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.”
Oral health is a topic that has been shrouded in myths and misconceptions for years. From old wives’ tales to internet rumours, it’s easy to get confused about the best way to look after your smile.
Thankfully, dentist Dr. Elham Kordrostami at PAIST, the UK’s first 100% plastic-free toothpaste tube has shared some of the most common oral care myths and replaced them with evidence-based truths. It’s time to set the record straight and ensure you’re on the right track to a healthier smile.
“You should brush your teeth after every meal.”
While it might seem like a good idea to brush your teeth right after eating, it’s not always the best approach. After you eat, due to many reasons the broken-down food can make your mouth more acidic, meaning brushing your teeth immediately after eating can weaken your tooth enamel. Dr Kordrostami recommends waiting at least 30 minutes before brushing as this allows your enamel to reharden, making it safe to brush.
“Rinsing with mouthwash is a suitable replacement for brushing.”
Mouthwash should not replace brushing; instead, it should complement your oral care routine. According to Dr. Kordrostami, if you choose to use mouthwash, incorporate it between meals for added freshness, but avoid using it immediately after brushing.
It’s important to note that relying solely on mouthwash is insufficient for maintaining healthy teeth and gums, and dentists do not recommend it.
The traditional toothbrush and floss remain essential for maintaining your oral health, as they effectively remove plaque and food particles. When selecting a mouthwash, opt for one without alcohol to prevent potential irritation.
“Brushing your teeth harder cleans them better.”
Some people think that brushing vigorously with a hard-bristle toothbrush will clean their teeth better. However, this can damage your tooth enamel and gums. It’s best to use a soft or medium toothbrush and brush gently. Zealous brushing can wear down the enamel, leading to yellow teeth in the long run and increased sensitivity of your teeth. It can also cause gum recession.
“All toothpaste tubes are recyclable.”
Not all toothpaste tubes are made from recyclable materials. Traditional toothpaste tubes are often made from a combination of materials that can be difficult to recycle. With 300 million plastic toothpaste tubes ending up in landfills every year, PAIST is committed to providing a fully recyclable alternative. Unlike traditional plastic toothpaste tubes, PAIST is 100% plastic-free, and is made from infinitely recyclable metal – cap included.
“Sugar free drinks are a safe option for your teeth.”
While sugar-free drinks don’t contain the sugars that can directly contribute to tooth decay, they can still be harmful to your teeth. Many sugar-free drinks are acidic, which can weaken tooth enamel over time. So, it’s essential to be mindful of the acidity and other potential tooth-damaging components in these beverages and consume them in moderation. Dr. Kordrostami advises using a straw when drinking anything other than water or milk to minimise potential damage to your teeth.
“Flossing isn’t important.”
Flossing is a crucial part of maintaining good oral hygiene. Brushing alone cannot effectively remove all the food particles and plaque build-up from between your teeth and along the gumline. Flossing helps to clean these hard-to-reach areas, preventing gum disease and cavities. Dr Kordrostami recommends flossing at least once a day to maintain optimal oral health. If you don’t floss, you’re missing cleaning 40% of your tooth surfaces. Most dental problems occur in between teeth due to the lack of flossing.
“You should rinse with water or mouthwash after you brush.”
You should not do this. Follow the “spit don’t rinse” rule. After brushing, spit out excess toothpaste but do not rinse with water or mouthwash. Rinsing immediately removes the beneficial ingredients from the toothpaste, and by not washing them away, you allow these ingredients more time to work effectively.
“Fluoride is bad for your health.”
Fluoride, when used in recommended amounts as directed by dental professionals, is safe and effective in preventing tooth decay.
There is no scientific evidence to support the claim that fluoride in toothpaste or water is generally bad for your health.
Sarah Boyack MSP has highlighted the grim findings that more than 3 in 4 Dental Practices serving patients in Musselburgh are no longer accepting NHS Patients.
Following up on concerns of Musselburgh residents, Lothian MSP Sarah Boyack contacted practices serving the Musselburgh area to inquire whether they were accepting new NHS patients.
The findings also highlighted those that were accepting new patients had waiting lists of over six months on average.
Commenting Scottish Labour MSP Sarah Boyack said: “Patients in Musselburgh are being routinely let-down by the lack of NHS Dental provision.
“With more than three quarters of NHS Dentists unable to accept new patients, the people of Musselburgh have been left with a two-tiered system that routinely fails them.
“We are now seeing the devastating effects of the SNP mismanagement of our NHS, with patients spending months suffering unnecessarily whilst they are unable to see an NHS Dentists.
“This cannot carry on, The SNP must act now before more communities like Musselburgh are left without access to NHS services.”
Data collected by the office of Sarah Boyack MSP for the 20 closest practices to Musselburgh on 5/5/23:
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.”
More than 90 dentists withdrew from NHS Lothian dental list from 2021 to June 2022, a Freedom of Information request submitted by the Scottish Labour has revealed.
Sarah Boyack warns of a health crisis as waiting times for A&E and NHS dentistry continue to spiral, while delayed discharges have gone up.
Scottish Labour’s FOI request revealed that between 2021 and June 2022, 92 dentists withdrew from NHS Lothian dental list. As at beginning of June this year, out of the 163 general dental practices in Lothian, only 51 confirmed that they are accepting patients, with some accepting children only.
Since 8th May 2022 and up until 11th December, there has been only one week during which the percentage of people seen within Scottish Government’s 4-hour target was above 70 per cent – in the week ending 11th December more than 1,756 people were stuck in A&E for more than four hours – only 63.6 per cent of those attending NHS Lothian’s emergencies were seen within 4 hours. In the same week, 353 people were stuck in A&E for more than 12 hours.
This comes as the recent monthly report on delayed discharge shows rates in NHS Lothian for October 2022 soaring to 1,644 compared to 1,420 in September 2022.
This makes NHS Lothian the second-worst performing health board in Scotland, only topped by NHS Greater Glasgow and Clyde, with 3,848 delayed discharges in October 2022.
October recorded the highest average number of beds occupied per day due to delayed discharges in Scotland since the current guidance came into place in July 2016.
Scottish Labour MSP for Lothian Sarah Boyacksaid: “Another month, another set of damning statistics from NHS Lothian.
“On top of the cost of living crisis, which is taking its toll on people’s mental and physical health, we see piling pressure on our NHS, worsening patients outcomes and huge waste of public money.
“With the freezing cold, people will get sick and they will require care. That’s why we need support to GPs to allow them to respond to the rising demand and handle cases, whenever possible, at primary care level.
“These are not just figures – it is someone’s dad, friend or life partner; it’s the NHS staff who is overworked and underpaid; it’s the people who left our health service because they simply couldn’t cope.
“With a general election approaching, now is the time focus on what really matters and make a difference for millions of people.”
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.”
NHS medical and dental staff will be awarded a 4.5% pay increase for this year backdated to 1 April 2022. This is for all NHS Scotland medical and dental staff, general medical practitioners and general dental practitioners.
This comes following recommendations by the independent Doctors and Dentists Pay Review Body (DDRB) of an annual pay uplift of 4.5% for NHS medical and dental staff. The Scottish Government has accepted this recommendation.
The Scottish Government, BMA Scotland and other relevant stakeholders all participated and provided evidence to the DDRB to allow them to make their independent recommendations.
This year’s award builds on the 3% uplift that was recommended and applied by the Scottish Government in 2021. This means staff have been awarded a 7.5% pay increase over the last two years – but inflation currently stands at over 9% and rising.
Health Secretary Humza Yousaf said: “The NHS has faced its biggest challenge during the pandemic and staff have been working tirelessly to continue to provide care while under increased pressure.
“The continued hard work and dedication of staff ensures that the people of Scotland continue to receive world class healthcare as we remobilise NHS services and tackle waiting times.
“This uplift demonstrates that we value all our medical and dental staff and the important contribution they make. It’s crucial that we continue to not only recruit and build our future NHS workforce, but also retain expertise within NHS Scotland.
“This announcement means that our senior medical staff will continue to be the best paid in the UK. This will help ensure that NHS Scotland remains an attractive employment option for all medical and dental staff.”
The 4.5% pay uplift will be applied to all NHS medical and dental staffing grades and will be included in salaries with backdated payments to 1 April 2022 to follow as soon as practical.
Scotland’s health union UNISON is balloting 35000 NHS staff across Scotland to recommend they reject the Scottish government’s pay offer and vote to take strike action in the coming months.
The NHS consultative digital ballot closes on 8 August.
UNISON report that their members are angry and feel they are being taken for granted. UNISON say the Scottish government 5% pay offer is well below the rate of inflation – which is 10% – and it is deeply unfair as it will give those at top of the pay bands a pay rise of over £5,000 per year whilst those on the lower pay bands will get nearer £1000 per year.
This ballot is launched in the midst of a staffing crisis in the NHS, staff turnover is higher than ever, waiting lists are at an all time high and the NHS is facing real challenges to recruit.
There are over 6000 nurse vacancies across Scotland. Staff report to UNISON that they are regularly left in wards working with staffing levels below minimum standards. Staff also report they are constantly worried they make mistakes, or fail to deliver basic patient care. The problems were building long before Covid, the pandemic has only exacerbated the issues.
Wilma Brown, chair of the UNISON Scotland health committee said: “NHS staff have been taken for granted, staff have endured over 10 years of real terms pay cuts only to be told by the Scottish Government that, yet again, they will have to accept a below inflation pay rise.
“NHS staff have family bills to pay, food, energy and petrol prices are rocketing. NHS staff are struggling to afford the price of fuel to get them to work. They need more than praise and platitudes from Government, they need a decent pay rise to support their families.
“A 5% pay increase across the board just doesn’t cut it and the Scottish Government need to understand how angry we are. UNISON are urging UNISON members to vote to reject this pay offer and indicate that they will take the very difficult decision to take industrial action, unless of course the Health Minister improves the offer on the table.”
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.”
SOME household dental care products can now be disposed responsibly in Edinburgh after Scotland’s largest dental group introduced a breakthrough scheme to divert waste from landfill.
Bellstane Dental Case in South Queensferry, Earl Grey Dental Practice, Gilmore Dental and Fairmilehead Dental Practice & Implant Centre, all based in the capital, have joined Philips’ Dental Care Recycling Programme, in partnership with TerraCycle®, the world leaders in recycling “hard-to-recycle” waste with patients and practices from the Highlands to the Scottish Borders benefiting.
The practice is part of Clyde Munro Dental Group, which is introducing the scheme north of the border to 48 of its 51, (the scheme is currently unable to collect from Orkney), reaching more than 360,000 patients – making it the biggest introduction of the programme in Scotland.
As well as used electric toothbrush heads and covers, it recycles the “non-recyclable”, including plastic floss holders, floss containers, electric flosser nozzles and interdental brushes from all brands.
Fiona Wood, Chief Operating Officer with Clyde Munro, said: “Household dental waste has long been problematic, in that you can’t recycle it in the usual way from home.
“It means plastic inevitably going to landfill, because there wasn’t an alternative option. With Terracycle, through our partnership with Philips, we now have that solution.
“We hope that our patients will embrace this – and help us do everything we can to reduce our footprint.”
TerraCycle® programmes allow consumers to send in traditionally non-recyclable products and packaging free of charge, which is then recycled into a format that is used to make new products.
The participating Clyde Munro practices will all offer a collection point within their reception area for patients to drop off dental care products at their next scheduled appointment.
As a further benefit, the practices will receive a charitable donation from TerraCycle® depending on the weight of the recycled material, with all that money donated to Clyde Munro’s partner charity, Alzheimer Scotland, or a local charity of each practices’ choice.
Clyde Munro was founded by Jim Hall in 2015 with the acquisition of seven practices. Since then, it has enjoyed rapid growth through acquisition and has plans to continue expanding. It now comprises 51 practices across Scotland, with more than 430,000 patients and 400 staff.
