Challenges and opportunities

The impact of NHS payment reform will become clear in the coming months

12 February, 2024 / editorial
 Will Peakin  

Analysing the future of NHS dentistry in Scotland in 2024 is a complex task, as the service faces numerous challenges and recent changes that could significantly impact accessibility and quality. Let’s consider some key factors, both challenges and opportunities.

First, the challenges. There’s a long-standing shortage of NHS dentists in Scotland, leading to difficulties finding appointments and long waiting times. This issue might persist in 2024 unless significant recruitment and retention strategies are implemented.

Then there are the financial pressures. Running an NHS dental practice can be a challenge, causing some dentists to move towards private practice. The new payment system introduced in November last year aims to address this, but its effectiveness remains uncertain.

For patients, access to NHS dentistry varies geographically and according to socio-economic status. Rural areas and low-income communities often face the biggest challenges. The COVID-19 pandemic disrupted dental services and created a backlog of patients needing treatment, which is still being worked through.

Conversely, there is the potential for improvement. The revised payment system could incentivise dentists to take on NHS patients and make it more financially viable to offer a wider range of treatments within the NHS. However, its impact remains to be seen. The Scottish Government has expressed its commitment to reforming and improving NHS dentistry.

In terms of practise, technological advancements, such as tele-dentistry and digital dentistry, could potentially improve access to care in remote areas and streamline processes. An increased focus on oral health education and preventative care could reduce the need for complex and expensive treatments in the future.

Overall, the future of NHS dentistry in Scotland in 2024 remains uncertain, with both challenges and potential improvements on the horizon. The success of the new payment system, the government’s commitment to reform, and the adoption of innovative technology will all play a crucial role in determining the accessibility and quality of care available to the public.

As we detail on page 20, there has recently been a surge in deaths from dental sepsis fuelled by ongoing access problems. The British Dental Association (BDA) is compiling data for Scotland, but one clinician in the North of England described their local hospital as “like a battlefield” given the volume of dental sepsis cases.

The Mirror quotes a dentist working in secondary care who observed: “We’re now seeing patients dying from toothache. We’ve never witnessed this before, and there have been multiple cases. One patient came into A&E, was intubated immediately, but died of dental infection without ever regaining consciousness.”

As previously reported by Scottish Dental magazine, data released last year showed 9,860 cases of mouth cancer in the UK in 2020/21 – up 12 per cent on the previous comparable year. The disease killed more than 3,000 people in 2021 which was up 46 per cent, from 2,075 a decade ago. Early detection results in a 90 per cent survival rate. This drops to a 50 per cent survival rate after a delayed diagnosis.

The BDA has previously observed how problems in dental primary care put pressure on other parts of the health service. A recent Freedom of Information request from the Labour Party showed 52,000 patients visited A&E with dental abscesses last year, with another 15,000 presenting with tooth decay.

Eddie Crouch, Chair of the British Dental Association, said: “This crisis is hitting every corner of our health service. It’s the patients piling into emergency rooms and GP surgeries. It’s the oral cancers caught too late, and the simple problems that end up as life-threatening infections. Official indifference to NHS dentistry has a body count.”

Now, while the challenges to NHS dentistry north and south of the border may be similar, Mr Crouch’s reference to “official indifference” does not apply here; the Scottish Government is engaged and has been actively working with the profession. Post the introduction of the new payment system – which was developed with the profession’s involvement – Scotland’s Chief Dental Officer is in the process of establishing a review group to ascertain the effect of payment reform on practising clinicians.

Its work will be ongoing; as Scottish Dental went to print, most practices will have only had one payment and reconciliation to date. But the principle – of working with the profession – has been established. The review group will not be the only forum, however. The BDA, of course, is long-established in acting as a channel for its members to communicate their experiences. It is calling on dentists UK-wide to share their feedback on what they are seeing at the chairside. You can complete their survey here.

The Editor

A portrait of Will Peakin.

Will Peakin. You can send opinions and article suggestions to for inclusion in future issues. Follow @ScottishDental on Twitter, Instagram, Facebook and LinkedIn.

Tags: Dentistry / NHS / Payment / Practice / Private / scotland / System / Times / Wait

Categories: Feature / Magazine

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