The British Dental Association Scotland has warned new data underlining the scale of the backlogs facing practices demonstrates the absurdity of government plans to return to pre-COVID models of care.
The new figures from Public Health Scotland indicate that the number of treatments delivered in the year to March 2021 was less than 25% of those delivered in previous 12-month period, corresponding to over 3.5 million appointments lost as a result of the pandemic.
Last week Cabinet Secretary Humza Yousaf wrote to all NHS dental teams in Scotland that all emergency support will be withdrawn by 1 April 2022.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.
Owing to ongoing disruption dentist leaders stress patients are now presenting with higher levels of need, requiring additional time. BDA Scotland have warned that the 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.
In light of the SNP’s centrepiece policy of providing free NHS dental care for all, BDA Scotland have stressed the need to develop a new, sustainable model for delivering care. In the interim, a workable interim funding model is needed to support dentists and their teams to care for their patients.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Dentists are facing an unprecedented backlog, as we continue to work to restrictions designed in the first lockdown.
“This new data underlines the sheer perversity of government plans to pretend COVID is yesterday’s news.
“Withdrawing emergency funding will pull away the life support from hundreds of dedicated NHS practices serving communities across Scotland.”
“To signal the return of a ‘business as usual’ model when the country is still in the grip of a pandemic is utterly reckless”
The British Dental Association Scotland has warned that plans to return NHS practices to pre-COVID models of work will devastate dental services across the country.
Cabinet Secretary Humza Yousaf yesterday wrote to every NHS dental team in Scotland, indicating that all emergency support will be withdrawn by 1 April 2022.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 restrictions that continue to limit capacity across the service.
A return to delivering a low margin/high volume model of care is, BDA Scotland contends, simply unsustainable under current conditions. While some restrictions may ease in the coming months, there are no indications the service is likely to return to anything resembling ‘business as usual’.
With a growing number of staff facing abuse from frustrated patients unable to secure appointments, the BDA has warned the move will only raise patient expectations, while pushing NHS colleagues into the private sector or out of dentistry altogether.
Yousaf has signalled minor changes to the payment system for dentists that will take effect from 1 February 2022, largely covering the treatment of children. While welcome, these reforms will have a negligible impact on capacity within the service and will not ease the pressure on practice finances once the COVID support payments are withdrawn.
The SNP committed to delivering free NHS care for all in Scotland in the recent election. The BDA has stressed this approach runs counter to that vision, and that real focus and energy must be applied to developing a new, sustainable model for delivering care.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“The Scottish Government seems set to pull the rug out from under every dedicated NHS dentist.
“If Ministers had an objective to decimate NHS dentistry, this approach would offer a great starting point. To signal the return of a ‘business as usual’ model when the country is still in the grip of a pandemic is utterly reckless. The net result will be to push colleagues out of the NHS and to leave this profession altogether.
“Ministers put NHS dentistry front and centre in their pitch for government. To deliver on their promises we need real commitment to find a new and better way for delivering for the patients that need us.”
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)
‘I firmly believe this scheme will save many more lives’ – Matheson
Communities across Scotland will have access to potentially life-saving defibrillators as the machines are installed in independent NHS dental practices across the country.
The £600,000 programme will see defibrillators delivered by the end of the month. The locations of the defibrillators will be logged with the Scottish Ambulance Service control system, which will increase community access to defibrillators, reduce delays in treatment and increase the chances of survival for cardiac arrest victims.
More than 1500 Scots died after suffering a cardiac arrest outwith hospital last year.
To mark yesterday’s roll-out launch, Minister for Public Health Michael Matheson visited the Montgomery Street Dental Practice in Edinburgh, one of the first to receive a defibrillator.
Mr Matheson, who is himself trained in the use of defibrillators, said: “Every second counts when someone suffers a cardiac arrest and having access to a defibrillator can mean the difference between life and death.
“By the end of this roll-out, there will be more defibrillators in public spaces. With these machines mapped to the Scottish Ambulance Service control system, people can be directed to them more quickly if there is an incident, cutting the delay in treatment and increasing the victim’s chance of survival.
“As these machines are becoming easier to use it is only right that the public have more access to its life-saving potential and I firmly believe that this scheme will save many more lives.”
Alex Coakley, Principal Dentist at the Montgomery Street Practice, added: “This is a fantastic initiative by the Scottish Government. Having defibrillators available in convenient locations such as dental practices will mean that they can be taken to the scene of any incident as quickly as possible, and hopefully save lives.”
Pat Kilpatrick, director of the British Dental Association Scotland, said: “BDA Scotland is delighted that the Scottish Government has recognised the important contribution that the dental team can make in saving lives, and for making this possible by providing defibrillators for every dental practice in Scotland.”
