The COVID-19 bite – perspectives behind two different doors
Shamir is a dentist and the Senior Clinical Dental Advisor, Fitness to Practise, for the GDC. In this blog, he discusses the impact of the pandemic at a personal level, through his different roles.
Dental patients and professionals have been profoundly affected by the COVID-19 pandemic. These impacts have been captured by the GDC’s recent COVID-19 and dentistry research. Many of the research outcomes resonate with my own experiences.
The last two years have been tough
I own two small practices in London, and over the course of the past 24 months, my practices have endured record losses of highly experienced team members. The recruitment of new staff has been a considerable struggle. These experiences are by no means unique. I believe there are likely to be several pandemic-related reasons for the staff changes, which include:
- The fear of the pandemic; for some team members, the risk of an adverse outcome from a coronavirus infection (especially pre-vaccination) questioned their desire and motivation to continue in the dental profession.
- The need to adapt to continually changing COVID-19 clinical guidance (including the interpretation of the guidance, which has sometimes been inconsistent and ambiguous).
- Challenges with acclimatising to new items of PPE.
- Unrealistic patient expectations and heightened patient demands.
- Regularly changing contractual targets, that at times have seemed unattainable, especially with staff needing to regularly self-isolate.
- Physical exhaustion and lower levels of wellbeing, perhaps exacerbated by fears of complaints.
As a mixed practice (providing NHS and private dental services), the pandemic has had a considerable negative financial impact. Rising fixed costs, the loss of income from non-NHS activity, insufficient staffing levels (especially the inability to recruit replacement NHS dental performers and experienced dental nurses), the need to invest in new types of PPE and mechanical ventilation units, have significantly curtailed our ability to invest and grow as a business. Times have never been as challenging.
The GDC’s recent COVID-19 research alluded to many dental professionals moving away from an overstretched and fragile NHS dental system to the private sector. With general low morale in dentistry, I have learned of many younger colleagues planning to leave the profession, seeking more rewarding careers in other sectors and senior colleagues retiring prematurely, having lost the drive and will to carry on.
It's been a difficult time for patients too
The GDC’s research also investigated the impact of the pandemic on the public. In line with the findings, we are now seeing higher numbers of patients attending for routine dental care. However, with many not receiving regular attention over the pandemic coupled with changing lifestyle and dietary habits, increasing levels of oral disease are being observed at my practices, especially amongst higher-risk groups. This pattern is likely to lead to widening of oral health inequalities.
For my team, the backlog from the pandemic has resulted in the need for significant catch up with the feeling of constantly being on the back foot. The need to adhere to new infection control guidelines has culminated in a reduction in our capacity. This has sometimes manifested in the expression of frustration by patients, due to longer waiting times and rising waiting lists, with occasional bursts of aggression and unacceptable behaviour.
Over the past two years my practices received record levels of complaints and concerns from patients, usually due to appointment waiting times. I am also aware of patients using organisations such as the GDC to threaten and intimidate dental professionals in attempts to forcefully get what they demand. This has not been helpful, and the mental health impact on dental professionals facing such pressures and threats can be draining. It can also lead to dental professionals taking a more defensive approach to their practice, which is an area of growing concern and something that is not in the best interest of patients or dental professionals.
Impact of COVID-19 on my role as a Clinical Dental Advisor
As part of my work as a Clinical Dental Advisor (CDA), it was refreshing to see the adoption of a clear stance by the GDC at the outset of the pandemic at the Initial Assessment (triage) stage with fitness to practise matters, to ensure mindfulness and understanding of the impact of the pandemic on dental professionals and the delivery of care.
A substantial amount of my and the in-house CDA team’s work involves preparing clinical advisory reports. The pandemic has culminated in the need to carefully consider the interpretation of the ‘reasonable’ standards expected from dental professionals and in a dynamic and sensible way. We are fully aware of the pressures of the pandemic, such as the effects of cancellations and longer waiting times, rising patient expectations, the limitations of remote triage and the occasional need to provide care that may not always be in line with usual protocol. Whilst the GDC has an important role in ensuring patients receive good and safe care, as well as maintaining the confidence in the dental profession, as a CDA, I have given very careful consideration to these novel circumstances whilst preparing my reports and giving advice, with the aim of being realistic, balanced, and proportionate.
At an individual level, I am acutely aware of many fellow dental professionals who live in the constant fear of their decision-making being scrutinised and challenged especially during these very difficult times, and I hope this blog offers some reassurance.
Looking to the future
The effects of the pandemic and other factors have provided further impetus to explore ways of tackling some of these important issues discussed above. I am aware of lots of important projects taking place at the GDC, which take these sectoral challenges into account. However, the speed of recovery from the pandemic will very much depend on the determination and collaborative efforts of key stakeholders. Whilst the pandemic has taught me that nothing is readily predictable, I am hopeful that action across all stakeholders, supported by the resilience and adaptive capacity of the dental profession, will help to bring some much-needed changes and in a timely way.