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.”
SCOTTISH GOVERNMENT ACCUSED OF ‘EXCRUITIATING NEGLECT’
The British Dental Association Scotland has welcomed the coming debate in the Scottish Parliament on the challenges facing NHS dentistry.
Scottish Liberal Democrat Willie Rennie MSP, who is leading Wednesday’s debate, accuses the SNP Government of “excruciating neglect”, revealing cases who have travelled to India for dental care and who have performed “DIY dentistry” with tools purchased from Amazon.
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.
Charlotte Waite, Director of British Dental Association Scotland said:“The crisis in this service has seen desperate patients take matters into their own hands, or head overseas for care that should be available in their own communities.
“The Scottish Government unveiled some reforms back in November. Time will tell if it’s enough to turn the tide, so those who want and need NHS care can secure it.”
Following the election of Humza Yousaf as SNP leader and his swearing in as First Minister, dentist leaders in Scotland have called for immediate action to ensure the beleaguered service has a future.
The leadership election has delayed the timetable for reform of the low margin/high volume system dentists work to, that has left providers facing the risk of delivering NHS care at a financial loss. In an open letter the British Dental Association has stressed that without immediate action the exodus from NHS dentistry will accelerate.
A recent survey of high street dentists across Scotland showed over half (59%) have reduced the amount of NHS work they do since lockdown, and four in five (83%) say they plan to reduce or further reduce their NHS commitment in the year ahead.
In the letter BDA’s Scottish leadership state: “In 2021 the SNP made a promise to the Scottish electorate: free NHS dentistry for all. The decisions you take in your first 100 days will effectively determine if that promise is going to be kept.”
Without reform NHS dentistry will go from crisis to collapse
Following yesterday’s debate in the Scottish Parliament the British Dental Association has urged the Scottish Government to deliver meaningful reform to NHS dentistry by the autumn, stressing failure to do so will take the service from crisis to collapse.
On Tuesday Ministers announced a ‘bridging payment’ – originally due to lapse on 1 April 2023 – which uprated NHS fees by 1.1 would continue to October 2023. With spiralling costs BDA Scotland has continued to stress that the traditional high volume/low margin model NHS dentistry works to was now unsustainable and removing the payment would push practices to bankruptcy or into the private sector.
Despite needed progress on this extension, BDA Scotland warns a new sustainable model must be in place by 31 October, otherwise the extension will only delay the inevitable. Practices are already facing the risk of providing care that involves laboratory work – like dentures – at a loss.
NHS dentistry in Scotland has not returned to anything resembling business as usual. Recent data has indicated claims submitted by NHS dentists for dental work are 43% down on 2019 levels and suggest a growing exodus from the NHS workforce.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“There was little need for a debate on whether NHS dentistry in Scotland is in crisis. On access, on workforce, on inequalities, wherever data exists it points to a service on the brink.
“The Scottish Government made the right call by not prematurely pulling the plug on vital support.
“The question is now whether come October we’ll have the reforms needed to give this service a future. Failure to do so will take us from crisis to collapse.”
The British Dental Association has called on the Scottish Government to fix the broken system underpinning NHS dentistry, as new data reveals little sign of a recovery in attendance and ever-widening health inequalities.
Figures from Public Health Scotland show participation rates – contact with a dentist within the past two years – continued to fall. On 30 September 2022 just 50.4% of all registered patients had seen an NHS dentist within the last two years, still down on the 52.6% seen in 2021, and a considerable reduction from almost two-thirds (65.1%) in 2020. The participation rate among registered children was higher than for adults (65.7% compared to 47.2%).
The gap between the most and least deprived areas in Scotland continues to grow, with the new data showing record inequalities in participation rates. 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 and oral cancers at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for patients.
Registration rates remain high due to lifetime registration – over 95.4% of the Scottish population were registered with an NHS dentist in September 2022– but the percentage of children registered fell marginally.
Free NHS dental for all remains a key Scottish Government policy. BDA Scotland has long warned that a return to a ‘business as usual model’ – low margin and high volume – will put practices under unsustainable financial pressure, with soaring running costs raising the risk of closure or movement to the private sector.
BDA Scotland stresses that Ministers must continue with additional financial support for practices, set to end on 1 April 2023 to support dentists and their teams as they work through the historic backlog of dental care and until a new, sustainable funding arrangement for NHS dentistry is in place. This data follows recent reports of a growing exodus of dentists from the NHS.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Patients in Scotland’s poorest communities are paying the price for the crisis in dentistry.
“The Scottish Government must not try to hide behind positive sounding registration figures. The reality is patient participation remains on the floor, and inequalities are set to widen.
“Dentists are reconsidering their futures working in a broken system. NHS dentistry is on the critical list, and real reform won’t wait.”
Over 8/10 NHS dental practices unable to offer appointments to new adult patients, in the most extensive survey of patient access ever undertaken
The British Dental Association has pressed government to step up and deliver urgent reform, as new research from the BBC underlines the scale of the access crisis facing NHS patients across the country.
Between May and July, BBC researchers reached out to every UK dental practice with an NHS contract to ask if they were taking on new patients. Working with the British Dental Association, the BBC identified 8,533 dental practices across the UK that were believed to hold NHS contracts and attempted to call them all.
The survey found:
In Scotland, 82% of NHS practices were not accepting new adult patients, 687 of 839.
Of those practices not taking on adults in Scotland, 39% (267) said they had an open waiting list, and 18% (124) said the wait time was a year or longer, or were unable to say how long it would be.
Out of 32 local authorities in Scotland, BBC researchers did not successfully reach any practices accepting new adult NHS patients in 9 (28%) local authorities.
In Scotland, 79% of NHS practices were not accepting new child patients, 663 of 839. Out of 32 local authorities in Scotland, BBC researchers did not successfully reach any practices accepting new child NHS patients in 7 (22%) local authorities.
Last month BDA Scotland warned the Scottish Government risked undermining the future sustainability of NHS dentistry, as they scaled down vital financial support for the service.
From April to June practices received a 1.7 multiplier to the fees paid to provide NHS care, a reflection of the unprecedented backlog practices have faced as they try to ‘live with Covid’ and the continued suppressed activity compared with pre-pandemic levels. This was cut down to 1.3 from July, following no discussion with the profession, leaving many dentists at risk of delivering some NHS treatments at a loss.
Official data suggests the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of Covid. The BDA has again urged the Scottish Government to, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said:“The Scottish Government promised free NHS dentistry for all, but the public are now living with the harsh reality.
“You can’t run a health service on soundbites and slogans. Ministers need to take a long hard look at the evidence, and bring forward the reforms and resources we need to deliver for patients across Scotland.”
UK-wide 90% of NHS practices were not accepting new adult patients, 6,193 of 6,880.
Of those practices not taking on adults in the UK, 25% (1,572) said they had an open waiting list, and 17% (1,039) said the wait time was a year or longer, or were unable to say how long it would be.
Out of 217 local authorities in the UK, BBC researchers did not successfully reach any practices accepting new adult NHS patients in 77 (35%) local authorities.
80% of NHS practices were not accepting new child patients, 5,506 of 6,880. Of those practices not taking on children in the UK, 1,480 (27%) said they had an open waiting list, and 16% (902) said wait time was a year or longer, or were unable to say how long it would be.
Out of 217 local authorities in the UK, BBC researchers did not successfully reach any practices accepting new child NHS patients in 25 (12%) local authorities.
The British Dental Association Scotland has warned Ministers they risk undermining the future sustainability of NHS dentistry, as they move to scale down vital financial support for the service.
For the last three months practices have received a 1.7 multiplier to the fees paid to provide NHS care, a reflection of the unprecedented backlog practices have faced as they try to ‘live with COVID’. The Scottish Government has now moved to pare the multiplier down to 1.3 for the next 3 months.
This reduction follows no dialogue with the profession despite the BDA calling for regular discussions with the Government about the latest activity data and any proposed changes.
The discredited low margin/high volume model dentists in Scotland work to means treatment can often be delivered at a loss, a growing problem given the growing levels of unmet need, particularly among those from move deprived communities.
Official data suggests the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of COVID. The BDA warn heavy-handed policies will only push Scottish dentists down the road of their colleagues in England, where thousands of dentists have left the NHS since lockdown, amid warnings from MPs south of the border that NHS dentistry now faces a ‘slow death’.
The BDA has again urged the Scottish Government to, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry.
Dentists remain anxious that the Government will look to remove the multiplier altogether at the first opportunity despite its stated intention not to return to the pre-pandemic financial arrangements. The BDA has repeatedly voiced its strong opposition to a return to the pre-Covid “treadmill”.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Ministers are playing with fire, pulling away the life support from a service millions depend on.
“This multiplier helped ensure NHS dentists received fees for care that actually covered their costs. Slashing them will leave colleagues churning out dentures at a loss while thinking twice about their future.
“Scotland has already lost too many NHS dentists since lockdown. Ministers are now blindly heading down the path the Westminster Government has chosen, which has sparked an exodus.
“Cuts have consequences. The Scottish Government promised free NHS dentistry for all. Short-sighted policies like this will likely result in the exact opposite, and stark oral health inequalities will only widen further.”
Revised arrangements will reward dentists for seeing more NHS patients – but dentists remain concerned
Revised payment arrangements for NHS dentists will be linked more closely to the number of patients they see under changes being introduced in April.
The revised arrangements will help ensure patients are able to access NHS services while dentists continue to be supported as they operate under necessary coronavirus (COVID-19) restrictions. The revised payments replace the emergency top-up arrangements that were introduced to protect the sector from the immediate impact of the pandemic.
Separately, an advisory group will be established to consider long term reform of the sector and future structure of NHS dentistry.
Public Health Minister Maree Todd said: “The pandemic has had a significant impact on the provision of dental care and our focus must now be on recovery and ensuring we equip the sector to work through the significant dental backlog.
“From April, the new system will support dentists to see more patients while avoiding a cliff-edge for practices and ensuring a soft transition during what is still a constrained period for dental teams.
“Importantly, this means dentists could earn more than they do now through COVID-19 payment support.
“We’re delivering record investment in dentistry – with a 9% increase in the budget for NHS dental services in 2022-23 – and there has been a 39% increase in the number of high-street dentists in Scotland between 2007 and 2021. Last year there were 55.6 dentists per 100,000 of the population providing NHS care in Scotland compared to 39.9 in England.
“We are absolutely committed to improving oral health, including the removal of NHS dental charges during the lifetime of this Parliament.”
Chief Dental Officer Tom Ferris said: “We know how important it is that NHS dental teams get the right support to carry on providing the services patients need. We’re confident that these revised arrangements are a step in the right direction to improving access, by linking financial support to seeing patients.
“We have been sharing our proposals with the British Dental Association from before Christmas, listening to the concerns of the sector and the need to avoid the cliff-edge when the emergency support payments come to an end.
“These revised arrangements are in addition to £50 million of financial support for dentists during the pandemic, along with £35 million of PPE. It also comes on top of new and increased fees for dentists for a range of treatments including enhanced appointments from 1 Feb 2022.”
However The British Dental Association Scotland has warned that dental practices will continue to face grave uncertainty, as the Scottish Government moved to impose an interim funding model for the service without meaningful negotiation.
While the BDA has welcomed the introduction of a ‘multiplier’ to be applied to dental fees, dentists have significant concerns that the planned 3-month review will have serious implications for patient care and will leave practices unable to plan.
The union remains steadfastly opposed to the return to the unworkable high volume/low margin model of care that operated pre-COVID, and has urged the Government to apply the multiplier until new contractual arrangements are in place.
The BDA had argued that the Scottish Government needed to significantly increase the current inadequate fees for extractions and denture repairs. Increased lab fees mean that dentists often provide these treatments at a loss, and the treatments are particularly prevalent in more deprived areas so any reduction in provision may further widen oral health inequalities.
The announcement follows a bruising debate in Holyrood last week, in which all opposition parties accused the Scottish Government of failing to heed the warnings from the BDA on the potential collapse of NHS dentistry in Scotland.
A BDA survey from late last year reported that 80% of dentists expect their practices will reduce their NHS commitment should the Scottish Government withdraw emergency support and return to pre-COVID models of care.
Dentist leaders have also warned that comments made yesterday by the Public Health Minister fly in the face of the facts, given the tight restrictions practices continue to work to.
Maree Todd MSP incorrectly stated that “from April, the new system will support dentists to see more patients”: an impossibility without meaningful change to COVID operating procedures.
Both the Scottish Government and the BDA recognise the urgent need for long-term contractual reform. The Government has committed to start discussions as soon as the interim funding model is in place. The BDA stress the negotiations must include all practice activity – including work on prevention that is currently unremunerated – and adopt an evidence-based approach to address the current low fees.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Bruised by the political pressure that’s been brought to bear in recent weeks Ministers have railroaded through a package that will leave practices totally unable to plan.
“The idea this package is the result of meaningful negotiation is laughable, and any idea that practices can see more patients from April flies in the face of the facts. Dentists are still working to tight restrictions, and there is no sense we are returning to anything resembling ‘business as usual’. The Government needs to communicate this clearly to patients.
“Applying a multiplier is the right call but the Government should have taken this opportunity to address derisory fees. We have faced the absurd situation where dentists are providing NHS care at a loss.
“What NHS dentists desperately needed was some certainty on what’s expected of them in the year ahead. The choice to put these new arrangements in place for just three months is an exercise in futility.”
The British Dental Association Scotland has greeted the unanimous support of opposition parties, while accusing the Scottish Government of failing to take needed action to halt an exodus from NHS dentistry and restore access to millions.
In a debate in Holyrood today Scottish Government MSPs voted against a motion on support for NHS dentistry tabled by the Scottish Conservatives and backed by both Scottish Labour and Liberal Democrats.
Ministers have been planning to cut pandemic support from April. While the Government has recently indicated that there will be no “cliff edge”, the BDA has consistently warned that the plans to end Covid support payments and return to a low margin/high volume model of care would devastate dental services across the country.
Morale in the profession is at an all-time low, with more than a third of dentists saying they intend to leave the profession in the next 12 months, and 80% planning to reduce their NHS commitment if the Government reverts to pre-pandemic arrangements. Failure to act risks sparking an exodus from the workforce which would mean families across Scotland losing access to NHS dentistry for good.
Over 3.5 million NHS dental appointments were lost in Scotland as a result of the pandemic. As infection prevention and control measures continue to limit the number of patients dentists can see, this unprecedented backlog continues to grow and will likely take years to clear.
The BDA has warned the SNP’s 2021 election pledge of free NHS dentistry for all will be unrealisable without meaningful support and real reform. It is pressing for a workable interim funding model, and long-term change to a system that prioritises prevention, is patient-centred and reflects modern dentistry.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“NHS dentistry in Scotland is facing crisis, but sadly Ministers seem asleep at the wheel.
“Opposition parties are all seeing the plain facts that Scottish Government plans could devastate services millions depend on and widen already unacceptable health inequalities.
“Promises have been made to the voting public that simply that can’t be kept unless we see meaningful support and real reform as we head out of the pandemic.”
Registration rates remain high due to lifetime registration – over 96% of the Scottish population were registered with an NHS dentist in September 2021 – but the percentage of children registered fell from 91.4% in 2020 to 87.7% in 2021.
Participation rates – contact with a dentist within the past 2 years – continued to fall during the pandemic due to ongoing restrictions imposed on dental practices. At 30 September 2021, just over half of registered patients (52.6%) had seen an NHS dentist within the last two years, a considerable reduction from almost two-thirds (65.1%) in 2020. The participation rate among children was higher than for adults (63.9% compared to 50.2%).
Oral health inequalities between the most and least deprived areas in Scotland continue to grow, with the new data showing record gaps in participation rates.
In September 2008, the gap between the child participation rates for the most and least deprived areas was three percentage points; this had increased to seven percentage points by 2010, and eighteen percentage points (55.3% compared to 73.1%) in September 2021.
Similarly, in September 2008 the gap among adults was three percentage points; this had increased to six percentage points by 2010, and eleven percentage points (45.1% compared for 56.4%) in September 2021.
The BDA has repeatedly warned that lower levels of participation will inevitably translate into a higher disease burden, with deep oral health inequalities expected to widen even further, given the cumulative impact of limited access to services, the suspension of public health programmes, and the impact of lockdown diets.
Lower participation will reduce the chance of picking up early signs of decay and oral cancers at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for patients.
Free NHS dental care at the point of use remains a central Scottish Government policy. The stark results of a recent BDA survey showed that Scottish Government plans to revert to pre-COVID models of care risk sparking a flight of dentists from the NHS, with potentially devastating consequences for patient access across Scotland.
BDA Scotland has long warned that a return to a ‘business as usual model’ – low margin and high volume – will put practices under unsustainable financial pressure and will likely lead to closures or movement to the private sector.
BDA Scotland repeats its assertion that the Scottish Government must, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry.
Robert Donald of the British Dental Association’s Scottish Council said: “Today’s figures provide further evidence of the devastating effect of the pandemic on dental services.
“Plummeting participation rates and the record gap in oral health inequalities present a bleak picture which will take a real commitment of time and resource to fix.
“The Scottish Government needs to heed the concerns of the profession. It’s not just their signature policy of free dentistry that risks becoming unattainable. Failure to act risks sparking an exodus from the workforce that will leave families across Scotland losing access to NHS dentistry for good.”
