New report shows pandemic has supercharged crisis facing dentists and their patients

News

Posted by: Dental Design 9th June 2022

The British Dental Association has welcomed new and wide-ranging reports from the regulator the General Dental Council, pointing to the devastating impact the pandemic has had on both patients and the dental profession¹. With access and workforce problems the norm, even before COVID, dentist leaders warn that oral health inequality will only widen until government delivers needed reform.

The research found that by October 2021 over a fifth of patients surveyed (22%) had tried and been unable to get an appointment at some point since August 2020 and 17% reported having had an appointment postponed or cancelled in the past 12 months. Half (52%) had yet to return to a dental practice, meaning that a very large proportion of the public would not have seen a dental professional at all for 18 months or more. A higher proportion of young people and those from Asian and Black ethnic backgrounds reported difficulties in accessing dental care.

One in five respondents (20%) had an appointment booked in the next three months, but the proportion fell to lower levels among respondents of Asian (10%) and Black (11%) ethnicity compared to those of White British ethnicity (23%).

Nearly a quarter of patients (24%) had experienced dental pain, yet over a third of people in rural areas were not able to get help when in pain (35%), compared to 19% in urban areas.

Among dental professionals, the GDC found a significant shift from NHS to private work, borne out by recent data indicating 3,000 dentists have left NHS work since the onset of the pandemic. Around two-in-five (39%) dental professionals foresaw they would be delivering more treatments in private dental care in October 2022 than prior to March 2020 – significantly more dentists than other dental team members agreed with this.

The report also shows morale in the profession is at crisis point. The mean average anxiety score among UK dentists was reported as 6.0, almost twice the average UK anxiety score in 2020/21 of 3.31. Dental professionals working in the private or mixed sectors were less anxious than those working predominantly in the NHS.

Last month the BDA has stressed to the Commons Health and Social Care Committee that without radical action to reform the discredited target-driven contract driving the exodus from the NHS the service faces a ‘slow death’. The professional body has called on government to deliver meaningful change by April of next year and put in place necessary funding to underpin the rebuild of the service. It would take an extra £880m a year simply to restore resources 2010 levels, after a decade of savage cuts.

BDA Chair Eddie Crouch said: “The pandemic has had a devastating impact on both patients and the dental profession, supercharging a crisis we’ve faced for a generation. The real question now is what this government is willing to do about it.

“Practices are struggling to meet demand, while every day dejected NHS dentists are calling it quits. Deep inequalities are set to widen unless Minister commit to fix this forgotten corner of our health service.”

References:

[1] The GDC research is comprised of two reports, commissioned by the dental regulator and undertaken in the autumn and early winter of 2021 with professionals and with the public into the impacts of COVID-19 on the public and dental professionals. Community Research undertook the research into the impacts on the public, and Pye Tait Consulting undertook the research into the impacts on dental professionals.

Some key findings include:

Increases in waiting times since March 2020 were noted by responding dental professionals for all types of service, notably for periodontal treatments (68%) and routine dental care (67%).
Just over half (52%) of people responding had not been to a dental practice since August 2020. Among those who had not attended a dental practice, the most common reason for not going was choosing to wait until after the pandemic (30%). However, affordability and access issues were also apparent with 15% citing cost concerns and 15% saying they tried but could not get an appointment. Furthermore, 7% said they had tried to book an NHS appointment but were told only private appointments were available.
To investigate the extent to which the COVID-19 pandemic had changed reliance on different income sources, all survey respondents except dental nurses (who work to a banded salary) were asked about their personal income prior to March 2020 compared to the current situation, broken down by NHS versus private income. There has been a noticeable shift from NHS to private working in the 18 months between March 2020 and when the fieldwork for this research was undertaken. The average (mean) percentage of dental professionals’ income from the NHS had decreased by around 5% and income from private work had increased by a similar proportion. A similar trend was seen in the median (middle) rating received to this question.
- Greater proportions of individuals in private and mixed practices predicted an increase in income (10% and 8%, respectively) compared with those working in the NHS (5%) – a significant difference. In a similar vein, a significantly higher proportion of those working in the NHS predicted a drop in income (41%) compared with those working privately (35%) or with mixed income sources (27%). While this question was asked specifically in the context of COVID-19, it is possible that other economic factors, such as pressures on disposable income, may have also affected or influenced how dental professionals have responded.
Across all aspects, bar affordability, private patients were more likely, than the sample as a whole, to say there was no difference between before the pandemic and their most recent visit. For example, with ease of getting an appointment, 69% of private patients said there was no difference, compared to 46% of patients who receive free NHS dental care, 48% of patients who pay for NHS care and 40% of those who receive a mix of NHS and private dental care.
- Almost three-quarters (72%) of all respondents stated that the dental care they received before the first national lockdown was from the NHS (either free or paid for). Findings indicate that, post lockdown, more people have been accessing private dental care. In October 2021, 13% of patients said that the type of care they received had changed, compared to before the pandemic. Amongst those who reported this change, a smaller proportion (61% compared to the previous 72%) stated that since August 2020 they had received (free or paid for) NHS care.
Fewer people reported that they were less likely to go for dental treatment, because of Coronavirus concerns, than was the case in August 2020. In October 2021, one in four (25%) said such concerns meant they were (a little/a lot) less likely to visit a dentist for a check-up. In August 2020, the equivalent figure was more than one in three (34%).
One in five (20%) had an appointment booked in the next three months, up from 11% in August 2020. Upcoming dental appointments were lower among those aged 18–34 (13%), and those of Asian (10%) and Black (11%) ethnicity, and higher for those aged 65+ (29%) and those of White British ethnicity (23%).
Respondents of Asian ethnicity showed a lower likelihood of attending a dental practice. 40% said they were less likely to go for a check-up because of Coronavirus concerns (vs.25% of the whole population).
The mean average happiness score among dental professionals was 5.2. For comparison, the average UK happiness score in 2020/21 was 7.31. There was some variation by registrant sub-group. Dental Care Professionals (DCPs) reported being significantly happier than dentists (5.5 vs 4.8), men more so than women (5.4 vs 4.9), and those in the private (5.6) or mixed (5.1) sectors more so than those working predominantly in the NHS (4.7).
The mean average anxiety score among dental professionals was 5.6. For comparison, the average UK anxiety score in 2020/21 was 3.31. A similar trend in anxiety by respondent sub-group was seen. Dentists reported being significantly more anxious than DCPs (6.0 vs 5.3), women more so than men (5.8 vs 5.4), and those working predominantly in the NHS (6.0) more so than those in private (5.4) or mixed (5.6) sectors.
In terms of wellbeing in the workplace, all respondents (except dental technicians who have fewer direct interactions with patients) were asked about their knowledge and experience of dealing with patients since August 2020 in the context of their role. Over two-thirds of dental professionals agreed or strongly agreed that patients were less tolerant of waiting (71%), or of delays (71%), while around two-thirds (65%) of dental business owners agreed or strongly agreed that patients were more likely to be aggressive towards their staff. Over half of dental professionals agreed or strongly agreed that patients were more likely to be aggressive towards them (55%), or be more likely to complain about their services (55%) although just over one-in-five (23% and 22%, respectively) disagreed or strongly disagreed with these statements
Significantly more DCPs than dentists (75% vs 66%) reported that patients were less tolerant of waiting, or of delays (74% vs 65%), with dental nurses and dental therapists reporting highest levels of agreement. Those in the private sector reported significantly higher levels of disagreement with all statements compared with those in working in the NHS or mixed sectors.