Treating vulnerable patients in UK practice improves lives and can be profitable for dental businesses

He believes a UK-wide, standardised care system within the scope of the NHS, and including improved treatment signposting, would hugely improve dental services for people who find it difficult to access services. And he stresses:  “It also has to be profitable for the practice because then it becomes part of the normal and the focus of the NHS.”

Dr Atkins, former Chair of the Salford Local Dental Committee (LDC) and a clinical expert to public health leads such as NICE and NHS England, was instrumental in lobbying the Greater Manchester commissioning team to fund a service for homeless people and those with complex needs some 15 years ago in his Ancoats Urban Village Medical Centre practice. He says: “One of the massive,  personal reasons for me attending the LDC and managed clinical network (MCN) meetings was to understand what was going on, where the extra funding is for dentistry, and get to know the commissioners. There are projects around currently, but if you don’t read about them, or get involved, you will be the last to know.”

He explains his practice was already operating out-of-hours and emergency services for Merseyside, Cheshire and a large area of Greater Manchester, which was inundated with vulnerable patients who’d found negotiating the NHS system a nightmare or banned from every other practice, who he and his team would see. “So we went back to our commissioner in Greater Manchester and proposed a proper access session just aimed at hard-to-reach and homeless people.”

The commissioner awarded a contract worth approximately £50,000, which Dr Atkins says enabled the practice to make a major difference to the dental health and wellbeing of vulnerable patients. “It also took the pressure off our actual out-of-hours service because we weren’t having to field 10 or 15 patients a week who were very complicated. The service went from strength-to-strength and it’s possibly the highlight of my career.”

Since selling his practice to Rodericks Dental, Dr Atkins has continued to champion and consult on contracts for hard-to-reach patients; there is now one piloting a service in Leeds and another starting the journey in Cornwall, but he stresses more are needed. “As a profession, we’re not really focused on where the actual needs are in society. We focus very much on the worried well and for me, they are not the patients I qualified to treat.”

Dr Nigel Carter, chief executive of the Oral Health Foundation agrees, adding “The most challenging needs often come from individuals with the highest rates of dental decay. Frustratingly, access points for this group are becoming scarce – with a growing number of dental deserts in the UK.”

However, Dr Atkins says there is now a drive towards getting a standardised process in place - not just for the homeless but also other disenfranchised groups that need prioritisation to access care. He stresses that the “building blocks are there” with dental practices operating to NICE guidelines easily able to accommodate hard-to-reach patients.

Aside from the issue of treatment contracts for vulnerable groups, Dr Atkins points to the hugely negative impact of Covid-19 in terms of the extra barriers now in place to accessing treatment for all patients, but particularly those who are already hard-to-reach. He explains: “There is already difficulty in the signposting journey throughout the NHS and because capacity has reduced across the board, the people who will be the hardest hit are the most vulnerable.” In Manchester, Dr Atkins’ team worked with local shelters to identify patients needing acute care, which he says was a “real success”.

He adds there are currently National Health Institute of Health Research projects looking into why some groups of people in society don’t go to the dentist. “99% of the time it’s about signposting…there are a lot of blockages we need to unblock before it become an easy journey.”

In terms of how the UK’s system of treating vulnerable patients benchmarks with other countries, he points to Canada having a good system of central referrals but adds that similar issues exist world-wide to those in the UK.

“We do it as well as any other country and there some really good signs that things are changing,” he concludes.

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