Closing the circle

15 August, 2019 / editorial

NHS National Services Scotland launches a three-pronged initiative to tackle waste

Taking part in a BBC Radio 4 programme earlier this summer about the history of the toothbrush, Peter Dyer, the chair of the British Dental Association’s Central Committee for Hospital Dental Services, was struck by a couple of statistics that emerged; first, that if we in the UK each use one toothbrush every three months, then we are disposing of approximately 200 million brushes each year – and, second, research has shown that it can take 400 years for a plastic toothbrush to degrade.

“Anyone who watched the Blue Planet series with David Attenborough or more recently the War on Plastic with Hugh and Anita [Hugh Fearnley-Whittingstall and Anita Rani], couldn’t help but be moved by the realisation that our reliance on plastics is causing havoc to the environment,” wrote Dyer last month in a blog post at

“The plastic-free July campaign [] has also made me think, what can we do in dentistry to help reduce plastic usage and reverse the dire consequences of using this material in such large quantities?”

While consumer-facing campaigns promoting environmental sustainability are at the forefront of public discourse, the role of medical professionals in reducing waste commands a lesser profile; understandably so, as their primary concern is the patient’s health and, in the case of of re-use or disposal, the public’s safety. The BDA is working on the issue of sustainability in dentistry across the UK, engaging with key stakeholders to develop policy and supporting dental practices to overcome the barriers to becoming more sustainable1.

In Scotland, environmental sustainability in dentistry is set to come to the fore as NHS National Services Scotland launches a three-pronged initiative to tackle waste in the profession. The re-tendering of NHS DenPro, the collaborative procurement scheme for NHS Dentists in Scotland, will influence the range and type of disposable items that practices can purchase. NSS is also working with Zero Waste Scotland to move practices from using non-recyclable white plastic cups to others that are recyclable. A new waste contract will provide opportunities to recapture some recyclable items, allowing practices to contribute to the circular economy.

“Scottish dental practices probably produce a disproportionately high level of waste in comparison to other Scottish health care providers, as a consequence of decontamination guidelines,” noted Paul Cushley, NSS’s Director of Dentistry. 

“Practices need to demonstrate a commitment to reducing waste and recycling as part of their responsibility for social stewardship in the communities they serve.

“Like every other business, they have to help contribute to the ‘reduce, recycle, reuse’ agenda rather than continuing to contribute to the growing amount of waste that is polluting our environment. NSS, in partnership with dental practices and dental suppliers, will drive this agenda through a number of initiatives providing support for dental practices to make positive environmental choices and help facilitate improved environmental stewardship.”

The organisation is developing an ‘eco-challenge’ which suppliers and practices can sign-up to, promoting awareness and delivering actions that foster good ecological stewardship. It will move suppliers towards tagging products using a red, amber, and green traffic light system identifying those which can be recaptured and contribute to the circular economy and allowing practices to make positive buying choices. It will also work with practices to provide a mechanism through the collection of the orange waste stream nationally to capture recyclable plastics.

Cushley said that initial feedback had been positive: “As part of the customer engagement process around the renewal of the DenPro contract, NSS surveyed the membership around the issues of disposable items. There was a positive response to being able to identify good environmental choices in the catalogue. 

“It was also recognised that there is a need to reduce choice where multiple, similar products are available. Although every change may not have an environmental benefit there could be associated benefits of standardisation. A reduced choice could potentially deliver a financial benefit through economy of scale purchasing as well as improving ecological outcomes.”

He also highlighted what had been achieved to date: “DenPro is the first NHS Scotland multi-practice buying group and has dispelled the myth that dentists could not or would not act in a collective manner. Dental practices signed up to a simple promise that NSS would go to the market and negotiate hard on behalf of our 400 member practices and deliver savings. 

“We have delivered huge savings since May 2016. We have expanded the offer during this time to include a broader range of goods and services available at a saving. We have created a one-stop shop for practices to allow them to concentrate on delivering the best quality of dental care, what they are best at, and reducing the need to spend time shopping around for the most competitive prices.

“Dental practices are no longer at the mercy of pricing that is solely determined by what the manufacturers and suppliers want to charge dental practices. NSS has delivered the savings and profoundly changed the dental market. Prices from all the dental suppliers and not just our current commercial partner have significantly reduced across the board in Scotland due to the influence that DenPro has had on the dental market.”

Looking ahead, Cushley said that under the new contract the range of goods and services will be protected. “We will award the new contract based on the actual product use data we have from running the contact for three years. Previously this was based on experience derived from similar exercises. We will redefine what the core items
are within the contract – those that are delivering the greatest saving and price stability – based on the most
up-to-date data.

“There will also be a process for the supplier to propose new product ranges to reflect changes in technology or legislation. The changes around packaging regulations and Brexit uncertainty, too, will influence the construction of the contract. Perhaps the greatest change in the offer will be towards a focus on savings on familiar products across the catalogue categories, rather than just on the most frequently purchase items across the whole catalogue.”

Cushley added that NSS is in an ongoing dialogue with Zero Waste Scotland about plastic cups; what is problematic about the existing type used, what are the alternatives, how easy will it be to introduce those, and what contribution that might they make in reducing waste in the long term. Making an impact depends not only on practices, he said, but also on a new waste contract that facilitates capturing all recyclable plastics. 

“The new contract offers a safe, high-quality, reliable, efficient, cost-effective, sustainable and legally-compliant service which guarantees value for money,” said Cushley. “Dental waste is just one of the component parts of the requirement for the new provider. This contract will also need to be more ambitious to help dental practices contribute to the circular economy by capturing all recyclables. The strategy is intended to open up the
market in Scotland, encourage innovation, and meet environmental targets.”

Further reading: Exploring attitudes and knowledge of climate change and sustainability in a dental practice: A feasibility study into resource management. J. Grose,J. Richardson, I. Mills, D. Moles, and M. Nasser.Developing sustainability in a dental practice through an action research approach. J. Grose, L. Burns, R. Mukonoweshuro, J. Richardson, I. Mills, M. Nasser, and D. Moles.



Tags: NHS / sustainability / waste

Categories: Magazine

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