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.”
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.”
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”
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.”
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.”
