On the critical list

06 February, 2023 / editorial

A portrait of Scottish Dental Editor, Will Peakin

The statistics came thick and fast in the first month of this year.

An eight per cent fall in the number of NHS practitioners since the outbreak of COVID, with 11 of the country’s 14 regional health boards reporting a decline. NHS dental activity is down 43 per cent. Four in five practices are not accepting new NHS patients.

Patients seeking hospital dental treatment on the NHS have, in some cases, been waiting for between two and three years. In NHS Lanarkshire, the average waiting time for inpatient or day case treatment through the Public Dental Service was 41 weeks last year – compared with four weeks in 2019.

Barely half (50.4 per cent) of NHS registered patients have seen a dentist in the past two years, compared with 65.1 per cent in 2020. The gap in child participation, between the most and least deprived areas in Scotland, now stands at 20 percentage points – compared with three in 2008.

The Scottish Government responded with numbers of its own: “A record number of people are registered with an NHS dentist, covering more than 95 per cent of the population of Scotland, and across key treatments NHS dental services are at comparable levels of activity to levels last seen before pandemic restrictions were introduced,” said a spokesperson.

“Dentistry is an important part of our NHS Recovery Plan. More than 1.5 million NHS examination appointments were completed between April and October, with an average of more than 300,000 courses of treatment per month, meaning we are on course for more than 3.5m contacts in the 2022/23 financial year. In total, the Scottish Government has provided over £150 million to date in additional support to maintain the capacity and capability of the sector.”

But, as David McColl, Chair British Dental Association’s Scottish Dental Practice Committee, commented: “Patients in Scotland’s poorest communities are paying the price for the crisis in dentistry. The Scottish Government must not try to hide behind positive sounding registration figures. The reality is patient participation remains on the floor, and inequalities are set to widen. Dentists are reconsidering their futures working in a broken system. NHS dentistry is on the critical list, and real reform won’t wait.”

Free NHS dental for all remains a key Scottish Government policy. Rightly, the BDA in Scotland continues to warn that a return to a ‘business as usual model’ – what it describes as ‘low margin and high volume’ – will put practices under unsustainable financial pressure, with soaring running costs raising the risk of closure or a move to the private sector. It has urged the Government to continue with its additional financial support for practices – which is set to end on 1 April – to support dentists and their teams as they work through the historic backlog of dental care and until a new, sustainable funding arrangement for NHS dentistry is in place.

But the reality is that the exceptional support will, indeed, come to an end; over a period of two months in the run-up to Christmas, Scotland’s Chief Dental Officer, his team, and an advisory group comprising general dental practitioners, dental care professionals and specialists, held a series of workshops to discuss the treatment items that should be available in a revised Determination 1 (though not funding – that, as the Group’s remit noted “is a matter for discussion between government and trade union representatives”).

They considered the elements of an oral health examination, diagnosis and treatment, preventative and periodontal care, and restorative and surgical treatment. At its final meeting in December, concerns were raised regarding the effect that a revised Determination 1 may have on the mixed practice model – and how the changes will be communicated to dentists.

As we acknowledged in the last edition, the founding of the group (and the commissioning of a sectoral survey that preceded it) were positive steps on the part of the Government’s Dentistry and Optometry Division. But revisions to the existing – and outmoded – model  of NHS dentistry are unlikely to stem the tide of negative statistics that ushered in the new year.

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