This is the 2020/21 edition of State of Care
Like all health and care services, COVID-19 has challenged how primary dental care is delivered.
Access to NHS dental care for all has been highlighted as an issue before the spread of COVID-19, and there are clear signs that this has been compounded by the pandemic. At the start, routine NHS dental services were paused in the interest of patient and dental staff safety. From June 2020, practices steadily restored services, while introducing enhanced infection prevention and control measures, such as using additional personal protective equipment, leaving fallow time between procedures, and carrying out more frequent deep cleaning.
The impact of COVID-19 on the service available is clearly seen in data from the NHS Business Services Authority on the total units of NHS dental activity (UDA) recorded – in 2020, this was 58% lower than it was in 2019. Activity levels fell to their lowest in May 2020, a reduction of 98% on the same month in 2019 (figure 9).
Access to NHS dentistry is one of the recurring issues that Healthwatch have regularly reported on. Even so, the total volume of feedback from the public that Healthwatch received increased dramatically during the pandemic, with feedback about dentistry increasing at a much higher rate than any other area of health and social care. From July to December 2020, more than seven in 10 people who contacted Healthwatch to share their experiences of NHS dentistry said they found it difficult to access help and support when they needed it. Issues around booking routine care, restarting treatment that began before the pandemic, and getting emergency treatment were common themes.
This was reflected in feedback we received about accessing dental services through our Give Feedback on Care service, phone calls and social media between April and December 2020. The personal impact described by people who did not have good access to services (across both dental and GP services) was sometimes significant, with people feeling abandoned, disrespected, frustrated, and sometimes in pain.
“We called for an emergency dental appointment. They point blank refused to see us, and told us to call the emergency dentist. When we advised they were not seeing anyone, they told us they couldn't help.”
Feedback to CQC's Give Feedback on Care service
Our inspectors heard about the particular problems that children and young people had in accessing routine dental care during the pandemic. We know that poor oral health can be linked to neglect, and this may therefore have affected the most vulnerable children.
According to the 2021 GP patient survey, which includes a section on NHS dentistry, the percentage of respondents who described their experience of NHS dentistry as ‘good’ fell from 84% in 2020 to 77% in 2021.
The dental providers we spoke to expressed pride in their staff, including their adaptability to new ways of working. Employees tended to feel supported by their employers to feel safe and have the skills they needed, with one practice organising "regular updates and team learning and WhatsApp groups for the staff team, which has helped with improving each other’s mental health".
We have seen examples of dental providers adapting their practices well to respond to the pandemic. These included:
- supporting staff to triage patients – for example, in services where the receptionists were responsible for triaging, the provider indicated that they were trained by nurses or clinicians. In some cases, senior staff monitored incoming calls and, in many cases, dentists were available for support if necessary
- offering additional hours in order to manage the number of people waiting for a service, including opening on Saturdays and extending hours during the week to as late as 8pm
- referring people between sister practices, and using buddy arrangements between different providers, to take on each other’s patients in the event of a sudden closure
- enabling staff to have remote access to the practice network in case they needed to work from home or unexpectedly close.
There were some examples of dental services working well with other health and care providers in a community, such as community pharmacies, NHS 111, secondary care services and urgent dental centres. However, our provider collaboration reviews found that dental services were not always invited to be an integral part of the system for shared planning and system-wide governance.
As a result of our findings, in our May 2021 report we presented four important questions that the dental sector needs to address:
- How will confidence be restored that access to NHS dental services is available for everyone?
- What measures need to be taken to prioritise and improve access to urgent dental care through NHS 111?
- Is there enough NHS dental capacity commissioned, and how will NHS policy leaders and commissioners deal with the demand to ensure those who are vulnerable and without a dentist have equality of access to NHS care?
- With a move to system working and joined-up working in a place, how will oral health be seen as an integral part, providing access to the right service, in the right place, first time?