Dentistry onthe NHSin decay?

Challenges made worse during pandemic

Difficulties in accessing NHS dentistry in West Sussex have been made worse by the pandemic, a health watchdog has said.

Even before coronavirus, dentistry was facing unprecedented challenges on multiple fronts including issues with access, huge numbers of people going to A&E with dental problems and rocketing rates of mouth cancer, an investigation by JPIMedia has revealed.

But the pandemic has made the situation substantially worse.

The British Dental Association said coronavirus had left the service facing an ‘existential crisis’.

In West Sussex, residents have spoken out about their struggles to get an NHS dentist appointment.

One woman from Worthing grew so desperate after not being able to register with an NHS dentist that she ended up pulling nine of her own teeth out.

Meanwhile a man from Chichester had to register with an NHS dentist 35 miles, and an hour’s drive, away from his home due to a lack of NHS availability ( see right hand panel).

Healthwatch West Sussex, an independent body which champions the views of health service users, said people had told them it was ‘impossible to find an NHS dentist in some parts of West Sussex’.

Locality manager Katrina Broadhill said that – since the announcement in June that dentists were open again – they had heard ‘a steady stream’ of stories similar to those reported by this newspaper.

“Many are from people who simply can’t find a dentist willing to provide face-to-face NHS treatment,” she said.

“However, prior to the pandemic we had been raising this as an issue with NHS England, as people were telling us it was impossible to find an NHS dentist in some parts of West Sussex.

“Throughoutthepandemic we’ve been working with the dental experts to get clearer information about how people can get access to NHS dental care and have escalated concerns within Sussex and nationally.”

Meanwhile, Healthwatch East Sussex said it spoke to the NHS dental helpline on November 17 and was told that no dentists were accepting new NHS patients in Sussex at the moment, and that this was unlikely to change before Christmas.

They were advised that temporary DIY filling kits were available from pharmacies or supermarkets for cracks or holes in teeth, and said they were offering telephone consultations in some circumstances.

Toby Hancock, chairman of the West Sussex Local Dental Committee, said: “Due toyearsofNHSunderfunding and exponential increases of bureaucracy and red tape, the difficulty with finding NHS dentists has always been present.

“Although now even more so due to Covid-19.”

During the first lockdown, all dental practices were stopped from seeing any patients face-to-face.

While practices stayed open, this was only to give advice over the phone, to issue prescriptions directly to pharmacies and to refer people to urgent dental clinics.

Mr Hancock said: “This created a backlog of around three months, including urgent case and routine care.”

The British Dental

Association (BDA) has reported that in the year to the end of August, 15 million appointments have been missed due to the pandemic while the service has only provided around a quarter of the treatments it would normally have done in preCovid times.

Mr Hancock said: “Due to a backlog of patients, stricter and more time-consuming procedures in place, the number of patients seen each day dramatically fell for both NHS and private patients.

“Priority remained with those in pain and those who had swellings. Even this wasn’t enough and more patients were forced to go to A&E departments or the Emergency Dental Service, as they have nowhere else to go.”

He said the impact on patients was likely to be felt in the long-term.

“The outcome of over six months of delayed NHS examinations and checkups has meant that routine care has limited all the usual checks that a dentist would undertake on a regular basis,” he said.

“Mouth cancer, other pathology, diseases such as tooth decay and gum disease have all gone unchecked.”

Eddie Crouch, chairman of the BDA, said it wasclear that dentistry was now grappling with an ‘existential crisis’.

“Access problems that were common pre-Covid are now the norm in every community,” he said.

“Meanwhile, practices face a deeply uncertain future, as they try to balance tight restrictions, higher costs, and a collapse in patient numbers.”

A spokesperson for NHS England disputed the claim that people were struggling to get dental appointments, saying: “Nearly 25,000 dentists are offering NHS care – the highest number on record – and during the first wave of the pandemic, over 600 urgent dental centres were set up so patients could access the care they needed.

“Dental practices are open and are understandably prioritising urgent care alongside recalling patients to complete routine care.”

People were telling us it was impossible to find an NHS dentist in some areas KATRINA BROADHILL Healthwatch

runs these services in West Sussex, said they were under ‘exceptional pressures’.

Emergency dental services are provided out-of-hours at centres in Worthing, Chichester, Crawley and Haywards Heath by appointment only, and on a first-come, first-served basis.

A spokesman said: “This limited service is under exceptional pressure. Already in 2020 we have provided nearly 12,000 emergency appointments, and have been offering consultation and treatment throughout the pandemic.”

Anyone who has a dental emergency outside of normal surgery hours, which cannot wait to see their own dentist, should call their local emergency dental clinic to ask for an appointment. Full details are available at www. sussexcommunity.nhs.uk.

How dentists have responded to the pandemic

The pandemic has had a profound impact on the way dental practices work, with new safety procedures making dentists’ jobs harder.

Toby Hancock, West Sussex Local Dental Committee chairman, said these included a one-hour fallow time between each patient, more PPE and thorough cleaning.

Many dentists have suffered financially. “Private self-employed dentists fell through the cracks for government support,” he said. “Only NHS practices received income, private dentists received nothing and relied on what savings they had while they had their doors closed.”

However, he said private dentistry had fared much better than the NHS, because it had managed to recoup the ‘significant cost’ of new safety equipment from patients.

He encouraged people to consider signing up to a private practice, which he said could be affordable, adding his practice, Richmond House dental practice in South Street, Chichester, could give a private patient an appointment within 24 hours.

Jessica Barber, a dental hygienist from Worthing, agreedthatthestringentsafety measures had put additional pressure on dentists. “Our jobs have certainly become much more difficult as we can only manually clean patients’ teeth with hand instruments,” she said. “As a practice we’ve invested heavily in risk mitigating procedures. We are unable to social distance so require high level PPE and the cost is huge now.” However she said that, ‘on a positive note’, patients had stepped up their oral health at home.