Keeping dentistry on the election agenda
With the Scottish Government elections just weeks away, the campaign trail is really starting to heat up. Dentistry is rarely front page news and you’ll be hard pressed to find mention of the profession in any party manifesto, but that doesn’t mean the election won’t affect practices up and down the country.
The British Dental Association (BDA) in Scotland has highlighted combating oral health inequalities as its major manifesto issue. It argues that despite improvements over the last 40 years or so, Scotland’s oral health still lags behind the rest of Western Europe and that inequalities between those with the best and worst oral health still persist.
The BDA recognises the role the successful Childsmile scheme has played in making inroads but it is calling for the fluoridation of water supplies to be put back on the agenda so that communities themselves can decide whether they would like to benefit from the measure.
The issue of lifelong registration is another item that the association in Scotland says needs a rethink by any new administration. The BDA is calling on the new government to recognise the importance of regular attendance in stemming the growing number of oral cancer cases. The union also highlights the number and location of dentists in the country as requiring attention, with a shortage of dental academics and geographical disparities in the provision of both primary and secondary care as problems that need to be addressed.
Andrew Lamb, BDA Director for Scotland, said: “Despite improvements in the dental health of Scotland over the last 40 years, there is still a great deal to do if we are to eradicate persistent oral health inequalities.
“We have successes to celebrate, including the excellent Childsmile scheme and improvements in access to dental care in some areas, but the new government will nonetheless face significant challenges in the field of dentistry and oral health.
“Candidates standing for election this year must pledge to work with the dental profession to take on those challenges and deliver improvements for patients.”
In its election wish list the Dental Professionals Association (DPA) also highlighted lifelong registration as one of their key issues. Reg Short, one of the association’s council members for Scotland, pointed out that, for dentists, continuing registration was never seen as anything other than a ploy to produce ever-improving registration figures.
However, he said: “The public could be forgiven for believing that this meant that the dental service was therefore improving. The profession warned that the reverse was likely since the incentive to visit for examination periodically was being removed.
“The only other incentive for many patients is the need for emergency treatment for relief of pain. This subject must be revisited as a matter of urgency before large parts of the service revert to pain relief only.”
The DPA also points to the recent problems with Practitioner Services Division’s records, saying a new IT system is needed.
The association also questions whether any incoming administration would take on what it regards as “a misuse of public funds” and address the misgivings within the profession over the ongoing decontamination issue.
The DPA maintains that no convincing case has ever been put forward that the proper, reasonable decontamination and sterilisation methods used prior to 2005 ever resulted in harm. It says that due to the precautionary principle, dentists are now bound to guard against risks that cannot be shown to exist.
We asked five dentists about their hopes, and fears, for the dental profession after the election:
Jackie Morrison, community dentist in Lanarkshire, vice chair of the Scottish Salaried Dentist Committee and chair of the Scottish Accredited Rep Group of the BDA
“As salaried dentists we jealously guard our special needs function and we hope that, with times being tight over the next few years, funds and time are made available for us to continue this.
“We have problems with recruitment and retention in the salaried service, which may be due to the protracted negotiations delaying the delivery of a new contract which compares favourably with what has been agreed in England. It is worth noting that we are the last part of the NHS not to have a review of our contract. The negotiations on this continue.
“Our main concern is funding. We are committed to seeing and treating vulnerable groups and those who find it difficult to access NHS dentistry. For this to continue proper funding must be assured.
“It seems that to make savings, posts will not be filled as people retire or move on, perhaps to parts of the country with better pay and conditions. Many salaried dentists, including myself are coming to the end of their career. If our posts are not filled, either to cut costs, or because new graduates do not find the jobs attractive, the concern is that vulnerable groups will not receive the treatment they are entitled to.
Lachlan MacDonald, GDP in Paisley, Renfrewshire
“England is rapidly moving towards private health care similar to the American model and, despite cries to the contrary from the Scottish National Party (similar to the student tuition fees fiasco), it is difficult to see how we are to fund both medical and dental care for the Scots who are gaily eating, smoking and drinking themselves to death.
“The mixture of dentists doing both private and NHS work must be addressed. Some private charges are appalling and yet the department of Dental Public Health within the Scottish Government Health Directorate will not increase the number of dentists working at the NHS ‘enamel face’.
“One answer is that any dentist who qualifies in Scotland should be obliged to work in the NHS (not in the private sector) for five or six years. Either that or that we nationalise the ‘tooth fairy’ and send the proceeds to Alex Salmond!”
Morven Swan, GDP in Huntly, Aberdeenshire
“As an NHS dentist working in times of recession and cutbacks, my main hope would be that money will continue to be invested towards improving NHS facilities and services, particularly in remote and rural areas.
“Over the past few years, my health board, NHS Grampian has invested in several major developments such as the new Aberdeen Dental School, the Spynie Outreach Centre in Elgin and our own dental practice in Huntly which offers independent, salaried and specialist services all within the one centre. I feel that, as a direct result of the increased funding we have received, both patient registrations and dentist numbers are now at an all time high within the region, and I would hope that sustaining this level of investment would allow these figures to rise even further.
“I would also hope that money would continue to be spent on improving oral health, in particular through the Childsmile programme. The most recent National Dental Inspection Programme produced the best ever results for children’s oral health, which not only illustrates the impact the scheme has already had on preventative care, but highlights the importance of continuing to invest in the Childsmile programme to ensure children from an early age are primed for a lifetime of good oral health.”
Terry Simpson, GDP in Livingston, West Lothian, honorary research fellow at Edinburgh Dental Institute and clinical effectiveness advisor for NHS Lothian
“In general terms I think any Scottish Government is going to have its hands tied to some extent by the economic conditions. Whatever happens there is going to be quite a tight squeeze on the finances and I think it is bound to come through to dentistry eventually.
“In fact, in some w
ays there is the argument that perhaps it should have been implemented a bit earlier. The fact that it has taken so long for the government to make cutbacks in Scotland means that there is probably going to be a bit of a catch-up process with our colleagues south of the border.
“I think there has also been a build up of bureaucracy within the system which needs to be slimmed back and we need to concentrate on the patient-dentist relationship more. I think there has been far too much interference by government and the problem is that this can detract a lot from patient care.”
Tony Coia, GDP from Clydebank, West Dunbartonshire and chair of LDC conference
“I think the first thing would be the effect of any future public sector cuts within dentistry. I’m sure that high street private independent dentistry is feeling the strain just now, but as far as health service dentistry is concerned, I think an awful lot will depend on whether the allowances are tinkered with because that would make a huge difference to the profitability of practices. We’ve had very little, less than one/one and a half per cent over the past three to four years, plus with the VAT increase people are struggling just now and profits are being squeezed.
“The other issue is pensions and that’s going to have a profound effect on morale, not so much for the dentists in their 30s but certainly for people in their 40s and older who are beginning to flag a wee bit and the thought of maybe another five, six or even seven years working doesn’t fill them with much optimism.
“I’m hoping that, coming up on 57 myself, I’ll be able to get out before things start to really hit the fan, but we will just have to wait and see.”