‘There will be no new normal after lockdown’

opening after lockdownRichard Scarborough speaks to Guy Deeming, owner of Queensway Orthodontics and former director for clinical practice at the British Orthodontic Society, about treating patients virtually during lockdown, why he doesn’t believe in ‘the new normal’ and why he believes the future is brighter than ever.

What was your immediate reaction following the decision to close dental practices as part of lockdown?

Guy: We went through the same sorts of phases that I think a lot of other dentists experienced. Shock at first and then denial, etc. But I think it was clear very early on that we had to be bold and emphatic in the steps we took in terms of closing down. People’s awareness of the risk of COVID-19 and the management of that risk was accelerating. We wanted to be ahead of that curve.

I thought we positioned ourselves fairly well to shift some of our services online. And also bring forward some of our existing projects.

One of the things that I come back to is the need to let go of the numbers and focus on the people. Right now, it’s all about doing the right thing. I had to have enough faith that this investment, in terms of goodwill and caring, would come back to us.

We planned to open three new NHS practices on 1 April. Our biggest anxiety was getting those sites ready in the madness of lockdown. And making sure those contracts were live and the transfer patients come under our care.

Thankfully we have a good relationship with the CQC and NHSE LAT who were really supportive and flexible to inspect and sign off the sites. We had a huge cohort of patients transferring to us in active orthodontic treatment. So we knew we had to have plans in place to help these patients in whatever way we could.

What have you done during lockdown in terms of offering a digital or online service?

Guy: I initially found the whole thing incredibly frightening from a business and personal point of view. While I still have good and bad days, overall, I think it’s been life affirming. It’s a once-in-a-lifetime opportunity to transform your business and the way you look at patients and the world for the better. To accelerate change and put yourself in the best position to survive what the future may hold.

The world is in the middle of a once-in-a-lifetime system shock. The pace of change has just increased 100-fold. We have to come out of this ahead of the wave. I now can’t accept that it’s ok for the patient to come into the practice for every single appointment because it is what we always did. It’s not reasonable or desirable. The technology is there to support a transition to a higher proportion of online or AI driven care.

We’ve been doing digital reviews, online consultations and we’ve opened an online shop during lockdown. The shop is something we were planning to do as a way of reducing the friction and pressure around reception. Lockdown was clearly the time to action this.

Now when someone needs mouthwash or loses a retainer, they can buy it online rather than phoning or visiting the practice. A huge benefit for all.

It makes the whole process fit with the way we all view shopping. Patients can buy these items at their leisure, as with other purchases outside of dentistry – obvious really. It has also been strangely reassuring during this period to see these little bits of revenue come into the practice account.

I’ve been using a virtual platform called Doxy.me for our online consultations. It’s a great platform with lots of functionality and good data governance; you can get digital consent during the consultation and a data processor agreement to fit with GDPR compliance. We will carry on with the model post-lockdown. The benefits are clear for all who have experienced it. Great feedback from patients.

Can you tell us more about how the virtual consultations and digital reviews are working?

Guy: We were already doing a little bit of virtual consultation with private patients using Smilemate from Dental Monitoring. So we have accelerated that across the whole range of patients. In addition, Dental Monitoring manages all of our Invisalign caseload, which works incredibly well. We are now rolling this out in a phased way for our fixed appliance patients too. A big change but a positive one.

Our digital reviews for existing patients have also gone down well. We have now done in excess of 1,000 of these. It is nice to provide patients with that contact, reassurance and support.

Fundamentally, it’s about sensibly reducing, rather than eliminating, face-to-face contact for those appointments where we can, and ensuring we don’t compromise the outcome. From that initial contact, that we’re having virtually at the moment, we can then move to put patients onto a waiting list for treatment or scheduling a case start safe in the knowledge that the requisite face-to-face visit is worthwhile and essential to progress things.

We’re going to create a timeline. Then we will know what the shortest amount of time is we need to make sure that we are compliant, safe and ready in terms of PPE and appointment scheduling, etc, for when we can reopen. So that at that point when we get the green light, we can put the plan into action. We’re hoping we have two to four weeks’ notice for reopening. But we’re planning for a week.

Doing these virtual consultations is giving us insight into what we will be facing when we go back; we’ve spoken to these patients so we have an idea of what stage their treatment is at.

It’s been unbelievably busy and that’s incredibly exciting. It’s about learning how much activity we can move into a virtual environment and initial impressions are that it is significant. The most dangerous phrase is ‘this is the way we’ve always done it’. I think in dental and healthcare settings we are often guilty of adopting this position.

What have patients’ reactions been to these virtual consultations?

Guy: My heart has swelled with the positive feedback from patients who have not had to leave their home. Especially when they can’t. It’s a revelation.

While it’s not the same as seeing a patient in person, it does help patients understand that we’re there for them and that we care. Patients know that we can’t deliver the service as normal. They completely understand that we’re making the effort to set up a new system, making the time to speak to them and reassure them that we will get things rolling for them again as soon as we can.

What has been your approach to furloughing the team and what challenges do you think this throws up when it comes to reopening?

Guy: We didn’t have to furlough any staff for the NHS practices in light of the guidance from HMRC and the CDO. In our existing practice our patient list is about 70% private. We ended up furloughing about half the team.

We’ve been talking more and more about how to smooth out the process of bringing furloughed and non-furloughed staff back together into one team. It will be important to protect them. This could be a very stressful and anxious time. Particularly when you have two different groups of people who have had very different experiences over these past couple of months.

It will be important to let them know we recognise that it’s difficult and that we will provide all the support possible. It’s potentially going to be frightening. We don’t know what that return to work looks like. There’s no ‘new normal’ in my view. Normal is going to now look very different across practices in the UK. One thing is certain in that it will never go back.

What are your thoughts on the future for dentistry after COVID-19? Are there reasons to be positive?

Guy: I think there may be some kind of polarisation between organisations who accelerate and establish an advantageous patient-centric position for a new world order that takes them to a better place, and those who are desperately trying to revert to the old ways which no longer exist.

The future is bright, especially for those, as most of us are, caring and empathetic providers of dental health care.

The way we relate to regulators may also be bright. They will hopefully see the need to re-visit their position as the balance of risk and benefit shifts. Especially with respect to technology utilisation as an alternative to face-to-face visits.

In reality, we may well see our profits wiped out this year. We have to buy all this PPE and set ourselves up for a return to practice. My view is that if we invest in the people, this sacrifice will turn into an investment. We will see a worthwhile return as patients reciprocate the goodwill and care shown.

My hunch is that there will be a metaphorical day of reckoning when organisations, within and outwith dentistry, will be judged by how they conducted themselves during and after the COVID-19 lockdown. If you have done the right thing and put people before numbers, even though it’s hard and scary in the short term, it will come back to you in spades from your team and your community.

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