NHS Education for Scotland
  • Edinburgh, United Kingdom
Recent publications
Introduction In response to the COVID-19 pandemic, the Scottish Dental Clinical Effectiveness Programme (SDCEP) initiated a rapid review of the evidence related to the generation and mitigation of aerosols in dental practice. To support this review, a survey was distributed to better understand the provision of aerosol generating procedures (AGPs) in dentistry. Methods An online questionnaire was distributed to dental professionals asking about their current practice and beliefs about AGPs. Data were analysed using qualitative content analysis. Results Analysis revealed confusion and uncertainty regarding mitigation of AGPs. There was also frustration and scepticism over the risk of SARS-COV-2 transmission within dental settings, the evidence underpinning the restrictions and the leadership and guidance being provided, as well as concern over financial implications and patient and staff safety. Discussion The frustration and concerns expressed by respondents mirrored findings from other recent studies and suggest there is a need for reflection within the profession so that lessons can be learned to better support staff and patients. Conclusion Understanding the profession’s views about AGP provision contributed to the SDCEP rapid review and provides insights to help inform policymakers and leaders in anticipation not only of future pandemics but in considering the success of any large scale and/or rapid organisational change.
Background The transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement worldwide, as for example in our 2014-15 study of an Incentivised Laparoscopy Practice programme (ILPv1). Drawing on learning from our subsequent multi-centre study examining barriers and facilitators, we revised the programme for 2018 onwards. We now report on engagement with the 2018–2022 versions of this home-based simulation programme (ILP v2.1–2.3). Methods In ILP v2.1–2.3, three consecutive year-groups of new-start Core Surgical Trainees (n = 48, 46 and 53) were loaned portable simulators. The 6-month education programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review (but not mandatory for progression). ILP was set within a wider reform, “Improving Surgical Training”. Results ILP v2.1–2.3 saw pass rates of 94%, 76% and 70% respectively (45/48, 35/46 and 37/53 trainees), compared with only 26% (7/27) in ILP v1, despite now including some trainees not intending careers in laparoscopic specialties. The ILP v2.2 group all reported their engagement with the whole simulation strategy was hampered by the COVID19 pandemic. Conclusions Simply providing take-home simulators, no matter how good, is not enough. To achieve trainee engagement, a whole programme is required, with motivated learners, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a “reform within a reform, within a context.”
BACKGROUND: The role of General Practice Clinical Pharmacists is becoming more clinically complex. Some are undertaking Advanced Clinical Examination & Assessment courses to further develop their skillsets. AIM To explore General Practice Clinical Pharmacists’ experience of Advanced Clinical Examination and Assessment courses, skills development and implementation. METHOD: This research used qualitative methods with theoretical underpinning at each stage. General Practice Clinical Pharmacists working in the Scottish National Health Service who had completed the relevant course were invited for qualitative online mini-focus groups. Informed written consent was obtained. A topic guide was developed using the Theoretical Domains Framework and piloted. Mini-focus groups were recorded, transcribed verbatim and analysed using a framework analysis informed by Theoretical Domains Framework and the “Capability, Opportunity, Motivation Behaviour System”. Ethics approval was granted. RESULTS: Fourteen pharmacists participated from eight Health Boards across Scotland. Themes were identified and mapped to frameworks underpinning this research. Participants reported that the course allowed them to gain skills needed to become clinically autonomous and supported them in taking a more holistic approach when reviewing patients. However, the pharmacist-product from the course in terms of skillset acquisition, and its potential application in general practice, was perceived by participants as poorly understood at the micro, meso and macro level. There was frustration among participants at the perceived lack of advanced practice opportunities within the current contractual healthcare system in general practice. CONCLUSION: Policy drivers should be urgently devised to reform general practice pharmacy services to best utilise pharmacists with these skills.
While the COVID-19 pandemic may no longer dominate headlines, significant pressures on the UK health and social care sector remain. Within dentistry, a profession with a long-standing association with poor mental health, practitioners continue to feel significant strain in terms of working conditions and financial pressures. They now also face a severe backlog of routine care for NHS patients.
Background: Infective endocarditis is a severe infection arising in the lining of the chambers of the heart. It can be caused by fungi, but most often is caused by bacteria. Many dental procedures cause bacteraemia, which could lead to bacterial endocarditis in a small proportion of people. The incidence of bacterial endocarditis is low, but it has a high mortality rate. Guidelines in many countries have recommended that antibiotics be administered to people at high risk of endocarditis prior to invasive dental procedures. However, guidance by the National Institute for Health and Care Excellence (NICE) in England and Wales states that antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. This is an update of a review that we first conducted in 2004 and last updated in 2013. Objectives: Primary objective To determine whether prophylactic antibiotic administration, compared to no antibiotic administration or placebo, before invasive dental procedures in people at risk or at high risk of bacterial endocarditis, influences mortality, serious illness or the incidence of endocarditis. Secondary objectives To determine whether the effect of dental antibiotic prophylaxis differs in people with different cardiac conditions predisposing them to increased risk of endocarditis, and in people undergoing different high risk dental procedures. Harms Had we foundno evidence from randomised controlled trials or cohort studies on whether prophylactic antibiotics affected mortality or serious illness, and we had found evidence from these or case-control studies suggesting that prophylaxis with antibiotics reduced the incidence of endocarditis, then we would also have assessed whether the harms of prophylaxis with single antibiotic doses, such as with penicillin (amoxicillin 2 g or 3 g) before invasive dental procedures, compared with no antibiotic or placebo, equalled the benefits in prevention of endocarditis in people at high risk of this disease. Search methods: An information specialist searched four bibliographic databases up to 10 May 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: Due to the low incidence of bacterial endocarditis, we anticipated that few if any trials would be located. For this reason, we included cohort and case-control studies with suitably matched control or comparison groups. The intervention was antibiotic prophylaxis, compared to no antibiotic prophylaxis or placebo, before a dental procedure in people with an increased risk of bacterial endocarditis. Cohort studies would need to follow at-risk individuals and assess outcomes following any invasive dental procedures, grouping participants according to whether or not they had received prophylaxis. Case-control studies would need to match people who had developed endocarditis after undergoing an invasive dental procedure (and who were known to be at increased risk before undergoing the procedure) with those at similar risk who had not developed endocarditis. Our outcomes of interest were mortality or serious adverse events requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse effects of the antibiotics; and the cost of antibiotic provision compared to that of caring for patients who developed endocarditis. Data collection and analysis: Two review authors independently screened search records, selected studies for inclusion, assessed the risk of bias in the included study and extracted data from the included study. As an author team, we judged the certainty of the evidence identified for the main comparison and key outcomes using GRADE criteria. We presented the main results in a summary of findings table. Main results: Our new search did not find any new studies for inclusion since the last version of the review in 2013. No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included in the previous versions of the review, but one case-control study met the inclusion criteria. The trial authors collected information on 48 people who had contracted bacterial endocarditis over a specific two-year period and had undergone a medical or dental procedure with an indication for prophylaxis within the past 180 days. These people were matched to a similar group of people who had not contracted bacterial endocarditis. All study participants had undergone an invasive medical or dental procedure. The two groups were compared to establish whether those who had received preventive antibiotics (penicillin) were less likely to have developed endocarditis. The authors found no significant effect of penicillin prophylaxis on the incidence of endocarditis. No data on other outcomes were reported. The level of certainty we have about the evidence is very low. Authors' conclusions: There remains no clear evidence about whether antibiotic prophylaxis is effective or ineffective against bacterial endocarditis in at-risk people who are about to undergo an invasive dental procedure. We cannot determine whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically, practitioners should discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
Cardiovascular complications due to COVID‐19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID‐19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high‐sensitivity troponin and N‐terminal pro B‐type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3–13%). Thirty‐day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N‐terminal pro B‐type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.
This article discusses the nutritional needs of moderate and late preterm infants (born between 32+0weeks and 36+6weeks' gestation) and makes recommendations for best practice both while these infants are in hospital and when they are discharged into the community. These recommendations were derived following a roundtable meeting of a group comprising two neonatologists, three paediatric dietitians, a health visitor/paediatric nurse and a midwife practitioner. The meeting and medical writing assistance was sponsored by Nutricia. None of the participants accepted honoraria for their contributions to the discussion.
Background Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology’s (ESE 2019) recent consensus statement recommends full pulpotomy , where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice. Method This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis. Discussion The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. Trial registration ISRCTN Registry, ISRCTN17973604 . Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021
Introduction Scottish Government aims to increase numbers of pharmacist independent prescribers (IP) in community to improve healthcare access. This includes utilising qualified IPs as Designated Prescribing Practitioners (DPP) to increase capacity to supervise pharmacists on IP courses. Aim To investigate views and perceptions of practice-based stakeholders and identify potential influences on DPP implementation for Scottish community pharmacists (CP) Methods A theory-based cross-sectional online survey of stakeholders involved in DPP role implementation (e.g. Directors of Pharmacy, Prescribing Leads, IP qualified CPs) was employed. Participation invites were shared with Scottish health boards and CP organisations via email and social media. Snowball sampling was used so no key individual was omitted. The questionnaire was informed by Royal Pharmaceutical Society (RPS) DPP Framework (1) and Consolidated Framework for Implementation Research (2). It examined views and awareness of DPP role, implementation drivers, and obstacles. The tool was reviewed for credibility and dependability then piloted. Data were analysed descriptively. Results Ninety-nine responses were received (NB: Since this was a national survey of multiple stakeholders without a defined sample list, response rate was indeterminate). Two-fifths (n=39, 40.2%) were community pharmacists with majority qualified for more than 10 years (n=76, 76.8%). Only 18 had previous involvement with IP courses. The table shows awareness and views of the role based on RPS framework. Respondents had positive attitudes to DPP implementation with the majority supporting it (72, 73.5%) and believing that its advantages outweigh any disadvantages (74, 75.5%). Facilitators of successful implementation were having clearly defined leadership roles (89, 90.9%), piloting (85, 87.6%), and incentives (65, 88.8%). Drivers for uptake of role included improving patient care (94, 96%) and the profession (91, 92.8%), self-development (91, 92.8%), developing individual pharmacists (89, 90.8%), payment (77, 79.4%), and being recognised by peers/employers (73, 75.2%). Conclusion There was positivity regarding DPP role, its acceptability in, and advantages for CP. Resource-related concerns were expressed that need further consideration to ensure effective implementation. This is the first study internationally to explore views on DPP role. Given the Scottish focus, findings may lack generalisability. Future research should focus on theory-based evaluation of structures and processes of implementation. References (1) Royal Pharmaceutical Society. Designated Prescribing Practitioner Competency Framework [internet]. London: Royal Pharmaceutical Society; 2019 [Cited 28/09/2021]. Available from: https://www.rpharms.com/resources/frameworks/designated-prescribing-practitioner-competency-framework (2) Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.
Introduction The two-year, NHS Education for Scotland (NES) post-registration foundation programme supports early career pharmacists in patient-facing sectors of practice. The experiential programme, based on an eight-element competency framework, also includes webinars, online resources, and tutor support. Learners complete an online evidence portfolio and undertake a summative OSCE. Aim The aim of this paper is to report the experiences of the community-pharmacist participants, with a focus on the ‘fitness-for-purpose’ of the programme. Methods This was a longitudinal mixed-methods study theoretically underpinned by Miller’s triangle and social cognitive theory. Eligible participants were all pharmacists registering for the programme in Scotland in September 2017 and February 2018, all participating Welsh community-pharmacists, and all tutors. Invitation packs were emailed by NES/HEIW staff with names forwarded to researchers following signed consent. Focus groups/interviews (face-to-face or virtual according to participant preference) were undertaken at start, mid-point and exit of programme, to explore expectations (benefits, social gains, professional identify), experiences (challenges, facilitators, meeting of learners’ needs) and barriers. Proceedings were digitally recorded, transcribed verbatim and managed using NVivo. Thematic analysis (1) was based on social cognitive theory (transferable behavioural skills and professional attitudes). An inductive analysis additionally identified emergent themes. Participants in Scotland were invited to complete an on-line base-line questionnaire to describe their self-assessed competence against the NES Foundation framework (personal and professional practice, membership of healthcare team, communication, patient centred approach to practice). Data was analysed in SPSS using descriptive statistics. Themes from qualitative and quantitative data were integrated. IRAS ethical approval was not required; NHS Research & Development approval was given. Results 96 pharmacists registered for the programme: 18 community-pharmacists in Scotland (11 health boards); 14 community pharmacists in Wales. In Scotland 15 community-pharmacists completed questionnaires: 9 expected an ‘increase in confidence’ and 11 to provide ‘better patient care’. Self-assessed competence against the framework was generally high. Across Scotland and Wales, 12 focus-groups (involving 19 community-pharmacists), 12 community-pharmacist interviews, 10 tutor focus-groups (8 community-pharmacist tutors) and 3 community-pharmacist tutor interviews were conducted. At midpoint and exit pharmacists and tutors reported increased confidence, the ability to reflect and pride in their achievement. Barriers: included lack of protected time; workload; and lack of support (tutor and employer). There were also programme issues (practicalities of portfolio; workplace-based assessment, no access to medical records); and cultural issues in community-pharmacy (‘speed & safety’; lack of recognition). Reasons for dropping out of the programme included: moved geographical area; too experienced; workload pressures; no incentive; no employer support. Four community-pharmacists in Scotland and none in Wales completed the programme. Conclusion Study limitations include the small numbers, programme delivery limited to Scotland and Wales, and limited response rate to focus-groups/interviews, exacerbated by COVID19. Overall community pharmacist expectations were met, and they perceived the programme was fit-for-purpose and worthwhile. However, barriers particularly related to the community pharmacy context, may have led to the high drop-out rate. These findings should be considered as the new UK-wide RPS curriculum for foundation pharmacists (2) is implemented in Scotland, to optimise its successful delivery. References (1) Braun, V. and Clarke, V. Using thematic analysis in psychology. Qualitative Research in Psychology. [Internet]. 2006; 3 (2): 77-101. ISSN 1478-0887 Available from: http://eprints.uwe.ac.uk/11735 (2) Post- registration Foundation Programme for Newly Qualified Pharmacists in Scotland [Internet] https://nes.scot.nhs.uk/our-work/post-registration-foundation-programme-for-newly-qualified-pharmacists-in-scotland-autumn-2021-onwards Accessed October 12, 2021.
Introduction: The ICD-11 includes a new grouping for "disorders specifically associated with stress" that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. Methods: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was "startle response." Discussion/conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.
Introduction: A new UK medical postgraduate curriculum prompted the creation of a novel national medical postgraduate 'boot camp'. An enhanced simulation-based mastery learning (SBML) methodology was created to deliver procedural skills teaching within this national boot camp. This study aimed to explore the impact of SBML in a UK medical boot camp. Methods: One-hundred and two Scottish medical trainees attended a 3-day boot camp starting in August 2019. The novel enhanced SBML pathway entailed online pre-learning resources, deliberate practice, and simulation assessment and feedback. Data were gathered via pre- and post-boot camp questionnaires and assessment checklists. Results: The vast majority of learners achieved the required standard of performance. Learners reported increased skill confidence levels, including skills not performed at the boot camp. Conclusion: An enhanced SBML methodology in a boot camp model enabled streamlined, standardised procedural skill teaching to a national cohort of junior doctors. Training curricular competencies were achieved alongside increased skill confidence.
Recruitment and retention of medical practitioners is a challenging contemporary policy issue for rural areas. In this paper we explore this issue in the context of doctors in rural and remote Scotland, drawing on findings from a service mapping exercise into the recruitment and retention of doctors in rural areas, conducted by interviewing key stakeholders in the delivery of healthcare in rural and remote Scotland, most of whom combine clinical and organisational responsibilities. The aim of this paper is to understand the key issues, drawing on what the stakeholders see across the day‐to‐day delivery of their clinical roles and within the varied levels of the organisational structure of Scottish healthcare to which they contribute. Our findings build on a review of key literature of contemporary issues in rural Scotland, healthcare delivery in rural areas and wider international literature on recruitment and retention of medical practitioners. Our findings focus around three key themes: power of place; how people make place; and, place and policy. In our conclusion, we argue that the importance of this stakeholder research is three‐fold. First, that such insights from stakeholders are important in shaping and preparing for future research on the topic, particularly interviewing those currently working. Second, it adds to and echoes the growing body of literature globally focussed on recruitment and retention, by expanding on the Scottish context. Finally, it proposes that appropriate and effective rural proofing is important in the implementation of new policies where place‐based challenges or differences can emerge.
Practice-Based Small Group Learning (PBSGL) is a continuing professional development programme use by various professions in primary healthcare teams in NHS Scotland. Primary healthcare teams have enlarged with the addition of new professions including First Contact Physiotherapists (FCP) who provide services to patients without the need for referral. In 2020 a pilot of FCPs groups using PBSGL was undertaken.The pilot involved volunteers from a FCP team in one large NHS board in Scotland. It lasted for 12 months and groups met in-person, switching to video-conferencing (VC) as a consequence of the pandemic. A grounded theory approach was adopted for the evaluation. Research participants took part in individual interviews held using VC. Interviews were recorded and transcribed. Data was analysed using grounded theory methods with codes and themes being constructed.Two PBSGL groups were formed from 10 participants and 2 facilitators. Ten took part in one-to-one research interviews. Seven main themes were constructed from the data. There was recognition that FCPs had a new role and work context. There was a sense of volunteerism in the pilot and that participants met in their own time. FCPs appreciated the PBSGL learning methods and their meetings fostered peer support and improved professional socialisation. There was a preference for in-person meetings rather than using VC and some participants wanted to join inter-professional groups in the future.
In 2019, the Royal College of General Practitioners (RCGP) introduced a mandatory workplace-based prescribing assessment for general practice trainees in their final year of training (GPST3). This assessment aimed to improve the quality of prescribing and reduce prescribing errors and it did not require pharmacist involvement. NHS Education for Scotland (NES) is the education and training body for NHS Scotland: delivering postgraduate training for GP trainees working in NHS Scotland. NES wished to evaluate the role that general practice pharmacists could have in this assessment.A training event for pharmacists was designed and delivered by the researchers in collaboration with the NES pharmacy team. Pharmacists attached to training practices in the West region of Scotland, where a GPST3 was undertaking the prescribing assessment, were invited to attend. The training described the prescribing assessment and the value that pharmacists could add to this workplace-based assessment. The evaluation aimed to explore the role of appropriately trained pharmacists in the prescribing assessment and their feedback to GP trainees, and evaluate the impact pharmacists had by exploring the views of GP trainers, GP trainees and pharmacists.Results showed that the intervention was viewed as a positive educational experience for all participants, and the interprofessional approach broadened the learning experience for GP trainees. We believe this to be innovative work replicable to primary healthcare colleagues to promote prescribing safety and interprofessional learning with pharmacy colleagues.
Introduction Recent cross-sectional surveys have shown the detrimental impact of COVID-19 on the health and well-being of dental practitioners and dental care professionals. This qualitative study complements the growing quantitative evidence base with an in-depth exploration of the lived experiences of those working in primary care dental teams in Scotland. Methods Focus groups were carried out with primary care dental team members and trainees between July and October 2020. Olsen's tripartite framework of health service sustainability was operationalised to explore how participants experienced uncertainty and their attempts to sustain dental services. Results Analysis revealed significant concerns surrounding the sustainability of dental services and dental training programmes as a consequence of the emergency level response to the pandemic. Restrictions on dentistry were seen to be severely impeding desirable clinical outcomes, particularly for the most vulnerable groups. Participants experienced being unable to deliver high quality care to their patients as both confusing and distressing. The capability of the dental health care system to meet a growing backlog of dental need and manage this effectively in a pandemic era was called in to serious question. Ongoing uncertainties were affecting how participants were thinking about their professional futures, with stress about income and employment, along with heightened experiences of professional isolation during the pandemic, resulting in some looking at possibilities for retraining or even considering leaving their profession altogether. Discussion The impact of the pandemic has produced considerable uncertainty regarding the sustainability of dental services in the medium to longer term. It has also served to expose the uncertainties practitioners grapple with routinely as they attempt to sustain their NHS dental service delivery. Conclusion This study brings in to sharp focus the diversity of challenges, confusions and uncertainties experienced by dental practitioners and dental care professionals during the COVID-19 pandemic and the need for suitable and ongoing measures to be put in place to support their mental well-being.
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Paul Bowie
  • Safety, Skills & Improvement Research Collaborative
David E Cunningham
  • Medicine Directorate
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