16/05/2020 13:26 BST

Coronavirus Has Left Dentistry In Crisis, And The Fallout Could Prove Disastrous For The NHS

Dentists were ordered to close on March 23. They've been given less government support than the gambling industry.

Phil Noble / Reuters
Some 70% of dentists could close before the end of lockdown.

Get the latest on coronavirus. Sign up to the Daily Brief for news, explainers, how-tos, opinion and more.

Dentists across the UK are calling for financial support from the government amid fears that some 70% of surgeries could close, with devastating consequences for the NHS. 

Every dental practice in the country was forced to shut its doors on March 23 when it was announced the UK would be going into lockdown. 

With income plummeting to zero overnight, private dentists – many of which also operate under smaller, but vital, NHS contracts alongside their private work – were left suddenly facing a crisis. 

The situation became even more critical when it emerged that many surgeries wouldn’t be eligible for any of the financial support unveiled by chancellor Rishi Sunak. 

The reasons some dental surgeries have been left in such a precarious financial position are varied and complicated.

NHS dentists still qualify for funding, though private practices do not. 

Many struggling businesses on the high street in the retail, hospitality or leisure sectors qualify for measures such as business rates relief, applied automatically by the council. Despite providing an essential public service, dental surgeries do not qualify for this support. 

And a large proportion of dentists also miss out on the small business grant fund, either because they earn more than the threshold, or in some cases own more than one surgery. Many dentists earn just above the £50,000 threshold for the Self-Employed Income Support Scheme (SEISS), which means they’re also facing a sudden drop in income personally, as well as across their business. 

With zero income, and costs mounting up, some surgeries believe they will only survive a matter of weeks before being forced to close their doors. 

Christina Chatfield, a hygienist, opened Dental Health Spa in Brighton in 2007, selling her home during the financial crisis to keep it open and training many of her own staff as apprentices. 

With no income and no financial help from the government, she fears she will be left bankrupt in a month. 

“I suppose if I look back over the last 13 years there are many, many things that I thought might finish me including spending those first years at the height of a recession,” she said. 

“But a pandemic isn’t something of anyone’s making, and to be excluded by the government as a healthcare professional from a lot of government support is one of the biggest sucker punches.”

On April 21, more than 100 MPs wrote to Rishi Sunak, highlighting the evidence that some 75% of dentists would receive no support from the government and calling on the government to change its approach to avoid “financial ruin” for the sector as a whole. 

To do so, they asked for the £50k cap on the SEISS to be raised by the Treasury, for easier access to the coronavirus business interruption loan (which some 90% of applicants were turned down for, according to the MPs’ letter), and for business rates to be extended to all practices. 

The Treasury has not yet made any changes to its approach. No comment was offered by the department when contacted by HuffPost UK, but it set out the help offered to small businesses generally, as well as pointing out that dentists are set to be fully remunerated for the NHS work they would have otherwise undertaken during the pandemic.

But dentists, and their representatives, need the government to move quickly, as they did in March when the gambling industry appealed for help from the government and then was included in an amendment to the measures. 

Bookmakers may now have a route to a future beyond coronavirus, but dentistry – an essential part of the nation’s healthcare system – does not. 

British Dental Association chair Mick Armstrong said: “A service tens of millions depend on is still waiting on government to throw it a lifeline.

“While bookies have been extended full relief from rates, it is costing many practices a fortune to remain closed.

“We aren’t looking for special treatment, just the same support that’s been offered to our neighbours on the high street.”

Many private dentists do not have NHS contracts, and even many of those who do are unlikely to survive the pandemic as it constitutes such a small fraction of their overall income. 

The disappearance of 70% of dental surgeries from the high street would mean a loss of jobs across the country, as well as severing patients from trusted healthcare professionals – a relationship that is especially significant in a sector of healthcare so synonymous with patient fear. 

Chatfield said: “The thing with dentistry is that fear keeps people away – a fear of the cost, fear of the pain. 

“If a patient has found somewhere they’re comfortable with and it’s taken them a long time to go, how do they then find a whole new pathway of care? 

“And then there are huge concerns about what you miss as a clinician if you’re not actually physically examining a patient. We know that mouth cancer kills more people than testicular or cervical cancer combined because of late detection. 

“If you’re talking over the phone with a dentist and you’ve got a little lump, they’ll probably prescribe you antibiotics for an abscess, and there are so many things that could be missed, in all sorts of areas. Those will have a much longer lasting impact.” 

As lockdown wears on emergency dental hubs have opened across the country, but referrals must be made by a dentist over the phone and the locations are kept highly secret. In Brighton, a local hub didn’t arrive for more than six weeks. 

“It’s not like the health of your mouth doesn’t matter – there are so many links to the rest of your body, especially if you look at Covid-19 and how it affects people with a compromised immune system,” Chatfield explained. 

“If you broke your arm you’d be able to get treatment for it, but if a patient knocks their front teeth and it ends up needing root treatment – which is really painful – you’re told all you can do is give patients antibiotics. 

“You know as a clinician that isn’t the right thing to do and you’re being told you shouldn’t be treating people, but dentists have taken a Hippocratic oath of care. That doesn’t switch off just because the government says you’ve got to stop treating people overnight.”  

That’s all we’re asking for as a profession, for the same help that other businesses have been given. Otherwise we’ll vanish.

Unlike other sectors of healthcare, dentistry isn’t easily split into the sectors of “public” and “private”. The NHS relies heavily upon private surgeries, who in many cases take on smaller public contracts – for example, treating children – and offering options that simply aren’t available on the NHS. 

NHS and private dentistry often takes place under the same roof, and the two are so closely interwoven that a crisis in privately-owned surgeries could create a secondary crisis in the NHS. 

Dr Glenn Steffin owns two dental practices in Sussex, both of which now face an uncertain future as a result of coronavirus. 

As with Chatfield’s business, the outgoing costs remain extremely high, but income has plummeted to zero. 

Without the support of the private sector, Steffin says, NHS dentistry faces a “disaster”. 

He added: “If you take all these private surgeries away then what is left? It was traumatic before for the NHS with regards to being able to see a dental patient. 

“If I do a referral I have to tell some of the patients they’ll have to wait for a year to be seen. And now you are taking that support line around the NHS away? 

“The impact will be disastrous, when it hits them. You won’t get an appointment.”

Chatfield added: “Private surgeries alleviate some of the pressure on an already underfunded NHS. The health service is bolstered by private dentistry. 

“If you’ve ever tried to get an NHS appointment for a check up, you know you’re in and out within in a minute because they simply don’t have the time. 

“Many people make the choice to go private, but if that’s taken away there’s no knowing what NHS dentistry will look like in the future.” 

NHS England have been contacted for comment. 

Even if dental surgeries can reopen, after overcoming huge financial difficulties, there’s no guarantee they’ll have the materials at hand to make it safe to do so. 

Although dentists have long made use of personal protective equipment (PPE), the current demand for medical-grade kit on the frontlines of the fight against Covid-19 means supplies are increasingly scarce, and have soared in price. 

Although the government has provided PPE advice to healthcare workers generally, as Steffin points out, there is no readily-available information specifically for dentists, or how they should prepare to reopen. 

In normal times, a box of 50 face masks for the Dental Health Spa would cost somewhere in the region of £5 to £6. For a box of certified FFP2 masks, Chatfield was quoted £375 plus VAT. A thousand masks would set the surgery around £3,000 plus VAT – money the surgery doesn’t have to spare. 

“Of course, we have to have a business to come back to,” Chatfield said. “We have to be able to survive. 

“That’s all we’re asking for as a profession, for the same help that other businesses have been given. Otherwise we’ll vanish.”

A spokesperson for DHSC said: “We are working around the clock so front line health staff, including urgent dental centres, have the equipment they need to provide safe care during this pandemic.

“We continue to discuss with PHE and the dental profession on the next steps forward, taking into account the risk of infection and consequent need for PPE.”