Tag: oral health

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.”

Eat Well for Oral Health programme at Pilton Community Health Project

We’re delighted to offer our Eat Well for Oral Health cooking, nutrition and oral health 8 week programme at @PiltonComHealth with LINKnet Mentoring.

These sessions will provide culturally appropriate nutritious food, recipes and support accessing an NHS Dentist

Edinburgh dentists commit to protecting children’s teeth

At risk youngsters in most deprived communities to get varnish treatment

DEDICATED dentists from five Edinburgh practices have pledged their time in the urgent fight to stem a growing oral health emergency affecting the country’s children.

Between them, Bellastane Dental Care, Earl Grey Dental Practice, Gilmore Dental, Fairmilehead Dental Practice & Implant Centre and KF Dental are part of Clyde Munro Dental Group’s target of treating at least 1000 children with a fluoride varnish (FV) application in dedicated out of hours clinics by the close of 2022 – one of the most effective treatments for preventing tooth decay in children from the age of two.

Typically offered up to twice a year, the pandemic-induced backlog means it is not currently as readily available to families under NHS services.

The pledge comes after worrying statistics showed that 850,000 fewer patients had been seen in the past two years compared to 2017-2019. In children’s services just 55% of children in the most deprived areas have seen a dentist.

The latest data 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.

These stark and persistent inequalities have widened as a result of the pandemic, with the collapse in access to routine services, the suspension of public health programmes and the impact of sugar-rich lockdown diets.

Tooth decay in children is a major health problem in the UK – and despite being entirely preventable is one of the most common reasons for hospital admission in children.

Jacqui Frederick is Group Clinical Director at Clyde Munro and one of the group’s dentists to have helped more than 100 young patients access FV treatment in 2021, since Clyde Munro started the children’s clinics in the last quarter of last year.

She said: “We’re a predominantly NHS-based group and we take our responsibility as Scotland’s biggest dental group seriously.”

“As you might imagine, our dentists are deeply concerned at falling numbers of young patients accessing NHS dentistry services. The pandemic has set back the oral health of so many people and we want to be a part of the fightback.

“We wish we didn’t have to volunteer time out of hours to get this done – but in doing so we can reach out to those in need, any concerned parents or guardians can contact their nearest Clyde Munro practice to enquire about  FV clinics.”

FV application is a dental treatment that takes around 10 minutes and Clyde Munro will prioritise its practices that are within reach of many of Scotland’s more deprived communities. It will not require the parent or the child to be a registered patient. It will release dates and times of its clinics regularly on its website.

The group has 54 practices, from Orkney to the Borders and is represented in all of Scotland’s cities and many of its towns, with 400 staff supporting 460,000 patients.

Clyde Munro provides quality, affordable, general and cosmetic dentistry in well equipped, modern practices. Locations are convenient and accessible making it easy to visit the dental facilities.

Find out more about Clyde Munro at https://clydemunrodental.com/

Dentist say seize the moment, as CMOs back water fluoridation

The British Dental Association has welcomed the new joint statement from all four UK Chief Medical Officers highlighting the benefits of water fluoridation in reducing tooth decay.

The BDA fully supports community water fluoridation as a safe and effective public health intervention, as part of a package of measures to improve dental health, where technically feasible and appropriate for local needs. The Health and Care Bill, currently before Parliament, is set to simplify the rollout of the policy in England. Dentist leaders are now urging all 4 UK administrations to restate their positions on water fluoridation in light of the statement.   

Public Health England modelling shows water fluoridation more than pays for itself in medium term, owing to reduction in treatment need. £1 spent equates to £12.71 savings in five years, rising to £21.98 in ten. The BDA has stressed that upfront investment by Government is vital to unlock these benefits. 

In their statement, the four UK CMOs recognise water fluoridation should be seen as a complementary strategy, and not a substitute for regular dental check-ups and other effective methods of increasing fluoride use. 

The BDA backs a joined-up approach in which tried and tested policies like water fluoridation and supervised tooth brushing in early years settings are expanded, with parallel effort applied to rebuilding high street dental services.

Oral health inequality is anticipated to widen, given combination of unprecedented access problems, the suspension and ongoing disruption to public health programmes and changes to dietary habits since the start of the pandemic. Over 30 million appointments have been lost in NHS dentistry since lockdown, in England alone.  

Around 5.8 million people in England receive fluoridated water, the lion’s share artificially added, but in some locations the appropriate level exists naturally within local water supplies.

British Dental Association Chair Eddie Crouch said: “Every dentist will thank the CMOs for recognising the lasting benefits water fluoridation could bring to the nation’s oral health.

“However, these gains are purely theoretical without upfront investment. Spending here will pay for itself, and Ministers need to show they are willing to seize the moment.

“We need a joined-up approach. COVID has left millions unable to access care, and deep inequalities are now set to widen. The four Governments must double down on tried and tested policies while rebuilding the services millions depend on.” 

Johnstone concern over missed tooth decay targets

01-jan-happy-kids-at-rwcc-burns-supper

Alison Johnstone MSP, Health spokesperson for the Scottish Greens, has expressed concern at statistics showing that half of Primary One children in deprived communities have tooth decay.

The NHS report concludes that “clear health inequalities persist, and reducing dental health inequality must remain a priority.”

The main finding is that in the most deprived communities 55 per cent of P1 children have no obvious tooth decay. The national target is 60 per cent. In the least deprived communities, 82 per cent have no decay.

Alison Johnstone MSP said: “Poor dental health among children in less well-off communities is a tragedy and we must do more to turn this around. Getting children into good habits to look after their teeth is vital and there are good schemes in operation across Scotland, but we need to see greater effort to support parents, carers, school staff and communities.

“On top of that, there are steps that we can take to reduce the income inequality that contributes to poor health outcomes. I’ve already persuaded Scottish Ministers to roll-out the Healthier Wealthier Children project which boosts the incomes of vulnerable families. We can go much further by improving wages and using tax powers to put more money in the pockets of those who need it most.”

National Dental Inspection Programme (NDIP) Report 2016:
https://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2016-10-25/2016-10-25-NDIP-Summary.pdf