Scottish dentistry – where next?

The SNP’s ‘100 days’ pledge to remove dental charges for care leavers and young adults is an immediate priority but fundamental reform of the nation’s oral healthcare system could span the five-year term of parliament

21 June, 2021 / indepth
 Will Peakin  

At the Conference of Scottish Local Dental Committees webinar, ‘Scottish Dentistry – Where Next?’, last month, the first question posed by a delegate to Tom Ferris, Scotland’s Chief Dental Officer, was about communication. This is, we know, a sore point with the profession.

In response, the CDO said that between March and December last year, there had been a total of 40 formal communications, comprising letters from his office and ‘PCAs’, the technical documents that are routinely issued by the Government’s Health and Social Care Directorate. Sometimes a few were issued in a short space of time, he said, other times there were longer gaps between communications.

“I accept that people may have wanted to hear more frequently,” he said. “Before the pandemic, CDO letters were relatively rare. We almost only communicated with GDPs through PCAs, which are quite technical and may not always have been widely read.

System reform will bring in a new, preventatively focused, patient-centred dental system that is free at the point of care, and we’ll do both things together

“So going forward, the CDO letter can be used more frequently to help signal changes that are coming, for example the manifesto commitment [by the SNP to scrap the patient charge].” Ferris said that the webinar itself, and others he had spoken at this year, was a format that could be used more extensively, adding “harnessing the power of digital, the simplicity of a CDO letter, and the detail of a PCA.”

Ferris said that it was not always in his gift to say something, even if he had wanted to; he is, he said, beholden to a legal team, Government ministers, and other parts of the Government to which he has to align. The questioner said they appreciated this but pointed out that on a few occasions the profession had been “blindsided” by announcements, perhaps made late on a Friday, or first heard via television news reports. “We learned from that too,” said the CDO, in response.

David Notman, the senior policy adviser to the Scottish Government, Dentistry and Optometry Division, added: “The last 12 months have been an incredible learning experience for us within government, and how best to work with the sector. There were two or three points that caused a degree of difficulty, we’ve taken that on board and will try and do better in the future.”

The CDO was asked about what plans there were for dentistry in the event of a third wave of COVID-19. He said: “If you take it that we remobilised on 1 November with a full range of care potentially available to patients, if practices were able to see them, and then after that, in the new year, we had a second wave [but] not very much changed in the way practices operated.

Tom Ferris, speaking at the LDCs Conference webinar

“We know they are safe; we know that dental teams are very good at infection prevention control. We’re not seeing clusters [of infection] associated with dental practices. So, I don’t see a third wave making a difference to the way we practise.”

He also addressed the issue of funding for ventilation, saying that although other nations of the UK had announced funding there was a concern that ‘quick fixes’ offered by the private sector may not, in the long run, be appropriate. The Scottish Government could have “thought of a number and divided it by 1,100” to arrive at a grant per practice, he said. But they had wanted to understand the issue for practices in more detail, so that the right kind of support could be offered.

A survey it had carried out had received a “really good” response; around 75 per cent of practices in Scotland. The results have been analysed, he has received a report and hopes to make an announcement soon. Ferris did say that it would likely be available to practices that had already invested in ventilation in order to see more patients: “It would be unfair to exclude them.” Funding would probably be for fixed systems, he added, rather than portable equipment.

The CDO was asked about the SNP’s patient charge manifesto pledge; how will the measure be introduced, will all treatments currently available to patients still be available, and how will practices be supported to cope with the likely increase in demand at the same time as dealing with the backlog of treatment which has built up during the pandemic.

Ferris said his team was currently working on the first part of the commitment, to remove dental charges within 100 days for care leavers. The second – free care for all NHS patients – is to be delivered over the lifetime of the parliament, that is five years. He said they were mindful of the potential for increased demand, even initially with care experienced patients.

“In terms of the free dental care, in my mind that’s tied up with the new model of care that we were hoping to do. There’s probably no point in having two major policy changes over the course of the parliament – ‘let’s make dentistry free and then let’s completely change the system of how we deliver dentistry’.

“Our view is part of that system reform will bring in a new, preventatively focused, patient-centred dental system that is free at the point of care, and we’ll do both things together. That’s a big piece of work which will involve a lot of discussion with a lot of groups, including DCP [dental care professional] groups whose skill mix might be more important as we go forward.

“It will also mean that we will have to have a conversation with the public because they ultimately fund the service, and they are the users. It’s a big piece of work and we need to sort out our immediate problems, which are things like ventilation, PPE, the 100 days commitment.”

Notman added that it was possible to look at the free dental care pledge “very positively” as, effectively, a commitment to dentistry by the Government worth about £76 million a year. He said, however, they were very aware of the consequences, in terms of demand, of making something free at the point of delivery and that the system of payment had to be looked at very closely.

The CDO was asked when the Government intended to address the issue of the medium-term funding of the general dental service “given that it is impossible for practice owners to create a business plan for the future when no such information is available,” said the questioner.

Ferris responded: “We’ve committed that financial support you currently have is in place for the remainder of this financial year. However, we’re conscious that the current way of paying your financial support was brought in very, very quickly, to address an emergency when we when we closed practices for face-to-face. Probably most dentists are in a reasonable ‘steady state’ position at the moment.

“But there are some issues where it’s not working quite as well as before. So, things like maternity pay, long term sickness, paternity and adoptive leave, where someone joins NHS Scotland from outwith Scotland, and where someone tries to move practice – it is not quite working as slightly as we wanted.

“So, we wanted to have a review of the way we fund it, because actually getting to the system reform piece is probably going to take a bit longer than we had expected. And the system remains compromised at the moment. So, we’re not even really going back to where we were pre-COVID, where we could say ‘right, item of service’ again, and the [current] financial support would stop.

“We want to have those discussions; those are probably our priority over the next while, once we deal with ventilation and the 100 days commitment. Financial support – stability – is our next priority. We were very conscious that we need to do it quickly, because we are aware that you are all small businesses, and you want to have that degree of stability and certainty. And that’s what we would like to be able to offer you.”

View the webinar here: https://tinyurl.com/2z468kf (Ventilation and funding – 27 minutes; free NHS dentistry – 35m; activity measurement – 1hr 23m; Associate recruitment, maternity, locums – 1hr 34m; New model of care – 1hr 42m; VT – 1hr 47m.)

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