Do you remember 2020? That was the year that toilet roll was more sought after than gold and an inadvertent sneeze in a supermarket could get you battered to death by an angry mob armed with batons of sourdough.

Do you remember 2020? That was the year that toilet roll was more sought after than gold and an inadvertent sneeze in a supermarket could get you battered to death by an angry mob armed with batons of sourdough.

I’m also guessing it was a year in which you probably did nothing particularly memorable on the social front, other than peer through the window of a High Street barbers, wondering why the hairdressers were wearing just visors and no facemasks when you are forced to cut off your facial arteries every day in masks AND visitors that makes you look like Darth Vader’s wicked stepmother.

Unless you managed to squeeze a holiday in at Barry Island between January and mid-March, or took a trip to the theatre to watch a worthy play about a not so far-fetched dystopian future in which the UK is self-isolated from the continent, before the first UK lockdown started, you’ve probably lived the social life of a sedated hermit since SARS-CoV-2 burst on the scene. I have little doubt that 2020 will remain etched in your memory for all eternity, or until the UK’s tier system ends, whichever comes first.

Spring

The 2020 crisis in dentistry started with the shutdown of routine practise nationwide as the first full lockdown began. Only emergencies were allowed to be dealt with and very few patients were given the privilege of seeing a dentist face-to-face. The three A’s were then introduced into the dental lexicon, which might have just as well stood for Avoid, Avert, Abstain, but which actually stood for Advice, Analgesics and Antibiotics. This went against the grain for many, and I actually heard of one patient being prescribed Amoxyl to help with a tongue that had been ripped to shreds by a fractured lower six lingual cusp.

Dentists felt almost cast adrift by the ruling authorities and I heard from a number of distressed colleagues complaining that they were really in the dark as to what they were allowed or not allowed to do for patients when the three A’s just didn’t cut it. One of the conundrums I heard ex-colleagues complain of was “what happens if I break a patient’s tooth during extraction? Do I even attempt an extraction if there’s a risk of fracture?” Many were perplexed and it probably went some way to explaining the tsunami of referrals to referral centres for potential surgicals that probably didn’t actually need doing once a grumpy and resentful consultant oral surgeon had rammed his luxator up it.

It doubtless didn’t help things that guidance from the England Chief Dental Officer was initially very limited and a lot of practitioners found themselves looking to advice from the CDO’s of Wales and Scotland for guidance, particularly when the dental service began to restart at the beginning of the summer. The advice from the England CDO was so sparse, one wag modified Sara Hurley’s Wikipedia page so announce she was “missing in action,” alluding to her military past.

Of course, you may remember the clinical problems were compounded by management dilemmas. With practices working at much reduced capacities, decisions had to be taken on which staff to furlough and which staff to keep working. I’d have kept the nurses who never complained about my iTunes playlist working, as well as taking into full consideration, a nurse’s daily Oreo requirements. Hygienists and therapists reluctantly took one for the team more often than not, and even when dentistry half-heartedly resumed, many therapists and hygienists were still not taken back on because of the pressure on surgery availability. Even now, some therapists and hygienists are still to be anywhere near fully employed as they were pre-COVID, for this very reason.

With many dental DCP’s on reduced or non-existent income, a good proportion found the forthcoming payments to the General Dental Council for the ARF, an onerous financial burden.

Pleas to the GDC to either reduce the ARF or introduce an emergency payment by instalment scheme in order to ease the burden for cash-strapped DCP’s, fell on deaf ears. The GDC bleated that their income wasn’t secure because of “wider uncertainties” due to the pandemic – which was exactly the point. With DCP’s being unable to pay the ARF, the GDC’s income was bound to go down. It was perhaps not a surprise that the number of DCP’s who failed to renew their registrations in July exceeded the numbers seen in previous years. It’s not clear whether the reduction was due to an inability to pay the ARF or whether they were just completely disillusioned with the profession and the way dental professionals had been treated. One nurse who contacted me directly, spoke of a colleague who was in desperate financial straits after being made redundant and couldn’t afford to pay her registration. Fortunately she was aided by nursing colleagues getting together to pay her fees AND find her another post.

The GDC’s intransigence won the regulator few new fans, particularly in the light of the revelation that they actually topped up the salaries of furloughed staff to the £2,000 government limit, while DCP’s struggled financially. The story was so alarming, it was taken up by Private Eye journalist Heather Mills, and was published in June, following a tip off by an ex-dentist. I wonder who that was?

Private Eye 17^th June 2020

The GDC’s perceived poor performance before and during the pandemic prompted one group of private practitioners to call for the early resignation of GDC Chair Dr William Moyes, who is due to end his term in the role in September 2021 anyway.

Summer/Autumn

The return to ‘routine’ dentistry was far from easy, with Standard Operating Procedures (SOP’s) being introduced into the dental vocabulary along with Aerosol Generating Procedures (AGP’s), being introduced at the same time as changes to the NHS dental contract which left many flummoxed, like I was whenever I was first faced with a tooth named under the Universal Numbering System.

Many dentists were confused as to what circumstances they could pick up a drill in, and exactly what they should be doing to check on air exchange rates and whether they were allowing sufficient fallow time between patients. For many practices which actually had enough surgeries to shuffle into, it was a case of musical chairs. This occasionally meant the shedding of associate positions or reducing the hours of associates, drastically. This situation isn’t helped by the fact that sound definitive evidence-based guidance on fallow times still doesn’t appear to have been issued, unless I missed it while I was coughing up a COVID-ridden lung.

The practicalities of ensuring patient and staff safety, mean incurred additional costs for practices. Air exchange units, swanky filtered masks and extra PPE added thousands to the annual cost of running a dental practice in the face of reduced turnover.

I have been distressed many times over the past few months, by female dental friends sending me pictures of their faces after hours of wearing the aforementioned Darth Vader breathing devices. One dentist, I hardly recognised – her face being distorted by deep grooves which made her look like she had been through the windscreen of a car. With male colleagues it was different. Some of the grooves didn’t make much difference anyway, they were so peculiar looking, while in others, the tramlines made them look slightly wiser and more enigmatic.

Confusion seemed to surround the targets set by NHS England. While the official minimal activity target for practices was 20% of their contract, I know of few dentists who were slackening their activity and cutting off once they hit the 20% and I recently objected to a few comments on Twitter which asserted that dentists were milking the system and taking it easy. It was my firm belief that all dentists want to help patients above all else, and the idea that dental professionals are taking advantage of the crisis was beyond the pale…until…

Last night, two of my former colleagues came to my doorstep bearing Xmas gifts. I naturally wanted to hear all the news of my old corporate practice and they filled me in. Since I left, the practice has struggled to fill two associate vacancies permanently and they have had to use locums as a fill-in. I was told last night that a locum (who I came across before when she was filling in for a colleague on maternity leave) had returned to the practice. When I knew her, she was paid on a daily basis, not based on activity. As a result, all she did was use Cavit to temporise stuff and refer back to the permanent associates. In fact, every patient was referred back, no matter what the presenting problem was. Even if she had patients booked in for treatment, she didn’t do it. At one point she told a patient to wait until the dentist on maternity leave returned, some six months hence.

During the current working arrangements, she is paid on the same arrangement as the two remaining permanent dentists and is expected to contribute her fair share towards the 20% practice target and exceed it if possible, to do so safely, as are her colleagues. Apparently, this locum was treating 20% as an absolute maximum and continued to claim emergencies only, referring back to other dentists as was her previous habit. She hasn’t completed one AGP since she joined the practice in June.  A couple of days ago came the news that the new NHS target for the new year will be 45%. The locum has now told everyone that she needs to carry out at least four AGP’s per day in order to hit her target. Staff have never witnessed the dentist carrying out one AGP EVER, so they doubt very much she can rise to the occasion and assume she will leave it to colleagues to make up the practice shortfall.

This 45% target for the new year in my opinion, is frankly insane. That target will be impractical for many, particularly those practices with no access to ‘spare’ surgeries. Attempting to hit the target will almost inevitably add to practitioner stress, as well as compromise patient and staff safety. Incredibly bad timing and not well thought through, despite the BDA’s warnings to the NHS.

Dental laboratories were particularly hard hit as a result of the pandemic and reduced output by dental practices. At a laboratory I know well, one third of the technical staff were made redundant and around the UK, labs are being decimated by the pandemic and its effects on dental output. One point made by laboratory owners is that money guaranteed to practices during most of this year, included a portion that would in normal circumstances have filtered down to the labs. While a few labs have had monetary contributions from practices, they are few and far between, and many labs have had to reluctantly cut their staff and face future difficulties in meeting demand when dentistry finally does return to ‘normal’ due to reduced staffing.

Naturally, some treatments were delayed as an inevitable result of the pandemic and treatment limitations, so of course, the dental litigation solicitors are currently offering to take up complaints from patients who allege they experienced unacceptable delays in receiving treatment. How that pans out for practitioners, only time will tell.

There WAS a little bit of good dental news towards the end of the year though. Dr Jason Wong, a principal at The Maltings Dental Practice in Grantham, was appointed as the Deputy Chief Dental Officer for England. Jason is a much respected general practitioner and a good communicator who I feel will give the CDO’s office a welcome input from a GDP’s perspective.

What Next?

But what of next year? What will 2021 bring to UK dentistry? In my next blog I will put my Nostradamus cap on. If you feel like crossing my palm with silver, make sure it’s not old silver points you’ve fished from the private drawer you also keep your four pack of Twix’s in.