Fears about NHS 'dental deserts' appearing across the country are long-standing, but have gained traction since the pandemic. Now, the Health and Social Care Committee has launched an inquiry into the issue of access, following a survey suggesting that 90% of UK practices were not accepting new adult NHS patients. It will hear evidence over the coming weeks and make recommendations to the government, including what incentives can be offered to recruit and retain dental professionals.
Of course, attracting new members of the dental team - and keeping them - is always going to be a difficult task in the current climate. Our own recent survey found that more than eight in ten (86%) dental professionals said that workplace pressures have increased in the past two to three years, and that nearly four in 10 (39%) said they were likely to retire or leave practice in the next five years.
There's little doubt the access issue is itself adding to the strain, as dental professionals struggle with being unable to provide the level of care they want because of factors outside their control. In addition, there are signs that the disruption is affecting their relationship with patients.
At a Westminster Health Forum event last year, I warned that patients had a lower threshold for raising a complaint since the pandemic. This was partly based on a survey of the UK public commissioned by the GDC last June, which found that a third of patients who had made a complaint about a dental professional would be even more likely to now in the same circumstances (only 6% said they would be less likely).
I fear this 'shorter fuse' may be a factor in the latest figures on written complaints in the NHS in 2021/22, which show an increase in NHS complaints involving primary care dental services, from 14,052 to in 2018/19 to 14,285 in 2021/22. While clinical treatment was the most common subject for complaints, the number in this category was actually lower than previous years. By contrast, complaints about costs and charges were around double what they had been before the pandemic, while appointment availability complaints were up too.
In this issue of the journal, we look at how members can best communicate with patients about the access problem and manage their expectations to reduce the risk of a complaint, as well as how to resolve access-related complaints when they do occur. I also encourage members to call us as soon as they are aware of a potential complaint so we can assist them with their response.
Patients deserve prompt and fair resolution in the event of a problem, but so too do dental professionals - and sadly this is often not what happens. This issue includes the story of a member who was subjected to a protracted three-year investigation following a vexatious NHS complaint by a fellow dental professional. They were exonerated with support from the DDU, but the experience was devastating.
...39% of dental nurses are looking to leave dentistry in the next two years, while numerous surveys have found that dental professionals are increasingly struggling with mental health problems...
Meanwhile, the GDC is still taking too long to resolve fitness to practise cases. In December 2022, the Professional Standards Authority (PSA) published its latest Performance Review of the GDC, which found the regulator had not met the standard for timeliness for the fifth year in a row. The PSA noted that the GDC is taking steps to improve its performance, but cases are being progressed through the system too slowly and the number of open older cases has increased. It has also written to the health secretary to raise its concerns.
The DDU is aware of senior dentists who have been suspended or worked under restrictive conditions for more than year while little progress has been made towards resolving their case. We have raised this important issue with the GDC repeatedly and also written to the national press to sound the alarm more widely - some of you may have seen our letters in The Guardian and The Times last year.
Not only are these delays highly stressful for individual members; it is not in patients' interests, at a time when there are gaps in provision. Nor is the time the GDC has been taking to process registration applications and appeals, another area where the PSA's Review says that the regulator's standard had not been met.
We know a small but significant number of members have been unable to treat patients for several weeks after their registration lapsed due to bank errors or missed correspondence. While the GDC is taking steps to address this problem, I would point members to our advice on registration renewal and CPD declaration to ensure there is no interruption to their practice.
As the Health and Social Care Committee will surely realise, there are many layers to the crisis in NHS dentistry and no quick and easy fixes. But if they want to prevent an exodus of dental professionals, the politicians and regulators must consider how they restore morale. In my last leader, I set out the measures where we want to see urgent progress, but now I'd like to remind them of the promises made during the pandemic.
In a Dear Colleagues letter of July 2020, the CDO for England signed off expressing gratitude, "for your continued contribution to the national response, which has not gone unrecognised." Meanwhile, the GDC said it recognised the highly challenging circumstances that dental professionals were working under and it would take "relevant environmental and human factors" into account, should concerns be raised.
While many understandably want to move on from the dark days of coronavirus, we can only really do so if we acknowledge the impact this experience had on everyone in dental practice and its serious long-term effect on the service.
The DDU will continue to do everything in our power to ease these ongoing pressures. Whether it's support when you need it or calling for dento-legal changes to make dental practice a better place, we will always be on your side and by your side.
Head of the DDU
Head of the DDU
John Makin BDS PgDL PgCDE FHEA is head of the DDU. He qualified in Manchester in 1983 and has worked as a general dental practitioner in Lancashire and Devon before joining the DDU as a dento-legal adviser. He was involved with foundation training for many years as both a trainer and VT adviser/training programme director with the Manchester and Exeter DFT schemes.
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