The British Dental Association Scotland has responded to new freedom of information data from the Scottish Liberal Democrats showing the number of dentists providing NHS services has fallen from pre-pandemic numbers across most health boards.
The BDA stress this data only begins to show the risks facing the service, as the data does not capture the mix of NHS and private work dentists undertake.
The professional body says the data gives no picture of the whole time equivalent NHS workforce, and without that there is no scope for robust workforce planning.
The broken high volume/low margin model high street NHS dentists work to proved unsustainable during COVID, and while some amends to this system were rolled out in November, it remains to be seen if reforms are sufficient to give the service a sustainable future
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“For years the broken system NHS dentistry works to has left dedicated colleagues looking to the exit.
“We’ve seen some reform, but time will tell if it’s enough to put a halt to this exodus.
“One point is abundantly clear. If this service is going to have a future there can be no complacency at Holyrood.”
The British Dental Association has said there can be no complacency from the Scottish Government on the crisis in NHS dentistry, following yesterday’s debate in the Scottish Parliament, in which MSPs raised the heart-breaking case of a single mother going without food to pay for care, with others travelling hundreds of miles for access or embarking on ‘DIY’ dentistry.
The BDA’s own recent surveys found 83% of dentist respondents in Scotland had treated patients that had performed some form of DIY dentistry since lockdown.
Some reforms to the discredited small margin/high volume system NHS dentists work to were rolled out in November 2023. This system has been in crisis for a generation but proved undeliverable during the pandemic. Facing soaring costs, some practices were left delivering some NHS treatments at a financial loss.
The BDA had been seeking a decisive break from this system, and a move to a patient-centred, prevention-focused model of care. The Scottish Government refused to break with the overall framework.
The BDA stress that this must be the beginning, not the end of the road for reform, and that access, outcomes and inequalities need to be closely monitored.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“MSPs and patients across Scotland have sent a clear message: the Scottish Government cannot pretend it’s ‘Mission Accomplished’ on NHS dentistry.
“Recent reforms may ease problems, but Ministers can’t afford to take their eyes off the crisis in this service.”
Services in all UK nations face hit, Northern Ireland an existential threat
The British Dental Association has warned the European Parliament’s vote to ban dental amalgam from 1 January 2025, will send shockwaves across the UK’s already struggling dental services.
Silver amalgam is the most common material for NHS permanent fillings across the UK. Fillings represent around a quarter of all courses of NHS treatment delivered in England, with amalgam used in around in around a third of procedures.
BDA estimate treatment times and costs of alternative materials are over 50% higher than those of amalgam. [1]
On 14 July, the European Commission adopted a proposal to revise the Mercury Regulation, to introduce a total phase-out of the use of dental amalgam and prohibit the manufacture and export of dental amalgam from the EU from 1 January 2025 – 5 years earlier than expected.
The vote will hit all four UK nations but will have a disproportionate impact on services in Northern Ireland, which has the highest proportion of filled teeth of any UK nation. [2] Under post Brexit arrangements, Northern Ireland will be expected to phase out dental amalgam on the same basis as EU member states. Divergence means the rest of the UK faces disruption and higher costs given the impact on supply chains, but not a formal ban.
In an open letter to all four UK Chief Dental Officers, the BDA stress there are currently no alternative restorative materials that compete with amalgam on speed of placement or longevity, meaning the ban will eat into clinical time and resource that are in short supply, likely creating further access barriers.
There are no indications where the millions in additional funding required will come from nor the workforce to carry out the tens of thousands of extra clinical hours.
MEPs also backed amendments stating that Member States need to “ensure appropriate reimbursement is made available for mercury-free alternatives” to limit the socio-economic impact. The BDA say the same approach is need from all UK Governments.
The Nuffield Trust warned in December that NHS dentistry was at the most precarious moment in its 75-year history. The BDA warn that without decisive action, this ban will only hasten the service’s demise.
While the BDA has long supported a phase-down in dental amalgam, it believes this rapid phase-out is neither feasible nor justifiable. Dental amalgam has been in use and extensively studied for 150 years as a restorative material. Its safety and durability are well established, and it remains the most appropriate material for a range of clinical situations.
BDA Chair Eddie Crouch said:“When we are set to lose a key weapon in the treatment of tooth decay all four UK Governments appear asleep at the wheel.
“When alternative materials can’t compete, this will add new costs and new uncertainties to practices already on the brink.
“Without decisive action this could be the straw that breaks the back of NHS dentistry.”
[1] BDA research on treatment times and costs, 2023. Figures are derived from a comprehensive research study into NHS dental treatment times. A unit price per treatment has been generated using official figures for dental expenses, courses of treatment and dentist earnings (available through NHS digital), supplemented by further BDA research.
[2] Total number of Teeth Filled per 100,000 population by UK nations and Financial Year, From Family Practitioner Services General Dental Statistics for Northern Ireland 2022/23
In Northern Ireland’s Item of Service Claims 2022/23, amalgam was used as a material in 153,000 of the 353,000 claims for permanent fillings on adults and children, or 46% of the total.
While amalgam use is not centrally recorded in England, the BDA understands these represent around a third of fillings placed in England on the NHS.
The British Dental Association has warned MSPs the pandemic has had an unparalleled impact on NHS dentistry, that leaves the service facing an existential threat.
As the professional body prepares to give evidence to the COVID-19 Recovery Committee inquiry into NHS dentistry today (22 June 2023), it has published new analysis showing the scale of the backlogs.
Initially closed to routine care, and then facing exacting Infection and prevention control guidelines that reduced patient throughput, lost capacity on the high street exceeds general medical practice and secondary care, resulting in backlogs that will take many years to clear:
Dentistry has lost over half (52%) of its capacity since lockdown, when comparing examinations delivered since March 2020 with typical levels pre-COVID.
For GPs, that figure is just over 30% (when looking at lost face-to-face appointments). It is just over 6% for hospital outpatients and in terms of volume, inpatient care appears to have already recovered lost ground.
By any measure captured in official data, whether it is examinations or Statement of Dental Remuneration (SDR) activity claims, Scotland has lost more than a year’s worth of NHS dentistry.
Ongoing access problems are fuelling backlogs, with patients presenting with higher levels of clinical need. In recent BDA surveys over two thirds (67%) of dentists cite higher needs patients requiring more clinical time as a key issue on return to ‘full’ capacity. The only comparable problems are those concerning recruitment and retention of dentists (61%).
Dentist leaders say it will be impossible to restore pre-pandemic activity without radical change. The low margin/high volume model the service works to was incompatible with working through the pandemic and cannot form the basis for a meaningful or sustainable recovery.
This leaves the service at a crossroads: with a contract that is unfit for purpose, underfunded, overstretched and facing the challenge of deep and widening oral health inequalities. BDA Scotland fear that an exodus of dentists from the NHS is already in motion. This shift is going unseen in official data, that counts heads not the amount of NHS work dentists do. These workforce statistics give an NHS full-timer the same weight as a dentist doing one NHS check-up a year.
Recent BDA surveys indicate only 1 in 5 (21%) of practices have returned to pre-COVID-19 capacity. The professional body say hard limits on restoring capacity, and the existential threats to NHS dental services require a proportionate response from the Scottish Government.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“COVID hit dentistry like no other part of the NHS in Scotland.
“We’re not asking for special treatment, just a proportionate response. One that recognises the scale of the backlogs and the existential threat to this service.
“NHS dentists are already walking away from a broken system. There can be no recovery without reform.”
The British Dental Association has responded to new figures from the Scottish Liberal Democrats warning the oral health gap between rich and poor children will widen, given ongoing access problems, and the growing exodus from a broken NHS system.
Official data from Public Health Scotland has already shown the fall in participation is hitting those in most deprived communities the most. In September 2008, the gap in child participation between the most and least deprived areas was three percentage points; this had increased to seven percentage points by 2010, eighteen percentage points (55.3% compared to 73.1%) in September 2021. The figure now stands at twenty percentage points (55.9% compared with 75.8%).
The BDA has warned that lower levels of participation will inevitably translate into a higher dental disease burden, with deep oral health inequalities expected to widen even further given the cumulative impact of limited access to services, the temporary suspension of public health programmes, and the impact of lockdown diets. Lower participation will reduce the chance of picking up early signs of decay at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for young patients.
The professional body has stressed that reform to the broken low margin/high volume model the service works to are now essential, and that a new model has been pledged for rollout in the autumn. At present certain key treatments can be delivered at a financial loss, accelerating the exodus from the service. A recent BDA survey showed over half (59%) of high street NHS dentist reported having reduced the amount of NHS work they did since lockdown. Over four in five (83%) said they plan to reduce or further reduce their NHS commitment in the year ahead.
The BDA says that the future of the service hinges on reform providing it with firm foundations, with a decent, sustainable model that can deliver for patients and dentists across Scotland.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“The oral health gap between rich and poor kids is set to widen.
“It’s a national scandal. Prevention is better than cure, but dentists are losing the chance to nip problems in the bud. The growing exodus from the NHS may make that permanent.
“Tooth decay is already the number one reason for hospital admissions among young children. It will take real reform to bring this service back from the brink.”
The British Dental Association has responded to new figures from the Scottish Liberal Democrats, acknowledging that the Scottish Government’s consistent use of registration figures to illustrate the supposed ‘recovery’ in the service is effectively meaningless.
Patients in Scotland are registered for life, so the key focus must be on participation, which remains stubbornly below pre-COVID levels.
The professional body has stressed that reform to the broken low margin/high volume model the service works to are now essential, and that a new model has bee pledged for rollout in the autumn.
At present certain key treatments can be delivered at a financial loss, accelerating the exodus from the service. A recent BDA survey showed over half (59%) of high street NHS dentist reported having reduced the amount of NHS work they did since lockdown.
Over four in five (83%) said they plan to reduce or further reduce their NHS commitment in the year ahead.
The BDA says that the future of the service hinges on reform providing it with firm foundations, with a decent, sustainable model that can deliver for patients and dentists across Scotland.
Charlotte Waite, National Director of the British Dental Association Scotland said:“When patients are put on the books for life registration is a meaningless metric.
“What really matters is the patients getting through our doors, and on that note NHS dentistry has not returned to anything resembling ‘business as usual’.
“This service is at a tipping point. Without reform there can be no recovery.”
The British Dental Association has announced that dentists in Scotland employed under the same contract as junior doctors, will join their medical colleagues in a 72-hour walkout, the dates of which are yet to be confirmed, if BMA ongoing negotiations with the Scottish government do not result in a credible pay offer.
The overwhelming majority of voters (91%) from this small but important cohort backed industrial action, on a turnout of 79%.
British Dental Association Chair Eddie Crouch said:“Our members stand ready to do whatever it takes to secure a fair deal on pay.
“Just like their medical colleagues these dentists aren’t worth a penny less than they were a decade ago.
“We are hopeful that a negotiated settlement can be found. But our members will take strike action if the Scottish Government fail to come back to the table with a serious pay offer.”
The British Dental Association has warned the future of NHS dentistry in Scotland is in doubt, and action here must be high on the agenda for the next First Minister.
A devastating new survey of dentists across Scotland reveals:
An exodus is in motion.59% of dentists say they have reduced the amount of NHS work they undertake since lockdown – by an average of over a fifth.This movement is going unseen in official data, which counts heads, not commitment, and gives the same weight to a dentist doing a single NHS check-up a year as an NHS full timer.
Over 4 in 5 (83%) now say they will reduce – or further reduce – their NHS commitment in the year ahead. Over a third (34%) say they will change career or seek early retirement.
Just 1 in 5 (21%) say their practices have returned to pre-COVID capacity. 61% cite recruitment problems as an issue, over two thirds (67%) cite treating patients with higher needs requiring more clinical time.
A sustainable model must be in place come October. 90% cite financial uncertainty as having a high impact on their morale.
Health Secretary Humza Yousaf recently stressed NHS staffing was “at a historically high level”, with ‘record’ numbers of dental staff in hospitals alongside medics and allied health professionals. However, NHS Education for Scotland data indicates an 8% drop in high street NHS dentists delivering care since lockdown, a fall from 3,038 in March 2020 to 2,791 in September 2022.
The BDA stress even this fall understates the full scale of losses in light of this new survey evidence. The Scottish Government has never attempted to make a ‘Whole Time Equivalent’ estimate of the NHS dental workforce. Most dentists combine NHS and private work, and the BDA warn that without these estimates movement to the private sector is going undetected, and workforce planning is effectively impossible.
NHS dental care free at the point of use remains a central Scottish Government policy. BDA Scotland has long warned that any return to the service’s ‘business as usual’ model – low margin and high volume – will put practices under huge financial pressure and will likely lead to closures or movement to the private sector, with many practices left delivering some NHS care at a loss.
The SNP leadership election has seen key deadlines to reform this broken system move. The profession had anticipated the Scottish Government would reveal changes to the payment model on 1 April, that would be rolled out from October.
The BDA stress a sustainable model must be in place come October, when the current bridging payments that uplifted NHS fees finally lapse, exposing many NHS practices to unsustainable costs.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said:“Behind hollow boasts on record workforce numbers is a service that is hollowing out.
“The majority of dentists have pared down their NHS work, and many more are set to follow. It’s an exodus that’s going untracked by government but is the inevitable result of working to a broken system.
“NHS dentistry’s survival requires rapid action, with meaningful reform and sustainable funding.
“The steps taken in the next First Minister’s First Hundred Days will determine whether this service will have a future.”
Online poll of General Dental Practitioners in Scotland, Fieldwork February 2023, 526 respondents:
What changes in your working life do you anticipate in the next 12 months? % Net Likely n
I will reduce my personal NHS commitment 83% 439
I will change career/seek early retirement 43% 178
Approximately what proportion of your income was NHS based prior to March 2020?
% n
100% (exclusively NHS) 4% 23
90-99% (NHS) 43% 227
80-89% (NHS) 23% 122
70-79% (NHS) 13% 69
60-69% (NHS) 4% 22
50-59% (NHS) 4% 22
40-49% (NHS) 2% 11
30-39% (NHS) 1% 3
20-29% (NHS) 2% 12
10-19% (NHS) 1% 4
1-9% (NHS) 2% 9
0% (exclusively private) 0% 2
Approximately what proportion of your income was NHS based now?
% n
100% (exclusively NHS) 2% 8
90-99% (NHS) 25% 134
80-89% (NHS) 19% 98
70-79% (NHS) 14% 71
60-69% (NHS) 9% 48
50-59% (NHS) 11% 60
40-49% (NHS) 6% 32
30-39% (NHS) 4% 20
20-29% (NHS) 4% 20
10-19% (NHS) 3% 16
1-9% (NHS) 3% 16
0% (exclusively private) 1% 3
309 respondents reported a fall in NHS work between March 2020 and February 2023 – with an average drop of 22%.
Please estimate your practice’s current overall capacity compared to pre-COVID levels.
100% (my practice is at full capacity) 21% 111
90-99% 17% 91
80-89% 22% 116
70-79% 19% 102
60-69% 10% 54
50-59% 4% 21
40-49% 0% 2
30-39% 0% 2
20-29% 1% 4
10-19% 0% 2
1-9% 0% 2
0% (my practice is not operating) 0% 0
Don’t know 4% 19
What factors would you say are constraining your practice from operating at pre-COVID capacity (select any that apply)
% n
Recruitment and retention problems for dentists 61% 304
Patient cancellations/Did Not Attends 44% 220
Ongoing Infection Prevention and Control restrictions 18% 93
Staff sickness 43% 213
Higher needs patients requiring more clinical time 67% 336
For each of the statements below please rate the impact each currently has on your morale working as a dentist
Net High impact % n
Inability to provide pre-COVID levels of care 61% 321
The British Dental Association has warned the Scottish Government must step up to prevent a wholesale exodus from the service in April, following new figures from the Scottish Liberal Democrats suggesting an 8% fall in the number of NHS dentists since lockdown.
The professional body warns that dentists have little sense of what payment system they will be working to come 1 April. On 1 October the Scottish Government cut the ‘multiplier’ designed to support the pandemic recovery, that increased NHS fees by 1.3. A lower bridging payment’ took effect uplifting NHS fees at a rate of 1.2 for the next three months, falling to 1.1 for the period up to April 2023.
While COVID emergency measures have been withdrawn, practices continue to face an historic backlog, with many patients requiring more extensive treatment having bottled up problems during the pandemic.
The BDA say that in the weeks ahead progress must be made to deliver needed change to the broken high volume/low margin model NHS dentistry is based on. Without reform it stresses we will see a further flight of dentists from the NHS that is already evident in other UK nations.
Facing surging practice running costs, the BDA says that without an adequate interim funding package several key treatments, and anything – like dentures – that requires laboratory work, risk being delivered at a financial loss.
Robert Donald, Chair of the British Dental Association’s Scottish Council said: “Ministers need to understand that Scotland can’t have NHS dentistry without NHS dentists.
“Today colleagues have little sense of what the future will bring when the last pandemic support is pulled away.
“What they do know is this service hasn’t bounced back, and that some NHS treatments are now being delivered at a loss. “The Scottish Government needs to make a serious long-term commitment to prevent a wholesale exodus from the NHS.”
‘Dentistry in Scotland is still light years away from business as usual‘
The British Dental Association has responded to new figures showing the number of claims for payment made to dentists for NHS treatments have fallen by more than 50% in some health boards since 2019.
It stresses the Scottish Government must rapidly move forward to fix the broken payment system at the heart of the service.
The Scottish Liberal Democrats analysed the number of NHS dental claims in all 14 health boards between 2019 and 2022. The analysis revealed that:
Across Scotland the number of NHS dental claims fell from 5,583,137 in 2019 to 3,184,858 between January and November of 2022
NHS Dumfries and Galloway saw a 55% drop in NHS dental claims, with claims falling from 139,988 in 2019 to 62,481 between January and November of 2022.
NHS Orkney saw a 64% drop in NHS dental claims, with claims falling from 20,149 in 2019 to 7,175 between January and November 2022.
NHS Shetland saw a 53% drop in NHS dental claims, with claims falling from 15,873 in 2019 to 7,510 between January and November 2022.
All 14 health boards saw a decrease in the number of claims submitted between 2019 and the first eleven months of 2022.
The BDA say that while COVID emergency measures have been withdrawn, practices continue to face of an historic backlog, with many patients requiring more extensive treatment having bottled up problems during the pandemic.
On 1 October the Scottish Government cut the ‘multiplier’ designed to support the pandemic recovery, that increased NHS fees by 1.3. A lower bridging payment’ took effect uplifting NHS fees at a rate of 1.2 for the next three months, falling to 1.1 for the period up to April 2023.
Dentist leaders stress that in the months ahead progress must be made to deliver needed change to the broken high volume/low margin model NHS dentistry is based on. Without reform, this package will simply delay an inevitable exodus of dentists from the NHS that is already evident in other UK nations.
Facing surging practice running costs, the BDA says that without an adequate interim funding package several key treatments, and anything – like dentures – that requires laboratory work, risk being delivered at a financial loss.
Robert Donald, Chair of the British Dental Association’s Scottish Council said:“Dentistry in Scotland is still lightyears away from business as usual.
“Ministers pledged free NHS dentistry for all, but to keep that promise they need to fix a broken system.
“Dentists are struggling, facing demand that can’t be met, with some NHS treatments already being delivered at a loss. They need to know that come April they will see real change, not just see the last safety net pulled away.”
