A year in review

At the Scottish LDCs Conference delegates heard of poor communication by the Government and warnings over its intention to scrap the patient charge

21 June, 2021 / indepth
 Will Peakin  

The Annual Conference of Scottish Local Dental Committees was held towards the end of last month, featuring presentations from David McColl, Chair of the Scottish Dental Practice Committee (SDPC), Helen Kaney, lead dento-legal Consultant and head of dental services at Dental Protection, a Platinum sponsor of the conference, and Derek Manson, Northern Ireland Representative on the SDPC.

David McColl reported on the work of the SDPC over the past year, including a detailed timeline of the committee’s activities during the pandemic which reflected the profession’s frustrations with the Scottish Government. From a meeting between the committee and the Government in May 2020, it emerged that: “The CDO [Chief Dental Officer] agreed that COVID highlighted that the way dentistry is funded does not work and that it was impossible to return to the SDR and a fee per time delivery model.”

On lifting the first lockdown last June, and practices reopening for face-to-face consultations: “This indicative date was controlled by the First Minister with the CDO telling SDPC that he would not know definitively until the day before or even the morning of the announcement. The announcement was poorly worded and referred to routine dentistry being available. We warned [the Scottish Government] not to increase public expectation of what was deliverable.”

The Government had the opportunity to pilot various models of care, as the General Dental Service was effectively salaried, but they chose not to

During July, said McColl, emails to the CDO went unanswered. “SDPC requested a meeting with the [then Public Health] Minister Joe FitzPatrick to discuss our extreme disappointment with the CDO and his team over the levels of regular and timely communication and engagement with SDPC and the profession.” At the meeting, the Government was urged to start working on a plan for the long-term future of dentistry as soon as possible.

During October, the Government indicated a remobilisation of dental care. “A return to routine dentistry during another lockdown seemed mistimed and the backlog of treatment was considerable,” said McColl. “At that time the R number was rising, we were in a second wave of rising community spread and we had no vaccine. [The Government] had the opportunity to pilot various models of care, as the General Dental Service was effectively salaried and on a capitation model, but they chose not to.”

It subsequently announced a return to the provision of routine care from November. “This was done without informing the profession first,” said McColl. “It [seemed] more important to the Minister to inform the media and the public prior to informing those delivering the service.”

Serious issues remained unresolved, including the provision of PPE, ventilation – “The CDO’s advice was to wait and explore” – and the long-term model of care – “[The] Scottish Government has done no work on this.”

The new year saw Scotland in Tier 4, activity-based COVID support payments deferred until June, subsequently changed to July, and activity measurement still undecided. In February, the government set the GDS budget at £431 million, announced a single measurement for activity – which is opposed by the SDPC – and acknowledged that the emergency funding measures had to be changed to reflect changing circumstances.

February saw the deferment of dentals students’ graduation, continued confusion over the profession’s role in the vaccinator programme, and the SNP’s election pledge to scrap the patient charge; a proposal it had not consulted on with the profession, said McColl.1

Among the motions2 adopted at the conference were:

GDS funding

“Given the recent manifesto pledge by the Scottish National Party to abolish patient charges for NHS treatment, without prior consultation with the profession, this conference demands a clear and unambiguous guarantee that the Scottish Government will put £431m into the GDS in the year 21-22. Additional costs and the potential for unlocking demand are fair assumptions to make on the back of the SNP’s announcement. The reality is that not only will the Scottish Government have to meet the cost of lost patient charge revenue, approximately £75m, but they will also have to fund the anticipated fresh demand for services.”

Fixed term CDO

“This conference supports a maximum term of office for the post of any future CDO. A set term of office … would show a conscious effort to avoid stagnation of ideas and concepts. Dentistry done well should be a dynamic, evolving, forward-looking discipline and rotation of this role could be a better reflection of this. Better succession planning would help moderate direction of policy, reintroducing some checks and balances that will help the profession gain and retain confidence in the office, avoiding the compounding and proliferation of entrenched views.”

Consultation on CDO

“This conference demands the dental profession have input into the selection of any future chief dental officer. In the last year, it has become increasingly apparent that the CDO does not understand how general dental practices operate. Past and current CDOs have come from the realm of public health. While an overall understanding of public health is clearly important to the role, the vast majority of dental treatment carried out in Scotland is in general dental practices by general dental practitioners. We should have an input into who guides the profession in Scotland. As a profession we should be confident the CDO can understand us and represent the profession to the Government.”

1 The Chair’s presentation is available for download at: https://tinyurl.com/76xc6u4

2 Wording has been edited for space – all motions can be viewed in full here: scot-ldc. co.uk/agenda/motions

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