Bernard's Summer Blog
hope all is well with you as we struggle on with Covid. I thought a quick update would be an idea so we ensure everyone is on board with where things are up to from the LDCs perspective. We have still been busy with the “day job” despite keeping an eye on Covid and have a number of Exec Actions underway as outlined below.
Covid 3rd Wave Action Plan
From the LASC LDC Exec position we have already organised an Action Plan which would be needed should we relapse (god forbid) into another lockdown. We are treating this as a “live” document which is continually updated and we would be able forewarn and advise the profession exactly what to do should the unlikely happen. This document is called C3WP (Covid 3rd Wave Plan) and is signed up to by the Local Area Team also. Fingers crossed we won’t need it, but with Bumbling Boris at the helm you never know!
For some time we have struggled to get adequate support in place for Sharps Injuries encountered by Dental Practice Staff. Nick Barkworth and myself worked up a protocol some 7 years ago which was agreed by the four Acute Trusts. When push came to shove the system failed and we have had a number of near misses over the past few years. In order to address the shortcomings in the system Andy Harvey (Co-Chair of East Lancs LDC and LASC LDC Exec member) and myself are now working on this together and the starting point is to get a meeting with the four Occupational Health Leads from the four Trusts. Mel Catleugh (Consultant in Dental Public Health Lancashire PHE North West) and myself wrote to the Medical Directors a couple of months ago and I am still awaiting a response from LTH and UHMB. The good news is that BTH came back straight away and ELHT a week or so later. I am about to try again for the other two (I am now on letter3!) but would really appreciate it if anyone out there has a connection with either LTH or UHMB and is willing to assist us in the process to get in touch. Once we get them all together we can revisit the previous protocol and risk assessment to work towards a workable new version.
Bariatric Patient's Pathway
Access to Dental Care for Bariatric Patients has been an issue for some time and we have never managed to solve the problem. We are now revisiting the situation and looking to achieve a resolution. Tom Gacesa (Central Lancs LDC Chair and LASC LDC Exec member) is leading the process supported by John Edwards (Coastal LDC Chair and LASC LDC Exec Chair). We have started by asking for practices with facilities for this cohort of patients to identify themselves should they be prepared to take referrals. To date there has been no response which is what we expected, but we had to start somewhere. The difficulty with these patients is that there are other considerations to bear in mind e.g. poor mobility, inability to climb stairs, transport and parking problems etc, etc... Special Care Dentistry have the facilities to cater for Bariatric Patients, but will only see them if they have co-morbidities. Our next step is to try and get some numbers on the problem. To this end Tom, supported by the Comms Team will be reaching out with a questionnaire to give us an idea what the numbers are like. The end result may need to be contract variation or additional funding to support this cohort of patients. The issue does impact as a Health Inequality which will escalate the situation. Watch out for the questionnaire and please do help us out.
Cardiac Patient's Pathway
Patients needing to be dentally fit prior to certain cardiac procedures is another of our problems. Cardiac Consultants vary in their opinion as to what procedures need confirmation of dental fitness. We have had recent problems with one case around these issues which ultimately culminated in the consultant leaving it very late in the day to ask for a dental opinion. The logical way forward to cover all angles is to get the consultants to start the consideration around the need for a confirmation earlier in the pathway, perhaps at GP level, as soon as cardiac surgery is deemed to be necessary. Ralph Pickup ( Co-Chair East Lancs LDC and LASC LDC Exec member) supported by Bruce Porteous (Central Lancs LDC Treasurer and LASC LDC Exec Treasurer) have this in hand, but if anyone has any contacts that may be of use please do let us know.
We have put an enormous amount of effort into our Practitioner Support Programme in order to ensure we have a robust process which will be able to support our Practitioners in all form of circumstances. We have undergone a considerable amount of training around the Psychological aspect of support and all the ramifications this brings with it. We have two elements to our Practitioner Support which are:
Executive Advice – this is support available to offer Peer Support and advice in all form of circumstances. Executive Advice can be accessed through the website.
Dental Practitioner Advice and Support Scheme (DPASS) – this has been up and running now for over 4 years and has had some great results in supporting Practitioners through a voluntary documented Remedial Process subsequent to attention from a Regulatory Body, such as NHSE/GDC/CQC. Again this support can be accessed through the website.
Our LASC Practitioner Support Lead is yours truly and we have been working hard recently to manage the process whereby NHSE are merging the three Professional Standards Committees from LASC, Cheshire Merseyside and Greater Manchester into one entity across the North West. We are working with our colleagues in CM and GM and have all agreed to adopt our LASC process which is welcomed by the NW Professional Standards Group. The key issue here is to ensure we mirror the NW footprint at the higher level whilst maintaining local sensitivity at the point of delivery.
Further information around Practitioner Support can be found on the LASC LDCs Website.
Two things have been consistent about the Covid situation and they are;
Nothing was ever consistent.
Information was lacking, late or contradictory – or a combination of all three.
All this is not good for a profession struggling to provide quality services in extremely difficult circumstances being bound by late, inconsistent and conflicting advice. What is so frequently missed by Whitehall is that in the midst of all this Dental Practices still have to run as a business, pay the bills and pay the staff. All of the above is compounded by the fact that news on the direction of contractual travel is late, inconsistent and conflicting (business as usual!)
All these decisions are taken at a high level before the information is forthcoming and the BDA are working hard to get some sense out of the situation for us as Dental Practitioners. I will add at this point that here in the NW there is a refreshing approach to the situation, with a desire to be flexible in the application of any contractual changes in order to support Dental Practices. Here in LASC we have a first-class relationship with commissioners and the LDC Exec are in constant contact with the Local Area Team.
Please do keep a record of anything that has affected your performance and include some numbers. Hot potato at the moment is patients failing appointments - do keep a detailed record of what happened in order for it to be considered in any underperformance conversations.
Unfortunately, nobody has a crystal ball so we are unable to know what will happen, but what is important is to keep together as a profession and utilise the LASC LDC Exec Comms Team as the conduit for all enquiries comments etc. What I am saying is that you are not on your own, we are here as your LASC LDC Exec and we will support you all the way.
Please contact us with any worries or concerns: email@example.com
Just one more thing...
Hopefully now we are coming to the end of the Covid situation (fingers crossed!) however it is becoming evident that the journey out of it all is exactly the same as the way in - utterly confusing! We now have a situation where we as a profession are still having to work with all the previous restrictions - PPE, Social Distancing, Fallow Periods etc... whilst the rest of the population are mixing shoulder to shoulder in pubs, restaurants and night clubs – bizarre. Yet again we are faced with information delivered late which creates so much stress and uncertainty - oh and we are also required to keep an eye on activity! Still you never know what might drop into the inbox by way of the latest SOP of the week outlining what we need to do as we had back to last year. In the midst of this practices are getting patients refusing to follow precautions whilst coming to the surgery and I can understand this situation.
Oh and another thing... (BA whinge section!)
One of my personal gripes through all of this was the lack of recognition the Dental Profession received over the past 18 months - in total we received Jack Diddly Squat in terms of appreciation and understanding. To cap it all the Minister for Dentistry (this Churchill woman) actually made the statement, when referring to Oral Cancer detection, that dentists were not really involved. She subsequently apologised, but that is less than useless - she should have known better in the first place!
Take care and stay safe all of you,
Bernard Alston BChD LDS RCS
Sec LASC LDC Executive
Practitioner Support Lead