Tag: NHS Dentistry

BDA: Payment reform cannot be final destination for Scotland’s dental service

The British Dental Association Scotland has stressed that there can be no complacency over the future of NHS dentistry, following the first evidence from frontline dentists since the Scottish Government’s reforms rolled out in November last year.

A new poll of high street dentists shows:

  • While two thirds (66%) of respondents say the new system represents an improvement on the previous model, 9 in 10 (88%) say this cannot be the final destination for NHS dentistry.
  • Only 22% say the new system enables a move to a preventive model of dentistry. Only 7% believe it will enhance access for NHS patients, and just 5% say it will support a reduction in oral health inequality.
  • 26% feel changes have made their practices more financially sustainable. 31% disagree. Nearly half have not formed an opinion.
  • 34% agreed reforms met the Scottish Government’s goal of increasing clinical freedom, while 38% disagreed. On reducing bureaucracy, respondents were tied for and against on 38%.

Just over a year ago the BDA’s Scottish Dental Practice Committee and the Scottish Government entered formal negotiations on the new fee structure and Payment Reform. This moved at pace within a challenging fiscal environment. The previous funding model was unsustainable, as surging costs had left dental practices delivering some NHS care at a financial loss.

In an open letter to the Scottish Government the BDA stress the Scottish Government must show it is willing to build on these reforms, and to double down on policies to ease the workforce crisis in the NHS.            

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said: “Given the critical place dental services were at this verdict is welcome news, but there is absolutely no room for complacency.

“Dentists have seen improvements, but have told us reform falls short on access, inequalities and prevention. Changes might make some practices more sustainable today, but they do not provide the foundations for a 21st century service.   

“The Scottish Government has set goals on improving access and sustainability. These promises must be kept.

“Scotland cannot have NHS dentistry without NHS dentists – and this service must be a place which can recruit and retain talent.”

Online survey of Scottish General Dental Practitioners, February-April 2024, 229 respondents:

Please indicate your agreement or disagreement to following statements

1. The new system means the practice I work in is better able to remain financially sustainable           


Strongly agree                                   3%        

Agree                                               23%

Neither agree nor disagree              27%

Disagree                                          21%

Strongly disagree                            10%

Don’t know/not applicable               15%

Net Agree                                        26%      

Net disagree                                   31%

2. The new system represents an improvement on the previous payment model

Strongly agree                                 10%      

Agree                                               55%      

Neither agree nor disagree             15%

Disagree                                         12%      

Strongly disagree                              7%

Don’t know/not applicable                 0%

Net agree                                        66%      

Net disagree                                   19%

3. The new system reduces bureaucracy

Strongly agree                                   4%        

Agree                                               34%      

Neither agree nor disagree              22%

Disagree                                          21%      

Strongly disagree                            17%

Don’t know/not applicable                 2%        

Net agree                                        38%                                  

Net disagree                                   38%

4. The new system increases clinical freedom

Strongly agree                                                 3%
Agree                                                             30%
Neither agree nor disagree                            27%      
Disagree                                                        26%
Strongly disagree                                          12%

Don’t know/not applicable                               1%        

Net agree                                                      34%                                  

Net disagree                                                 38%                                   

5. The new system enables a move a preventive model of dentistry       

         
Strongly agree                                                 3%

Agree                                                             20%

Neither agree nor disagree                            24%

Disagree                                                        27%                                         

Strongly disagree                                          25%                    

Don’t know/not applicable                               2%        

Net agree                                                      22%                                  

Net disagree                                                 52%

6. The new system will enhance access for NHS patients            

Strongly agree                                                1%

Agree                                                              6%

Neither agree nor disagree                           18%      

Disagree                                                       34%

Strongly disagree                                         39%

Don’t know/not applicable                              2%        
Net agree                                                       7%                                        

Net disagree                                                 73%

7. The new system will support a reduction in oral health inequality

Strongly agree                                               1%

Agree                                                             4%

Neither agree nor disagree                          18%

Disagree                                                       35%

Strongly disagree                                          38%

Don’t know/not applicable                              3%

Net agree                                                       5%

Net disagree                                                 73%

8. The new system should be a final destination for reform of NHS        

Strongly agree                                               0%

Agree                                                             2%

Neither agree nor disagree                            7%

Disagree                                                       27%                                  

Strongly disagree                                          61%

Don’t know/not applicable                              2%        

Net agree                                                       2%

Net disagree                                                 88%

New dentists required to deliver NHS care under UK Government plans

Consultation asks whether newly qualified dentists should commit to delivering a minimum amount of NHS work after graduating or repay some training fees

  • Proposals would require dental graduates to work in the NHS for several years after graduating or repay their training fees
  • Part of Westminster government and NHS plan to recover dentistry and boost the dental workforce through 40% training expansion

Newly qualified dentists could be required to deliver NHS care for several years after they graduate under a government consultation being launched yesterday.

Training an individual dentist can cost up to around £300,000, of which costs in the region of £200,000 are not repayable by the student.

However, a growing proportion of dentists are opting to go straight into private practice or are choosing to deliver little to no NHS work shortly after completing postgraduate dental foundation training.

Of more than 35,000 dentists registered with the General Dental Council in England, just over 24,000 delivered some NHS care in England in 2022 to 2023. This means nearly one-third of registered dentists are not contributing to NHS dentistry and may be working solely in private practice.

Under its consultation, which will run for 8 weeks, the government is asking whether newly qualified dentists should commit to delivering a minimum amount of NHS dental care for a minimum number of years after graduating, and whether they should repay some of the public funding invested in their training if they do not.

Health and Social Care Secretary Victoria Atkins said: “I want to make access to dentistry faster, simpler and fairer for everyone – and part of this is ensuring that dentists are supporting the NHS with their skills and expertise.

Taxpayers make a significant investment in training dentists, so it is only right to expect dental graduates to work in the NHS once they’ve completed their training.

“This builds on our dental recovery plan, which set out how we will create up to 2.5 million extra appointments this year alone and is already showing results with an extra 500 practices providing appointments.”

Thursday’s proposals form part of the government’s overall plan to accelerate the recovery of NHS dentistry from the COVID-19 pandemic and reform how NHS dentistry operates.

They build on the aims of NHS Long Term Workforce Plan to expand the dental workforce and improve access to NHS dental care, especially in under-served parts of the country. 

The UK government believes working in the NHS will give dental graduates the best start to their careers, by giving them the broadest range of experience, great support from strong teams of dental professionals and the most comprehensive training.

Experience in NHS dentistry helps to produce well-rounded clinicians who can work alongside different professions and deliver high quality and safe patient care, and can be supplemented by additional work in private dentistry. The government believes this balance is better for our skilled dental workforce and better for the patients they treat.

NHS dentists are currently delivering a greater volume of NHS treatment than the year before, with ‘courses of treatments delivered’ increasing by 23% in 2022 to 2023, compared to the previous year.

Primary Care Minister Andrea Leadsom said: “I want to thank our hard-working dentists for their efforts in treating more and more patients over recent years and helping us improve access to care.

“Through our dental recovery plan, we’re helping the sector recover from the pandemic and making NHS dentistry a more attractive career choice.

“Today’s proposals will ensure dental graduates benefit from the broad experience and comprehensive training of working in the NHS, while also delivering value for money for the taxpayer.”

There is currently no requirement for dentists to work in the NHS following the completion of their training. In contrast, a graduate medic in the UK must undertake a minimum of one year of foundation training to register as a doctor, followed by an additional year of foundation training and at least 3 years of general practice specialty training to become a GP.

Jason Wong, Chief Dental Officer for England, said: “Dental services were severely impacted by the pandemic, and it is a priority for the NHS to improve access, so it is easier for people to see a dentist.

“We launched our dental recovery plan earlier this year to deliver millions more appointments across England – and boosting the workforce is one step we can take to achieve this.”

Neil Carmichael, Executive Chair of the Association of Dental Groups, said: “We welcome the chance to engage with this consultation and ensure the NHS benefits from the skills of our graduate dentists.

“We need to see more trained dentists entering the profession and we will work with the government to ensure these proposals reflect the sector’s mixed economy and considers the needs of both NHS and private dentistry.”

Louise Ansari, CEO at Healthwatch England, said: “We welcome the opportunity for the public to have their say about these long-term proposals to address dental workforce issues, especially as access to NHS appointments continues to be one of the main issues we hear about from people across the country.  

“We also look forward to seeing separate government proposals on reforming the NHS dental contract in the coming months, as set out in the dental recovery plan.

“In the meantime, NHS bodies that plan and fund dentistry across England should take concerted and imaginative action to ensure people in greatest need can get dental care quickly.”

The launch of the consultation is the latest milestone in the delivery of the Westminster government’s dental recovery plan.

Since the plan was published in February, the government and NHS have worked to:

  • introduce a new patient premium, supporting dentists to take on new patients – with more than 500 more practices saying they are now open to new patients compared to January
  • launch the ‘golden hello’ recruitment scheme to incentivise dentists to work in under-served areas
  • raise the minimum units of dental activity (UDA) rate to £28 this year, making NHS work more attractive and sustainable
  • open a consultation on proposals to make it easier for overseas dentists to work in the UK

Responding to the proposal that Dental graduates in England could be compelled to work in the NHS work or face repaying some training costs, Prof. Grant McIntyre, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of Edinburgh, commented: “As most dental graduates already start their careers in the NHS and contribute to NHS patient care as an undergraduate student and during their early professional career, we are uncertain of what practical benefits this proposal will have.

“Most dental graduates have also accrued significant personal debts to complete their dental training, usually in excess of £100,000. Therefore, we believe this proposal is likely to make NHS dentistry even more unattractive for dentists to provide NHS dental care as their career develops.

“As per our election manifesto, we believe a more constructive approach is needed that focuses on creating a positive working environment to encourage sustained delivery of NHS practice. This means reforming the current dental contract, improving workforce planning and a renewed emphasis on preventative health and reducing health inequalities.

“We believe positive rather than punitive steps are required to lift morale, improve dental recruitment and retention, and improve access to services for the benefit of patients and the population.”

NHS dentistry in Scotland: SNP can’t pretend it’s “Mission Accomplished”

The British Dental Association has said there can be no complacency from the Scottish Government on the crisis in NHS dentistry, following yesterday’s debate in the Scottish Parliament, in which MSPs raised the heart-breaking case of a single mother going without food to pay for care, with others travelling hundreds of miles for access or embarking on ‘DIY’ dentistry. 

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.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “MSPs and patients across Scotland have sent a clear message: the Scottish Government cannot pretend it’s ‘Mission Accomplished’ on NHS dentistry.

“Recent reforms may ease problems, but Ministers can’t afford to take their eyes off the crisis in this service.”

Dentists back Holyrood putting ‘DIY dentistry’ under the spotlight

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.”

Government failure on amalgam ban ‘could break NHS dentistry’

Services in all UK nations face hit, Northern Ireland an existential threat

The British Dental Association has warned the European Parliament’s vote to ban dental amalgam from 1 January 2025, will send shockwaves across the UK’s already struggling dental services.

Silver amalgam is the most common material for NHS permanent fillings across the UK. Fillings represent around a quarter of all courses of NHS treatment delivered in England, with amalgam used in around in around a third of procedures.

BDA estimate treatment times and costs of alternative materials are over 50% higher than those of amalgam. [1]

On 14 July, the European Commission adopted a proposal to revise the Mercury Regulation, to introduce a total phase-out of the use of dental amalgam and prohibit the manufacture and export of dental amalgam from the EU from 1 January 2025 – 5 years earlier than expected.

The vote will hit all four UK nations but will have a disproportionate impact on services in Northern Ireland, which has the highest proportion of filled teeth of any UK nation. [2] Under post Brexit arrangements, Northern Ireland will be expected to phase out dental amalgam on the same basis as EU member states. Divergence means the rest of the UK faces disruption and higher costs given the impact on supply chains, but not a formal ban.

In an open letter to all four UK Chief Dental Officers, the BDA stress there are currently no alternative restorative materials that compete with amalgam on speed of placement or longevity, meaning the ban will eat into clinical time and resource that are in short supply, likely creating further access barriers. 

There are no indications where the millions in additional funding required will come from nor the workforce to carry out the tens of thousands of extra clinical hours.

MEPs also backed amendments stating that Member States need to “ensure appropriate reimbursement is made available for mercury-free alternatives” to limit the socio-economic impact. The BDA say the same approach is need from all UK Governments. 

The Nuffield Trust warned in December that NHS dentistry was at the most precarious moment in its 75-year history. The BDA warn that without decisive action, this ban will only hasten the service’s demise.

While the BDA has long supported a phase-down in dental amalgam, it believes this rapid phase-out is neither feasible nor justifiable. Dental amalgam has been in use and extensively studied for 150 years as a restorative material. Its safety and durability are well established, and it remains the most appropriate material for a range of clinical situations. 

BDA Chair Eddie Crouch said: “When we are set to lose a key weapon in the treatment of tooth decay all four UK Governments appear asleep at the wheel. 

“When alternative materials can’t compete, this will add new costs and new uncertainties to practices already on the brink.

“Without decisive action this could be the straw that breaks the back of NHS dentistry.”

[1] BDA research on treatment times and costs, 2023. Figures are derived from a comprehensive research study into NHS dental treatment times. A unit price per treatment has been generated using official figures for dental expenses, courses of treatment and dentist earnings (available through NHS digital), supplemented by further BDA research. 

[2] Total number of Teeth Filled per 100,000 population by UK nations and Financial Year, From Family Practitioner Services General Dental Statistics for Northern Ireland 2022/23

In Northern Ireland’s Item of Service Claims 2022/23, amalgam was used as a material in 153,000 of the 353,000 claims for permanent fillings on adults and children, or 46% of the total.

While amalgam use is not centrally recorded in England, the BDA understands these represent around a third of fillings placed in England on the NHS.

Dentistry: COVID impact on scale unseen in any other part of NHS

The British Dental Association has warned MSPs the pandemic has had an unparalleled impact on NHS dentistry, that leaves the service facing an existential threat. 

As the professional body prepares to give evidence to the COVID-19 Recovery Committee inquiry into NHS dentistry today (22 June 2023), it has published new analysis showing the scale of the backlogs.

Initially closed to routine care, and then facing exacting Infection and prevention control guidelines that reduced patient throughput, lost capacity on the high street exceeds general medical practice and secondary care, resulting in backlogs that will take many years to clear:

  • Dentistry has lost over half (52%) of its capacity since lockdown, when comparing examinations delivered since March 2020 with typical levels pre-COVID.
  • For GPs, that figure is just over 30% (when looking at lost face-to-face appointments). It is just over 6% for hospital outpatients and in terms of volume, inpatient care appears to have already recovered lost ground.
  • By any measure captured in official data, whether it is examinations or Statement of Dental Remuneration (SDR) activity claims, Scotland has lost more than a year’s worth of NHS dentistry.
  • Ongoing access problems are fuelling backlogs, with patients presenting with higher levels of clinical need. In recent BDA surveys over two thirds (67%) of dentists cite higher needs patients requiring more clinical time as a key issue on return to ‘full’ capacity. The only comparable problems are those concerning recruitment and retention of dentists (61%).

Dentist leaders say it will be impossible to restore pre-pandemic activity without radical change. The low margin/high volume model the service works to was incompatible with working through the pandemic and cannot form the basis for a meaningful or sustainable recovery.

This leaves the service at a crossroads: with a contract that is unfit for purpose, underfunded, overstretched and facing the challenge of deep and widening oral health inequalities. BDA Scotland fear that an exodus of dentists from the     NHS is already in motion. This shift is going unseen in official data, that counts heads not the amount of NHS work dentists do. These workforce statistics give an NHS full-timer the same weight as a dentist doing one NHS check-up a year.

Recent BDA surveys indicate only 1 in 5 (21%) of practices have returned to pre-COVID-19 capacity. The professional body say hard limits on restoring capacity, and the existential threats to NHS dental services require a proportionate response from the Scottish Government.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “COVID hit dentistry like no other part of the NHS in Scotland.  

“We’re not asking for special treatment, just a proportionate response. One that recognises the scale of the backlogs and the existential threat to this service.

“NHS dentists are already walking away from a broken system. There can be no recovery without reform.”

Poor children to suffer, as Scotland’s oral health gap set to widen

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.”

‘A meaningless metric’: Scotland’s dentists respond to Lib Dem figures on registration

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.”

Next First Minister must halt exodus from NHS dentistry

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

Financial uncertainty                                            90%                                           472

Patient Anger/Abuse                                            67%                                           352

“A service on the brink”

Without reform NHS dentistry will go from crisis to collapse

Following yesterday’s debate in the Scottish Parliament the British Dental Association has urged the Scottish Government to deliver meaningful reform to NHS dentistry by the autumn, stressing failure to do so will take the service from crisis to collapse.

On Tuesday Ministers announced a ‘bridging payment’ – originally due to lapse on 1 April 2023 – which uprated NHS fees by 1.1 would continue to October 2023. With spiralling costs BDA Scotland has continued to stress that the traditional high volume/low margin model NHS dentistry works to was now unsustainable and removing the payment would push practices to bankruptcy or into the private sector. 

Despite needed progress on this extension, BDA Scotland warns a new sustainable model must be in place by 31 October, otherwise the extension will only delay the inevitable. Practices are already facing the risk of providing care that involves laboratory work – like dentures – at a loss.

NHS dentistry in Scotland has not returned to anything resembling business as usual. Recent data has indicated claims submitted by NHS dentists for dental work are 43% down on 2019 levels and suggest a growing exodus from the NHS workforce.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “There was little need for a debate on whether NHS dentistry in Scotland is in crisis. On access, on workforce, on inequalities, wherever data exists it points to a service on the brink.

“The Scottish Government made the right call by not prematurely pulling the plug on vital support.

“The question is now whether come October we’ll have the reforms needed to give this service a future. Failure to do so will take us from crisis to collapse.”