New payment system to expand services comes into force
NHS dental teams will receive increased fees under a new payment structure from today (1 November) to help them to provide a comprehensive range of NHS care and treatment.
Examinations will continue to be free for all patients, with pregnant and new mothers, those claiming certain benefits, and the under 26s remaining exempt from treatment charges – around a quarter of all adult NHS dental patients.
A new awareness campaign called Brush Up will help people know where to get information and help to meet the costs.
For dentists, the new fee structure will streamline payments, cut bureaucracy and give them greater authority over the treatments offered.
In line with guidance from the National Institute for Health and Care Excellence (NICE), dentists will now also be able to advise patients on how often they need check ups based on their oral health, rather than everyone being seen every six months.
Public Health Minister Jenni Minto said: “Our aim with this payment reform is to incentivise dentists to remain in the NHS, provide long term sustainability to the sector, and improve access for patients.
“Replacing the existing fees with a new improved set will allow dentists to provide a full range of NHS care and treatment, while those unable to pay will continue to get help.
“All patients will continue to receive free NHS dental examinations and I want to reassure those who are exempt from NHS dental charges – including children and young people under 26, and those on certain benefits – they will continue to receive free care and treatment. People on a low income are also eligible for support, details of which can be found on NHS Inform.”
You may have heard about changes to NHS dental care in Scotland.
What isn’t changing is that you can still get a comprehensive range of treatments through the NHS. And for some people, it could be completely free.
Supporting the Brush Up campaign, Chair of the General Dental Council, Lord Toby Harris, said: “It’s important that everyone knows what to expect from dental healthcare. Dental professionals across the UK understand that patients’ interests must come first.
“They also know that this principle is woven through their professional standards. Everyone should have confidence that the whole dental team will continue to prioritise patients’ interests.”
Improved payment system to expand services – but BDA says the reforms will not repair a ‘broken system’
NHS dental teams will receive increased fees under a new payment structure which will help them to provide enhanced NHS care and treatment.
Developed in partnership with the dental sector and as part of the Oral Health Improvement Plan, the reforms also include an additional £10 million from the Scottish Government to support the delivery of laboratory-based treatment items, such as dentures.
The updated system will drive greater consideration of patients’ specific oral health needs, with more focus on patient-centred care such as preventative periodontal – gum disease – treatment.
For dentists it will streamline Item of Service payments by reducing the numbers of fees from over 700 to 45, cutting bureaucracy and giving them greater authority over the treatments offered.
While patients that are required to pay a NHS charge are likely to see an increase in costs, this will be dependent on overall treatment plan. Around 40% of patients will continue to receive free NHS care and treatment, as they did under the previous arrangements.
Public Health Minister Jenni Minto said: “This new NHS offer improves the system for both dental teams and patients and is the first step in the process to make the services available on the NHS reflect the changing oral health needs of the population. It also reaffirms our commitment to the sector and to all NHS patients in Scotland.
“We are confident that the modernised system, with increased clinical freedom for dentists, will provide longer-term sustainability to the sector and encourage dentists to continue to provide NHS care.
“All patients will continue to receive free NHS dental examinations and I want to reassure those who are exempt from NHS dental charges – including children and young people under 26, and those on certain benefits – they will continue to receive free care and treatment. People on a low income are also eligible for support, details of which can be found on NHS Inform.
“I’d like to take this opportunity to thank all NHS dental teams for their continued engagement and commitment to NHS dentistry. Increased costs for energy and the cost of living crisis still pose challenges for them but we will continue to work together to ensure the best quality of care is available.”
The British Dental Association has said Scottish Government reforms to NHS dentistry announced today fall short of the root and branch change required to make the service fit for the 2020s.
Following tense negotiations, a reformed payment system will be rolled out from 1 November 2023. This includes changes to the fees provided for many treatments and will see the number of items on the ‘menu’ at dental practices slimmed down – purportedly meant to make it less burdensome – to 45 codes down from around 400. The BDA had stressed that surging costs had left practices delivering some NHS care at a financial loss, particularly for items like dentures that require laboratory work. These items have seen significant increases in fee levels.
However, the professional body has stressed reforms offer no fundamental changes to the current model of care. The service is still predicated on a low margin/high volume system, without the appropriate targeting of resources for those in highest need. The BDA had been seeking a clean break towards a new patient-centred and prevention-focused model and say the package as it stands will do little to tackle deep oral health inequality across Scotland.
Dentist leaders have warned ministers not to view the current package as a ‘final destination’. There is uncertainty over whether these changes will be sufficient to halt the exodus of dentists from NHS services and restore access to millions.
The Scottish Parliament COVID Recovery Committee recently concluded its inquiry into the recovery of NHS dentistry, including a recommendation that the Scottish Government provide costings for – and consults on – different service model options, including those that it does not prefer, in partnership with the sector so that the opportunity is not missed to consider a full range of options for the future of service delivery.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“We’ve secured some improvements, but the fundamentals of a broken system remain unchanged.
“The Scottish Government have stuck with a drill and fill model designed in the 20th century. They were unwilling to even start a conversation on making this service fit for the 21st.
“Ministers cannot pretend this is a final destination for NHS dentistry in Scotland. We struggle to see how these changes alone will close the oral health gap, end the access crisis or halt the exodus from the NHS.”
Anyone struggling to pay for their dental care is urged to visit NHS Inform to view the support available. Patients can check if they are exempt from NHS dental charges by visiting NHS Inform.
For those not eligible for exemption but on a low income, financial support is available via the NHS low income scheme. Patients can apply for this support by completing a HC1 form. Paper copies can be picked up at community pharmacies, GP practices, Citizens Advice Scotland offices and Jobcentre Plus offices.
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.”
Revised arrangements will reward dentists for seeing more NHS patients – but dentists remain concerned
Revised payment arrangements for NHS dentists will be linked more closely to the number of patients they see under changes being introduced in April.
The revised arrangements will help ensure patients are able to access NHS services while dentists continue to be supported as they operate under necessary coronavirus (COVID-19) restrictions. The revised payments replace the emergency top-up arrangements that were introduced to protect the sector from the immediate impact of the pandemic.
Separately, an advisory group will be established to consider long term reform of the sector and future structure of NHS dentistry.
Public Health Minister Maree Todd said: “The pandemic has had a significant impact on the provision of dental care and our focus must now be on recovery and ensuring we equip the sector to work through the significant dental backlog.
“From April, the new system will support dentists to see more patients while avoiding a cliff-edge for practices and ensuring a soft transition during what is still a constrained period for dental teams.
“Importantly, this means dentists could earn more than they do now through COVID-19 payment support.
“We’re delivering record investment in dentistry – with a 9% increase in the budget for NHS dental services in 2022-23 – and there has been a 39% increase in the number of high-street dentists in Scotland between 2007 and 2021. Last year there were 55.6 dentists per 100,000 of the population providing NHS care in Scotland compared to 39.9 in England.
“We are absolutely committed to improving oral health, including the removal of NHS dental charges during the lifetime of this Parliament.”
Chief Dental Officer Tom Ferris said: “We know how important it is that NHS dental teams get the right support to carry on providing the services patients need. We’re confident that these revised arrangements are a step in the right direction to improving access, by linking financial support to seeing patients.
“We have been sharing our proposals with the British Dental Association from before Christmas, listening to the concerns of the sector and the need to avoid the cliff-edge when the emergency support payments come to an end.
“These revised arrangements are in addition to £50 million of financial support for dentists during the pandemic, along with £35 million of PPE. It also comes on top of new and increased fees for dentists for a range of treatments including enhanced appointments from 1 Feb 2022.”
However The British Dental Association Scotland has warned that dental practices will continue to face grave uncertainty, as the Scottish Government moved to impose an interim funding model for the service without meaningful negotiation.
While the BDA has welcomed the introduction of a ‘multiplier’ to be applied to dental fees, dentists have significant concerns that the planned 3-month review will have serious implications for patient care and will leave practices unable to plan.
The union remains steadfastly opposed to the return to the unworkable high volume/low margin model of care that operated pre-COVID, and has urged the Government to apply the multiplier until new contractual arrangements are in place.
The BDA had argued that the Scottish Government needed to significantly increase the current inadequate fees for extractions and denture repairs. Increased lab fees mean that dentists often provide these treatments at a loss, and the treatments are particularly prevalent in more deprived areas so any reduction in provision may further widen oral health inequalities.
The announcement follows a bruising debate in Holyrood last week, in which all opposition parties accused the Scottish Government of failing to heed the warnings from the BDA on the potential collapse of NHS dentistry in Scotland.
A BDA survey from late last year reported that 80% of dentists expect their practices will reduce their NHS commitment should the Scottish Government withdraw emergency support and return to pre-COVID models of care.
Dentist leaders have also warned that comments made yesterday by the Public Health Minister fly in the face of the facts, given the tight restrictions practices continue to work to.
Maree Todd MSP incorrectly stated that “from April, the new system will support dentists to see more patients”: an impossibility without meaningful change to COVID operating procedures.
Both the Scottish Government and the BDA recognise the urgent need for long-term contractual reform. The Government has committed to start discussions as soon as the interim funding model is in place. The BDA stress the negotiations must include all practice activity – including work on prevention that is currently unremunerated – and adopt an evidence-based approach to address the current low fees.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Bruised by the political pressure that’s been brought to bear in recent weeks Ministers have railroaded through a package that will leave practices totally unable to plan.
“The idea this package is the result of meaningful negotiation is laughable, and any idea that practices can see more patients from April flies in the face of the facts. Dentists are still working to tight restrictions, and there is no sense we are returning to anything resembling ‘business as usual’. The Government needs to communicate this clearly to patients.
“Applying a multiplier is the right call but the Government should have taken this opportunity to address derisory fees. We have faced the absurd situation where dentists are providing NHS care at a loss.
“What NHS dentists desperately needed was some certainty on what’s expected of them in the year ahead. The choice to put these new arrangements in place for just three months is an exercise in futility.”
