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Dentistry watchdog: ‘It’s a national crisis’
The scale of the problems in dentistry caused by the pandemic has been highlighted in a recent report by Healthwatch England.
There are over 150 local Healthwatch organisations across England, creating a national network that listen to the issues faced by health and social care patients and bring them to the attention of the powers that be.
In December 2020 they produced a report based on 1,300 people’s experience of accessing dental care. I spoke to Jacob Lant, Head of Policy, Public Affairs and Research, to find out more about those experiences and what it all means for the dentistry now and in the future.
Craig: What were the main findings of the report?
Jacob: We already knew there were issues with access to dentistry before the pandemic, particularly in certain geographic areas or for specific demographic groups.
But we saw these issues explode during the pandemic and we’re now in the position of calling it a national crisis. Which is why we created our report ‘What People Are Telling Us’.
The report is based on evidence gathered during July to September, after practices had re-opened following the first lockdown.
During that time, we had a 452% increase in calls from people sharing their dental stories and asking for help to find a dentist.
That was significantly higher than the number of calls we received for other areas of health and social care. The number of patients telling us they were unable to access their dentists was almost twice as much as those saying they were unable to access a GP.
Because of that, we did a snap poll and asked our network of local Healthwatch teams around the country what they were seeing.
Over half of those who responded said they’d seen a significant rise in the number of people contacting them about dental issues. More than 90% said things had got a lot worse during the pandemic.
We also found that dental concerns were being raised in areas where we’ve never had them before, such as in London and the South East.
Craig: What were the main themes of patient feedback highlighted in the report?
Jacob: People were unable to access routine treatment after practices reopened as only urgent treatment was being offered. While that was understandable, patients were frustrated that no indications were being given for when they could access routine treatment again.
The definition of urgent treatment was also an issue. Lots of patients were being told they didn’t qualify for such treatment or were only being offered treatment they didn’t think was appropriate, such as extractions.
This led to people self-medicating or doing DIY dentistry. While the latter wasn’t a massive issue, I’ve seen more examples of it during the pandemic than ever before.
There were also concerns from pregnant women and new mums who have lost out on being able to access their free appointments during this time. Lack of access and regular routine care also meant cases of oral cancer weren’t being identified early and other issues were being missed which led to trips to A&E or hospital stays.
With more people being on furlough or losing their job, the issue of affordability of dentistry became more significant. This wasn’t helped by the increase in NHS charges in December 2020.
Patients were often being told they couldn’t receive treatment on the NHS but they could if they paid more for private service.
Even if this was a genuine offer to try and help the patient access the treatment they needed, some were telling us it felt like they were being given no option but to go private, which they couldn’t afford.
Finally, there was a lack of information about how to access an NHS dentist due to the data available on the NHS website being quite poor.
Ninety per cent of calls to some of our local Healthwatch teams were about how to find an NHS dentist and it’s the second most popular topic on our website.
Craig: Why do you think there was such an increase in feedback for dentistry during this period compared to other healthcare sectors?
Jacob: Firstly, because most of us don’t have routine appointments with GPs in the same way that we do with dentists.
Secondly, it’s much easier to carry out a lot of GP care remotely by phone or video.
When you see the GP, you mostly have a conversation and a physical examination isn’t always necessary. But when you see a dentist, they pretty much always need to put their fingers in your mouth.
While lots of dentists have moved to remote consultations, and it’s surprising how much can be done via this route, they obviously can’t do as much as they usually do.
GPs also didn’t need to worry about issues like fallow time, so their capacity to see patients wasn’t as impacted.
The conditions created for dentists by the pandemic led to a perfect storm of massive access issues.
Craig: If these issues were created by the pandemic, will they simply disappear once it’s over?
Jacob: No, there are long-term consequences of what’s happened during the pandemic.
There’s now a backlog of routine treatment that needs to be carried out as well as remedial treatment to manage problems that occurred during the pandemic.
There’s also an issue with the breakdown of trust between dentists and patients.
We already know that there’s a perception that it’s difficult to get an NHS dentist, even in areas where it’s not that hard, and the experience of patients during the pandemic will only have exacerbated this.
Ultimately, these long-term consequences will need to lead to some kind of radical change in the way we do dentistry.
Everyone is so frustrated at how long contract reform has taken so far, and now this pandemic has highlighted the problems that exist.
Dentistry needs the policy and political focus that it deserves to ‘build back better’ out of the pandemic.
Craig: What do you think the next six to 12 months might hold?
Jacob: I would be hugely surprised if the number of calls we receive changes and I expect it to be a very bumpy road for dentistry, partly because of the backlog of routine appointments and care.
There’s also going to be so much focus on NHS recovery in other areas that I fear dentistry won’t be seen as important enough or given the attention it needs.
That’s one of the reasons we’re keen to keep up momentum on this and show that it does matter.
Dentistry is the only truly preventative service that the NHS offers throughout your entire life.
If the NHS is truly focused on keeping people well rather than just treating illnesses, it needs to harness what already exists in dentistry to drive that culture change.
Craig: Is there anything dentists can do to improve the issues facing patients? And does this differ depending on whether you’re in the NHS or private?
Jacob: Firstly, making sure you update your records on the NHS website to say whether you’re taking on NHS patients would be really helpful.
Committing to doing that regularly – ideally once a week and at least monthly – would be even better.
The NHS website is patients’ first port of call and it will make it significantly easier for them if everyone keeps their record up-to-date. It also means they’re less likely to be frustrated when they arrive at apractice that can take them on.
Secondly, it’s worth taking the time when you’re going through the treatments to explain what the current restrictions are and why some treatments are offered on the NHS and some can only be done privately.
It’s also worth discussing when that will change – even if you’re not sure exactly when that will be, giving a rough idea can be helpful.
If it’s not an urgent treatment, some patients may choose to wait three months to have it done on the NHS – if they know that’s a possibility. At the moment patients are simply hearing ‘it’s not available on the NHS but if you pay more you can have it done privately’, and it’s not always going down well.
That message needs to be clearer in order to avoid reputational damage to dentistry and a relationship breakdown between dentist and patient.
Craig: How can the powers that be in dentistry help the profession to resolve the issues highlighted in this report?
Jacob: They need to present a united front and to work with the Government to make this a priority for the NHS.
Everyone needs to come together to say that the pandemic has exposed a number of structural issues in the way we deliver dentistry and it needs a proper solution.
Bodies such as the CQC, BDA, GDC and NHSE need to work together make sure dentistry gets the focus it needs.
There’s an opportunity to do this by supporting the forthcoming health bill in May around the commissioning of healthcare, including dentistry.
I don’t think national commissioning of dentistry works. It’s not responsive enough and it doesn’t address problems fast enough.
The white paper behind the health bill seems to be driving towards commissioning at the Integrated Care Systems (ICS) level, and everyone should get behind that.
To read the full report from Healthwatch England, click here.
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