Jacqui Elsden, president of the British Association of Dental Nurses (BADN), opens up about what needs to happen to better support dental nursing.
Going back to last March, up until now, how has dental nursing been impacted by the pandemic?
I can only answer in relation to my own experience as BADN president – certainly in the very beginning we had lots of calls into the office. It was a real unknown, the whole of the nation was unsure as to what was going to happen.
We potentially thought that it might be a short-term thing. Initially some of the questions coming through were: ‘I’ve been made redundant what can I do?’
I suspect the actions of the employer was an immediate result to the reaction of the news that we were going to be locked in. From the employer’s point of view that meant they wouldn’t have to pay their dental nurse anymore.
We were also receiving calls from members to complain that they had been asked to forfeit their leave as they were at home during the first lockdown.
These were things that happened prior to the furlough scheme being announced, right back in the very beginning when we didn’t really have that government support.
We were finding that our BADN dental nurses were coming to us very distressed because they didn’t have a job anymore. They didn’t know how they were going to pay their bills.
Did you find this was a common theme?
There was lots of variation on that theme. From being made redundant immediately without any financial support to having to take annual leave.
When the furlough scheme came in and some of our BADN dental nurses were placed on furlough, they were still being asked to go into the practice and tidy the garden or paint the surgery or paint the waiting room – to do chores within the practice.
I do have to stress it wasn’t every practice in the country. However, these were the stories that were coming into the BADN head office.
To me it felt unfair. The practice owner was receiving their furlough money from the government and they were still asking that employee to come into work and carry out tasks within the practice.
This meant that in the lockdown situation, they were also encouraging their employees to leave home and travel. That was not a good situation.
In terms of the initial impact, I think that unfortunately, many dental nurses now have a lack of trust with their employers, and with the dental profession, because they were dealt that particular hand.
A lot of dental nurses left the profession when it came to renewing their registrations last year.
What was your reaction to this?
We asked the GDC to reduce their annual retention fee, or even allow for them to pay in instalments. They declined, which was another belly blow.
Not only do these dental nurses feel undervalued, they also were not listened to in terms of the annual retention fee with the GDC.
We are still trying to get some change regarding the annual retention fee with the GDC. But I’m sad to say I am not sure whether we are making good progress. We understand that they must regulate the profession and that should be done. However, this is a different time and people are struggling.
Dental nurses are the lowest paid member of the dental team but still must pay the same registration fee as anyone else in the dental team apart from the dentist.
We also had dental nurses explaining that when they arrived at the supermarket, the shelves were empty. A similar experience to most during the panic buy stage of lockdown.
However, these dental nurses could only shop before or after work and dental nurses work long hours. A lot of practices had to make up for lost time, which again was understandable, but it meant working long hours.
Dental nurses were not afforded the one hour given to NHS workers. They are not recognised as such despite working in an NHS practice.
Various interim measures were arranged for some but not for all. So, there were a lot of unhappy dental nurses out there – and maybe still are. They were not properly acknowledged for the great work they were all doing, alongside everyone else.
Do you think things have got better as time has gone on?
I do think it is better. I think that some of these situations have been acknowledged because we certainly now have the key workers status for dental nurses and dental teams have received the vaccine as a priority group.
Other associations I am sure have also put pressure where it’s needed to support their members as have the BADN.
Therefore it’s good there has been progress in some areas. We need to be hopeful, but we just need to continue to make sure that the other issues are addressed.
The complexity of situations is interesting. For example, in lockdown 3.0, one of our member’s children missed out on a school space. Although she has now been awarded key worker status, and can put her child into school. Unfortunately the spaces in the school were limited because of the number of teachers available.
Her child was put on the waiting list to get them into school, but she was still expected to go to work. So, she asked her employer could she be put on furlough because of the situation. She needed to be at home because her child could not get to school. Unfortunately, there was resistance from the practice.
She was very upset about the fact that the employer was being difficult. These sorts of things happen; different people have different issues.
These are some examples that have been brought to our attention at the BADN and this is my experience.
Why do you think many are disillusioned within the profession?
I think when it came to registering with the GDC last year, morale was really low, and dental nurses certainly felt undervalued. That’s why shortly after that we brought our campaign into view.
We want dental nurses to be properly recognised for what they actually do.
I’m sure most people would agree with me that without a dental nurse in the practice you wouldn’t get an awful lot of your work done.
I believe dental nurses are a very valuable member of the team. But sadly, they still aren’t acknowledged for that, and the pay is often minimum wage.
So, when you consider it all; paying out for CPD, and the annual retention fee together with COVID on top of that, alongside feeling undervalued and not appreciated. Many dropped off the GDC register last year. There were new entries into the register, however that was likely to be dental nurses that were already in training prior to COVID.
When you think about COVID and the impact on training and trainee dental nurses, they won’t have had access to any procedures required for their observations or whatever is needed to complete their practical element of the course.
I believe the reduced patient footfall will impact greatly upon dental nurses’ training programmes.
Whilst we experienced some dental nurses leaving the profession, and some dental nurses coming in; I think that the number coming in this year will be fewer, and those leaving will be even greater.
Do you think there will be more concerns going forward regarding staff shortages?
I do, yes. Having said that, I think this is an opportunity.
I think that for those who are in positions of influence, there is an opportunity. But it will involve raising the minimum payment for a dental nurse in terms of salary.
Some within the profession are coming towards retirement. Maybe they have been put off by COVID and decide that this July, they’re not going to renew.
So, a segment of dental nursing will be leaving, and with that disappears all of their knowledge and their experience. Then you have fewer coming into the profession as a result of potentially not qualifying.
Let’s consider some of the training providers who have struggled as well to survive during COVID.
All sorts of areas will be impacted. I do think that we may well see more dental nurses leaving the profession, and fewer dental nurses on the GDC register this year.
There will be a time lag for this impact to hit. Unless we consider this, we will continue to see a loss to the profession.
What do you think needs to happen?
Dental nurses could get another job and be paid more money for less hassle. If it’s the money that’s driving them to work, and for most of us it is – because at the end of the day we need to be able to pay the bills.
Many of these situations combined, I think will contribute to recruitment and retention issues in the future.
Like I said, I think there is an opportunity for us to put pressure on improving dental nurses pay and conditions. Practice owners would like to have the luxury of having a good pool of people to recruit. I think we are going to have make the role more attractive financially.
Now we have the opportunity to have some debate about dental nursing salaries. Thinking about the future of dental nursing, we need to allow dental nurses to do more. For example, allow them to use their additional skills (as per the GDC Scope of Practice).
Once trained in radiography, for example, we need to allow them to use those skills. And pay them to acknowledge that.
If their pay doesn’t increase when they learn these additional skills, where is the incentive?
I think COVID has expedited a lot of things. I was involved in a working group last summer that the FGDP(UK) brought together. Out of this we produced the guidance document ‘Implications of COVID-19 for the safe management of general practice – a practical guide’.
There were people from all aspects of dentistry on the group and it was put together very professionally and well managed.
It is an example of what has been achieved in dentistry in a short space of time across all areas of the profession. So why not for dental nurses pay and conditions?
How do we achieve this?
The mindset needs amending slightly. It’s difficult because there is always an element of push back when we try to move the dental nursing profession forward. But since 2008 (date of registration), sometimes I sit here and think we are still no further forward and why is that? I think it’s because we haven’t been vocal enough as dental nurses.
Particularly in the NHS, if you think about it, there has been a lot of interrupted treatments when we experienced the lockdown.
Of course, dental practices are trying to meet their targets in a lockdown situation. Potentially many patients may have thought the practice was shut again, as it was in the first lockdown.
Again, this is where I think the dental nurses with additional skills can be utilised in terms of being able to screen for cancer etc. If they have completed their qualifications in relation to additional skills, they know what they should be looking for.
They could apply fluoride, take radiographs – carry out duties to assist in ensuring patients are seen and their treatments completed.
It might take some organisation. Not every practice will be able to accommodate that, but at least have some conversations about it.
As president I am committed to continue to ensure the BADN is sitting at the right table to push forward our campaign.
The fact that we have the technology to meet online certainly opens up a new opportunity to keep our campaign alive.
I have to comment that in some instances we are being listened to. I am not about to give up that easily.
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