Mitigating against the harms of COVID-19 on oral health: Prioritising Equity and Inclusion

The Consultant in Dental Public Health/Chief Administrative Dental Officers group remains committed to working with Scottish Government and other partners to progress the equitable remobilisation of dental and oral health services.

Mitigating against the harms of COVID-19 on oral health: Prioritising Equity and Inclusion

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In a new guest post, Emma O’Keefe, Consultant in Dental Health/Realistic Medicine Co-Lead at NHS Fife has prepared a blog on the equitable remobilisation of dental services.


The Consultant in Dental Public Health/Chief Administrative Dental Officers group remains committed to working with Scottish Government and other partners to progress the equitable remobilisation of dental and oral health services.

The COVID-19 pandemic remains a public health emergency. Through the process of recovery and re-mobilisation concerted efforts to mitigate against the wider harms of the COVID-19 pandemic must be made, not least against widening health inequalities, while ensuring services are safe, effective and equitable. John Connaghan (Former Interim Chief Executive, NHS Scotland) wrote to NHS Boards: ‘The COVID-19 pandemic has both exposed and exacerbated our health inequalities crisis with disproportionate harm caused to minority ethnic groups and people living in greatest deprivation. Addressing inequalities for all citizens and our health workforce is therefore a vital theme which must be at the very core of your planning, and the delivery of your services.’

Providing high quality care, including promoting prevention at all levels

Oral health improvement programmes should be remobilised as a matter of urgency. Recognition of the limitations of continued restrictions in the different settings may limit some activity.

Recommendations:

  • Request the return of oral health staff to their substantive duties. 
  • Review of current oral health improvement programmes and explore new ways of working to overcome the challenges.
  • Oral and dental health should be included in general health improvement and health inequalities policies.
  • Interim changes to the Statement of Dental Remuneration (SDR) to record prevention activities.

Promoting equitable access to care and promoting NHS care

Protect the availability of NHS care in independent dental practices through financial stability and a robust plan for the remobilisation of services. The potential threat of reduced access to NHS care may place the Public Dental Service (PDS) under increasing pressure to be the safety net for unregistered patients and for registered individuals seeking urgent care. The PDS must be enabled to provide care to those patients otherwise unable to accept care in GDS.

Recommendations:

  • Take a holistic approach to patient care and consider the costs to the patient associated with attendance, for example, transport and time away from work. Providing self-enabled, person-centred care close to home.
  • Incentivise the re-registration of patients abandoned by one practice with a commitment to financial support for practices increasing GDS capacity.
  • Use remote consultations (teledentistry) for certain care pathways especially in urgent care and Hospital Dentistry where there is limited evidence of effectiveness and patient acceptability1.

Safety for staff and patients

Anecdotal evidence suggests that patients may be reluctant to access dental care with routine appointments cancelled or postponed. Those with dental anxieties may have additional fear due to the pandemic. We must reassure the public that services are safe. 

Recommendations:

  • Work should be undertaken to evidence the safety of dental services, including tracking where chains of transmission exist.
  • Develop a communications plan to inform, educate and reassure the population utilising different media platforms. This should be available to GDPs for their own websites and social media.

Staff wellbeing

Support staff to feel secure in their employment and deliver high quality services for patients. The dental workforce in Scotland has reported high levels of burnout, concern about job security and depressive symptoms during the current pandemic2.  

Recommendations:

  • Scottish Government, Regulatory bodies, Royal Colleges and NES should consider, assess and support the mental health of all those working within dentistry.

Cost

There has been a significant impact on income across the population. With continued restrictions on businesses, individuals and families are experiencing long-term losses in income. There is a risk that the offer of NHS dentistry becomes less advantageous to practitioners and more patients may find NHS care is limited either in availability or accessibility.

Recommendations:

  • Dental services must respond to the needs of the population who may struggle to pay for dental care. A focus on preventive measures and low cost solutions to oral health problems should be prioritised.
  • The Scottish Government should establish a sustainable financial business model for NHS GDS practices to incentivise the prioritisation of NHS care over private options.

Blog taken from a position paper written on behalf of CsDPH/CADO group by: Jay Wragg, Jacky Burns, Anthony Visocchi, David Conway, Ruth Freeman.

References:

1 Rahman, N., Nathwani, S. & Kandiah, T. Teledentistry from a patient perspective during the coronavirus pandemic. Br Dent J (2020). https://doi.org/10.1038/s41415-020-1919-6

2 Humphris GM, Knights J, Beaton L, Araujo M, Yuan S, Clarkson J, Young L, Freeman R. Exploring the effect of the COVID-19 pandemic on the dental team: preparedness, psychological impacts and emotional reactions. Front. Oral. Health | https://www.frontiersin.org/articles/10.3389/froh.2021.669752/full


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