In my role, I meet many dedicated dental professionals, so I've been saddened to see the recent swathe of negative headlines and implied criticism directed at the profession for a situation that is not of its making.
Whether it's gruesome DIY dentistry, Healthwatch surveys highlighting public dissatisfaction with unfair charges or towns and even whole counties with no available NHS appointments, every report points to unhappy patients and a system in crisis.
Meanwhile, NHS practices are also under huge pressure from above to return to pre-pandemic activity levels, and there is a tension between the need to prioritise patients in pain and offer continuity of care for regular, long-term patients. A recent letter from the CDO for England reminded practices that "urgent dental care should be provided as part of their core service offer to patients, and that adherence to risk based recall intervals and other NICE guidance is a contractual requirement."
We all recognise that access to NHS dental care and specialist treatment is a long-term problem - dramatically worsened by the pandemic - for which there are no quick fixes. But inevitably, it is those on the frontline who are bearing the brunt of people's frustration and anxiety.
The DDU had its busiest year on record during 2021 and we are seeing more complaints and even claims where commissioning turns out to be a more significant factor than allegations of sub-standard treatment by the practitioner.
While the DDU is not a political organisation, we will always support and robustly defend our members in these challenging circumstances. We recently expanded our team of advisers to twenty dentists, so any member who calls our advice-line will be able to speak to a fellow professional straight away for expert advice and reassurance.
Our advisers are happy to help members respond where commissioning and capacity issues are integral to a complaint, politely explaining the situation to complainants. And if they are facing criticism, we will ensure the context in which the practitioner was working at the time is properly taken into account.
Inevitably, it is those on the frontline who are bearing the brunt of people's frustration and anxiety.
While practices cannot conjure appointments from thin air, we can also suggest practical risk management steps to help pre-empt problems. As ever, these revolve around effective communication with patients and colleagues and setting realistic expectations. For example:
- Delegate a senior member of the practice team to keep in touch with local commissioners and referral centres and circulate up-to-date information about availability, current waiting times and arrangements for specialist NHS referrals. Don't assume that national shortages mean that a particular service isn't available locally.
- Ensure a referral is appropriate and the patient's condition meets the local eligibility criteria so you aren't wasting their time and setting them up for disappointment.
- Help patients make an informed decision by clearly setting out their treatment options, including the option to have their treatment privately and the cost. If you're aware there are delays for a particular service, you should make this clear and manage their expectations - but be careful to avoid the impression they should opt for private care if NHS treatment is available.
- Listen to patients who are frustrated or anxious about costs. The situation may be outside your control but it is still important to be empathetic when patients express their concerns, and answer their questions. But this does not mean you have to tolerate abuse, and this DDU journal article has advice on dealing with aggressive and challenging behaviour.
- Be clear about information required when making a referral, including the service specifications, so you are not responsible for delays because something is missing.
- Document these interactions with patients to ensure continuity of care and that you have evidence of the steps you have taken.
Of course, managing expectations has always been an important part of a professional's skillset but I understand these measures will do little to relieve the frustration felt by those who came into dentistry to help people and feel they are currently unable to meet their own high standards. As our interview with Rory O'Connor of the Dental Health Support Trust makes clear, the pandemic has exerted a huge toll on everyone involved in dental practice and I hope that those who feel their mental health has suffered will seek help.
The current situation is very challenging but I believe practitioners can be proud of the huge effort they are making to adapt and provide safe, high-quality care, despite limited resources. Speaking for the DDU, we will continue to guide, support and defend members against unjust criticism - you should expect nothing less.