‘Dental services for all’ plan announced by Government￼
Revised arrangements will 'reward dentists for seeing more NHS patients', it says
Revised payment arrangements for NHS dentists will be linked more closely to the number of patients they see under changes being introduced in April, the Scottish Government said today.
The arrangements will “help ensure patients are able to access NHS services while dentists continue to be supported as they operate under necessary coronavirus (COVID-19) restrictions,” it said in a statement.
The revised payments replace the emergency top-up arrangements that were introduced to protect the sector from the immediate impact of the pandemic. Separately, said the statement, an advisory group will be established to consider long term reform of the sector and future structure of NHS dentistry.
Maree Todd, the Public Health Minister, said: “The pandemic has had a significant impact on the provision of dental care and our focus must now be on recovery and ensuring we equip the sector to work through the significant dental backlog.
“From April, the new system will support dentists to see more patients while avoiding a cliff-edge for practices and ensuring a soft transition during what is still a constrained period for dental teams.
“Importantly, this means dentists could earn more than they do now through COVID-19 payment support.
“We’re delivering record investment in dentistry – with a nine per cent increase in the budget for NHS dental services in 2022-23 – and there has been a 39 per cent increase in the number of high street dentists in Scotland between 2007 and 2021. Last year there were 55.6 dentists per 100,000 of the population providing NHS care in Scotland compared to 39.9 in England.”
The Minister added: “We are absolutely committed to improving oral health, including the removal of NHS dental charges during the lifetime of this Parliament.”
Tom Ferris, the Chief Dental Officer, added: “We know how important it is that NHS dental teams get the right support to carry on providing the services patients need. We’re confident that these revised arrangements are a step in the right direction to improving access, by linking financial support to seeing patients.
“We have been sharing our proposals with the British Dental Association from before Christmas, listening to the concerns of the sector and the need to avoid the cliff-edge when the emergency support payments come to an end.
“These revised arrangements are in addition to £50 million of financial support for dentists during the pandemic, along with £35 million of PPE. It also comes on top of new and increased fees for dentists for a range of treatments including enhanced appointments from 1 February 2022.”
The BDA has issued a statement in response: “The British Dental Association Scotland has warned that dental practices will continue to face grave uncertainty, as the Scottish Government moved to impose an interim funding model for the service without meaningful negotiation.
“While the BDA has welcomed the introduction of a ‘multiplier’ to be applied to dental fees, dentists have significant concerns that the planned three-month review will have serious implications for patient care and will leave practices unable to plan. The union remains steadfastly opposed to the return to the unworkable high volume/low margin model of care that operated pre-COVID, and has urged the Government to apply the multiplier until new contractual arrangements are in place.
“The BDA had argued that the Scottish Government needed to significantly increase the current inadequate fees for extractions and denture repairs. Increased lab fees mean that dentists often provide these treatments at a loss, and the treatments are particularly prevalent in more deprived areas so any reduction in provision may further widen oral health inequalities.
“The announcement follows a bruising debate in Holyrood last week, in which all opposition parties accused the Scottish Government of failing to heed the warnings from the BDA on the potential collapse of NHS dentistry in Scotland. A BDA survey from late last year reported that 80 per cent of dentists expect their practices will reduce their NHS commitment should the Scottish Government withdraw emergency support and return to pre-COVID models of care.
“Dentist leaders have also warned that comments made yesterday by the Public Health Minister fly in the face of the facts, given the tight restrictions practices continue to work to. Maree Todd MSP incorrectly stated that ‘from April, the new system will support dentists to see more patients’: an impossibility without meaningful change to COVID operating procedures.
“Both the Scottish Government and the BDA recognise the urgent need for long-term contractual reform. The Government has committed to start discussions as soon as the interim funding model is in place. The BDA stress the negotiations must include all practice activity – including work on prevention that is currently unremunerated – and adopt an evidence-based approach to address the current low fees.”
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, added: “Bruised by the political pressure that’s been brought to bear in recent weeks Ministers have railroaded through a package that will leave practices totally unable to plan.
“The idea this package is the result of meaningful negotiation is laughable, and any idea that practices can see more patients from April flies in the face of the facts. Dentists are still working to tight restrictions, and there is no sense we are returning to anything resembling ‘business as usual’. The Government needs to communicate this clearly to patients.
“Applying a multiplier is the right call but the Government should have taken this opportunity to address derisory fees. We have faced the absurd situation where dentists are providing NHS care at a loss.
“What NHS dentists desperately needed was some certainty on what’s expected of them in the year ahead. The choice to put these new arrangements in place for just three months is an exercise in futility.”
A statement from the Scottish Dental Practice Owners’ Group read: “The Government proposals do nothing to address the long-standing systemic failings in Scottish NHS dentistry, but simply ‘kick the can down the road’. Scottish dentists remain stuck with an archaic, bureaucratic NHS system that fails patients and fails dental workers.
“In the decades leading up to the pandemic government failure to modernise NHS dentistry, along with chronic under investment, had rendered the service unfit for purpose. The pandemic further exposed the unsustainability of Scottish NHS dentistry under the low fee, high output, disease centred approach. Government talk of reform since 2016 has come to nothing, and the proposal for April onwards is simply a temporary ‘sticking plaster’ solution for a broken system. The loathed and discredited SDR remains the basis for the delivery of NHS dentistry, despite almost unanimous opposition from the profession.
“Government messaging to the public is at odds with the brutal reality that dental teams face in trying to deliver appropriate modern healthcare under an impossibly flawed system. Ongoing IPC restrictions further add to the dichotomy between what the public are led to expect and what dental teams can actually deliver.
“Although some opposition MSPs clearly understand the failings in NHS dentistry and the threat to the service, there seems little evidence that government ministers are committed to rapid root and branch reform. Against this backdrop is there now any reason for dentists to sustain NHS commitment? If dentists cannot look after their patients, their staff, their businesses, or their own wellbeing under contract terms set by Scottish government, then perhaps now is the time for independent contractors to reduce NHS commitment. This is already happening, with discussions around private plans and practice conversions, a frequent topic of discussion on dental social media platforms.
“The combined efforts of Scotland’s practice owners and their teams have ensured that generations of Scots have enjoyed ready access to NHS dental care. It is regrettable that poor governance of the service is leading committed professionals to look for the exit.”
The new arrangements will see:
- withdrawal of emergency financial support arrangements – which were paid to dentists regardless of their rates of activity – from 1 April 2022 to be replaced with interim funding arrangements
- interim arrangements to pay more than emergency financial support to dentists who are performing above average activity, and the same for those performing at average activity levels
- establishment of an advisory group to the Chief Dental Officer to consider reform of the sector and future structure of the current NHS dental model
The revised payments come on top of support introduced in February for a range of items detailed below, at a potential investment, said the Government, of £20 million per year, and an extension of free PPE for the sector funded by more than £12 million per year, said the Government:
Enhanced examination fees for adult patients
- The basic examination fee for adults of £9.95 will be replaced by an enhanced fee of £14.85. The period between claims for the enhanced examination fee has also been reduced to five months from 23 months
New enhanced examination and radiograph fees for children
- Dentists will have the opportunity to claim the enhanced examination fee for children (i.e., the same as for adults) and will also be able to claim a fee for small film radiographs for children. Larger radiographs taken for general treatment remain as before. Orthodontics is unchanged
Extension of Childsmile eligibility, streamlining existing fee codes
- Dentists can claim Childsmile for children and young people up to age 17 (previously up to age five), and fluoride varnish application between two and 12 (previously between two and five). This will address the increase in oral health inequalities that may have arisen in children and young people during the pandemic