building a dental practiceLindsay Gibson speaks to us about her experience trying to open a new dental practice just as the COVID-19 lockdown hit.

You were looking to open another dental practice before COVID-19 hit. How was it all going?

It was going really well up until the lockdown.

I had located an old building that I was in the process of renovating. There was a lot of work in the project, stripping it right back to the brick work, rewiring, etc. All before fitting it out for a dental practice.

We had a bit of an experience with the local building control department. They made an unplanned additional visit to the site. This resulted in them insisting on extra reinforcements. They requested that we had to put steel beams underneath the floorboards and completely take down and rebuild one wall for fireproofing. But they didn’t tell us that until we had already begun flooring and plastering!

The project has been going since the start of 2019, in terms of looking for a suitable area and premises. The work on this building began last October. So, come January/February this year, a lot of the work had been completed. I was actually in the process of advertising for staff. We planned the inspection with my local health board for April. We were expecting to open in May this year.

At that stage there was still a bit of work to do. We had constructed an extension on the side of the building, which needed completing. It is an old cottage and my idea was to create a modern, glass-fronted extension for the new entrance.

But as soon as lockdown hit, everything just stopped. In March we had to down tools completely and this did not start to pick up again until late June.

You’d already taken quite a big financial hit before the COVID-19 lockdown renovating the practice. What impact did the lockdown have on you and the practice?

Yes, I’d taken a business loan from my bank and invested a fair amount of my own money in the project as well.

All the equipment was on order at that stage and it had to go into storage instead of fitting. I was lucky that some of the supply companies have been generous in so much as allowing the equipment to go on hold for the time being.

The health board got in touch to postpone the inspection. There was a real possibility we might not open at all. Initially the health board told me I wouldn’t get an inspection this year, however, after keeping in regular contact with them and explaining my situation they have thankfully agreed to arrange an inspection for me in the Autumn.

Financially, it really wouldn’t have been viable to have the practice just sitting there for much longer. I had used up my rent-free period with my landlord, which started just before Christmas and came to an end in April, right in the middle of lockdown.

While there were financial schemes to utilise, such as payment holidays, bounce back loans and the Coronavirus Job Retention Scheme, there’s only so long you can keep using these schemes for until payments kick back in again.

When I was told I wasn’t going to get an inspection that year I was thinking: ‘What else could I do with the premises?’ It really was getting to that stage.

But, through persevering with the health board, we’ve got a new inspection date in August. Thank goodness!

Do you think it was through chasing that got you an inspection date this year?

Yes. I’ve been asking them regularly and explaining in no uncertain terms that if it is not going to be possible to get the new premises inspected and opened soon then it is likely that it won’t just be the new business that will suffer, but potentially, it could impact on my existing practice and the patients there too.

What was the communication like with the health boards during the lockdown?

They have actually been really good and have been in contact frequently. And I understand the current situation ties their hands to some extent. The decision has come from above forcing health boards to stop all inspections during lockdown.

During our discussions they informed me that their plan was to wait until we started to come out of stage two and were going in to stage three before they started booking into practice inspections again and that seems fairly sensible.

What impact has this had on you personally?

It’s been very challenging. The whole COVID situation and trying to navigate through that with my existing practice and staff has been challenging enough. Everything is so unknown and there’s been a lot of conflicting information. The lack of communication and evidence based advice has been very frustrating. So, to have a potential new business fail before it has even opened thrown into the mix has been really tough.

Plus, I have a young child who was no longer in nursery during lockdown and entertaining her at home hasn’t been easy. It’s been a tough spell, but it looks like we’re coming out the other side of it now, which is good.

When do you think you will be able to open then?

Unfortunately, the inspection is only one part of it and even if I could open my doors tomorrow, because of the severe restrictions on NHS dentists, limiting what treatment we can provide, not allowing us to make any treatment claims or allowing us to register any NHS patients, the plan for opening is still on hold.

The future of NHS dentistry itself is very uncertain. My options would be to offer patients treatment outwith the NHS model which, thanks to COVID, is not affordable for many people at the moment.

So for the time being we are cautiously moving along with the fit out and hoping that the restrictions are relaxed as we get close to opening in the Autumn.

On reflection, do you think your situation could have been better handled regarding your practice? With the practice shut is this not the perfect opportunity to carry out an inspection?

It would and I guess that’s what is going to happen. The stage I was at, I didn’t quite have all the equipment in. It’s only been from June that I’ve really been able to start working on the building again. In terms of the inspection, I really don’t think we could do this any differently.

I didn’t want to proceed with any further work and equipment installation during the lockdown until I had an inspection date. Otherwise I’d be paying for an expensive bit of kit that was just going to sit there. It’s been a difficult one to judge and time correctly, made even more difficult by the current situation.

How do you think the government could handle dentistry during the COVID-19 lockdown differently?

Better communication to the dentists from above. Listening to dentists’ frustrations. It certainly appears that once the First Minister makes an announcement, the CDO then tweets and that’s how we all find out about it at the last minute.

Certainly, the plan for remobilising dentistry could have been set out more clearly from the beginning, taking into consideration what other countries are doing around the world and applying common sense. I’m not sure why Scotland is taking a separate, more cautious approach to dental treatment. And with the current transmission rates so low, why are they still preventing form working?

Unfortunately, we have now dug a huge PPE hole for ourselves that we can’t afford to get out of. Ultimately it is patient care that is suffering at the end of the day.