Tag: British Dental Association Scotland

Dentistry: Latest data highlights access crisis and widening inequalities in Scotland

The British Dental Association Scotland has called on the Scottish Government to strongly support NHS dentistry to address the large reduction in patients visiting the dentist as new data reveal further decreases in attendance and ever-widening inequalities. 
  
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. 

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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.”

Dentists: New guidelines will not soften blow of Scottish Govt plans

The British Dental Association Scotland has said new standard operating procedures for dentists published yesterday will NOT restore access to pre-COVID levels.

With high levels of COVID and other seasonal infections, and now the emergence of the Omicron variant, dentist leaders stress they will also do nothing to avert the potentially catastrophic impact of Scottish Government plans to pull away pandemic support from NHS practices.

Patients in Scotland will now be placed on one of two pathways, given the likelihood of them carrying a respiratory illness. It replaces what amounted to a ‘one size fits all’ approach that has been in place since the outset of the pandemic, which reduced capacity across the service.  

Those on the non-respiratory pathway can be managed in line with pre-COVID standard infection control precautions for non-aerosol generating procedures.

However, for an aerosol-generating procedure, enhanced precautions will still be required for non-respiratory patients since pre-appointment PCR testing is not carried out in dentistry. 

Any patient placed on the respiratory pathway and requiring urgent care will remain subject to enhanced precautions for all procedures, which will include maintaining ‘fallow time’ gaps of up to an hour between treatments. 

The new model is unveiled on the day the Omicron variant was confirmed to be present in Scotland. Even setting aside any potential spike in COVID infection, large numbers of patients are likely to end up on the respiratory pathway given typical patterns with seasonal flu and the common cold.

It is anticipated a number of dentists may opt for a ‘safety first’ approach, and use flexibility within new protocols to maintain existing protective measures, particularly given the uncertain effectiveness of triage questions in identifying symptoms of the Omicron variant.   

Over 3.5 million NHS dental appointments have been lost in Scotland since the first lockdown, driven by ongoing restrictions.  

Cabinet Secretary Humza Yousaf wrote to all NHS dental teams last month stating that all emergency support will be withdrawn by 1 April 2022, as part of a new policy to return to the low margin and high volume system the service operated to pre-pandemic.

The move drew criticism from all opposition parties, given the unsustainable pressure it would place on practices. According to a BDA survey conducted at the time 80% of dentists estimate their practices are set to reduce their NHS commitment should the Scottish Government remove emergency support and return to pre-COVID models of care.  

Yousaf told the Scottish Parliament on 3 November that “reform at this stage would be a disruption.” Governments in both Westminster and Cardiff Bay are taking through reforms to their NHS dental systems at this time. 

NHS dental care free at the point of use remains a centrepiece SNP policy. BDA Scotland has said the Scottish Government must change course to achieve that goal, develop an interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable model for delivering care.    

David McColl. Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Since the spring we have been pressing for a plan to safely ease COVID restrictions, to help increase patient numbers.

“Sadly, these new guidelines will not magically restore services. They land as we head into winter when respiratory diseases are set to skyrocket. And with Omicron now present in Scotland many practices will understandably take a safety-first approach.

“We are still facing massive backlogs, saddled with a system that is unfit for purpose. New protocols will not soften the blow of plans to pull away emergency support at this challenging time for infections and try and return to a ‘business as usual’ model during a pandemic.

“Ministers say now is not the time for reform. Reform won’t wait for millions of patients in Scotland who need NHS dentistry to have a future.” 

“No-brainer”: £5 million to remobilise NHS dentists

£5 million to help meet safety standards and see more patients

Additional funding of up to £5 million is available to NHS dentists to help remobilise services as Scotland recovers from the coronavirus pandemic.

This new funding will help NHS dental practices to purchase, renew or upgrade ventilation equipment as improved ventilation in surgeries can substantially reduce the time between seeing patients, and offer dental teams the opportunity to see more patients safely.

Health Secretary Humza Yousaf said: “The remobilisation of the NHS is one of our number one priorities and the Scottish Government remains committed to ensuring that NHS dental services emerge from this pandemic well-placed to care for the oral health of the population.

“This new funding is an important step in ensuring the continued remobilisation of NHS dental services and to ensure more patients can be seen safely. We will also continue to fund free PPE for the dental sector and, from July, we will increase it by up to 50 per cent.

“We are continuing to work with the sector to provide much-needed support to fully remobilise dental services.”

Funding will be available throughout this financial year, and will be distributed by NHS boards to those practices meeting the scheme’s conditions. Claims can be made for the period 1 April 2020 to 31 March 2022. Further details of the scheme and how to apply will be provided to the dental sector by separate circular issued by the office of the Chief Dental Officer.

The British Dental Association Scotland has welcomed confirmation the Scottish Government will allocate £5 million to help practices invest in ventilation equipment to increase patient volumes while meeting COVID restrictions.   

The BDA first made the bid for financial support to improve ventilation to the Scottish Government in November. England is now the only UK nation not to have committed any capital funding for ventilation to help restore services.   

Chief Dental Officer Tom Ferris has confirmed funds can be used to purchase, renew or upgrade ventilation systems, and practices can claim retrospectively for the period 1 April 2020 – 31 March 2022.

 The BDA is awaiting details of the conditions applied to the scheme, but has expressed concern that it may not cover those practices who have already installed portable units or air cleaners (such as HEPA filters) when they were unable to improve ventilation by other means in the short term, following guidance from the Scottish Dental Clinical Effectiveness Programme (SDCEP).

Many in this position are based in sites unsuitable for major works, such as premises owned by health boards, in densely packed city centres with adjoining residential and commercial units, or in listed properties.

To meet strict guidelines on COVID transmission, dentists have had to leave surgeries fallow between most common procedures. Investment in ventilation ensures practices can reduce these gaps and increase patient throughput.    

Restrictions have left practices operating at a fraction of their former capacity. Data from Public Health Scotland has shown a dramatic reduction in NHS dentistry delivered, which has hit those in most deprived communities the hardest. Between April and November 2020, the number of courses of treatment delivered was 83% lower than during the same period in 2019.  

This week Scotland’s CDO joined colleagues from the other three UK nations to commit to reviewing current restrictions. [1] While the review may reduce the need for a fallow time longer-term, the BDA has stressed this investment is required to ‘future proof’ services in the advent of any future pandemic, to secure an immediate boost in access, and will prove cost-neutral through increased patient charge revenues.   

David McColl, chair of the British Dental Association’s Scottish Dental Practice Committee said: “This is a no-brainer from the Scottish Government. Investment in ventilation can future proof Scotland’s dental services, boost patient numbers, and pay for itself.

“We must avoid half measures. Many dentists have had no option but to buy portable systems to get patients back through their doors. Ministers must ensure they do not lose out.  

“For our patients’ sake, this needs to mark a turning point when it comes to providing ongoing support to practices. Access to services has fallen off a cliff. A signature policy on free dentistry for all will be a promise that can’t be kept unless we see real commitment from ministers.”  

Scotland’s dental crisis: New data shows all parties need to act as inequalities widen

The British Dental Association Scotland has called on all political parties to set out an effective response to the crisis facing dentistry as new data reveals the collapse in attendance during the COVID pandemic.  

While registration rates remained high and broadly stable – owing to lifetime registration – data indicates the number of children seen between May and December 2020 was around a quarter of the 2018-19 average due to the pandemic.

Between September and November 2020, the number of adults seen was around a third of the 2018-19 average, before falling to 28% of the 2018-19 average in December 2020. 

The traditional measure of ‘participation’ – capturing attendance at an NHS dentist in the past 2 years – has less meaning in the context of COVID, as the full impact of the pandemic has yet to filter through.

Those in more deprived communities have traditionally experienced lower levels of participation. This data shows that in 2020, children and adults from the most deprived areas were less likely to have seen their dentist within the last two years than those from the least deprived areas (73.5% compared to 85.7% of children and 55.9% compared to 67.1% of adults). These inequalities in access between the most and least deprived areas have grown since 2019, particularly in children.

The BDA has warned lower levels of participation will inevitably translate into a higher disease burden. Early signs of decay and oral cancers are picked up at routine check-ups, and delays will mean both higher costs to the NHS and worse outcomes for patients. 

Dental care in Scotland is now facing crises on many fronts, 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.  The pioneering Childsmile programme has not fully resumed, with many key elements, such as supervised brushing, delivered via schools and nurseries. 

Recent announcements by Scottish dental schools that many final year students will not graduate in 2021 and will also not be in a position to take on new undergraduates, are likely to have wide-ranging effects on the NHS workforce for years to come.   

While both the Welsh and Northern Irish governments have set aside ring-fenced investment to improve practice ventilation – and thereby increase patient numbers while meeting tight COVID restrictions – no commitments have yet been made by the Scottish Government and the BDA await clear guidance for practices.  

Robert Donald, Chair of the British Dental Association’s Scottish Council said: “These numbers underline the scale of the challenge ahead. Millions have missed out on dentistry. Problems that could have been caught early, from decay to oral cancer, have been missed.  

“Scotland’s huge oral health inequalities cannot be allowed to widen. Every party heading into May’s election now has a responsibility to set out how they will ensure families across Scotland can get the care they need.”  

Support confirmed for dental students

The British Dental Association Scotland has welcomed action from the Scottish Government in response to its call to support dental undergraduates who face having to repeat a year owing to COVID disruption.  

A bursary of up to £6,750 will now be offered to students at Aberdeen, Dundee and Glasgow Dental Schools that all moved to defer graduation given the limitations on clinical contact in the last year.  

The BDA issued an open letter to Cabinet Secretary for Health and Sport Jeane Freeman, and Deputy First Minister and Cabinet Secretary for Education and Skills John Swinney on 2 February, calling for necessary action to prevent the next generation of dentists being saddled with unmanageable debt.  

Scottish dental students can already expect to graduate with debts of over £34,000. An additional year of study without a bursary would have pushed levels to over £40,000.

The Scottish Government has also confirmed it will continue to support trainers and trainees, based in NHS practices across Scotland. The BDA has renewed its call on the Scottish Government to provide additional funding to dental schools to mitigate the financial losses associated with today’s announcement.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “This is the leadership we’ve needed from the Scottish Government.  

“No one wanted graduations to be deferred, but now the next generation of dentists have real certainty, support, and protection from what would have been eye-watering levels of debt.

“It’s inevitable that COVID will widen oral health inequalities that have long blighted Scotland. We can draw some comfort that Ministers have helped secure the pipeline of new talent we’ll need to meet these challenges.”

Public Health Minister Mairi Gougeon said: “This difficult but necessary decision by Scotland’s Dental Schools will be extremely disappointing news for dental students across the country. This is not their fault and that is why the Scottish Government is doing all we can to support them and ensure they do not suffer financially.

“Due to the potential risk of spreading COVID from aerosol generating procedures, dental training has had to be restricted and many students have not gained the necessary clinical experience this year which has resulted in the difficult decision to defer graduation.

“To ensure dental students who have to repeat a year are supported, we are giving each student an extra year’s bursary to the value to of their normal student loan of up to £6,750.

“Aerosol procedures are common in dentistry placements and unusual in other student placements. Therefore we are assured that despite the wider impact on clinical placements for other controlled entry university subjects, such as medicine, nursing and midwifery, students on those courses will not be required to repeat a year and any extensions to their programmes will be covered by other arrangements.

“The quality and calibre of dental treatment in Scotland is outstanding and it needs to be protected by taking the appropriate measures in education to ensure future dental professionals have reached the General Dental Council’s standard of clinical competence and can enter the workforce with confidence.”

Dentists: Patient expectations need managing as ‘full service’ resumes in Scotland

The British Dental Association Scotland has warned that the reintroduction of the ‘full range’ of NHS treatments from Sunday 1 November will not signal a return to routine care, as a new poll reveals the limited capacity in the service. 

According to new data from practices across Scotland: 

  • Two-thirds (66%) are operating at less than a quarter of their pre-COVID capacity, with social distancing and new operating procedures leaving them capable of seeing a fraction of their former patient numbers. 
  • 80% report less focus on routine NHS dentistry, with 53% report more focus on urgent cases, with 63% stating less focus on cosmetic dentistry.   
  • The greatest levels of concern with the Scottish Government’s performance has been on managing patient expectations, where 84% of practices expressed dissatisfaction with the government’s record.  This compares to 43% dissatisfied with access to PPE, 58% on financial support. 82% were dissatisfied with the government’s overall performance during the pandemic in relation to the service.  

The BDA has welcomed positive signals that the Scottish Government is developing communications to provide a needed ‘reality-check’ to patients.  It has said clear and consistent messages from government and all NHS Boards are now essential to reduce patient frustration and prevent practices and their staff from being overwhelmed.  

Dentist leaders have stressed that the pandemic has caused a huge backlog in unmet treatment built up over lockdown, and will require continued priority to be given to urgent cases, those midway through courses of treatment, and high-risk patients who have not been seen for several years.  

While the BDA has recognised growing anxiety about an increasingly ‘two-tier’ system in Scotland it has questioned the timing of reintroduction of a full range of NHS dental services when COVID transmission rates are increasing significantly, and a huge swathe of the country is already facing Level 3-type restrictions. 



David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “November will not mark a return to ‘normal’ dental services in Scotland.

“Since the return to a ‘full range’ of services was announced the phones at many practices have been ringing off the hook. Dentists may be able to offer a wider range of treatment but now face demand that simply cannot be met.

“The Scottish Government is making the right noises, but we need every Health Board onside to prevent practices from being overwhelmed. Dentistry remains a skeleton service and urgent and high-risk cases need to be at the front of the queue. 

“It is paramount that officials communicate this message effectively to the public. It now takes a nurse 42 minutes to thoroughly deep clean a surgery following a procedure. Rules designed to keep the public and staff safe mean dentists that once saw twenty patients a day are now capable of seeing just five.”