BAPD takes vote of no confidence in Office of Chief Dental Officer

18 May 2020
5 min read
Published:

"Dear Mr Health Secretary
Re: Vote of No Confidence in the Office of the Chief Dental Officer (England).
We are writing on behalf of the members of the British Association of Private
Dentistry. It is our position that the members we represent have no confidence in the
current structure, remit and functioning of the Office of the Chief Dental Officer of
England and therefore the manner in which dental care in England and the UK is
being managed. Patients have the right to expect reasonable access to necessary
dental care during this crisis, regardless of where they reside in the UK.
A vote has now been held of our members which indicated that 97.5% have no
confidence in the Office of the Chief Dental Officer. There were over 1600
respondents.
We absolutely recognise that the COVID-19 pandemic is an unprecedented global
event that has led to a crisis in the delivery of healthcare generally, but sadly, for
those patients in England who have had to suffer with severe dental problems, it has
also exposed serious gaps in the planning and administrative systems for the
delivery of dental services in our country, and also the lack of a coherent plan
involving all service providers in the event of a crisis such as the current pandemic.
The overt exclusion of private dental care providers from the outset has almost
certainly led to much of the unnecessary pain and suffering and even life-threatening
situations some patients have had to face. The dental profession and dental patients
are in the news for all the wrong reasons.
Dentistry is an essential part of any healthcare system, indeed the government
document of 1st May 2020 recognises this and clearly indicates that dental practices
were exempt from the requirement to close. Therefore the events that unfolded for
dentists and their patients, namely:
● the instruction for all practices to cease seeing patients face to face
● the lack of timely guidance for all providers of dental care
● the revelation of the lack of a clear command structure for all of dentistry,
● the lack of clear information for patients
● the poorly implemented contingency arrangement (UDC’s)
● the pressure put on dentists to inappropriately prescribe antibiotics,
have harmed patients, affected the mental health of many dental professionals and
undermined the public perception of and confidence in the profession.
Dental practices should never have been compelled to close in the manner in which
they were, and it should never be allowed to happen again, and certainly not for any
further COVID-19 wave, if there is one. A system needs to be in place where
dentists, irrespective of whether the care they provide is funded by the NHS or
privately, have input into a coordinated approach for the delivery of dental care in the
UK . The lack of a proper plan for the immediate provision of ongoing emergency
and urgent care for our patients and then permitting only ‘AAA treatment’ (advice,
analgesics and antibiotics), flies in the face of the standard of care expected for
patients at any other time. It has starkly exposed a gaping void in the delivery of the
most basic emergency dental care, even taking into account the need to protect the
public from unnecessary travel and contact with others.
Dental professionals are used to high levels of PPE and cross infection control; we
have a significantly high grasp of the cross infection measures needed to protect
ourselves, our teams and our patients from the risk of COVID-19 transmission and
we should have been consulted on these matters as soon as it became clear there
was confusion about authority and guidance. Instead the establishment continued on
a path that has landed dentistry in the current crisis.
The ongoing assertion of the OCDO that they only advise on NHS Dental matters,
and not those involving private dentistry, is disingenuous at best. Given the influence
the OCDO has on recommended advice from the Department of Health, and
therefore the GDC and CQC, this office does indeed significantly influence the
regulation of private dental care by association. Furthermore, the practical reality is
that indemnification of all dental professionals has been influenced by the
recommendations of the OCDO irrespective of whether they are said to be directed
at NHS dentistry.
There is also the ongoing lack of timely communication that the profession has had
to contend with. The delivery and clarity of messages throughout the entire
Coronavirus crisis with regards to dentistry in England, has left the profession at
times bewildered and confused as to what the various messages have meant for
their patients. In contrast, the message delivery and protocols from the devolved
administrations have been timely and clear.
The roll-out of Urgent Dental Centres has been slow and beset by problems from the
outset, and there appears to be great variation in the approach by local
commissioning teams, meaning some areas have good coverage while others have
nothing, once again pointing to a lack of central leadership and control. We have
seen UDCs close due to a lack of financial support from the NHS, leaving patients,
dentists and 111 call handlers with unnecessary challenges. Patients who today are
very savvy about treatment options for their dental health are being presented with a
single third world treatment option; that of extraction, meaning the loss of many teeth
which could have otherwise been saved.
More recently, we find ourselves in the position that despite the Prime Minister
announcing those who cannot work from home should return to work, we are unable
to do so as we have no guidance whatsoever from the OCDO as to when a proper
return to work might be permitted, or what protocols would need to be in place when
it happens. This is despite the abundance of well-published protocols being available
from around the world where dental care provision has not been completely
discontinued.
Dental practices are businesses too, and combined with the dental trade, dentistry is
a microeconomy providing employment and a livelihood to hundreds of thousands of
people and their families. We would like to emphasise that an instruction to ‘not see
patients face to face’, is the same as instructing a dental practice to close. Dentists
cannot treat patients without seeing them. With the OCDO therefore essentially
going against the recommendation of the government regarding dental practices
remaining open, and then providing a financial parachute for NHS practices only, the
survival of mixed and private dental practices through this crisis has been seriously
endangered. This is not only pacing in jeopardy the livelihoods of thousands, but is
adding to the crisis of patients accessing proper first world dental care in a
post-pandemic world.
With the continued lack of communication to the profession as a whole, and the lack
of an exit plan from this enforced closure, dentists are now left spending time and
money trying to second-guess what lies ahead. Furthermore, with no proper plan for
a return to work or an idea of what demands will be made of it, dentistry is in danger
of being plunged into confusion and uncertainty for the entire dental team.
The consequences of the lack of clear leadership for all of dentistry in England,
pointed out by Professor Nairn Wilson (BDJ Editorial 2014), have come to fruition.
Something is going wrong and it is clear that change needs to happen swiftly. If
dental provision outside of the NHS continues to be unrepresented at the highest
level and is allowed to wither and die because of a dogmatic belief that it has nothing
to do with the OCDO, the ripples exposed during this COVID-19 crisis will grow into
a wave of patient demand for first world dental care, that will overwhelm the ability of
the NHS dental sector to cope. If we want to protect our NHS we need to recognise
the contribution made by private dentistry and respect and protect that too.
Unless there are urgent changes, the country is heading for a dental health crisis that
will certainly bring with it major general health implications for the populace and will
set back oral health gains by decades.
It is time for a clarity of leadership in dentistry.
From the members of The British Association of Private Dentistry."