In this series of four articles, DDU members from different backgrounds reflect on how 2020 changed the way they work, talking about their experiences of adjusting to our new ways of working and offering advice for the future from their own unique perspectives.
My name is Simon Kidd. My 'day job' is as an associate in a busy mixed dental practice in the West of Scotland. I've been in the same practice for nearly 14 years and have been a vocational trainer for six years. I am secretary to the Local Dental Committee and in that capacity I sit on many advisory groups which have been particularly active during this time.
To what extent has your practice been affected by changes brought about as a result of the coronavirus pandemic?
All Scottish dental practices were instructed to cease face-to-face patient care and establish a triage and 'advice, analgesics and antimicrobials (AAA)' service as the first national lockdown came into force. For patients with emergency dental needs, urgent dental care centres (UDCCs) were established at hospital and community dental units. There soon followed a number of requests for dental teams to volunteer to support the UDCCs and wider NHS frontline services.
Scotland took a more phased approach to the return to patient-facing care than our counterparts across the UK. We returned to practice in late June but were unable to provide anything but urgent NHS care until early November, with the re-introduction of AGPs coming at a very late stage. The resultant effect was that, for several months, my own practice had been limited to extractions and the careful application of glass ionomer to compromised (and slightly damp) teeth.
Were you redeployed, what challenges did you face?
I was initially deployed to a COVID assessment centre (CAC) to help with the triage of COVID patients whose symptoms were worsening. As a dentist, it quickly became clear that my usefulness was limited. Nonetheless, leaning heavily on the expertise of others and the training that was provided, I did what I could. The lasting benefit of having had this experience is that it made the virus very real for me. I often keep this in mind when I am layering on enhanced PPE.
As lockdown restrictions were eased and case numbers fell, the CAC released me and I was more than a little relieved to be reassigned to a UDCC. This provided quite a different set of challenges compared with working in practice. The limited treatment options we had at our disposal meant that patients had some very tough decisions to make.
How do you feel patient care has been affected?
In the early stages and even when practices reopened, patients in pain were routinely faced with a choice between an immediate extraction or a long wait (often up to a week) for an AGP intervention at a UDCC. Unnervingly, most opted for the extraction rather than risk another sleepless night. My dento-legal knowledge and clinical experience helped steer me through many of these difficult conversations but it never did sit well with me. I therefore went to great pains to reference the restrictions that were in place at the time when making clinical records.
With a blanket ban on AGPs in NHS dental practices continuing throughout the summer, dentists became increasingly frustrated with their inability to help patients. In light of this, private dentistry veered away from the CDO's remobilisation plan and began to provide AGPs on an independent basis. This two tier system attracted a lot of attention from the media and led to much debate over the moral dilemma this raises. It is not difficult to see why a great many patients were complaining about the perceived lack of access to NHS care or being 'forced' into private treatment.
What sorts of challenges have you experienced on a personal level, rather than professionally?
There was a significant period of uncertainty where dental teams did not know what financial support was coming down the pipeline, if any. The threat of staff redundancies, associate percentage cuts and practice closures felt very real and certainly raised my anxiety levels. The notion that I might not have been able to pay my bills was extremely worrying and it was hard not to think about anything else in the first weeks of lockdown. Thankfully I was able to benefit from the NHS financial support measures, which relieved some of the stress.
Everyone has been incredibly understanding and supportive of one another throughout this crisis.
What have you found most difficult aspects of returning to dentistry during the pandemic?
The return to more routine dentistry has actually been a welcome dose of normality. Aside from the enhanced PPE, lifting a handpiece feels very much like riding a bike. What I have found really difficult is keeping up with the advice and guidance. It felt like almost every day there was a new communication from one body of opinion or another, necessitating constant changes to procedures and protocols at the practice level. I think it is really important that every practice has someone charged with monitoring the guidance who can keep the whole team up to date with the key information.
I've been very careful to carry out a risk assessment for every procedure I undertook during this time. I tried to involve the patient in every decision to treat, documenting the justifications and mapping decisions to the relevant guidance. Unfortunately, I feel like I now spend more time triaging, risk assessing and record keeping than actually seeing patients.
What are your thoughts for the future?
Now that multiple vaccines are being rolled out there is some light at the end of the tunnel. Unfortunately, due to the sheer scale of the vaccine programme and the time it will take to deliver, it is quite clear that many of the restrictions on how we practice dentistry will have to remain in place until the pandemic is under control.
The cumulative impact these delays and restrictions will have on patients' dental health is of great concern to me. Realistically, it might be more than a year before we have cleared the backlog of outstanding treatment. This means the majority of my patients might go unseen for over 18 months. I dread to think what horrors my once-stable patients might present with.
Nonetheless, I'm heartened by the resolve shown by my colleagues and patients alike. Everyone has been incredibly understanding and supportive of one another throughout this crisis. I was particularly impressed by the enthusiasm shown by this year's cohort of vocational trainees during the recruitment process. The optimism was, for lack of a more fitting word, infectious.