A global pandemic

A global pandemic

The thoughts and personal experience of a dental hygienist / therapist working in an NHS general practice during the COVID-19 Pandemic.

We have seen an unprecedented event unfold for human kind and with it, unprecedented measures globally.

At first, we all witnessed what appeared to be a slightly alarming situation develop on the other side of the world. But that has rapidly become a pandemic and today it impacts on each and every one of us.

Unsurprisingly, we looked for professional guidance and support to help us make the right and proper decisions in the best interests of patients, ourselves and those close to us. However, this unprecedented event meant there were few experts to guide us: we waited for information, education and advice! “Fake news” made it difficult to separate the facts from fiction at times.

As a busy NHS dental practice joined to a large Medical Centre we were alarmed to see the huge efforts made during the early stages of the reported outbreak by the GP surgery staff with whom we share a building. Crisis meetings were being held daily for all medical staff: policies drawn up; risk assessments taken; messages to staff and patients; and finally, a telephone only triage service was set up before patients would even be considered entrance to the building.

Meanwhile, despite us reviewing everything from NHS England, checking our email, looking on sites from our professional bodies we continued with some discomfort to operate for a few days as normal.

It became very evident very quickly that we should not be operating as normal! Our professional bodies began to issue alarming statements and there was confusion among the profession regarding who should be making the best practice decisions - both the GDC and professional bodies looked to the NHS for this, and we at grass roots desperately looked for leadership and advice.

The second week in March was challenging! We tried to find advice on patient and staff safety and acting in best interests, but struggled. Although some advice had been issued (continue with routine care and apply best practice in infection control) it seemed polarising in comparison to the extreme working differences we were experiencing as we watched our colleagues in the medical team one floor below.

Support staff became alarmed and clinicians uncomfortable around the treatment they continued to provide, particularly to those who might be vulnerable. By the third week in March staff members were becoming unsettled and we had crisis talks with the practice owners. Thankfully they were supportive and we took matters into our own hands and issued a statement to patients and advice on attendance.

We let patients know the possible symptoms of the COVID-19 virus by text and email and advised against them attending if they had them. We began calling all patients to triage them prior to their appointments and give them guidance should they be exhibiting symptoms. We also offered them the opportunity to cancel routine appointments with us even if they were asymptomatic to COVID-19. Many did cancel, preferring to socially distance but many others still wanted to attend taking advantage of their ‘home working’ situation.

The government had advocated social distancing to the population yet our guidance said we should be open as usual so we still struggled to understand our boundaries. We were also unsure of our contractual obligations and unable to gain clarity on this from the area team.

Frustration, confusion and at times anger were exhibited throughout the dental profession in England during this week on social media over a perceived lack of guidance, support and leadership during the development of what is now finally acknowledged to be a pandemic.

Whilst the medical professionals on the floor below us appeared to have clarity, education and direction we were busy trawling social media for advice and updating open tabs on our practice PC’s to the GDC, BDA and NHS England. We were desperately hoping for an update to reassure us we were making the right best practice decisions for us, and our patients.

Last Tuesday we decided to follow the advice issued by NHS Wales and I downed tools as a dental hygienist and therapist. I looked through my diary and considered if any of my clinical treatment was essential to sustaining the life of my patients in the foreseeable short -term future and decided it was not. We considered the risks to staff, ourselves and patients and calculated that oral health advice, triage and emergency care or referral moving forward would be our best interest choice.

We decided to only see healthy (COVID-19 asymptomatic) and non- vulnerable to COVID-19 patients requiring emergency care, to prevent the unnecessary use of aerosols and provide a very limited dental service.

At this point we had no idea whether this was the correct thing to do in England. As with all practices holding an NHS contract, we were acutely aware that the decisions we made had a huge impact on attendance and activity and meant we were not going to meet our contractual target obligations. Even before we made these decisions our understandably anxious patients had already begun to cancel their routine appointments as fears rose over the virus, especially as most of our clients were seeing the significant changes in practice with GPs one floor below us. By this point, we were now two clinicians and one dental nurse down, with no hope of securing temporary staff at short notice.

In that week two associates self-isolated recognising they fell into the vulnerable categories and one called in sick with a view to a possible suspected COVID-19 virus.

Toward the end of last week, we finally received the advice we needed. The advice, if not slightly ambiguous, gave us direction, and we at least knew we had already taken the steps required to protect patients and staff.

Today the practice is operating on a skeleton of rostered staff. Patients are first phone triaged by the clinician and only invited to attend if considered a non-vulnerable asymptomatic COVID-19 risk. Then, if they do attend, minimally invasive and non aerosol treatment is provided where possible and if not guidelines for treatment and referral are carefully followed. We are also aware and adhering to the guidelines for those we need to consider who are vulnerable or COVID-19 symptomatic. To date, we have not had such a situation arise.

We still do not know how this will affect our contractual obligation but know we are doing right by our patients and staff. We hear today that the government intends to help businesses help to pay staff but the situation appeared uncertain regarding its assistance to those who are self-employed treating NHS patients.

I know that I could not have continued as ‘normal’ and I’m confident with my decision, as are the associates I work with, despite realising that we have lost our livelihoods during the pandemic, along with thousands of others. We hope that those policy and decision makers that set out our guidance understand this and will provide financial support and assistance to practices during the pandemic.

I am keen to help during the pandemic where I can and will do so if requested, within my capabilities. Our dental team at the practice is very special and we are all hoping we can in be utilised in other ways while dentistry takes a back seat, unless really needed.

My sympathies have been with all those affected by the pandemic. Its effects are diverse and far reaching, medically, emotionally, mentally, financially - turning our lives and the lives of those around us upside down.

However, we are the human race, built for survival. We will race and we will win. Together.

Sally Simpson

Dental Therapist

Past President BSDHT 2010-2012

 

Photo byMartin Sanchezon Unsplash

 

 




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