What is the Practitioner Health Service?

NHS Practitioner Health Service is a confidential service that specialises in treating doctors and dentists with mental illness and/or addiction issues. It recognises the difficulty practitioners can face when accessing healthcare through mainstream routes and helps them make the transition from clinician to patient.

Doctors and dentists are a hard to reach group in terms of mental healthcare for a number of important reasons, such as fears about confidentiality and the impact being unwell might have on their career and reputation. Unsociable hours, shift work, and moving location frequently during training also mean that doctors and dentists can find accessing mainstream healthcare services difficult.

PH has been running for over a decade in London and is now available across England. It is a fantastic organisation staffed by highly dedicated people and one that I am proud to work for. We were delighted to be rated as an outstanding service by the CQC in 2019.

What services does it offer?

We provide patients with a safe space within which to talk about the problems they face, be they professional or personal. Once an initial assessment has taken place, all patients are discussed at a multi-disciplinary team meeting where a tailored treatment plan is formulated. This may include on-going follow up with our clinicians, talking therapy and/or pharmacological therapy where indicated. If necessary, we are able to issue fit-notes, and liaise with external agencies (with patients' consent).

PH also has access to residential rehabilitation services for patients with addiction problems. Our expertise lies in understanding the pressures dentists face, the environment they work in and the regulatory systems they are subject to.

The service is available to any registered dentist in England (both NHS and private) on a self-referral basis. After contacting the service, the dentist will be asked to complete a set of registration and wellbeing questionnaires and will then be able to book an assessment appointment with a clinician of their choice. We have clinicians available across England who are able to provide both face to face and online consultations. Our clinicians are trained in treating health professionals as patients and understand the unique issues dentists may face.

Why might dentists specifically need a service like this?

Dentists often work in isolation, without the support of peers and colleagues, and face organisational, financial and time pressures on a daily basis. They often hold the responsibility for their practice, which takes its own emotional and economic toll, as well as dealing with patients who can sometimes be quite anxious and challenging because of the treatment they need. Taking time off for holidays or sickness can be difficult as it impacts on the practice and staff.

In 2008 the service was established in London to support dentists in accessing care in a safe, confidential environment. In 2019, NHS England recognised that dentists across England still face these same difficulties and have now commissioned PH to widen access and give dentists across the country a route to treatment and support, with the aim of keeping dentists in work and able to provide care to patients.

Over the last ten years in London the service has seen dentists dealing with a range of mental health and addiction issues. Dentists have higher rates of substance misuse than most specialties, often related to their easy access to drugs. They are also more likely to suffer from stress-related problems than the general population. As with the medical profession, dentists have a higher suicide rate than the general population (twice the rate). Emotional illnesses (anxiety, depression) are the third most frequent health problems suffered by dentists, while they are the tenth most frequent in the general population.

Medico-legal and dento-legal issues frequently feature among the reasons patients access the service, and we always ask about any such issues during our initial assessment. We have a great deal of experience supporting patients through complaints, claims, regulatory processes, criminal investigations and other dento-legal issues.

We know that there is evidence to show that those practitioners who are subject to complaints are at higher risk of mental health problems and suicide. Complaints often feature in the narratives of doctors who have taken their own lives and we always take these matters very seriously.

Why might dentists be less frequent users of the service?

From the start of the service, we created an agreement (Memorandum of Understanding [MOU]) with the General Medical Council (GMC) and the General Dental Council (GDC) and updated it as we expanded.

The MOU allows doctors and dentists approaching the service to be reassured that their case will be handled on a confidential basis and sets the parameters for when we, PH, must disclose an issue to the GMC/GDC. It allows us some flexibility and confirms that for the vast majority of patients, we do not need to share information with the GMC and GDC.

There are of course some exceptions where we may need to report, or breach confidentiality; for example, where a practitioner continues to work despite serious potential risk to patients, against our advice. These scenarios are thankfully few and far between - we work to the principle that a practitioner-patient should never be worse off being part of PH than not attending us.

This acts as a guide for us when, in exceptional circumstances, we do need to breach confidentiality. Any such disclosure is treated as a significant event and discussed at a team meeting and always made with the full knowledge of the practitioner-patient.

Dentists have historically accessed the service less than their medical colleagues and we hope that now our service has expanded across England and become more widely known about, this will change. Doctors and dentists are by their very nature already highly resilient people and should be reassured that it is okay to ask for help when it is needed. That is what we are here for.

What can dentists do to help themselves, and others? And what can other bodies (including the DDU) do to support them?

Dentists should recognise that they may suffer with ill health like anyone else, but that the added pressures of their role make them more susceptible to mental health and addiction problems.

Although it may seem unfeasible, very simple things throughout the day like taking a brief break to get out of the consulting room for a short walk for 5-10 minutes can really help. I know from general practice how easy it is to never leave the consulting room or practice for a break during the day because it is so busy. Even brief breaks can help relieve stress, and the pressure of intense clinical work. Try to ensure that holidays from the practice are planned well in advance so that cover can be sought and income unaffected. Everyone needs time away from the everyday pressure of working life or something will inevitably 'give'.

Most importantly dentists should look out for one another. If you spot signs of burnout or stress in yourself or colleagues, seek help early and encourage others to do the same. Tiredness, headaches, irritability, sleeplessness, as well as having a drink (or two, or three) every evening to relax, can be the first signs that all is not well.

Dentists make great patients and with the right help may not need to take any time off. Any dentist in England can self-refer to PH, and we can treat and support dentists with mental health difficulties and get them back to practice quickly and safely. Understanding and developing techniques for managing stress, dealing with anxieties and coping with the challenges of dental practice, can help a practitioner maintain their health and wellbeing for the years to come.

What other sources of support are available?

Within PH we offer a range of therapeutic groups with an open invite to all eligible doctors/dentists. Our website also offers a range of resources to help those facing a complaint or navigating an investigation with the regulator.

We also coordinate a bereavement group for families of dentists lost to suicide, as we recognise how difficult it can be for them to access support in these circumstances. We also hold a memory list of health professionals who have died in this way.

In addition, there are many charities, organisations and sources of online support for dentists, from the Royal Dental Benevolent Fund (financial assistance) and the Dentists' Health Support Programme for advice around addiction issues.

The expansion of NHS Practitioner Health provides a unique offering to dentists across England to access confidential NHS care for mental health issues. We hope dentists will make use of this service, for themselves and for their colleagues who may be in distress. We would encourage every dentist to make a note of the contact details and to pass them on if they see a colleague who may need help.

Dental practice can be tough on the individual, but there is help and treatment available if you ask for it. You are not alone.

Visit practitionerhealth.nhs.uk to find out more.