COVID Restrictions in Dentistry: Update 1/11/20

The Scottish Government has said normal NHS services resumed from the 1st November so why can’t I book in for my treatment?

As of the 1st November we moved in to ‘Phase 4’ of the remobilisation of NHS dental services in Scotland. This means that dental practices are, once again, allowed to offer the full range of NHS services to patients in need of both urgent and non-urgent care. What the Chief Dental Officer for Scotland and NHS Lanarkshire have been keen to stress, however, is this does NOT mean a return to business as usual, indeed far from it.

With COVID cases once again peaking, and NHS services (particularly in Lanarkshire) struggling to cope with increased demand, it would be impossible for the dental sector to be able to safely provide the same level of care as we did prior to lock down. Although the Scottish Government has now given us permission to offer the full range of NHS services please understand very few, if any, practices are actually in a position to be able to do so. All the restrictions that were imposed upon dentistry during lock down to help prevent the spread of Coronavirus remain in place so we are still in the unfortunate position of having to triage patients. We have a back log of 8 months-worth of patients to see and a waiting list that grows bigger with every day that passes. With a limit imposed upon us by the health board regarding the number of patients we can safely treat in a day (we are only being supplied with enough PPE to treat a maximum of 10 NHS patients per day), we have no choice but to appoint patients based upon urgency of need. As such, only the dentists can assess the waiting list and determine who needs to be seen most urgently. The dentists are responsible for structuring the order of the waiting list and reception are then advised to contact patients to book them in in order of the waiting list. This is why we are not accepting requests from patients to book themselves in for anything. With such huge demand, the only way we can operate fairly under current restrictions is to stay faithful to the waiting lists.

What NHS treatments are currently on offer at Hannigan Dental Care?

As it is not possible to see the same numbers of patients as we did prior to lock down we have decided to only offer the following categories of NHS treatment for the time being:

(1) EMERGENCIES

As we are still limited to treating 10 NHS patients per day, we must prioritise emergency appointments first. An EMERGENCY appointment is given for the following complaints ONLY:

  • SEVERE dental pain that cannot be managed by analgesia
  • Dental TRAUMA (i.e. following a facial injury, not a broken tooth/filling as a result of eating)
  • UNCONTROLLABLE bleeding from the mouth (i.e. following an earlier tooth extraction, not bleeding gums when brushing)
  • Dental or facial SWELLING, particularly if this is causing difficulty speaking/swallowing/breathing, or extending towards the eye.

True dental emergencies, falling into one of the above categories, will be given an appointment within 24 hours of calling. The earlier in the day you phone, the more likely you are to get a same day appointment.

(2) URGENT CARE

URGENT appointments cover issues that cannot wait long-term but do not need to be seen immediately. For example:

  • Broken teeth/fillings
  • Crowns/bridge/veneer out
  • Dental pain or sensitivity that is coming/going or can be controlled with painkillers

Whilst we appreciate that pre-COVID we normally saw these kinds of problems within 24/48 hours, this is not currently possible. We anticipate a waiting time of 1-2 weeks for an appointment of this nature.

(3) COMPLETION OF ROOT CANAL TREATMENTS

Any patients who had a tooth accessed and a root canal treatment started from February onwards we would now hope to be able to book in to get the root treatment finished and the tooth sealed. This should hopefully prevent unnecessary loss of teeth.

(4) OPEN COURSES OF TREATMENT

We will also be focussing on providing treatment for those patients who already had open courses of treatment pre-dating lock down. Decisions influencing priority in this scenario will be based upon:

  • Decay stabilisation – i.e. completing fillings first to prevent decay deepening and turning into tooth ache
  • Who has been waiting the longest
  • Age of the patient – we aim to give children priority access to treatment, where possible, for obvious reasons.

(5) NEW PATIENT EXAMS

This means we will once again be allowed to register new patients on the NHS. This does not mean that new patients will get preferential treatment ahead of existing patients, nor will they get any treatment required faster. It simply means they will be officially registered at the practice, which means they can then access NHS EMERGENCY care should they require it in future. If treatment is required, they will need to join the waiting list, same as all our existing patients.

We anticipate that working through emergencies and this initial back log of treatment will keep us booked out for many weeks, if not months to come. To ensure that patients are appointed fairly, based on the triaging system described above, our reception team will be working through our waiting list over the coming weeks and contacting patients directly to book them in for treatment. We politely ask that you DO NOT CALL RECEPTION TO TRY TO BOOK IN YOURSELF unless you require an emergency appointment. APPOINTMENTS WILL BE ISSUED BY RECEPTION IN ORDER OF THE WAITING LIST.

What NHS treatments are not currently available at Hannigan Dental Care?

Until such a time that we have cleared the back log of treatment dating back to March, patients will NOT be able to book in for the following NHS treatments, which we have deemed ‘non-urgent’:

  • Crown/bridge/veneer work
  • New dentures
  • Check ups
  • Scale & polishes

How are you deciding who gets seen first and what are your current waiting times?

The waiting list is determined by urgency of need so it is fluid, changing daily as new emergencies present. Our order for appointing patients is as follows:

  1. Emergencies: true dental emergencies should be appointed within 24 hours during the working week. If you have a dental emergency in the evening/weekend/public holiday you should phone NHS24 on 111 (same as prior to COVID) who will put you in contact with the Out of Hours dental team.
  2. Urgent care: we endeavour to appoint these problems as quickly as possible but at present we would warn patients to expect a wait of 1-2 weeks. It really all depends how many emergencies phone in a day (something we cannot predict), so it may be possible that you are seen sooner than this.
  3. New patient exams: as these are shorter appointments, we will try to fit them in around emergencies on days when there is not a space in the diary long enough to e.g. complete a root canal treatment. Anyone who contacted the practice looking to register as an NHS patient since March should expect to be contacted in the next month or so. This will be on a first come, first serve basis so the earlier in the year you contacted the practice the sooner you will be seen. People who only contacted us recently will have to wait longer.
  4. Completion of root canal treatments: a root canal appointment is lengthy, even more so with new COVID protocol and fallow times. We are having to try schedule these appointments in around the emergencies/urgent care so it may only be possible to complete e.g. 1 a day depending how busy we are. We anticipate it may still be several months before we have got through the waiting list for RCT completion.
  5. Open courses of treatment: we anticipate it will likely be into the new year before we will be able to start contacting patients for fillings etc. Patients with open courses of treatment should expect to still wait several months before we will be in contact with them.

My friend was able to book in for a check up at her dentist, why can’t I?

The decision as to how to prioritise patients has been left up to the individual practices, not dictated by the health boards, so please do not be surprised if services offered by one practice differ from another. Pearse and I have worked hard to try formulate a system that is, in our eyes, as fair as possible, but with waiting lists as long as they are it is inevitable that people are going to be disappointed and for this we can only apologise.

It is also worth remembering that not all practices are the same, e.g. some are larger than others, having thousands more patients to attend to. The more patients you have registered the more emergencies you will have to contend with and thus the less space you will have to do other treatments. Equally, other practices may have more surgeries or more dentists working at them than others, and so are able to offer comparatively more treatments. It is highly likely you will become aware of differences between practices. Again, this does not mean practices are failing to uphold their NHS responsibilities, only that different practices have chosen to triage their waiting lists in different ways.

Why can I get my treatment done privately but not on the NHS?

Hannigan Dental Care is a mixed practice meaning we have patients registered both on the NHS and privately, and we have an obligation to look after all of these patients. At the moment we are restricted by the health board to treating a maximum of 10 NHS patients per day because we are only being supplied by the health board with enough PPE to treat 10 patients per day, of which only 5 can be for Aerosol Generating Procedures (AGPs). The practice has to source its own PPE for treating privately registered patients, we are not allowed to use the NHS-supplied PPE. As we are buying the PPE in ourselves, we can see as many private patients as time (and social distancing requirements) permit, which is one reason why we may be able to work through our private waiting list more quickly.

To ensure our NHS and private patients both receive fair access to treatment we have divided our appointment diary into NHS and private slots, based on the percentage of NHS/private patients we have registered at the practice. As we have more NHS patients registered than we do private, there is significantly more time in the diary allocated to NHS appointments. However, demand for NHS appointments is substantially higher so even though there are more NHS spaces available it is likely private patients are able to get an appointment sooner because there are fewer of them on the waiting list and we are not limited in the number of private patients we can treat in a session so can work through the private waiting list more quickly.

Although we are not currently in a position to book patients in for e.g. NHS check ups or scales, this does not mean these services will not become available again in the future. Once we have cleared the initial back log of urgent treatment, we will start booking patients in again for routine NHS care, however at this moment in time it is impossible to predict how long that will take so we have made the decision not to book patients in until we can offer them definitive dates. So, to reiterate, there will never be a case of you cannot get this done on the NHS, only you cannot get certain things done on the NHS at this time.  

It is also worth remembering that being an NHS patient does not mean you can only avail of NHS treatments. Many of our NHS patients choose to pay privately for services not available on the NHS, e.g. a white filling on a back tooth. So, you can also have the scenario where an NHS patient uses up a ‘private’ appointment because they don’t want the NHS option, e.g. a silver filling. Same as prior to lock down, patients are always given the full range of NHS and private treatment options and it is entirely up to them what they choose. Our dentists will never force you into choosing one type of treatment over another. The decision always lies solely with the patient.

COVID has created unprecedented waiting times across all areas of health care, from GPs to hospitals, both in the NHS and private sector. Whilst this is massively unfortunate, it is not of our own doing and health care providers are not to blame. We did not create the waiting lists, the pandemic did, and we are working through lists as quickly as we can but make no mistake, there is no quick fix here. This is going to take time. Patients who might have been waiting 18 months for a knee or hip replacement prior to COVID are likely now facing a wait of several years on the NHS. Those same patients may choose to pay privately to get seen sooner as is their choice. Dentistry is no different in this respect.

I’m an NHS patient, why am I now being told I have to pay if I want dental treatment?

I have read numerous threads on social media and listened to segments on radio phone-ins from patients complaining they have been told they need to pay if they want dental treatment. The implication has been that they are being forced into paying for private dental care when they are NHS patients, but this actually highlights a very common misconception – that NHS dentistry is free. NHS dentistry is not now, nor was it prior to COVID, free unless you are exempt (e.g. under 18 years old, pregnant/nursing mother, in receipt of a specific type of benefit). Everyone else – including students and pensioners – needs to pay for NHS dental treatment and always has done. The difference between NHS and private dental treatment is that the government subsidise the cost of NHS treatment, so you do not need to pay the full cost of the treatment, but you do still need to pay! Paying for your treatment does not make you a private patient or entitled to private appointment/treatments. If you are at all unsure whether you are an NHS or private patient you can contact the practice to clarify. If you are unsure whether you qualify for free NHS treatment please visit https://www.gov.scot/policies/primary-care-services/dentistry-and-oral-health/#charges for further information.  

When will I be able to book in for my check-up again?

Whilst we are still very much in the midst of this pandemic it is utterly impossible to say. All we can advise patients is we are facing a huge backlog of treatment that needs to take priority and until this has been cleared and patients have been stabilised, we are unable to offer routine check-ups. We believe it is extremely unlikely we will be in a position to offer check ups again before Spring 2021. Of course, we could be wrong and we may be able to start sooner but equally it might take even longer. Dental experts are predicting it could take 2-3 years to get practices back on track so everyone needs to prepare themselves for a long road back to normality.