Who and what you know - making the most of our contacts to vulnerable patients

Oral health ambassador scheme: training needs analysis in the community setting. Br Dent J 2022; https://doi.org/10.1038/s41415-022-5031-y

Many oral diseases are largely preventable, and it is often through prevention that oral health inequalities are mediated and remedied. As the UK approaches what is forecasted to be the longest recession in over 100 years,¹ effective and resource-efficient delivery of preventative strategies will be paramount in tackling polarising health inequalities.

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Not many are closer to this frontline than community nurses. As part of the integrated multidisciplinary team (IMT), community nurses fight the strangled access to healthcare for vulnerable individuals. Associated with additional medical, cognitive and medical disabilities, this patient cohort often presents with an increased risk of oral health including symptoms affiliated with xerostomia and candidiasis.

Following redeployment into the IMT during the COVID-19 pandemic, the authors of this paper sought to understand the previous experience of community nurses in managing oral health. The authors employed a training needs analysis (TNA) to understand previous training, self-rated confidence and barriers faced in oral health promotion (OHP). This was distributed amongst patient-facing staff in five divisions of the Birmingham Community Healthcare (BCHC) NHS Foundation Trust. Such an analysis used an electronic survey to identify disparities between staff aspirations for development and organisational requirements for effective service delivery.

The results from 179 TNAs (with 132 meeting the inclusion criteria) make for rather harrowing reading. Despite 91% of respondents recalling that they had seen a patient with oral health concerns, only 32% had received previous oral health training. When faced with these situations, free-text answers revealed that many staff were referring patients to their general medical practitioner (GMP). In fact, no participants referred a patient with oral health concerns to a dental professional. This is particularly problematic when considering that dental problems account for more than 600,000 GMP consultations per annum,² and previous studies have indicated that 94% of junior doctors do not feel confident in managing oral conditions.³

When exploring the reasons for this line of approach amongst nursing teams, the lowest confidence ratings were reported for accessing resources to support patients with their oral needs and providing mouth care in a patient with challenging behaviour. Insufficient training, equipment, time and patient cooperation were the most commonly cited barriers to OHP.

Within the BCHC NHS Foundation Trust, the authors used these findings to develop a bespoke e-learning package to support specific training needs. A local 'oral health ambassador scheme' was also implemented to support the integration of oral health into the wider healthcare system. However, the results from this TNA provide pertinent lessons for all future OHP strategies. With soaring energy and food prices, demand on our already 'burnt-out' healthcare system is only set to increase. The strategic development of staff skill-mix, supported by accessible and relevant training, will be crucial to the success of the NHS.

By Jamie Daly

Associate Dentist, Wembley, Middlesex, HA0 4TH, UK