Reader survey confirms a shift from NHS to purely private practice
A lack of access to NHS dentistry in Scotland is forcing many to seek treatment privately, despite the expense, a survey of readers of The Herald has revealed.
Some have been removed from a practice’s list because a dentist has left, or their practice has gone 100% private, and they have been unable to register with or locate another NHS practice in their area.
“I’ve rung every NHS dentist within a 25 mile radius,” said one respondent, “and not one was taking on new patients.”
More dentists should be trained and made to work in NHS dentistry for a defined time period given the huge training costs borne by taxpayers
Survey respondent
Many readers in Fife, Stirling, Dumfries and Galloway and the Highlands, specifically, reported problems accessing an NHS dentist. Practices going 100% private was an oft-cited reason.
It has resulted in, among those who can afford to, patients paying hundreds, sometimes thousands, of pounds to undergo essential treatment. Others have taken out dental care plans, paid monthly, to guarantee and pay for treatment.
While some readers did share positive experiences of NHS dentistry, the overall picture gained from the survey is of a service under pressure and, in places, shifting from NHS to purely private practise.
The survey was carried out in partnership with Scottish Dental magazine. This Friday, senior officials will come face to face with the dental profession as around 2,000 delegates gather in Glasgow for the annual Scottish Dental Show.
The officials will provide an update on progress in the reform of NHS dentistry. Last November, in a bid to help it recover from the impact of the COVID-19 pandemic, the Scottish Government introduced a streamlined ‘statement of dental remuneration’ (SDR), the system by which dentists are paid to carry out NHS dentistry.
At its launch, the Government described it as a “high-trust, low bureaucracy model”. Among the changes introduced was a significant reduction in the ‘items of service’ – treatments, procedures and undertakings – for which NHS dentists receive payment, from more than 500 to 45.
Fees – for fillings, extractions, dentures, root canal, and other common dental treatments – were increased with the aim of making it more affordable for dental surgeries to provide these on an NHS basis.
The hope was that NHS activity would increase as a result, reducing waiting lists, and making dental treatment more accessible again to patients on the NHS instead of having to go private.
Routine check-ups also changed. Instead of fixed six-monthly recalls, dentists can now choose how often a patient should have an NHS dental examination based on their treatment needs. This can range from less than six months, to once every two years.
The Government said the changes were designed to “empower dentists to use their clinical discretion and knowledge of best practice in delivering care.”
It added: “Payment reform is also the first step towards a truly modern NHS dental service which appropriately assesses, responds to and supports the oral health needs of every patient in Scotland.”
But findings from the survey question how effectively the reform is being carried out. Most respondents said that their dentist had not explained the changes; a remarkable omission given that one of the aims is for practitioners to have a conversation with their patients about focussing on the prevention of disease rather than waiting until treatment is unavoidable.
Where dentists had spoken about the changes, when it came to the routine checkup interval nearly all said simply that it was being extended from six months to a year – as opposed to the needs-based model which has been introduced. One respondent said: “My dentist said that to get paid the full amount for carrying out a checkup it had to be 12 months.”
Some respondents proposed changes to the way NHS dentistry in Scotland is managed: “More dentists should be trained and made to work in NHS dentistry for a defined time period given the huge training costs borne by taxpayers,” said one.
Last week, the Department of Health and Social Care in England launched a public consultation in which it asked whether newly qualified dentists should “commit to delivering a minimum amount of NHS dental care for a minimum number of years after graduating, and whether they should repay some of the public funding invested in their training if they do not.”
A Scottish Government spokeswoman told The Herald: “The Scottish Government increased fees for dentists as part of major payment reform introduced in November last year, and this is one of the steps we are taking to improve access to, and quality of NHS dental services for everyone in Scotland.
“Based on NICE best practice guidance, our reform now ensures that patients are seen according to individual oral health need. Patients are advised to discuss their individual recall period with their dentist, and in particular where there has been a change.
“Official statistics on the performance of the NHS dental sector in the quarter ending 31 March 2024 are due to be published shortly and will provide an objective read-out of the sector.”
Last week, NHS Scotland launched a new ‘Scottish Dental Access Initiative’ (SDAI) page on its website. The SDAI aims to “support NHS dental provision in designated geographic areas where access to general dental services is low and there is evidence of unmet patient demand and/or high oral health needs.”
Grant funding of up to £100,000 is available to contractors – either dentists or corporate groups – within a designated area who intend to:
- Establish a new NHS dental practice
- Expand an existing dental practice, with associated increase in NHS registration e.g. addition of a new surgery
- Purchase and maintain an existing dental practice and NHS patient registration list.
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