BDA: Funding vital to realise Advancing Dental Care ambitions

The British Dental Association has said new funding is essential to realise the ambitions set out in Health Education England’s Advancing Dental Care review.  

The report, published this week, concludes a three-year programme examining training pathways in dentistry and makes a number of recommendations for future change. The BDA has been involved and provided feedback on ADC proposals since its inception.

The BDA has supported proposals for more flexibility in training, and shares concerns raised in the report about underserved areas. It is also supportive of working with the GDC to continue developing a more workable route for mediated entry to the specialist lists.

However, the BDA maintains concerns that plans may risk destabilising some of the existing training structures that serve current populations. While dentist leaders were offered assurances that posts will not be taken away and reallocated, and will only be created with extra funding, the report itself does not offer guarantees. While it mentions ‘new posts’ the review focuses more generally on ‘equitable distribution’. The BDA has also warned that creating new Centres for Dental Development will require significant investment, and that jobs must be available for those undertaking training for new qualifications.

The union remains unconvinced about some of the suggestions of how future dental teams will workespecially the suggestion that teams working with high-needs patients do not require a dentistanreminds HEE that contract reform in England will need to lead to a more workable arrangement if the government is serious about countering the exodus of professionals from the NHS.  It has also expressed disappointment that financial modelling from consultancy London Economics – on which many of the assumptions in the report are based – have not been published alongside the main report.

The report identifies 20 workstreams, covering 5 core proposals. The BDA has stressed partnership working will be fundamental going forward, given many fall outside of HEE’s statutory role, a point the report itself acknowledges. The BDA has stated it expects to feed into all workstreams going forward.  All relevant BDA committees will now consider the review in detail and will provide further commentary in due course.

Shareena Ilyas Chair of the British Dental Association’s Education, Ethics & Dental Team Working Group, said: “While many of the ideas and ambitions set out are laudable, there is a tangible risk plans could destabilise services across England. These trainees provide care to thousands of patients. ‘Redistributing’ existing places will only mean moving young dentists from areas already struggling to meet demand.

“All practices face huge and competing demands, and any idea we can secure new training places without new funding is pie in the sky. The numbers this report is based on have not yet been shared. As we move forward we need HEE to make openness the rule, and to ensure dentists have a seat at the table.”  

BDA presses Sajid Javid for support as PM pledges to ‘make NHS dentistry a better place for profession’

With Health Secretary Sajid Javid now confirmed to be staying in post following the reshuffle, the British Dental Association have issued an open letter, seeking assurances on how the £36 billion recently committed to the NHS will be used to support the recovery of dental services across primary and secondary care.

The boost, funded by the new Health and Social Care Levy, was described by the Prime Minister as the “biggest catch-up programme in the NHS’s history”.

Yesterday the Prime Minister told the House of Commons he recognised the need to ‘fix’ NHS dentistry, stating that “we want the NHS to be a better place for the dental profession.” In the letter, the BDA stress their commitment to work with Ministers to achieve the PM’s objective.

Dental leaders are seeking clarity on the proportion of new money will be allocated to help tackle the unprecedented backlog of dental care, and enable dentists to continue to provide NHS care in the years ahead. England remains the only UK nation not to commit any capital funding for ventilation improvements to enable a safe increase in patient numbers.

Oral health inequalities are now set to widen owing to the suspension of public health programmes, and ongoing access problems. Over 30 million appointments have been lost in high street services since the first lockdown in England alone. Recently published NHS Dental Statistics indicate the proportion of children seen by an NHS dentist in the last 12 months fell from 59% in March 2020 to just 23% in March 2021.
 
Copies of the message have been sent to the dentistry Minister Jo Churchill MP, as well Sir James Mackey, who has recently been appointed to advise on clearing the enormous backlog of elective surgery that has built up over the past 18 months –  including dental procedures under general anaesthetic, where patients already faced year-long waiting times prior to COVID. 

The letter is available here: https://bda.org/advice/Coronavirus/Documents/letter-from-bda-to-sajid-javid-sep-21.pdf

Professor Liz Kay takes office as BDA’s 135th President

Professor Liz Kay, a leading dental academic and dental public health specialist, has taken up office as the 135th president of the British Dental Association.

Taking over the role from past-President Russ Ladwa, Professor Kay has vowed to keep up the work done over the past few years to pursue fairness in the profession, and to continue to tackle the problem of oral health inequality.

Professor Kay qualified in 1982 from the University of Edinburgh. She went on to acquire a Masters Degree in Public Health from the University of Glasgow and remained there as a lecturer while studying for a PhD and working in the dental hospital and gaining her Fellowship in Dental Surgery.

She then became senior lecturer at the University of Dundee, before joining the University of Manchester where she became Professor of dental health services research and head of the orthodontic and children’s department. She also undertook specialist training in dental public health and for the last 25 years has been a consultant in the speciality.

Her dental academic career culminated in her being appointed as the inaugural dean of Peninsula Dental School in the South West where she introduced a new model of primary care based education for dental students.

Professor Kay serves as vice chair of the Medical and Dental Students Trust, served as oral health topic expert for NICE, and currently chairs a NICE guideline committee on epilepsies in children. She is also a non-executive director of an NHS Hospital Trust. She  held the post as an equality advisor to the Medical and Dental School Councils and is also trustee, and immediate past President of the Oral Health Foundation.

Her scholarly work includes over 250 scientific papers and journal articles, being principal author or editor of six textbooks, along with contributing several chapters to academic books. Her research interests lie in decision analysis, health service research and behavioural science.

Professor Kay was previously chair of the BDA’s Health and Science Committee and the BDA’s scientific advisor. More recently she has been appointed as editor of the BDJ’s Evidence Based Dentistry where her mission is to bring the research community and general dental practice closer together and which now takes original publications as well as commentaries on scientific articles.

Professor Kay said: “I am honoured to take up this role, notwithstanding that this is one of the most challenging times in our history. Covid has had a devastating impact not just on dentists’ livelihoods and wellbeing but also on our patients and has exacerbated pre-existing inequalities and access difficulties. However, I hope that the long anticipated roadmap out of Covid will focus minds on tackling these difficult issues and will result in a fairer system for patients and a more welcoming environment for dentists and their teams.

“The BDA has been working hard to raise awareness of all these issues, which are dear to my heart; I look forward to being part of this and meeting dentists around the country in the year ahead.”

Professor Kay was officially installed at the BDA’s AGM on 7 September 2021 – you can view the proceedings online.

She will hold the post for two years, instead of the usual one, due to the disruption caused by the pandemic.

SNOMED disruption: urgent statement now required

The British Dental Association has urged NHSX and the Office of the Chief Dental Officer to issue an urgent statement on the status of SNOMED CT, following updates instructing practices to implement the system from 1 September 2021.

SNOMED aims to ensure better interoperability between health services for patients, by ensuring clinical notes are coded in a standardised way. The planned implementation was postponed from 1 April 2021. The BDA had previously expressed grave concerns that the systems in place for its use in dental practices are not sufficiently robust at present to ensure patient safety and a smooth rollout that would not impact on time spent with patients.  

The recent announcement came as a surprise to GDPs and many major software suppliers. 

Shawn Charlwood, Chair of the BDA General Dental Practice Committee, said: “Since March, we have been engaging with NHSX, as advised by the Minister Jo Churchill, to resolve the outstanding issues with implementation of SNOMED CT. In our meetings, NHSX has been clear that it did not regard it as necessary for dental practices to implement SNOMED from 1 September 2021 and that instead it wished to take the time to work with BDA to develop a subset of dental-specific SNOMED codes that would be appropriate for use.

“It was therefore unexpected that NHS England and the Office of the Chief Dental Officer announced on 31 August that practices were expected to begin using SNOMED from 1 September.

“As a result, we sought urgent clarification from NHSX, as the NHS body responsible for SNOMED, as to what practices were required to do and we demanded a joint statement from NHSX and the OCDO today to clarify matters. It is disappointing that there have been conflicting views from the two organisations.

“The BDA has been engaging with various NHS bodies including NHS England, the Office of the Chief Dental Officer, the NHS BSA and NHSX since it was announced in 2016 that storage of records using SNOMED CT would become a requirement.

“Our objective throughout this was to ensure that there was clear information about what implementation would entail and that the process for doing so would not disrupt practices’ operation. It is regrettable that, despite our efforts, the various NHS bodies have not provided dentists, their practices, and software suppliers with the clarity needed to implement SNOMED without such disruption. We will continue to press for an urgent statement from NHSX and the OCDO.”

500 dentists call on NI Government to ensure service survives pandemic

The British Dental Association NI and 500 high street dentists have written to Health Minister Robin Swann to call time on the dire situation facing Health Service dentistry, urging the Department of Health to set out tangible solutions to overhaul the decades-old General Dental Services (GDS) contract.

18 months on from the start of this pandemic, signatories state that many are now burned out and utterly demoralised, and that the present situation in Health Service dentistry has become intolerable, and unstainable. Dentists report they have been working harder than ever to meet more stringent Infection Prevention Control measures but remain “hamstrung” in the number of patients they can see in a day. 

Many indicate they are now being pushed out of being able to continue to offer care under the NHS. Latest published figures show dental earnings in Northern Ireland have fallen once again, by an average of 4.2% compared with the previous year, or 36% in real terms for Associates and 43% for Practice Owners since 2008/09. Those with the highest commitment to Health Service dentistry (75% or more) have recorded the lowest earnings of all, averaging taxable income of £49,700 in 2019/20.

Practices are now facing huge challenges trying to recruit Associates and dental nurses to provide Health Service care, and the growing public access problems that have resulted post-COVID. Health Service dentistry has been on a downward trajectory for over a decade, with the service becoming increasingly financially unviable in its own right.

Dentists have urged the Department of Health to face up to the crisis in dentistry and come forward with concrete solutions aimed at modernising Health Service dentistry, and that addresses the terms and conditions associated with providing Health Service dentistry to safeguard its future.

Richard Graham, Chair of the British Dental Association’s NI Dental Practice Committee, said: “We have reached a point where the majority of NHS committed dental professionals are feeling utterly demoralised, burned-out, and concerned for the future.

“Already, we see the difficulties patients have in being able to access NHS dental services. That situation will only be compounded many times over if dentists continue to see little hope that their decades-old contract model will be replaced with something that works, both for practitioners, and the public alike. A 1990s activity-based contract model that was driven into the ground pre-Covid, has collapsed irreparably. We need an overhaul of GDS, and we need it urgently.   

“Over the course of a weekend, almost half of GDPs in Northern Ireland put their name to our letter to the Minister saying ‘enough is enough. 

“Without a fundamental shift of trajectory away from a race to the bottom, and meaningful work on a new GDS contract that works better for the public and practitioners alike, Health Service dentistry will not survive.”

BDA: Support needed as 9 million children miss out on care

The British Dental Association has stressed government must meaningfully support practices to boost capacity, as new official figures underline the collapse in NHS access during the Covid pandemic.

NHS dental statistics for England 2020/21 show the proportion of children seen by an NHS dentist in the last 12 months fell from 58.7% as of 31 March 2020 to 23 % on 31 March 2021, meaning over 9 million missed out on care in the year following the first lockdown.  

The BDA has emphasised the data is yet to capture the full impact of the pandemic on access to services among adults, where attendance is measured every two years.  49.6% of adults were seen by an NHS Dentist in the 24-months up to April 2020, falling to 42.8% in the period up to April 20211.

Figures also show 12 million courses of treatment were delivered in 2020-21, a decrease of 69% compared to the previous year.

Over 30 million courses of NHS treatment have now been lost since the first lockdown. Delays in diagnosis can mean poorer outcomes for patients, and can require more complex treatments.

Capacity across the service remains low. The BDA understands around half the NHS practices in England are not currently meeting controversial targets imposed by government that require them to hit 60% of pre-Covid activity levels, and as a result will face financial penalties. Dentist leaders stress this reflects the limits of what’s possible under strict infection control guidance, which remains largely unchanged since the resumption of routine care in June 2020.  A 45% target was imposed on 1 January 2021, days before the country entered a third national lockdown, rising to its current level on 1 April.

While every other UK nation has provided capital funding to help practices increase capacity through new high-volume ventilation systems, there has been no commitment from authorities in England. Investment here would quickly pay for itself through recovery of patient charge revenues.

The BDA is also seeking a clear roadmap to safely ease restrictions, including the instructions to maintain ‘gaps’ between appointments that have radically reduced patient volumes.  While in response to calls all four UK Chief Dental Officers issued an unprecedented joint statement in June indicating a review would take place, there has been no meaningful relaxation of standard operating procedures2.

Access problems were already widespread prior to the pandemic, with funds allocated to provide NHS care for barely half the population, and unmet need estimated at over 4 million people, or nearly 1 in 10 adults3. With oral health inequality now expected to widen the BDA has urged the government to be ambitious, and ensure recent pledges to reform NHS dentistry turn the page on both the current crisis and historic problems that have dogged the service.  

Shawn Charlwood, Chair of the BDA’s General Dental Practice Committee said: “Millions are still missing out on dental care, and patients will be paying the price for years to come. Dentists in England have had capacity slashed by pandemic restrictions, and need help to get patients back through their doors.  Sadly while every other UK nation has committed funds, Westminster chose to impose targets that thousands of practices are now struggling to hit.

“To deliver for patients we need real support, and a clear roadmap to ease restrictions. But even before Covid there simply wasn’t enough NHS dentistry to go round. We cannot return to a ‘business as usual’ where access problems are the norm.”

Scottish dentists effectively given 24 hours’ notice to prepare for free dental policy

The British Dental Association Scotland has warned the Scottish Government it must improve communication, and carefully manage patient expectations, as it issued Friday 20th August 2021 to Health Boards on delivering free NHS dental care to 18-25 year olds, just one full working day before the policy takes effect on Tuesday.  The instructions are unlikely to reach practices until next week.

The policy was a centrepiece of the SNP’s May election bid, and plans to abolish dental charges for this age group were introduced over two months ago. Today’s communication is the first formal instruction on how practices should implement the policy.  

Many practices will simply be unable to introduce the required changes at such short notice. The eleventh-hour timing has all but ruled out the possibility of delivering necessary staff training for the new arrangements, and the opportunity and introduce appropriate practice management systems.

BDA Scotland has also expressed deep concern over the absence of clear messaging to manage patient expectations. Practices are continuing to operate at low capacity owing to ongoing Covid restrictions, with no capacity to cater for an anticipated spike in demand.

Analysis of Freedom of Information requests made by the BDA indicate over 4 million appointments have been lost since the first lockdown in Scotland, when compared to pre-Covid levels, with just 25% of the usual volumes of dentistry delivered. As of April 2021 the service was delivering less than half the courses of treatment it offered in a given month before the pandemic.    

Scotland already operates free NHS dental check-ups. Official data from before the pandemic indicated Scotland had 25% higher adult participation rates compared to England, which hints at the scale of demand suppression effects of charges, which the BDA believe are the wrong way to fund NHS dentistry. The Business Assessment Document for the new policy states that additional costs may arise due to increased Item of Service treatments, but this is “not quantifiable”. 

While BDA representatives discussed the change briefly with the Cabinet Secretary in June, at which it stressed the need for clear public messaging, the Scottish Government has acknowledged that no formal public or business consultation on this policy has been undertaken.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “It beggars belief that practices have been given a single working day to prepare for seismic change in how dentistry is delivered in Scotland. The rollout of free dentistry will inevitably increase patient expectations and heap more pressure on dental teams who are already struggling to address a colossal backlog.   

“Ministers risk creating demand for care that simply cannot be met, and must communicate clearly what is and isn’t available. Failure to do so will only leave hard-pressed colleagues bearing the brunt of patients’ frustrations. The Scottish Government hasn’t fully understood the operation of dental practice throughout this pandemic. We need better communication and appropriate investment. This is not the way to implement a landmark policy.”  

 

BDA reacts to NHS Dental earnings data: ‘Lost decade undermining NHS dentistry’s Covid recovery’

‘A historic collapse in dentists’ earnings across the UK is jeopardising the long term recovery of the service from the Covid pandemic,’ says the British Dental Association.

BDA analysis of new official figures on earnings and expense levels in NHS dental practice show high street dentists in England have seen taxable income fall by nearly 40% in real terms over the last decade. The story is replicated across the UK nations, with real terms falls in Wales, Scotland and Northern Ireland of well over a third since 2009.

The new 2019/20 figures capture the period just before the first lockdown. Above-inflation uplifts have remained the exception rather than the rule since the financial crash, with across-the-board cuts in pay in both cash and real terms.

Unlike their medical colleagues NHS dentists do not typically receive any capital investment from central government, with profits funding all improvements in equipment, training, and facilities for NHS practices. While devolved governments have provided millions to invest in new ventilation systems, to help increase patient numbers while maintaining strict infection prevention control measures, there have been no parallel commitments from Westminster. Practices are also facing mounting costs for clinical waste and essential equipment, without comprehensive support.

The BDA has warned continued pay restraint will only accelerate the drift away from NHS dentistry. Recent surveys have indicated nearly half (47%) of dentists in England indicate they are now likely to change career or seek early retirement in the next 12 months should current Covid restrictions remain in place. The same proportion state they are likely to reduce their NHS commitment.

The historic driver of low morale in the sector remains the discredited target-based NHS dental contract imposed on the profession in 2006, which has proved incompatible with providing care during the pandemic.

Prior to Covid, unmet need for NHS dental services was already estimated at over 4 million, or 1 in 10 of the adult population. Over 30 million NHS appointments have been lost since the first lockdown in England alone.

Shawn Charlwood, the BDA’s Chair of the BDA’s General Dental Practice Committee said: “This lost decade on pay will inevitably undermine NHS dentistry’s recovery. Government has taken the ‘do more with less’ mantra to the nth degree. Every penny of investment in this service comes from dentists’ own pockets. This historic squeeze has left practices unable to deliver needed improvements in facilities, equipment, and training, even before the added costs of Covid arrived.

“The pandemic has exposed the rotten foundations this service is built on, with failed systems and underinvestment leaving millions unable to secure the care they need. Dentists need to see this service as a place they’d chose to build a career. From discredited contracts to flat lining pay, no one should be penalised for working in the NHS.”

General Dental Service/Primary Dental Service taxable incomes, nominal and real 2008-2020, for Associate dentists and Owners. Cash figures from Dental Earnings and Expenses Estimates 2019/20, 19 Aug 2021. Real terms calculations by British Dental Association deflated by the Retail Price Index.

      2008/09 2019/20 % fall 2008/09-2019/20
England Associate Dentists Cash terms £67,800 £58,100 14%
    Real terms £67,800 £42,942 37%
  Practice Owners Cash terms £131,500 £112,600 14%
    Real terms £131,500 £82,223 37%
Wales Associate Dentists Cash terms £66,500 £61,900 7%
    Real terms £66,500 £45,750 31%
  Practice Owners Cash terms £122,400 £98,900 19%
    Real terms £122,400 £73,097 40%
Scotland Associate Dentists Cash terms £67,100 £58,300 13%
    Real terms £67,100 £43,089 36%
  Practice Owners Cash terms £118,700 £103,700 13%
    Real terms £118,700 £76,645 35%
Northern Ireland Associate Dentists Cash terms £66,700 £57,200 14%
    Real terms £66,700 £42,276 37%
  Practice Owners Cash terms £129,600 £99,200 23%
    Real terms £129,600 £73,319 43%

BDA: Scottish Government must apply full pay award

The British Dental Association has called on the Scottish Government to confirm that the recently announced 3% pay award for dentists will be applied to practitioners’ overall remuneration package to avoid front line staff potentially being left out of pocket and practices struggling to invest to improve care. 

Historically in Scotland the recommended uplift has not applied to all dentists allowances and payments, meaning the overall awards often fall short of the pay review body’s recommendations.

Last year the Scottish Government did not apply the recommended 2.8% uplift to practice allowances – which make up around 16% of practice income – leaving an overall increase of less than the review body’s recommendations. The BDA estimates that the net award for that year was around 2.3%.

While one-off support to fund improvements in ventilation has been offered by the Scottish Government, NHS dentists do not routinely receive capital investment. These earnings serve to fund all improvements in equipment, training, and facilities for NHS practices.

Scottish Government officials have stated they will provide details of how the package will operate in due course. The BDA is calling for the 3% uplift to be applied to the full remuneration package.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “The Scottish Government’s announcement has left key questions unanswered. This uplift will do little to correct a decade of austerity, and not all of this increase may actually reach dentists, who rely on their earnings to invest in their practices.

“In the recent election, Ministers put dentistry front and centre in their pitch for government. If they are going to deliver on their promises they shouldn’t be short-changing front line practitioners.”

Chris Morris elected to BDA Board

Chris Morris has been elected to the BDA’s Board (known as the Principal Executive Committee) in the 2021 by-election for the vacant UK-wide seat.
 
Chris first qualified as a dental surgeon, and practised dentistry in the UK and overseas for ten years before training as a solicitor, becoming a partner at Hempsons, a national healthcare law firm, where he specialised in defending dentists.
 
He has served as legal adviser to the British Dental Journal for twenty years, and as President of the Dental Law and Ethics Forum since 2000. His term of office will run until 31 December 2023.
 
UK-wide by-election 2021