Everyone’s a Winner
“There is no competition, there is no point scoring, it is just a very positive, collaborative framework that we’ve got.”
These are the words of Andrew Hall, final year coordinator at Dundee Dental School, but they could have been spoken by any one of a number of people involved in one of the most successful, and far-reaching, dental projects of recent times.
Both Dundee and Glasgow dental schools have collaborated with ten out of the 14 health boards in Scotland, as well as NHS Education for Scotland, to produce a comprehensive dental outreach programme that is garnering overwhelmingly positive reviews from all involved.
Dental outreach is not especially new, Glasgow has been running a paediatric outreach programme for a number of years and it also piloted student outreach back in 1997. What is different about the current system, introduced nationwide in 2006, is the fact that it brings together so many different elements and provides so many solutions to common problems.
Andrew Forgie, (pictured) Associate Dean for Postgraduate Dental Education at NHS Education for Scotland, who supplies all the revenue funding for outreach, explained: “I think that it has been successful because nobody is trying to get more out of it than anyone else. If everyone is gaining and nobody is trying to take advantage of anyone else then I think you are more likely to get better collaboration.
“The ethos behind outreach was threefold: to give students experience outwith the dental schools, to provide service in areas that have either a lack of NHS provision or where there is a high treatment need, and finally, to promote recruitment into areas that are having difficulty recruiting dentists or students.”
There are currently 12 dental outreach centres across the country, providing more than 70 chairs. And, with a further five centres in development, the number of outreach chairs will be over 100 by 2012. Glasgow and Dundee students (and eventually Aberdeen when their first final year comes through) spend roughly half their final year on outreach placements in various locations, seeing a diverse range of patients.
David Watson, Senior Clinical University Teacher and course coordinator for BDS5 at Glasgow Dental School, is the teaching lead for outreach at Glasgow and was involved with the original pilot at Greenock Health Centre. He was a salaried dentist working in the centre when outreach was trialled and he had no doubt it was a positive development. He said: “I always did think it would work. I didn’t think it would be easy, and it has been a lot of hard work on all sides. It has involved a lot of travelling around and monitoring, but I think that the feedback that we have had has confirmed that it is working.”
And, although the outreach programmes at Glasgow and Dundee differ in the specifics, the two schools have worked closely together over the past few years, sharing knowledge and experience. The fact that Andrew worked with David in Greenock when the original outreach was being set-up, further strengthens the alliance. Andrew said: “It’s a great working relationship and I know that if I have a problem in Dundee, I can phone up David and ask them what they did in Glasgow, how they got round a particular problem and vice versa.”
David and Andrew are supported by full-time outreach administrators Frank Bonner and Bruce Watt, who deal with timetabling and placement issues, logistics and expenses as well as helping the teaching leads evaluate the programme, amongst many other things.
The Scottish Government has invested over £100 million into dentistry since 2005 and a significant amount of that has been used to build and refurbish community dental centres, some of which now include a proportion of outreach chairs. Patients visiting the outreach centre don’t pay for their treatment, providing a much- needed service to people on low incomes or those who have been unable to register with another NHS practice.
The students work under close supervision with a tutor on hand to advise them at all times and with nurses available to provide a level of assistance that just isn’t possible in the dental school. Donald Macfarlane, one of the tutors at the Kilmarnock outreach clinic, explained that having better nursing support is often cited in student feedback, but the experience gives them a better understanding of what lies ahead. He said: “They get much more of a taste as to what it is like working in general practice. They get to experience the whole range of treatment that a general practitioner would be expected to provide and in the safe environment of a supervised clinic. They are free to carry out their treatment but they know that if they have to ask questions, or things go wrong then they have a safety net.”
His fellow tutor at the North West Kilmarnock Area Centre, James McCall, added: “I think they get a more realistic picture of what things are like when they are out in practice. They get to bring all the individual elements that they learn in the hospital together, in order to treat patients in a more holistic manner. I think it is quite good preparation for them going into VT.”
Donald and James currently have four Glasgow students on placement at the centre, each seeing up to five patients a day. Final year student Viraj Patel, 23, explained how he was enjoying his time in outreach: “It’s absolutely brilliant. You just get to do so much more, seeing patients one after the other and it’s good preparation for what it is going to be like in practice. You just get such a variety of things and I’m really enjoying it.
“The supervision from the tutors is great. Even if you don’t have a patient, or someone cancels, they can give you tutorials and talk to you about anything else you might need help with.”
Fellow outreach student Jamie Kinnell, 26, paid tribute to the staff. He said: “The facilities are excellent; the staff and nurses are great. At the dental hospital we don’t have as many nurses but here we have staff on hand to assist us, and help us. We can also see more patients, and there is a greater integration with the dental team.
“It is just thoroughly enjoyable, we see more patients, we get to do more dentistry and it lets us feel more like dentists.”
But the benefits are not just restricted to the students, as Donald explained: “It’s a very stimulating environment to work in. These guys are young, enthusiastic, keen to learn and they are also learning the latest techniques and developments in materials from the dental hospital, which we are then required to know about in order to teach them. So we ourselves have to continue learning and it keeps us on our toes.”
His sentiments were echoed by James: “If you are teaching somebody you need to be really sure about what you are talking about. I think it encourages you to keep up-to-date and to develop yourself. It is quite inspiring seeing some of these students, they are so keen and that fires your own enthusiasm.”
Dental outreach in Scotland seems to be a unique example of multiple organisations working together to achieve multiple goals. Everyone benefits, from the NHS boards and their patients, to the students and the universities.
Andrew Forgie concluded by saying: “I think it has been a win-win situation for all those involved. Hopefully it will produce students who are much more aware of the real world situation and we are getting patients treated who may otherwise have struggled to get care. So I think that is about as good as you can really get.”
And the view from the universities is also very positive David said: “The success of outreach to date has been the result of teamwork. Considering the close working relationships which have developed among all of the stakeholders: NES, the universities and the host NHS boards, outreach is probably one of the best examples of partnership working you can find in the present time.”