid-July, it is anticipated that routine dental care will return to Northern Ireland as part of phase three of the resumption of services. Phase two, which began on 29 June, saw the reintroduction of aerosol-generating procedures (AGPs). In the Republic of Ireland, routine care resumed on 18 May. In Northern Ireland, the Health and Social Care Board has established a working group to look at the immediate and longer-term oral health needs of the population.
In the Republic, attempts by the Irish Dental Association (IDA) to elicit any meaningful thoughts from the Government’s Health Department on the future of dentistry, and the associated wellbeing of the population, have been rebuffed.
Indeed, as Fintan Hourihan, Chief Executive of the IDA, said: “Dentists have been left out in the cold by a Government which has merely paid lip service to the provision of PPE (personal protective equipment)and has not engaged regarding emergency adjustments to the medical card scheme or regarding support for dental practices in general, the vast majority of which have suffered significant shortfalls since the emergence of COVID-19.”
However, while there may have been considerably more engagement by government with the profession in Northern Ireland during the pandemic, the future of dentistry there hangs in the balance also. At a Northern Ireland Assembly Committee for Health meeting on 25 June, the British Dental Association (BDA) said that dental practices were set to resume face-to-face care during July “at a fraction of their pre-pandemic capacity, limited by PPE costs and shortages, and requirements to meet strict social distancing and decontamination guidelines”.
The combination of lower patient numbers and higher costs will have a “devastating impact on high street services,” members of the committee were told. The system on which health service dentistry operates – the item of service – which sees dentists remunerated on the basis of treatments delivered, will be unable to cope with an expected collapse in patient numbers unless the Government is willing to offer long-term support or change the current model. The Department of Health has intimated existing support packages could be wound down after August, and any future support will have to be “subject to the confines of the dental budget”.
Richard Graham, Chair of the BDA’s Northern Ireland Dental Practice Committee, told the committee: “The future of dental services in Northern Ireland now hangs in the balance. Without adequate ongoing support from government it is frankly impossible to sustain a model based on activity when activity has fallen through the floor. In addition, clarity on last week’s commitment to provide PPE support is needed urgently. Dentists need support, and a conversation must start on finding a new way to restore confidence in the sector.”
In our cover story (p18), John Marley, a Consultant Oral Surgeon in Belfast, and immediate past Dean of the Faculty of Dentistry RCSI, explores what will be required in a post-COVID (PC) world. We must start, as always, with the patient, he says. As well as being treated safely, expertly, efficiently and effectively, patients expect to be treated in a timely fashion. In the PC world, waiting lists will increase significantly, “creating a tsunami of issues for an already understrength dental service especially as winter returns with the likelihood of a further ‘surge’”. Health services have survived this time by ‘robbing from Peter to pay Paul’ and ‘redeploying’ resources.
“However, with the demands of new and existing disease raising its head alongside a second surge or even just a chronic background of COVID, this may not be so easy the next time,” he writes. Our patients deserve graduates, specialists and consultants who have appropriate training. This will require more, not fewer, human and general resources in the PC world. Marley concludes: “These … interventions … will all demand willpower, unity of approach and of course funding. The ‘urgency of the now’ is upon us and we must act together.”