Darnall in Sheffield is an area described as having a high dental needs population. Vasileios (Bill) Orliaklis principal dentist at the practice, is aware that this poses him and his team a number of specific challenges.
He explains “Darnall is one of the most deprived of areas in Sheffield.
“The majority of people that attend our practice need multiple appointments to become dentally fit.”
The practice started offering urgent access sessions in November 2022. This initiative allowed the practice to see more patients based on sessional activity rather than units of dental activity (UDAs), which are used to measure the amount of work done during treatment.
The practice team has found this has improved patient experience.
“The urgent access sessions allow us to spend more time with the patient…” says Bill
“I saw a patient though the scheme that had problems with all of their teeth …they wanted to stay in the practice and carry on the rest of the treatments. Once the patient is out of pain, I can use follow-up appointments to do other work they need carrying out.”
The practice team see a wide range of cases through the urgent access scheme. The practice allocates three appointment slots per session for 111 referrals with the remaining slots used for new patients or existing patients with urgent needs.
Bill continues: “The urgent care referrals we get through from 111 usually involve adults and children with toothache, broken teeth, swellings and bleeding gums. Children often have a high number of caries and as they’ve not been to a dentist, they develop problems and pain.”
Unlike GP surgeries, dental practices don’t have restrictions along ICB boundaries. Although patients don’t register with a dentist in the way they do a GP practice, many practices have a regular list of patients they continue to see. The practice has significantly increased this list from 7,000 to 12,500 patients over the 2.5-year period since the sessions began.
“I started as a sole practice principle over 20 years ago and now the practice has nine surgeries.” recalls Bill.
“Since we started the urgent access sessions we’ve more or less doubled the size of the practice.
“Sometimes they have a problem with their teeth because they’ve not seen a dentist for two or three years. We’ve got patients coming all the way from York, Hull or even from down in Nottingham because they know that we are seeing new patients through these sessions.”
Although the practice has increased in size rapidly, the sessions are still continuing.
Bill adds, ““We started working with the urgent access initiative as we had some capacity – we had dentists that had the ability to work more and see more patients.
“However now we have grown our practice we continue to do it because we want people to be able to see a dentist.”
The challenges faced when meeting patient needs
The practice team face ongoing challenges in managing their diverse patient population.
Sarah Fletcher Practice Manager, says:
“There is a high workload associated with meeting the needs of our patient group, for example we call many of our patients with reminders which helps keep our levels of non-attendance (DNAs) down. Our team also spend a lot of time managing patient expectations around the treatment available from an NHS dentist.
The practice sees up to 20 new patients per day on specific days (Tuesday, Wednesday, and Thursday) between 2:00pm and 3:00 pm This system helps manage the high demand and ensure that the practice can continue to accommodate new patients and help those that need it the most.
A significant number of patients come from Asian and Eastern European backgrounds, which can lead to language barriers. The team have implemented new ways of working to handle the demand in a way that is accessible and easy to understand. Sarah continues,
“We now use a token system to manage the high demand for new patient registrations. Patients are given tokens to determine the order in which they will be seen, preventing conflicts and ensuring an orderly process. This is helping reduce the pressure on our staff who sometimes have to deal with challenging behaviour.”
Positive impact on patient lives
The team can really see the positive impact of their work on a patients’ quality of life.
Says Sarah “I’ve just heard from a patient that’s had a terrible experience in the past and was petrified to go to a dentist, he told us that we have changed that. And that’s what makes you want to do this job, you’re helping people to access an NHS dentist.”
“I’ve worked in dentistry a long time and you see people come in and their face looks puffy. But sometimes the facial swelling is so big you realise that It’s not just their dental health at stake, it’s their overall well-being.
“Dental infections are so serious because if they go into the system, you’ve got sepsis then to deal with.”
Bill adds “With our walk-in emergency slots, somebody who has swelling or a lot of pain can come through the door even if they haven’t seen us before. Then if we have an appointment available on the day, we can offer it to them and then we can see if we can get them out of pain.”
However, even if the patient isn’t suffering huge amounts of pain, a trip to the dentist can still be life changing.
“I saw a patient that wasn’t in tremendous pain but had a small swelling on the floor of the mouth which didn’t look right,” remembers Bill
I did a referral. They had a biopsy, and the diagnosis came back that that they had cancer. It was at an early stage so the patient could get the correct treatment with every chance of a positive outcome,”
“It’s not every day you think you may have saved somebody’s life.”
Making patients smile again
Changing lives isn’t always down to a timely oral cancer diagnosis.
Bill recalls a victim of violent crime he was able to help during the urgent access sessions:
“She had multiple teeth that were damaged, including the loss of her front teeth and she had a job where she needed to deal with the public.
“I did all the work and obviously stopped the pain. Took some roots and for the broken teeth, that could not be saved I made her a denture. She was really happy because she worried that she would not be able to have her own teeth. But she did. And she was very appreciative.”
Sarah adds:
“By the end, they feel confident to smile because we got them to that point. One lady was fitted with a set of dentures after a full clearance, and she felt her quality of life was returned …she was crying at reception. She couldn’t believe she could actually smile again.”
Looking to the future
Given the practice team’s experiences through the urgent access sessions, particularly with young patients, they are also involved in two new pilots in South Yorkshire,
One is a children’s project for 0 to 5 years and involves running dedicated sessions for infants and their parent/carer. These clinics are already up and running and the many of the early clinics have been fully booked. The practice team has also been visiting nurseries and plans to visit mother and toddler groups to provide dental advice and information to parents.
Bill continues, “A big part of dentistry is education. You need to know the basics. We are trying to tell our patients about prevention as a three-year old child will not know that they have to brush their teeth and avoid too many sugars in the diet…It’s mum, dad and the whole wider family.”
The other is an inclusion health project which aims to provide dental care to transient and vulnerable populations during a weekly clinic. The team are working closely with local charities such as The Sanctuary as, despite the high demand, there are still some barriers to be navigated when it comes to getting people through the door to receive care.
Bill concludes:
“It’s a very busy practice with a huge workload but it’s incredibly rewarding. A colleague years ago asked me why do you work in Darnall because of the challenges you face there? The reason is because I want to help people out of their problems, out of their pain. And here I can do this more than anywhere else.”
For more information on the support dentists can receive visit: NHS England » Update on the Dental Recovery Plan