Positive steps
Building on her involvement in driving payment reform, Scotland’s new Chief Dental Officer has signalled her resolve to go further
NHS dentistry in Scotland is in a state of transition, characterised by funding boosts and structural reforms aimed at addressing a longstanding access crisis. While the Scottish Government has introduced measures to improve access, patients and professional bodies continue to report local challenges.
The Scottish Government’s Draft Budget for 2026-27 has allocated a record £526.5 million for dentistry, representing a near 40% increase in funding over the current parliamentary term. Towards the end of last year, student places for Bachelor of Dental Surgery (BDS) courses were increased by 7%. Additionally, the Government has moved to streamline the mandatory training requirements, allowing dentists to join the NHS dental list on a provisional basis to speed up the entry of new practitioners into the workforce.
Clearly, it is too early to expect an impact on access to care. Recent data indicates that while approximately 96% of the population is registered with an NHS dentist, participation rates – the number of patients seen within a two-year window – hover around 62%. Rural areas, particularly Dumfries and Galloway and Fife, have reported acute shortages, with some practices closed to new NHS patients. Public Health Scotland reports that patients in the most deprived areas remain significantly less likely to access regular care compared with those in the least deprived quintiles.
While the British Dental Association (BDA) has acknowledged that the 2023 payment reforms, which moved toward a ‘high-trust, low-bureaucracy’ model, were a positive step, it has highlighted also that many practices still provide NHS care at a financial loss and struggle with to recruit staff. In January, the BDA highlighted that while national underspends have fallen to historic lows, indicating higher activity, further “root and branch” reform is needed to shift the focus from treatment to prevention.
In a Q&A with Scottish Dental, Gillian Leslie, Scotland’s new Chief Dental Officer, notes that the post-pandemic years have been financially challenging but that the significance of achieving reform should not be underestimated. The system is not perfect, says the CDO, but the reforms were a positive step. Fiscal challenges will remain the main issue for the profession and policymakers, she says. Recruitment, the skill mix and health inequalities are high on the agenda.
Ms Leslie is taking over during a period of political uncertainty, albeit the health policies to which she and her team will work will become clear after the Scottish election in May. But she has flagged areas where she would like to see change; improved pathways for dentists to develop enhanced skills and deliver more services within primary care, for example.
Interestingly, the CDO wants to effect direct access for patients to therapists; something which that group of dental care professionals has been calling for but which has been resisted by previous incumbents of the office of the CDO.
She also wants to see the development of a more accessible training pathway for Dental Technicians
“who are so important to our everyday working lives”.
Secondary legislation for changes to Prior Approval and Mandatory Training has recently been laid down. Both are still in development and negotiation with the BDA.
The intention with Prior Approval, she said, is to move away from the financial limit “and it will be about clinical treatment, particularly those items such as crowns/bridges/endo and/or a combination of these items.” Certain items which are causing the financial limit to be reached such as dentures, sedation and multiple extractions will be removed. For Mandatory Training, all dentists entering Scotland will still be required to complete it, but if they fall between the quarterly courses they will be allowed to provisionally list.
These are all positive steps, both for the profession and for patients.
About the author
Will Peakin is Editor of Scottish Dental magazine and Education Programme Organiser for the Scottish Dental Show, you can contact him by email here. Follow Scottish Dental on Instagram, Facebook and LinkedIn.
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