Dentistry On The Road: How A Mobile Dental Unit Became The Fisherman's Friend
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- Published: Wednesday, 28 February 2024 08:39
- Written by Guy Tuggle
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’Smile Together’ has been driving a mobile dental unit (MDU) to Cornish and Devon harbour sides since 2017 and was cited by the Dental Recovery Plan as a model for delivery. As the government proposes to dispatch MDUs to remote communities, GDPUK’sGuy Tuggle speaks with Tracy Wilson of dental group Smile Together, about the initiative.
When did your ‘van’ start operating and how did it come to be? Who funded its construction and who decked it out?
Being an employee-owned community interest company (CIC), ’Smile Together’ colleagues are very much engaged in the business and frequently suggest how we might improve and enhance our
patient care delivery and impact in local communities.
In 2016 one of our dentists attended Porthleven Food Festival in West Cornwall and met The Fishermen’s Mission charity who explained how difficult it is for fishermen to access dental (in fact any health) care due to the demands of their work and their remote locations. They suggested instead, that we might take our care to them. And that’s how ’Smiles at Sea’ began, providing urgent and emergency dental care to fishermen and their dependent family members at the harbourside.
It’s now funded by Smile Together (as a CIC, investing profits back into the community to improve oral health) and delivered in partnership with The Fishermen’s Mission SeaFit service and their healthcare partner network.
Some years, including in 2023, additional funding from Seafarers Hospital Society has enabled us to visit even more harbourside locations during Smiles at Sea.
We were initially loaned a mobile dental unit (MDU) byDentaid and then by fellow dental CIC CDS in Bedfordshire for a couple of weeks each year. We then purchased our own second-hand MDU in< 2021, which came to us fully kitted out and ready to go. We just had to re-brand it as ’Smile Together’.
How is your ’van’ typically used?
We use our MDU for our annual ’Smiles at Sea’ tour and for providing care to other under-served communities such as those experiencing homelessness, often delivered with other partners as integrated healthcare initiatives to make every contact count.Complementing the oral health promotion programme that we deliver in local primary schools, we have taken our MDU along for the children to experience the inside of a dental surgery (albeit it on wheels), some for the first time.
Are you subject to CQC inspections? Does being a mobile surgery pose any unique compliance issues?
Yes, the MDU, as a mobile dental surgery, falls under the same compliance regulations as our dental practices - CQC, Health & Safety, contractual arrangements for all our dental equipment repairs and maintenance, RIDDOR and legionella compliance.
There are also special vehicle maintenance regulations for the MDU that we adhere to, along with driver operational checks and procedures for opening and closing down the MDU after use.
All our clinical team members are registered dental professionals with the GDC, and all have training for working on the MDU. There are specific risk assessments in place for operating and working on the MDU, along with locational risk assessments, as required.
Are all staff volunteers? Do you struggle to attract volunteers after the ‘novelty’ wears off – are they from your group or can any professional take a turn?
Smile Together has a dedicated Outreach Team which includes a clinical manager, a dental therapist, three dental nurses and an administrator. To complement that core team and support initiatives
such as Smiles at Sea or Health for Homeless, other clinical colleagues are invited to provide care from our MDU.
No-one is required to do so, but we’re never short of volunteers as it gives such variety from their ‘normal’ surgery environment and is seen as a rewarding opportunity to genuinely make a difference to people who rarely get to see a dentist.
In many Cornish coastal locations, the view from the MDU can be pretty spectacular!
There is a delicate balance required, as working on the MDU arguably takes clinicians away from delivering the urgent/emergency or referred services that we are commissioned to deliver, so other
dental professionals are welcome to support and, subject to the necessary checks, we do have dentists from other practices and hospital locations working in our MDU. We have also had locum dentists working in our MDU, some of whom have subsequently chosen to join Smile Together due to the breadth and impactful nature of our work, so it’s proved a useful recruitment tool!
Walk in, sit and wait or appointments? Available to all the community or only target groups?
Generally, appointments to see a dentist or therapist in our MDU are first come, first served.For Smiles at Sea 2023 we trialled an advance appointment system so the fishermen didn’t have to sit and wait, which proved popular but gave other healthcare partners less opportunity to engage with
patients whilst waiting.
Currently, dental care provision from our MDU is for target groups, specifically those more vulnerable or hard to reach individuals in our community.
Our ability to widen delivery from the MDU is dependent upon our profitability (our mantra as a CIC being ‘more margin, more mission’), external funding and clinical resource – we do not currently
have the capacity to deliver dental care from our MDU to a whole community in any location that we currently visit. We would be overwhelmed.
Which procedures account for the most work? Pain relief and extractions? What don’t you offer?
And what about procedures that will require follow up? Who sees the patients?
Given our targeted patient groups, it is predominantly urgent/emergency care provision and getting people out of pain – tooth/root extractions are common. During Smiles at Sea 2023 for example, we
saw 119 patients and did 39 fillings, 16 extractions, 16 scale and polish, and 59 x-rays, provided oral cancer screening for all adult patients, referring 4 for more complex urgent care/oral surgery or
suspected oral cancer. 11% of those we saw hadn’t visited a dentist for 5 years or more (in 2018 it was over 70%).
We endeavour to provide whatever care is required for that patient, that can be delivered safely from our MDU in the time we have available in each location.
We don’t currently deliver any private routine care from our MDU in any location, it is reserved specifically for urgent/emergency care or oral health promotion to support the prevention agenda.
Any tales of long queues or heart rendering patient stories?
Our outreach provision is well targeted and managed to avoid lengthy queues. We do, however, see many patients who are and often have been experiencing dental pain for some significant time yet
remain anxious about seeing the dentist – watching them enter our MDU in such pain but emerge smiling makes it so worthwhile.
Where our MDU visits are promoted on a ‘first come, first served’ basis, we advise patients of potential waiting times. Where possible we’ll try to pre-book to avoid disappointment on the day.
Occasionally, we’ve had to turn people away, for example where they have turned up late in the day when we have been closing down the MDU - if this happens and the patient is in pain or needs
urgent dental care, we will try to arrange a visit to one of our dental practices. The majority of those we see are hugely appreciative of the service we offer.
How do you promote that the van will be visiting a particular place / area?
Smiles at Sea is promoted well in advance via The Fishermen’s Mission, their SeaFit service and healthcare partner network, and local harbour masters, plus through our own online channels.Seven consecutive years’ worth of delivery means we know how to effectively reach this target audience and they know where to find information about forthcoming tours.
Similarly, our Health for Homeless partners enable us to promote where we will be and when with our MDU, though these pop-ups are not publicly promoted in the same way as Smiles at Sea, due to
the vulnerable patients we’re seeking to help.
Any planned school visits are publicised well in advance so teachers and parents/carers can accommodate this opportunity for the children accordingly.
Who funds all the materials and running costs...driver, fuel etc?
Our MDU was purchased entirely by Smile Together and is fully funded by us – everything from maintenance and running costs through to the clinical/IT equipment and materials on board.
A number of colleagues drive the MDU and we fund an external driver if one is required.
If we are able to acquire external funding to support our work, this is generally used to enhance patient care delivery in additional locations.
As an organisation with coal face experience, what advice would you have for others in the profession tempted to get involved with mobile dentistry?
Think carefully about the size of MDU being acquired.For us in Cornwall a much larger double-surgery unit would be impractical given the nature of the locations we visit. In Mevagissey, for example, we physically can’t get our single-surgery MDU harbourside due to the narrow streets, so fishermen and their families come and find us in the car park on the outskirts of the town!
Any MDU needs using regularly – mechanically they are not vehicles that do well parked up stationary for long periods of time. We keep ours moving as much as possible, it is regularly
maintained and clinically checked/fully equipped and ready to go as needed.
It’s not a cheap or easy option delivering dental care from an MDU – you’re taking colleagues away from their usual places of work so there is travel time to consider. The days can be long as patient
demand is high, even with such specific target groups, so colleagues need to be efficient and flexible. They tell us it’s not like a ‘normal day in practice’!
We’ve clearly branded our MDU so that we’re easily recognisable in each location and people get to know and trust our patient care delivery whenever we visit.
We frequently get enquiries from others desperate to access NHS dental care, but when we explain why we’re delivering care to specific (often vulnerable or hard to reach) groups in that location they are generally understanding – however, it’s important to be able to explain why they can’t also be treated, in a simple, understandable way.
As a dental CIC and certified B Corporation, we always try to maximise our impact. For example, during Smiles at Sea tours we encourage the fishermen and local community to bring along their old
oral health items for recycling through the Colgate TerraCycle scheme (our Bodmin practice is a registered location) and at Newquay harbour we did a beach clean with kit supplied by Surfers
Against Sewage, thereby generating new partnerships and providing even more content for web and social media, essential for audience engagement and promoting future initiatives.
Is there anything else our dental readers might like to know?
We would love to expand our dental care delivery from MDU’s in even more remote locations across Cornwall and for even more individuals/groups who find it difficult to access dental care, but for us
this depends very much on more clinical recruitment, capacity and funding.
Perhaps, as more detail emerges from the Government’s Dental Recovery Plan, we will be able to find ways to successfully achieve this. In the meantime, we will continue doing what we can to tackle oral health inequality across Cornwall and the Isles of Scilly, complementing what we’re commissioned to deliver on behalf of Cornwall NHS and Integrated Care Board for local people and visitors to our
county.
Tracy, thanks for talking to GDPUK and I’m sure all in the profession will be heartened to read of your outreach.
Smile Together Dental CIC is an independent social enterprise delivering a range of NHS and private care from seven active practice locations across Cornwall and the Isles of Scilly and operates a mobile dental unit. For further information see https://smiletogether.co.uk/our-impact/community-and-social-impact/our-mobile-dental-unit/
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