Scotland's top dentist says patients shouldn't be forced into private treatment

A dentist treating a patient while in PPE.A dentist treating a patient while in PPE.
A dentist treating a patient while in PPE.
People in need of dental treatment should not be put in the “invidious position” of being forced to pay for private treatment because of a backlog of NHS appointments due to the coronavirus shutdown, Scotland's chief dental officer has said.

Tom Ferris, who has come in for criticism from NHS dentists over a lack of communication about why they had to be shut while private dentists could operate safely, said it was not yet “business as usual”. But he said all dentists were now able to “offer the full range of dental care that was offered pre-Covid”, if to a smaller number patients per day.

He also said the appointment backlog created by NHS surgeries not being open for months would be dealt with through the “clinical expertise” of dentists.

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Speaking on the BBC radio show Call Kaye yesterday, he said dentistry had changed dramatically, with staff now wearing enhanced PPE, ensuring there was enough time between patients to make surgeries infection free, and ventilation improvements in surgeries.

Challenged about the length of time it took for NHS dentists to be able to offer routine treatments while private surgeries were open, he said: “The amount of private dentistry is relatively small. I was trying to plan the reopening of 1,100 dental practices across Scotland.

“Some practices were able to get PPE at an enhanced rate and passed that charge to patients as part of the private fee. I was trying to get every practice access to PPE to allow them to all open at the same time which was a much bigger logistical problem.”

He added: “Private dentists don't work to different standards, but a private arrangement with a dentist and patient is between the two of them. The NHS system takes in 94 per cent of the Scottish population, and is over 3,000 dentists, so the scale is much bigger.

“We were going safely because had it gone wrong in a private practice and caused a cluster of transmission, it was a very small number of individuals involved. Had it happened systemically across the whole of NHS dentistry, that would have been a much more difficult issue to deal with. We had to be cautious.”

Asked if the problem had been supply of the right PPE to NHS dentists, he added: “We have the PPE, it was the logistics of getting it out to 1,100 different practices which was the issue. The NHS has never provided PPE to practices before March. This is a new way of operating.

“And because the PPE supply was so disrupted in the early months of the pandemic, we were very reliant on Chinese suppliers. We now have Scottish suppliers so the supply chain is much more secure and we have that PPE going out to dental practices.”

Mr Ferris also denied that people were forced to go private for emergency treatment, pointing to 71 urgent dental care centres which were opened to cope with the worst of patients’ dental problems.

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Dentists have complained the profession has been “uniquely disadvantaged” throughout the pandemic, with a lack of support from the Scottish Government, with some saying restrictions over treatments, costs for PPE, and other practice safeguards had left them with "no option” but to offer private treatments to stay afloat.

Mr Ferris said dentists needed to have “honest and frank” discussions with patients about when treatment was possible, but added: “I don't think an NHS patient should be told to go private. I think that's an invidious position to put a patient into.

Patients have always had that decision to make in terms of NHS or private care and this [the pandemic] exacerbated that. But root canal work, for instance, was available and people could have been referred for a temporary fix to relieve discomfort until now when NHS practices open again.”

Asked how big the backlog was, he said it would vary between practices. “The people who know patients best are their dentists and they will use clinical judgement to prioritise who gets seen first,” he said. "Someone halfway through root canal treatment should be a priority.”

But he suggested people in less pain should accept they would take longer be treated because of a “finite number” of available appointments. “If they're not in a lot of discomfort, perhaps they could be patient to let those in more pain to be seen first. If you're [dental health is] relatively stable and you've been looking after your teeth, then be patient, but if you're having trouble you will be seen relatively quickly because dentists will use their clinical judgements.”

Mr Ferris also revealed that he had not expected dentists to be reopening as transmission of Covid-19 was rising again, and there had been a hope they could have used normal PPE, rather than the enhanced version required.

However, he said dentists were safe because of the PPE and the most up-to-date international review of “aerosol generating procedures”, which proves treatment can be done safely. He said: “There's little evidence across Europe of transmission between dental patients and staff.

“We now know a lot more than we did in March and April when there was a huge list of unknowns about the risk of transmission. There are other countries which have re-mobilised dental services faster than Scotland and we've looked at their experience and there doesn’t seem to be a significant risk for dentists or patients in the clinical space.”

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Challenged about whether he should resign, Mr Ferris said he was "aware" how unhappy many dentists had been, but that he also received messages of support telling him to carry on with his approach.

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