Tag: British Dental Association

NHS dentistry: Support extended, but there can be no return to ‘business as usual’  

Dentists have warned that the Scottish Government’s last-minute extension of financial support for NHS practices must go hand in hand with meaningful reform to avert a crisis in the service.

A new ‘bridging payment’ will replace the current ‘multiplier’ set to expire on 1 October, uplifting NHS fees a rate of 1.2 for the next three months, falling to 1.1 for the period up to April 2023.  

The Cabinet Secretary had previously told the BDA that the multiplier – which at its current level increased NHS fees by 1.3 – had not been included in the Scottish Government’s budget forecasting. The professional body has not ceased reminding officials that without an adequate interim funding package several key treatments including extractions, and anything – like dentures – that requires laboratory work, risk being delivered at a financial loss.

The BDA stress that the new support package cannot presage a return to ‘business as usual’ from April 2023. Dentist leaders stress that in the months ahead efforts 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.  

While COVID emergency measures have been withdrawn, dentistry in Scotland has not returned to anything resembling pre-pandemic norms, with practices continuing to work under capacity in the face of an historic backlog.  Latest figures indicate 261,537 claims were made by dentists delivering NHS treatments in July 2022, less than 60% of the number made in the same month in 2019.   

Recent research by the BBC indicated 9 in 10 practices UK-wide were unable to take on new adult patients. In Scotland figures stood at 82%, the multiplier likely playing a decisive role.  

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “The Scottish Government seem to have recognised the wholesale inadequacy of the funding model for NHS dentistry.  

“It’s not rocket science. Without additional support, the basics of NHS care – from extractions to dentures – would have been delivered at a loss. No business can operate on that basis.   

“We now need some serious long-term thinking. Unless Ministers are prepared to revisit the system this service is built on, this funding will amount to sticking plaster on a gaping wound.

“If this is just delaying the return to a broken ‘business as usual’ then millions of patients stand to lose out.”   

Veteran campaigner Charlotte downs drill to fight for future of dentistry service in Scotland

The British Dental Association is delighted to announce dentist and experienced campaigner Charlotte Waite will take on a leading role in the fight for the future of dental services in Scotland.

She will take up the role of Director of BDA Scotland in October, supporting members in negotiations with the Scottish Government and overseeing outreach to the Scottish Parliament, officials, the press and wider stakeholders.

Prior to the pandemic Charlotte exposed the scandal of Westminster’s aggressive NHS fines regime, which saw millions of often vulnerable patients face £100 fines for attempting to claim free dental care or prescriptions. 

Working with the media and speaking up for patients in the UK parliament, she lifted the lid on a system that saw 1.7 million fines – worth £188 million – withdrawn because the ‘fraudsters’ targeted were actually fully entitled to claim support towards NHS dental or prescription charges.

Off the back of her powerful evidence to the Westminster Public Accounts Committee, the UK Department of Health and Social Care abandoned a ‘fines first’ policy, based on the presumption of guilt. 

While redeployed on the front line during COVID she revealed chronic PPE shortages that left hundreds of Urgent Dental Care centres struggling to deliver care to patients in agony, when most practices were closed for routine care.

Working with partners including Mencap she has continued to press the UK government for action on backlogs for patients facing yearlong waiting times for dental treatment under general anaesthetic as a result of pandemic disruption. She has also led efforts to encourage the use of Makaton – a unique language programme that uses symbols and signs, alongside speech – within dental settings, to break down barriers to communication with dental patients with learning disabilities. 

She has also spoken out in the press and lobbied the UK Government for better investment and provision of dental services for people experiencing homelessness and for residents in care homes.

News of Charlotte’s appointment comes in a week the BBC revealed 82% of NHS practices in Scotland were not accepting new adult patients, with 1 in 5 stating they had waiting times of a year or longer. Researchers were unable to find any practices taking on new patients in 9 of Scotland’s 32 local authorities.   

BDA Scotland has warned Ministers and officials they risk undermining the future sustainability of NHS dentistry, with cuts to financial support leaving some practices delivering some NHS treatments at a loss. There is a growing exodus from NHS dental services, with official data showing the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of Covid.

Waite will be pursuing BDA Scotland’s call for development of a new, sustainable long-term model for NHS dentistry, support for dentists in all fields of practice, and effective action to tackle Scotland’s deep oral health inequalities, which are now set to widen as a result of the pandemic.

The Glasgow-born Waite qualified in Dundee, before completing general professional training in the East of Scotland, locuming in Australia and then working in the Community Dental Service (CDS). She will be leaving her longstanding role in the CDS where she has provided dental care for some of the most vulnerable in society.  

Charlotte Waite said: “I’m downing my drill to fight for the future of dentistry in Scotland.    

“The service is on the brink and the public are living with the results. The Scottish Government pledged free NHS dental care for all, but we now face an exodus from the workforce, the risk of a two-tier system, and a shameful oral health gap that will only widen.  

“Our message to every MSP and every party is that this crisis will not end without real commitment. Sit down with us and we can secure a better future for a service millions depend on” 

NHS Dentistry: Scottish Government plans set to spark exodus from service

The British Dental Association has warned the Scottish Government plans to revert to pre-COVID models of care risks sparking a flight of dentists from the NHS, with potentially devastating consequences for patient access across Scotland. 

In October Cabinet Secretary Humza Yousaf wrote to all NHS dental teams that all emergency support will be withdrawn by 1 April 2022. Since the first lockdown NHS practices have operated under a COVID support package, reflecting pandemic pressures and tight infection control restrictions that continue to limit capacity across the service. 

According to a new survey of dentists in Scotland [1]:

  • 80% of dentists estimate their practices will reduce their NHS commitment should the Scottish Government withdraw emergency support and return to pre-COVID models of care. Over a third (38%) of dentists indicate they are now likely to change career or seek early retirement in the next 12 months should the policy be taken forward. 15%  say they are likely to practice dentistry outside of Scotland, and 1 in 10 estimate their practice is likely to cease operations. 
     
  • Half of dentists report that they are operating at less than 50% of pre-COVID capacity. While the Scottish Government has offered a support package to boost capacity, many practices are unwilling to commit to a broken NHS model. Over 30% say they have not applied, andamong those half (50%) say they are now unable to commit to the NHS long-term. Support for ventilation costs requires a minimum 3 year commitment to the NHS.
     
  • 9 in 10 of dentists (89%) estimate the removal of emergency funding will have a high impact on the short-medium term sustainability of their practices.

BDA Scotland have warned from the outset 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. Practices are facing an unprecedented backlog, with recent data from Public Health Scotland indicating that the number of treatments delivered in the year to March 2021 was less than 25% of those delivered in the previous 12-month period, corresponding to over 3.5 million appointments lost as a result of the pandemic.

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: “Free NHS dentistry for all is a worthy ambition. Rather than exploring ways to actually achieve that goal the Scottish Government has blindly headed down a road that could destroy this service.

“COVID has slashed our capacity, yet emergency support will end. Yes, Ministers have offered some support, but with small print many practices simply could not sign up to in good conscience.

“Dentists are unwilling to be shackled to a corpse. When aid hinges on committing to an NHS model that is now frankly unsustainable it is unsurprising take up appears so modest.

“We doubt Humza Yousaf wants to be remembered as the man who killed NHS dentistry in Scotland. Without a willingness to reflect on choices made in recent weeks that risks being his legacy.”

Dentist say seize the moment, as CMOs back water fluoridation

The British Dental Association has welcomed the new joint statement from all four UK Chief Medical Officers highlighting the benefits of water fluoridation in reducing tooth decay.

The BDA fully supports community water fluoridation as a safe and effective public health intervention, as part of a package of measures to improve dental health, where technically feasible and appropriate for local needs. The Health and Care Bill, currently before Parliament, is set to simplify the rollout of the policy in England. Dentist leaders are now urging all 4 UK administrations to restate their positions on water fluoridation in light of the statement.   

Public Health England modelling shows water fluoridation more than pays for itself in medium term, owing to reduction in treatment need. £1 spent equates to £12.71 savings in five years, rising to £21.98 in ten. The BDA has stressed that upfront investment by Government is vital to unlock these benefits. 

In their statement, the four UK CMOs recognise water fluoridation should be seen as a complementary strategy, and not a substitute for regular dental check-ups and other effective methods of increasing fluoride use. 

The BDA backs a joined-up approach in which tried and tested policies like water fluoridation and supervised tooth brushing in early years settings are expanded, with parallel effort applied to rebuilding high street dental services.

Oral health inequality is anticipated to widen, given combination of unprecedented access problems, the suspension and ongoing disruption to public health programmes and changes to dietary habits since the start of the pandemic. Over 30 million appointments have been lost in NHS dentistry since lockdown, in England alone.  

Around 5.8 million people in England receive fluoridated water, the lion’s share artificially added, but in some locations the appropriate level exists naturally within local water supplies.

British Dental Association Chair Eddie Crouch said: “Every dentist will thank the CMOs for recognising the lasting benefits water fluoridation could bring to the nation’s oral health.

“However, these gains are purely theoretical without upfront investment. Spending here will pay for itself, and Ministers need to show they are willing to seize the moment.

“We need a joined-up approach. COVID has left millions unable to access care, and deep inequalities are now set to widen. The four Governments must double down on tried and tested policies while rebuilding the services millions depend on.” 

Dentists ready to work with next Scottish Government to rebuild services

The British Dental Association has indicated it is ready to work with a future SNP government on wide-ranging pledges made in the party’s manifesto, which could fundamentally change the way dentistry is delivered in Scotland.  
 
The party has pledged to abolish patient charges over the course of the next parliament, and to work with the BDA to “shape a reformed funding arrangement for NHS dentists so that they are supported for the future”.

Approximately 20% of the NHS dental budget – some £74 million in 2018/19 – is drawn from charges. The BDA believes charges represent a tangible barrier to care for those on modest incomes but will be seeking assurances that any move will not lead to a reduction in overall funding for the service. 
 
The Scottish Budget 2021- 22 provided £431 million for general dental services, a rise of just 0.6% from the year before which represents a real-terms cut at a time the service faces an unprecedented backlog. The dental budget in Scotland has been cut in real terms in three out of the last four years. 
 
The dentist’s union has warned of widening inequality following the COVID pandemic, with high street services operating at a fraction of their former capacity, with an estimated 2,500 children now facing up to year-long waits for dental extractions in hospitals.  

Public Health Scotland data has shown a dramatic reduction in NHS dentistry due to COVID, which is hitting 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. Practices are operating at significantly reduced capacity to meet infection control protocols, and the BDA is seeking capital investment in areas such as ventilation that can help restore patient volumes.

David McColl, chair of the British Dental Association’s Scottish Dental Practice Committee, said: “Dentistry in Scotland risks becoming a casualty of this pandemic. We have called for wholesale change to the way care is delivered, and we will work with the next Scottish Government to achieve that.  
 
“These are big plans to bring down barriers to care and improve access, but they must go hand in hand with needed investment if services millions depend on are going to remain sustainable.

“Practices are now operating at a fraction of their former capacity. Dentists will need real and ongoing support if we’re ever going to meet historic levels of demand.”

Dentists urge action on ‘shameful’ oral health inequalities

The British Dental Association has urged all candidates contesting the Scottish election to pledge to commit to tackling the shameful inequalities in oral health set to go into overdrive as a result of the pandemic.

Unpublished data from Public Health Scotland has shown a dramatic reduction in NHS dentistry due to COVID, which is hitting 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.  

Official figures show that primary school children from the most deprived communities experience more than four times the level of tooth decay compared to children in the least deprived areas. Latest data also 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) and this gap has widened compared to the year before.   

The impact is now being felt in all corners of the service. The Public Dental Service– which treats specific patient groups including care home residents, children with additional needs and adults with disability – also faces a huge backlog, with many of its staff redeployed to urgent dental care centres. 2,500 children are now estimated by the BDA to be on waiting lists for dental extractions under general anaesthetic, which may take years to clear.   

High street practices continue to face wide-ranging restrictions, which have radically reduced patient numbers, including the need to maintain gaps between most routine procedures where surgeries are left ‘fallow’ to reduce risk of viral transmission.

Governments in Northern Ireland and Wales have already offered millions to help practices invest in new ventilation systems to cut down this time, and hence significantly expand patient volumes. The BDA is seeking commitments from Scotland’s parties to follow the same path.      

The BDA says prevention is now more essential than ever. The pioneering Childsmile programme, delivered via primary schools and nurseries, has secured record-breaking reductions in decay but has been suspended for much of the last year, with many core elements like supervised brushing yet to resume.

Restarting that programme, and providing additional support in high needs areas is at the centre of the BDA’s plan, alongside calls for Health Boards to be supported to conduct feasibility studies on water fluoridation. 

Dentistry challenges are now likely to be exacerbated by workforce problems. None of Scotland’s dental schools is on track to graduate classes at the usual time this year, which will have a domino effect on workforce planning for years to come. The BDA has called for a long-term strategy to ensure Scotland has the dentists it needs to meet this threat, and parallel challenges – including Brexit.   

Oral cancers kill three times more Scots than car accidents – and the country has one of the highest rates for the condition in Europe.

Residents in Scotland’s most deprived communities are more than twice as likely to develop and die from oral cancer as those in more affluent areas. The BDA is therefore seeking action on smoking cessation, and assurances that a rapid catch up programme will be in place to ensure school children are protected from the Human Papillomavirus via vaccination.

HPV is an important risk factor for oral cancer, and while steps were in place to extend the programme to boys in the last academic year, the programme continues to face massive disruption as a result of school closures.   

The Association is making direct contact with every candidate seeking election to Holyrood to ask them to commit to addressing oral health inequality.  

Robert Donald, Chair of the British Dental Association’s Scottish Council said: “A wealthy 21st century nation shouldn’t accept that a wholly preventable disease remains the number one reason its children are admitted to hospital. Sadly, COVID risks undermining hard-won progress, while leaving our dental service a shadow of its former self.  

“The result is that from decay to oral cancers, Scotland’s oral health gap is set to widen, and we need all parties to offer a plan. 

“In this campaign we need candidates to do more than talk about ‘prevention’. From helping practices boost capacity, through to expansion of the sugar levy, we have set out simple steps that can put that principle into action, addressing inequality, and restoring services to millions.”

The BDA Scotland manifesto: Bridging the Gap: Tackling Oral Health Inequalities (PDF)  

Dentistry in Scotland at risk as dental schools face uncertain future

The British Dental Association has urged the Scottish Government to provide a clear safety net to protect students, universities and the future of patient care, as questions emerge of whether Scotland’s dental schools will graduate classes in 2021. 

The COVID pandemic has limited the clinical experience of many dental undergraduates. In 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 the BDA has warned action is needed to minimise wide-ranging impacts on the future of education, training and the sustainability of the NHS workforce.

The union has warned against saddling undergraduates with unmanageable debt. Scottish dental students can already expect to graduate with over £34,000 debt. An additional year of study could push it to over £40,000.

Dentist leaders have stressed that any changes will have an impact not just on this year’s graduating class, but on the shape and size of the 2021 intake.

The BDA is now calling on the Scottish Government to support any undergraduates who are required to take additional periods of study via an emergency bursary, to offer appropriate support for dental schools covering tuition fees where appropriate, teaching grant and clinical placement funding, and ongoing support for the network of NHS trainers who take on trainees following graduation.

Any disruption will have a significant impact on patient access. Graduate dentists are typically given higher needs patients to maximise their clinical experience during their vocational training. Longer-term this disruption may also translate into fewer qualified dentists entering the NHS workforce in years to come. The BDA has stressed any inaction will make the huge backlog facing Scotland’s dental services even more difficult to clear.

David McColl, Chair, British Dental Association’s Scottish Dental Practice Committee said: “What dental students across Scotland really need now is certainty. The Scottish Government must offer a safety net, which protects the next generation, supports our universities, and secures the future of patient care.

“Should these students be unable to graduate in 2021 it will have a serious impact on both the workforce and patients’ ability to access NHS services.

“The pipeline of health professionals should not be left at risk. We need to see a plan that guarantees graduates aren’t saddled with unmanageable debt, keeps schools viable, and ensures Scotland has the dentists it needs.”