A new model
As the UK headed towards lockdown in March 2020, Scottish Dental went to print with a cover story about the proposed new model of care for NHS dentistry in Scotland. It was to be a model based on preventing disease, rather than allowing it to proceed to a point requiring surgical treatment. But lockdown put that work on hold. Now it has restarted – though tentatively, it must be said. That is probably a good thing; better to reach that goal of a new model through discussion, drawing on evidence and by reaching a consensus among the profession.
In this tentative way, the Scottish Government is focused first on achieving consensus on an element of the old model of care; specifically, Determination I – part of the Statement of Dental Remuneration. Though perhaps frustrating to modernisers, this makes sense. Financially – as well as in its manner of practice – the dental profession is still transitioning from the period of pandemic and post-pandemic. To introduce a radically different model of care now could be problematic.
However, elements of new thinking can still be introduced. The way the government is handling this transition is to be commended. It did two things; the first was to survey the profession about what treatments should be available on the NHS and, second, it established an advisory group that could both consider the results of the survey and bring a range of experience and expertise to the government’s work on a new Determination I, to be introduced in April next year.
As we report on page 10, the survey showed that most dentists in Scotland believe that a simplified Determination I – the list of treatments available on the NHS – should be developed. There was also a series of questions about each of the six sections contained in the list of treatment items (orthodontics was not included in the list as it will be considered in a separate phase of reform).
The treatments mostly commonly mentioned for inclusion were periodontal care, preventive care/screening and extractions for urgent dental care. The treatments most cited for exclusion were endodontics, veneers, dentures and crowns. For endodontics, the most cited for exclusion was molar endodontics, you can read the full report here.
To consider the results of the survey and to provide experience and expertise to the government, an advisory group was established by Tom Ferris, the Chief Dental Officer (CDO). The group is part of an “iterative engagement with the sector” and is designed to ensure that comment and advice on the format of a revised Statement of Dental Remuneration is available to the CDO. The overarching approach is to “consider and develop the full range of treatment options that are necessary to ensure that NHS dental contractors are able to provide care to patients that secures and maintains the oral health of NHS patients.”
Among ideas discussed at the first meeting were: the introduction of a ‘traffic light-style’ oral health risk assessment; that a move toward prevention rather than treatment of disease be reflected in the Statement of Dental Remuneration (SDR); and that the role of Dental Care Professionals be incorporated into the SDR – for the delivery of preventive care, periodontal cleaning and charting.
There was debate – but only partial agreement – on increasing the time between full oral health assessments from six to 12 months, and there was disagreement over increasing the time for ‘low-risk’ patients to 24 months. At two subsequent meetings – in October and November – the group discussed urgent, preventative and periodontal care as well as restorative and surgical treatment, full details can be found on the NHS Scotland Scottish Dental website.
To the outside observer, this all looks very positive.
The dental profession does, of course, have a trade body – the British Dental Association (BDA) – to represent its interests and, in Scotland, the pandemic yielded two other organisations, the Scottish Dental Association (SDA) and the Scottish Dental Practice Owners (SDPO) group. It is not being suggested that the role of the BDA should be usurped in any way (and, indeed, its recently appointed director in Scotland promises to bring new energy to its purpose). There are some legitimate arguments for the SDA and SDPO to exist, though what impact they have had, thus far, is open to question.
But those two steps taken by the government this year – survey the profession and provide a forum for debate on the nature of practice – should become permanent, and regularly used, features of the way the profession and policymakers shape the future of dentistry in Scotland.