BDJ Team meets some of the dental care professionals closely involved in Revive Dental Care's dental nurse-led Hard to Reach service in Greater Manchester.
Revive Dental Care is an award-winning dental practice in Manchester providing NHS and private dental treatment in Monton, Davyhulme, Urmston and Trafford. In 2013 it began operating a community outreach dental service for homeless and ‘hard to reach’ patients living in Greater Manchester. Patients are predominantly homeless or from disadvantaged backgrounds and have complex health needs which include substance and alcohol misuse.
The Hard to Reach service works with community drop-in centres used by this population, conducting a general examination and if further treatment is required, referring patients to a weekly clinic in a Revive practice. In 2016 the clinic treated 400 patients from the Hard to Reach service and completed an average of seven cases a week. A dentist delivers the treatments supported by a clinical dental technician (CDT) who makes the dentures required.
In this article we meet dental care professionals (DCPs) Deborah Parker, Faye Greenhalgh and Jennifer Musgrave to find out more about their background in dentistry and their involvement in the Hard to Reach service.
Deborah Parker
Chief Executive Officer
Debbie, 55, qualified as a dental nurse in 1989 but is no longer registered. She is Chief Executive Officer at Revive Dental Care and helped set up the Hard to Reach service with Faye Greenhalgh.
Debbie is originally from Hythe in Kent but now lives in Bolton. She is married and can't live without family, coffee and laughter!
How did you start out in dentistry?
It was a total accident! I was looking for a change in direction after working in a microbiology lab and planned to be a nurse for six months whilst I looked around … 33 years later I am still here!
The patient contact appealed to me - interacting with the patients was always the bit I enjoyed the most.
Back then we only had the National Exam for dental nurses and training sites were not easily accessible. I didn't qualify as a dental nurse until I had been working as one for four years. I studied one evening a week for six months at night school then took the National Exam. Later on I did a post qualification certificate in dental radiography.
In 2010 I became practice manager at Revive Dental Care and I am now Chief Executive. I work full time and am based at the headquarters but visit all sites across Manchester, Merseyside and Cheshire.
How did the Hard to Reach service come about?
We were asked by a local GP who runs the homeless medical drop-in if we could support his service and offer dental treatment to his patients. We approached our local NHS Commissioners and they agreed a pilot scheme.
Although my colleagues now run the service, I still play an active role, giving presentations to other Clinical Commissioning Groups (CCGs) and Hard to Reach charities.
When you started the Hard to Reach service, were the people you met happy to speak to you and talk about their oral health?
People in these groups are often more open and more willing to discuss matters with us than the general population. There are times when we are given information that can be heart rending or shocking to us but which is run of the mill for the patients: random acts of violence against them, being urinated on whilst they sleep, being badly treated by bogus ‘landlords’ – tales that sometimes beggar belief.
Is it mostly homeless people that are encountered in the service?
Initially it was homeless patients but this has extended to sex workers, refugees, asylum seekers and patients with mental health issues. We visit drop-in centres across Greater Manchester – we actively seek out new venues and our list is growing.
How does it feel to have been involved in setting up this service? What are your future plans?
I am inordinately proud of the work our team do. Seeing a patient complete a course of treatment and becoming pain free and dentally fit is a huge thing. You should never underestimate the importance of a smile.
The Hard to Reach service has been the best and most rewarding service I have ever worked on. I have worked in practice, hospital and a specialist ortho clinic and even done some forensic dentistry, but nothing comes close to the satisfaction and happiness that this service and its users offer us.
I am here for the duration! I intend to see my career out working for Ben Atkins, the Clinical Director of Revive Dental Care.
Faye Greenhalgh
Dental nurse and Project Development Manager
Faye, 28, qualified as a dental nurse in 2007 and has post qualifications in sedation, oral health and fluoride application. Originally from Salford, she lives in Bolton with her partner and two children. The three things she can't live without are her phone, food and her family.
How did you start out in dentistry?
My mum had a lot of dental treatment/appointments when I was in high school which I attended with her. I was really interested in the job and went on to do my work experience in a dental practice. I didn't want to go to college; I just wanted to become a dental nurse at the time of leaving high school.
I liked that dental nursing was an interactive job and you meet a wide variety of people. I also liked that it was in a clinical setting and I could go on to progress up the ladder: the opportunities are endless.
I started my dental nurse qualification in 2005, going to night school at Manchester dental hospital, and qualified in 2007.
Can you describe a typical working week?
I am currently based at Rocky Lane which is the closest clinic to my home but last year I was based at Ancoats which is one of the furthest away. At Rocky Lane we see families from the local area, mixed NHS/private. At Ancoats it was hard to reach people, who could not hold down a place at a general dental practice due to their chaotic lifestyle.
I work three days a week from 8 am until 5 pm.
I am also the manager of the out of hours service and was the oral surgery sedation nurse previously, but now I mainly manage or attend the drop-in centres.
How did you become involved in the Hard to Reach service and what is your current role?
I returned from maternity leave with my first child and was put on the project. I helped Deb Parker to start the service up. It has been my favourite project to date.
I liaise with the GP homeless service in the building, attend meetings and book patients in. I meet with managers at most of the local homeless centres. I attend the homeless drop-in centres as a team of myself, nurse and dentist and I have also attended these alone to meet with the patients in a non-clinical area.
On a centre drop-in, I inform the manager what dates I will be attending and they will put a poster up informing everyone which day the dentist will be on site. When we arrive we set up and run a clinic, each patient having a chat with the dentist, and then they will be offered an appointment at the Ancoats practice. They will be given directions, an appointment slip and free toothpaste and toothbrush.
How did it feel to meet people at the drop-in centres for the first time?
At first I was bit nervous as the drop-in centres can get very busy but once I got used to it and realised how much of a difference I was helping to make to the patients’ lives it became very satisfying. I think patients from the drop-in find it much easier to speak to you there rather than in a dental practice. They are more open and willing to engage with you.
Can you describe a memorable case of an individual you met at a drop-in centre?
One patient I met at the drop-in centres only had stumps for teeth and needed a full clearance. She was a sex worker with not much confidence and she came for treatment, had all her treatment completed and a set of dentures made. She was so happy walking out of the surgery with her new teeth. She later came in and told me she had been for a ‘proper’ job interview and we had given her the confidence to do that.
Are you proud of your involvement with the Hard to Reach service? What are your future career plans?
Yes I am quite proud; I wouldn't have stayed so long if I wasn't enjoying it. The Hard to Reach project has been the most enjoyable, most challenging and most rewarding project that I have worked on.
I’m undecided about my future plans. I would like to go back into oral surgery and maybe go on to do an implant post qualification.
Do you have any exciting plans this year?
I attended an awards ceremony in May this year in which I won the highly recommended award for best oral health promoter.
Otherwise I will be spending time with my family.
Jennifer Musgrave
Senior Dental Nurse
Jennie, 25, is a Senior Dental Nurse at Revive Dental Care's Ancoats clinic and runs the Hard to Reach service. She completed the Level 3 Diploma in Dental Nursing in 2013.
What first attracted you to working in dentistry and what did you like about working in a dental practice?
I always wanted to help people and just find teeth fascinating. When I first started I really enjoyed learning new things, helping people and seeing the difference receiving dental treatment makes to people's lives.
I began my dental nursing qualification in 2012 and qualified and became GDC registered in September 2013. I studied with a company called Start Training who came out to the practice to complete coursework and observations.
I am also a trained first aider and am currently preparing to start a fluoride course which I am really looking forward to.
Ancoats Primary Care Centre is about 25 minutes from my home in Salford. We see a wide range of patients with a mix of NHS and private treatment as we are quite close to the city centre and businesses so not all our patients are from the Ancoats area. On a Wednesday we solely see hard to reach patients.
Can you describe a typical working week?
I work 8.30 am to 5 pm Monday to Friday: on Wednesday I am chairside on the Hard to Reach service clinic (11 am to 3 pm); on Thursdays I go out to the drop-in centres to see patients and give oral hygiene advice; and on the other days I work chairside on the in-hours service while working closely alongside my manager learning the admin side of the business.
I also work for Revive's out of hours service, where I am on call every Monday night and also work some weekends on a rotational basis.
How did you become involved in the Hard to Reach service?
It was established as I was going through my dental nursing qualification. I was working at another site so used to come over to nurse and the opportunity came along to cover the manager of the service while she went on maternity leave and I jumped at the chance.
On Thursdays I go to around ten different community drop-in centres on a rotational basis on my own.
What happens on the drop-in centre visits?
I give out oral health advice, toothbrushes, toothpaste and mouthwash. I try and encourage patients to register with the dentist to have a full examination and see to any dental needs they have.
When I first started going to the drop-in centres I didn't know what to expect. I didn't know how people would react to me coming in or if they would even consider registering. As time went on and I continued going to the centres people were more than happy to come and speak to me, not always about dental treatment, sometimes just about what they did that day.
Recently we filmed for BBC Breakfast at one of the drop-in centres. A link to the BBC recording made in June shows the service in action: https://www.youtube.com/watch?v=ujJDhqjJnrs.
I have been to one centre where the police were called due to a fight happening inside. While I was there chairs and tables were being thrown and no one was allowed to leave until the police arrived and the area was safe for everyone using the centre.
As an example of a patient I have encountered at one of the clinics, I once saw a patient who was in quite a lot of pain from broken down teeth. He built up the courage to come and see us at the practice and within four weeks he left smiling with a new set of teeth (dentures). He could not thank us enough for our help; he went on to find the confidence to go for job interviews.
Is it mostly homeless people that are encountered in the service?
‘Hard to reach’ includes the homeless, sex workers, asylum seekers and drug users. We see a wide range of people who are simply hard to reach and don't have general access to a dental practice. We do go round to centres which can be solely for that group. For example, I go to one which is just for sex workers.
As well as giving out oral health advice on the visits to drop-in centres, we are currently in the process of setting up some education sessions with H3 (an organisation helping the homeless into housing).
Are you enjoying your career at the moment? What are your future plans?
I love what I do and helping towards putting a smile back on a patient's face. It makes me proud to work on the Hard to Reach service and seeing life in a different light.
In the future I hope to become a practice manager.
What do you like to do outside work?
I currently train a group of girls in Morris dancing whilst dancing myself. I have been doing this for over 20 years. I don't have a lot of time for anything else - I work too hard!
Is your dental practice or hospital involved in a special project or exciting new pilot scheme? Why not share your story with BDJ Team readers? Email bdjteam@nature.com.
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‘The best and most rewarding service I have ever worked on’. BDJ Team 4, 17137 (2017). https://doi.org/10.1038/bdjteam.2017.137
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DOI: https://doi.org/10.1038/bdjteam.2017.137
