NHS dental services ‘to restart across Scotland from 1 November’, says Government
See also 13 October update appended to this post.
NHS dentistry services in Scotland are set to resume next month, according to the Scottish Government, after being stopped because of the COVID-19 pandemic. In plans announced at Holyrood today, services will be able to restart for patients from 1 November.
But the way in which the news was announced and the pressure it will put on practices to maintain safety – at the same time as meeting heightened demand and expectations from patients – has angered the profession.
While practices were able to some restart treatments over the summer, including urgent care, the full range of NHS procedures was not available to patients and the restriction on the number of people that can be seen per day has created a backlog that will impact the oral health of the nation.
The announcement follows the publication last month of the Scottish Dental Clinical Effectiveness Programme’s (SDCEP) rapid review into the use of aerosol generating procedures (AGPs) and pressure from within the Government’s own party over its ‘neglect’ of the profession.
On publication of SDCEP’s rapid review, Tom Ferris, Scotland’s Chief Dental Officer (CDO), tweeted that the review and a joint statement by the UK Governments “form [the] background of our plans to restart routine dentistry”.
However, there is pressure on the governments to provide new financial support to the profession for capital investment in equipment that would allow a return to routine care on a significant scale.
A member of the review’s working group said that the report held out the hope of dentist activity increasing significantly, possibly to between 60 and 70 per cent of pre-COVID-19 levels.
“I truly believe that this is the report the profession has been looking for,” said Mick Armstrong, former chair of the British Dental Association. “We now need and eagerly await Government policy.”
Making his announcement today, Joe FitzPatrick, Scotland’s Public Health Minister, said: “This pandemic has been an extremely challenging time for dentistry and I extend my sincerest thanks to the sector for their patience and resilience throughout the period.
“The Government is committed to ensuring that the needs of patients to be seen for NHS dental treatment can be met in a way that supports efforts in practice to maintain the high standards of health and safety needed to minimise the threat from COVID-19.
“Work has been carried out at pace to improve our understanding and risk management of COVID-19 transmission in dental settings, allowing for further progress with the NHS dental remobilisation and I am pleased practitioners, from November 1, will be able to provide a full range of treatments to all NHS patients within dental practices.”
Despite the reopening, FitzPatrick said the sector will not return to “business as usual” as practices still need to limit the number of patients they see due to the ongoing spread of the virus.
He added: “But by making available a full range of treatments for NHS patients, dentists and dental teams will be able to provide a wider range of NHS care, prioritised by clinical judgment and in line with wider public health protection measures.
“We stand ready to continue working constructively with the sector to help facilitate this remobilisation. I would like to thank the sector for their efforts in providing safe care to patients and I am sure they stand ready to continue to provide the best of care as we navigate the coming months together.”
But the response of many in the profession – to an announcement released via a written Parliamentary answer and first reported by STV – was not favourable. “Is this really how you expect to inform the profession?,” tweeted Ashley Chisholm, an Edinburgh-based dentist.
Southside Dental Care added: “A total lack of respect for the hardworking people of this industry for us to find out via STV news at the same time as our patients. We would love guidance and communication on how we can safely see the high volumes of NHS patients during this time in the pandemic.”
After the written parliamentary answer had been published and reported by STV, health boards received a letter from the CDO this afternoon confirming the announcement and saying: “You should be assured that I fully recognise the position that a return to pre-COVID levels of patient volume will not be achievable under the current health protection measures.
“I am aware that it will still be necessary for you to prioritise appointments for patients requiring urgent dental care, those at greatest risk of oral disease and the backlog of patients from during the ‘lockdown’. This is not business as usual but by making available a full range of treatments for NHS patients, we are enabling dentists and dental teams to provide a wider
range of NHS care for their patients, prioritised by your clinical judgement.
“I also understand that you will have a range of questions about the funding of NHS dentistry and our longer term plans. In the immediate term it is necessary to return NHS dental services back in a way that is familiar to you and patients are used to as well.
“This means we will be reintroducing item of service fees and NHS patient charges because the activity that is undertaken allows us to understand the patterns of care provided during this interim period. Reintroducing the NHS patient charge will allow us to increase the top-up emergency payments to NHS dental contractors. I will provide the full details of these new arrangements to you very soon.”
The British Dental Association said in a statement: “We were disappointed that the profession was not informed of the Scottish Government’s decision before it was announced this morning.
“Many patients have already been contacting dental practices about the extended range of treatments which has increased the stress on dentists and their teams.
“The Scottish Government is due to publish further details later this week on the expanded services and the support funding for dentists. We will comment further when we receive this information.”
UPDATED 13 OCTOBER:
The Greater Glasgow & Clyde Local Dental Committee said that the CDO’s letter of 12 October “essentially introduces another intermediary remobilisation phase. This has quickly come to be known (unofficially) as Phase 3c”.
The LDC’s update continues:
What we know:
- The full range of NHS dental treatments will be made available from 1 November.
- Patient charges will be reintroduced.
- The SDR [Statement of Dental Renumeration] will be back (for time-being).
- Most AGPs will still require FFP3, gowns, ventilation and fallow time (the letter states that NHS guidance and SOPs are in development).
- PPE will continue to be provided centrally.
And it adds:
Questions we are asking:
- What Financial Support Measures will replace the current Covid FSM
- Will any new FSM will be contingent on activity?
- Will the Prior Approval system be reactivated?
- What do practices who can’t provide AGPs do with all the patients who will now expect treatment?
- Will there be financial support forthcoming to retrofit ventilation to accommodate AGPs?