Does NHS dentistry have a future?

08 April, 2024 / editorial
 Arthur Dent  

We need to train more dentists in Scotland; this will drive greater supply for patients, improve access and reduce the ability of dentists to force patients into private care

Rhetoric is strong at the moment.  Broken Britain, broken NHS, broken NHS dentistry. The BDA is the most active I think I’ve ever seen in my career.  One of the points it makes in England is what the ‘new’ SDR is doing for Scottish NHS dentistry. Well, at least there’s more money in it.

I do wonder how this narrative will play out. The BDA has always pushed for a high level of private care in a ‘mixed’ practice model.  I understand why. The majority of UK dentistry is performed in the southeast of England as the major population centre. However, it’s also the area with the best oral health in the UK. Therefore, it’s not the epicentre of NHS dentistry.

Socio-economic links to health and the geographic split of the UK means the further north you go, the worse health gets until you reach the west of Scotland with its shockingly bad health and oral health. If we in Scotland preside over the worst of it, then it’s no wonder that NHS dentistry is more prominent in our model of care and that we derive a larger proportion of our funding from it. The arguments that the BDA are making in Westminster are, arguably, more relevant in Scotland. Are they trying to make it look so bad that patients have sympathy with dentists moving towards solely private care?

Pointing to the changes made in Scotland as a better way forward, we should look at how this is panning out a few months in. In particular, following the first serious amendments in version 163, I feel it is worthy of review.

First and foremost, we’re getting paid. The new system seems to be coping with the changes both from the point of view of software providers and PSD. It is not functioning perfectly yet. I know that Carestream is working through some problems, but it is improving. Our staff are coming to terms with the new codes and provisos. All in all, I’d say we’re finding it simpler and probably fairer to patients and dentists. Certainly better in terms of remuneration, particularly some of the fees which were very out of date in terms of their viability, especially lab work related items.

I do find the ‘unscheduled care’ code a little problematic when people turn up with multiple problems. It falls short of fair in those circumstances. I think the composite supplement should be a ‘per tooth’ code rather than per filling. It would just be so much simpler to administer and the software providers could add it automatically rather than having to select multiple options.

I think the amendments made recently should be seen as a measure of how reasonably the codes are being applied. There are certainly things which need clarification, but I feel these changes have been well considered and reflect pragmatic improvements to benefit us and our patients.

I think many people feared that the ‘high trust, light touch’ environment would vanish pretty quickly. That doesn’t appear to be affected by this first round of changes and I hope it comforts those doubters. I also hope that ethos continues.

If things are generally positive, the question would be: are they positive enough? Does this new dawn make dentists want to stay in the NHS or at least provide a significant amount of NHS dentistry? 

Time will tell. However, the number of people looking for an NHS dentist is very high. Only yesterday I heard of another practice where I stay advising their patients of a shift to private care. This is not uncommon and many other practices are not taking on new patients. Where do patients looking for NHS care go?

This is the problem for the Scottish Government. How can we push more people through a system when the cogs want to run more slowly. 

It will be fascinating to see the results of the workforce planning research due out in April. I wonder if the results will ever see the light of day. Probably time for an FOI request to assess what’s really happening in dentistry. Especially, if they ask questions about access of registered patients to urgent care and assess the value for money the Scottish Government is getting for its capitation payments.

The ultimate question is does NHS dentistry have a future? Are there ways to affect this other than pay more? I don’t think there are short term fixes that will do much. We need to train many more dentists in Scotland. Most will stay, creating a larger pool of professionals to supply a static population. This will drive greater supply for patients, improve access and reduce the ability of dentists to force patients into private care. 

The BDA will never suggest this because it will reduce our scarcity and bargaining power. However, the BDA doesn’t get to make that choice. They don’t dictate the university places or pay for them.  

Keep the new SDR and enhance it. Keep the service funded well and train a lot more dentists. It’s the only way I can see to improve things, but it’ll take a decade or two to really work. Can we wait that long and can the government afford it?  Can they afford not to?

Arthur Dent is a practising NHS dentist in Scotland
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