Tag: NHS Dentistry

Health crisis in NHS Lothian can no longer be ignored, warns Boyack

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 Boyack said: “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.”

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

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

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

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

The BDA stress that the new support package cannot presage a return to ‘business as usual’ from April 2023. Dentist leaders stress that in the months ahead efforts must be made to deliver needed change to the broken high volume/low margin model NHS dentistry is based on. Without reform, this package will simply delay an inevitable exodus of dentists from the NHS that is already evident in other UK nations.  

While COVID emergency measures have been withdrawn, dentistry in Scotland has not returned to anything resembling pre-pandemic norms, with practices continuing to work under capacity in the face of an historic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

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

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

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

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

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

Playing with fire: NHS dentistry on the brink as Ministers cut vital support

The British Dental Association Scotland has warned Ministers they risk undermining the future sustainability of NHS dentistry, as they move to scale down vital financial support for the service.  

For the last three months practices have received a 1.7 multiplier to the fees paid to provide NHS care, a reflection of the unprecedented backlog practices have faced as they try to ‘live with COVID’. The Scottish Government has now moved to pare the multiplier down to 1.3 for the next 3 months. 

This reduction follows no dialogue with the profession despite the BDA calling for regular discussions with the Government about the latest activity data and any proposed changes.

The discredited low margin/high volume model dentists in Scotland work to means treatment can often be delivered at a loss, a growing problem given the growing levels of unmet need, particularly among those from move deprived communities.   

Official data suggests the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of COVID. The BDA warn heavy-handed policies will only push Scottish dentists down the road of their colleagues in England, where thousands of dentists have left the NHS since lockdown, amid warnings from MPs south of the border that NHS dentistry now faces a ‘slow death’. 

The BDA has again urged the Scottish Government to, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry. 

Dentists remain anxious that the Government will look to remove the multiplier altogether at the first opportunity despite its stated intention not to return to the pre-pandemic financial arrangements. The BDA has repeatedly voiced its strong opposition to a return to the pre-Covid “treadmill”.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Ministers are playing with fire, pulling away the life support from a service millions depend on.  

“This multiplier helped ensure NHS dentists received fees for care that actually covered their costs.  Slashing them will leave colleagues churning out dentures at a loss while thinking twice about their future. 

“Scotland has already lost too many NHS dentists since lockdown. Ministers are now blindly heading down the path the Westminster Government has chosen, which has sparked an exodus. 

“Cuts have consequences. The Scottish Government promised free NHS dentistry for all. Short-sighted policies like this will likely result in the exact opposite, and stark oral health inequalities will only widen further.”

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

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

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

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

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

BDA Scotland have warned from the outset that a return to a ‘business as usual model’ – low margin and high volume – will put practices under unsustainable financial pressure and will likely lead to closures or movement to the private sector. Practices are facing an unprecedented backlog, with recent data from Public Health Scotland indicating that the number of treatments delivered in the year to March 2021 was less than 25% of those delivered in the previous 12-month period, corresponding to over 3.5 million appointments lost as a result of the pandemic.

NHS dental care free at the point of use remains a centrepiece SNP policy. BDA Scotland has said the Scottish Government must change course to achieve that goal, develop an interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable model for delivering care.  

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Free NHS dentistry for all is a worthy ambition. Rather than exploring ways to actually achieve that goal the Scottish Government has blindly headed down a road that could destroy this service.

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

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

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