High volume… low margin… disease centred
Parliamentary committee hears damning verdict on NHS dental service model
The Scottish Government is under pressure to account for the failure of NHS dental services to return to pre-pandemic levels.
In evidence to the COVID-19 Recovery Committee, Jenni Minto, the Minister for Public Health, said that its recovery policy “has been successful, with sustained increases in dental activity from April 2023. We have achieved over 3.7 million patient NHS contacts for the period April 2022–March 2023”.
But she added that she understood “there is some concern we have not yet reached the levels of dental activity seen before the pandemic”. The minister argued that an explanatory factor “is a significant change introduced from February 2022, replacing the basic examination fee with an enhanced examination”.
We have achieved over 3.7 million patient NHS contacts for the period April 2022–March 2023
Jenni Minto MSP, Minister for Public Health
The committee had been told by service providers that a significant backlog of patients waiting for NHS treatment persists; 69 per cent of dentists who responded to the committee’s survey said they have not yet cleared the post-pandemic NHS treatment backlog and asked how long it would take, 35 per cent said more than two years.
The British Dental Association (BDA), the Scottish Dental Association (SDA) and the Scottish Dental Practice Owners group (SDPO) told the committee that a full recovery will not be possible without reform to services.
Dentists described the current service model as “high volume … low margin … disease centred”. It places too much focus on treatment activity for decay and disease as a measure of productivity and not enough on measuring and incentivising preventative healthcare, the committee was told.
In written evidence, the health minister said that “the single most important reform that Scottish Government can facilitate, in partnership with the sector, is payment reform”. The committee has sought clarification that the Government remains committed to implementing reform by 1 November.
It said it “understands that the Government appears to be committed to maintaining a blended system of payment, comprising a fee per item, capitation, allowance and direct reimbursement payment model.
“Nonetheless, the committee considers that the COVID recovery period presents an opportunity to rethink the service model for NHS dentistry and for the Government to consult meaningfully with the sector on this issue.”
The BDA said its preference was for a fully capitated model, along the lines of general practice, where lump-sum payments are made to care providers based on the number of patients in a population to provide some or all their care needs.
The committee said the Government should provide costings for – and consult on – different service model options “including those that it does not prefer, in partnership with the sector so that the opportunity is not missed to consider a full range of options for the future of service delivery.”
Consultation should include the SDA and SDPO, not just the BDA, said the committee.