Dr Nathan Welch
Access To NHS Dentistry In The Spotlight
As I am sure many of you have seen in the papers today the spotlight on access to NHS dental care is coming under fire.
First and foremost it must be noted the data used in these reports is from England and not Wales. However that is not to say that NHS Dentistry in Wales is without its problems.
Coronavirus has had a devastating affect on the way Dentistry can be delivered.
First in Lockdown 1.0, dental practices in Wales were “open” but advised to treat as many problems as possible over the phone and with analgesics and antibiotics. The only face to face treatments being offered were for extractions, or if available a referral to an urgent care centre to have your tooth dressed. Dentists cannot work over the phone or on video call effectively. It is a hands on job where things need looking at in minute detail, not via a fuzzy video link from 2 feet away.
Secondly in August, we were allowed to follow extremely strict “standard operating procedures”, these were a legal requirement straight from Welsh Government. Yes we were open and back able to offer treatments that required “Aerosol Generating Procedures”. However every time one of these AGPs was carried out the surgery then had to sit empty for 60 minutes - this “Fallow Time” was to allow aerosols to settle from the air and then once 60 minutes had elapsed the room was disinfected. You can see how waiting 60 minutes between each treatment would mean that you don’t actually get a lot of work done in an 8 hour day.
Thirdly at Christmas time “Fallow Time” was reduced to 30 minutes in a surgery with natural ventilation (a window), and 10 minutes with mechanical ventilation exceeding 10 air changes per hour (industrial extractor fan). This was the beginning of some semblance of normality for general dental services. Some 9 months from the initial Lockdown 1.0.
Added onto this is the additional time it takes to put on and take off our enhanced PPE.
Since Christmas we have worked tirelessly at Y Bont Faen Dental Surgery to work our way through the “backlog” of patients. There are literally 1000’s of our patients who we have not been able to see over the months March 2020 to January 2021. All of your names are printed and highlighted and we are calling you as fast as we can. Please bear with us. We are about a third of the way through the list and picking up pace as we have less and less AGP’s to perform.
Why aren’t we taking on new NHS patients? Why is our NHS waiting list so long? Because we feel we have a duty to our existing patients and they come first. It is not that we don’t care about the population of Wales' teeth at all, we do, if we could help everybody we would but we are directly responsible for our registered patients teeth.
Why can I been seen privately? Because NHS services at a dental practice are a limited resource. Every practice in Wales has a limited amount of NHS work it can carry out in a financial year. If you go over this quota you do it for free. Would your business survive if you gave away your services for free? If you want more NHS dental services in your area you do not need to campaign to dentists, take those complaints to your local MP and get them to put it to the assembly government.
The Chief Dental Officer of Wales controls how NHS dental services are provided and one of her main aims is to increase access to NHS dental care to the whole population. There is now a Cardiff and Vale central waiting list for NHS spaces. Practices are being encouraged to see patients from this central list but it is my opinion that this should not be at the detriment to our existing patients.
Whenever Dentists are in the headlines it always seems to be doom and gloom. I just wanted to give my personal opinion and an insight into what happens behind the scenes that make such captivating headlines.
Hoping to see you all very soon,