BDA

Omicron threat leaves dentists struggling to restore services

The British Dental Association has warned that recent moves to ease the high levels of pandemic restrictions facing dental practices in England are unlikely to soften access problems, as new evidence from Healthwatch England highlights the ongoing crisis facing dental services, including the high numbers of children missing out on care.

According to a survey of high street dentists in England: 

  • Nearly a third of dentists (33%) have said they have no intention of relaxing COVID precautions, in line with new protocols issued by NHS England in November. Half say the arrival of the Omicron variant has had a high impact on their willingness to ease restrictions. Until the changes took effect, dentists have had to maintain gaps of up to an hour between most treatments, to reduce the risk of viral transmission, an approach that has radically reduced patient numbers.
  • In light of wider winter pressures, and expected surge in other conditions like flu and the common cold 62% say the changes – which place patients on two pathways given risk of respiratory infection – will make little to no difference to the volumes of patients they can treat.   
  • Over 40% of dentists indicate they are now likely to change career or seek early retirement in the next 12 months given the current pressures on the service. Over half state they are likely to reduce their NHS commitment. 1 in 10 estimate their practices will close in the next 12 months.  
  • The Government’s handling of NHS dentistry is having a devastating impact on morale. 72% state the lack of clarity over the government’s controversial imposed activity targets – widely expected to increase on 1 January 2022 – is having a high impact on their morale. 70% say the same given uncertainty over the direction of pledged reforms to the service.
  • Nearly 2/3 of practices (62%) estimate they are continuing to operate under 70% of their pre-COVID capacity.

The BDA and Healthwatch both issue a joint message to Chancellor Rishi Sunak ahead of the budget to guarantee funding for the rebuild and recovery of services. At this time not a penny of the government’s multi-billion pound catch-up programme has been allocated to primary care dentistry. Over 37 million NHS appointments have been lost since lockdown in England alone, over 11 million for children. Tooth decay has been long established as the number one reason for hospital admissions among young children.

While the government has pledged reform of NHS dentistry by April 2022, the BDA has consistently warned that steps must be taken to stem the flow of talent from the workforce, and to provide the necessary resources to underpin any new system.

BDA Chair Eddie Crouch said: “It is tragic that so many million children are missing out on dental care. The government has a duty to ensure this does not become the new normal. For the sake of families across England we need to see real ambition from Ministers. Pandemic restrictions have been eased, but the gains appear modest at best. Patients are still struggling to secure appointments, and a frustrated workforce is looking for the exit.  

“The Government keeps saying NHS dentistry is a top priority, but not a penny of investment has been offered. These problems are being felt in every community, and require deeds, not words.”

BDA: New guidelines will not soften blow of Scottish Government plans

The British Dental Association Scotland has said new standard operating procedures for dentists published on 29th November will not restore access to pre-Covid levels. With high levels of Covid and other seasonal infections, and now the emergence of the Omicron variant, dentist leaders stress they will also do nothing to avert the potentially catastrophic impact of Scottish Government plans to pull away pandemic support from NHS practices.

Patients in Scotland will now be placed on one of two pathways, given the likelihood of them carrying a respiratory illness. It replaces what amounted to a ‘one size fits all’ approach that has been in place since the outset of the pandemic, which reduced capacity across the service.   

Those on the non-respiratory pathway can be managed in line with pre-Covid standard infection control precautions for non-aerosol generating procedures. However, for an aerosol-generating procedure, enhanced precautions will still be required for non-respiratory patients since pre-appointment PCR testing is not carried out in dentistry. Any patient placed on the respiratory pathway and requiring urgent care will remain subject to enhanced precautions for all procedures, which will include maintaining ‘fallow time’ gaps of up to an hour between treatments. 

The new model is unveiled on the day the Omicron variant was confirmed to be present in Scotland. Even setting aside any potential spike in Covid infection, large numbers of patients are likely to end up on the respiratory pathway given typical patterns with seasonal flu and the common cold. It is anticipated a number of dentists may opt for a ‘safety first’ approach, and use flexibility within new protocols to maintain existing protective measures, particularly given the uncertain effectiveness of triage questions in identifying symptoms of the Omicron variant.   

Over 3.5 million NHS dental appointments have been lost in Scotland since the first lockdown, driven by ongoing restrictions.  

Cabinet Secretary Humza Yousaf wrote to all NHS dental teams last month stating that all emergency support will be withdrawn by 1 April 2022, as part of a new policy to return to the low margin and high volume system the service operated to pre-pandemic. The move drew criticism from all opposition parties, given the unsustainable pressure it would place on practices. According to a BDA survey conducted at the time 80% of dentists estimate their practices are set to reduce their NHS commitment should the Scottish Government remove emergency support and return to pre-Covid models of care.  

Yousaf told the Scottish Parliament on 3 November that “reform at this stage would be a disruption.” Governments in both Westminster and Cardiff Bay are taking through reforms to their NHS dental systems at this time. NHS dental care free at the point of use remains a centrepiece SNP policy. BDA Scotland has said the Scottish Government must change course to achieve that goal, develop an interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable model for delivering care.    

David McColl. Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Since the spring we have been pressing for a plan to safely ease Covid restrictions, to help increase patient numbers. Sadly, these new guidelines will not magically restore services. They land as we head into winter when respiratory diseases are set to skyrocket. And with Omicron now present in Scotland many practices will understandably take a safety-first approach.

“We are still facing massive backlogs, saddled with a system that is unfit for purpose. New protocols will not soften the blow of plans to pull away emergency support at this challenging time for infections and try and return to a ‘business as usual’ model during a pandemic. Ministers say now is not the time for reform. Reform won’t wait for millions of patients in Scotland who need NHS dentistry to have a future.”

New Covid guidelines unlikely to bring ‘business as usual’ back to dentistry

The British Dental Association has said new standard operating procedures for dentists in England published yesterday are unlikely to represent a silver bullet for restoring patient access to services.   

The new model places patients on two pathways, given the likelihood of them suffering from respiratory illness. It replaces restrictions that have been all but universal for most treatments and most patients since the first lockdown, which has radically reduced capacity across the service.  

Those on the non-respiratory pathway can be managed in line with pre-Covidstandard infection control precautions.  Any placed on the respiratory pathway will remain subject to enhanced precautions, including maintaining ‘fallow time’ gaps of up to an hour between treatments. Screening to determine the pathway will take place both before attendance and on arrival the practice.

Dentist leaders anticipate a relatively high proportion of the population may find themselves on the respiratory pathway as the country heads into winter, given traditional patterns with seasonal flu and the common cold, even setting aside any surge in Covid rates.   

Over 35 million NHS dental appointments have been lost since the first lockdown, driven by ongoing restrictions. The service has not received a penny of additional investment from the Government’s multi-billion-pound NHS ‘catch up’ programme to help bring down these backlogs, despite pressure from Healthwatch England and a growing number of MPs. 

Unlike their colleagues in other UK nations dentists in England have received no capital funding to invest in ventilation systems that can allow for increased patient volumes while keeping to Covid restrictions.

BDA Chair Eddie Crouch said: “We have long called for roadmap to ease Covid restrictions. This approach is progress but will not represent a silver bullet for the tens of millions left without access to dental care. We cannot realistically expect a return to ‘business as usual’ as we head into winter given surging rates of respiratory disease.

“These new guidelines may help increase patient volumes but will barely make a dent into the unprecedented backlogs we now face. Without needed support from government we will continue to struggle to deliver for the patients that need us.”  

 

BDA: Placeholder prescriptions undoing years of progress in fight against antibiotic resistance

The British Dental Association has warned that ongoing difficulties in accessing dental services risk fuelling the parallel health crisis of antibiotic resistance, as new data from the UK Health Security Agency underlines the surge in prescriptions in the dental sector.     

While all other healthcare settings recorded further drops in antibiotic prescribing, the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report shows dentistry alone saw an increase, of almost a fifth in 2020. However, patient volumes fell by more than half that year. COVID restrictions have radically reduced patient numbers, and staff were advised to adopt an ‘AAA’ model during the first lockdown – Advice, Analgesics, or Antibiotics.     

Antibiotic prescribing in the NHS dental settings had been steadily decreasing from 2016 to 2019 (0.16 and 0.13 items per 1,000 inhabitants per day respectively, -18.4%). This decline was interrupted in 2020 with an increase of 17.6% reported (from 0.13 to 0.15 items per 1,000 inhabitants per day).

Data shows primary care general practice accounts for 84.2% of prescribing for items per 1,000 inhabitants per day. This was followed by the dentistry (10.3%).

Dentist leaders have stressed Government must do more to increase access sustainably and ensure patients – particularly urgent cases – have the time for operative interventions, to ensure they are not offered antibiotics as a placeholder. The current target-based NHS contract in operation in England has long represented a key barrier to progress.      

A failure to address the problem of antibiotic resistance could result in ten million deaths, every year, globally by 2050. As the pandemic continues and into the future, the BDA has stressed it is essential that dentists are supported to once again reduce the rate of antibiotics prescribed.

BDA Chair Eddie Crouch said: “Antimicrobial resistance poses an even greater threat to human health than COVID. Sadly, the pandemic has wiped out years of progress in bringing down antibiotic use in dentistry. Placeholder prescriptions are now filling deficits in access and time, which the government has chosen not to factor in. Ministers have a responsibility to help dentists turn the page.”

Pressure mounts on failed NHS contract: amendments tabled to Health Bill

MPs are continuing to join our call to break from the discredited NHS contract, with amendments now tabled to the landmark Health and Care Bill currently before parliament. 
 
Building on the momentum of the British Dental Association’s joint letter with Healthwatch England and the cross-party letter from over 40 MPs to the Treasury about the crisis in the system, the Labour frontbench has tabled a proposed New Clause to the Bill calling for measures to ensure universal access to NHS dentistry.
 
Introducing this amendment, Labour’s Shadow Health Minister Alex Norris MP attacked the Government’s record on NHS dentistry. Quoting BDA research, he highlighted the savage cuts to dental budgets and called for a proportion of the recently pledged funding for NHS recovery to be earmarked for dentistry. He stressed the crisis in morale amongst the dental workforce, and urged the Minister to get on with the critical work of contract reform.
 
“There is consensus that UDAs are long out of date and that after 15 years it’s time to move away from them. We really need to get on with this, because there are lots of dentists waiting on that before making a judgement as to whether NHS dentistry is in their future or not” he argued, adding “it is not a hyperbole when the BDA talk about “last chance saloon”, it is not a hyperbole to say that we will not have NHS dentistry in the medium term if we don’t have a course check”.
 
The SNP health spokesperson Dr Philippa Whitford echoed his points on the chronic underfunding of dentistry in England, calling for capital investment in ventilation for dental practices and oral health prevention schemes. She lamented the return of the UDA system post-pandemic, calling it “an enormous missed opportunity to improve NHS dental access for everyone”.
 
In his response the Health Minister Edward Argar reiterated the Government’s commitment to contract reform, saying “transformation in NHS dentistry is essential” and stressing they wanted “to see a contract that is attractive for professionals”, but offered no specifics on when changes might be implemented.
 
BDA Chair Eddie Crouch said: “Both dentists and patients will thank MPs for not letting up after the missed opportunities in last week’s budget. It’s time for answers on what meaningful support is going to be offered to ensure this service can have a future. Ministers are offering boilerplate responses when we need a plan and ambition to rebuild services millions depend on.”

As the Bill continues its passage through Parliament the BDA is speaking to and providing targeted briefings to the Government, MPs and Peers and fighting for the interests of dentists and patients, as well as trying to strengthen the public health measures included in the Bill.

BMA and BDA: Real terms pay cut a slap in the face for armed forces doctors and dentists

In a joint statement British Medical Association Chair Chaand Nagpaul and British Dental Association Chair Eddie Crouch have decried the recommendations of the Armed Forces Pay Review Body: 

“The recommendations of the Armed Forces Pay Review Body’s (AFPRB) 50th report amount to a real-terms pay cut for the armed forces doctors and dentists who, like their NHS colleagues, have contributed so much and made extraordinary sacrifices in the fight against COVID yet, unlike these colleagues, will receive no award for their efforts.

“A pay freeze for those earning more than £24,000, paired with increased charges for accommodation and the current rate of inflation, will mean that our members have essentially paid for the role they played in the pandemic out of their own pockets. While the BMA believes the 3% pay award applied to civilian doctors in the NHS (including consultants and salaried GPs) was insufficient, the total lack of recognition of the role of uniformed doctors and dentists can only be regarded as demeaning their efforts.

“Uniformed doctors and dentists have gone above and beyond throughout the pandemic – whether serving side‐by‐side with doctors in NHS settings, or in Defence Primary Healthcare and single service medical units; leading the acceleration of the national vaccination programme, or playing a crucial role in the establishment of the Nightingale hospitals – both at home and overseas. However, it would appear their hard work and dedication have counted for naught.

“The AFPRB report acknowledges the outstanding work of uniformed doctors and dentists, the risks around DMS staffing levels, and the challenges posed through the pandemic. Yet they offer no meaningful recognition for contributions made or threats faced. While described as an independent pay review body, the AFPRB has evidently felt constrained by the Government’s directions and simply accepted their imposed pay restraint, rather than behaving with independence. We engaged with the pay review process in good faith; we leave it feeling our evidence has been ignored.

“Uniformed doctors and dentists have been denied parity with their civilian colleagues. The lack of a pay offer is not only inadequate but fundamentally unfair, and runs counter to the principles of the Armed Forces Covenant. The BMA and BDA will work together to consider what next steps should be taken to ensure our members are compensated for the contributions they make, rather than penalised for the commissions they hold and the uniforms they wear.”

BDA: “Budget leaves NHS dentistry in last chance saloon”

The British Dental Association has lamented the budget’s failure to recognise the challenges facing dental services across England. It follows calls from both the BDA and Healthwatch England to provide vital funding for the recovery and rebuild of services, which was backed yesterday by over 40 cross-party MPs.

Reform of the widely discredited model the service operates to was pledged by April 2022. Dentist leaders have expressed disbelief that no commitments have been made to provide the necessary resources to deal with the backlogs and underpin a transition to a new and sustainable model of care. 

Over 35 million appointments have been lost in England since lockdown, and even before Covid funding was sufficient to cover barely half the population.

The BDA had joined with public health leaders in early October for reversal of savage cuts to local public health budgets. There is no indications the Treasury appears willing to change tack.

The 50% business rates discount extended to the retail and hospitality sectors once again leaves dentists as among the only businesses on the high street not receiving needed support.

British Dental Association Chair Eddie Crouch said: “MPs have recognised NHS dentistry is in the last chance saloon. Sadly the Chancellor has offered this service no help clearing the backlogs, no support for the rebuild and recovery, and no boost for public health. Covid busted an already failed system, but any reform plan is doomed without new investment. Any credible ‘levelling up’ agenda cannot ignore millions of patients with no hope of securing needed care.”

BDA Scotland: Scottish Government plans set to decimate NHS dentistry

The British Dental Association Scotland has warned plans to return NHS practices to pre-Covid models of work will devastate dental services across the country.

Cabinet Secretary Humza Yousaf has written today to every NHS dental team in Scotland, indicating that all emergency support will be withdrawn by 1 April 2022. Since the first lockdown, NHS practices have operated under a COVID support package, reflecting pandemic pressures and tight restrictions that continue to limit capacity across the service.

A return to delivering a low margin/high volume model of care is, BDA Scotland contends, simply unsustainable under current conditions. While some restrictions may ease in the coming months, there are no indications the service is likely to return to anything resembling ‘business as usual’.

With a growing number of staff facing abuse from frustrated patients unable to secure appointments, the BDA has warned the move will only raise patient expectations, while pushing NHS colleagues into the private sector or out of dentistry altogether.

Yousaf has signalled minor changes to the payment system for dentists that will take effect from 1 February 2022, largely covering the treatment of children. While welcome, these reforms will have a negligible impact on capacity within the service and will not ease the pressure on practice finances once the Covid support payments are withdrawn.

The SNP committed to delivering free NHS care for all in Scotland in the recent election. The BDA has stressed this approach runs counter to that vision, and that real focus and energy must be applied to developing a new, sustainable model for delivering care.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “The Scottish Government seems set to pull the rug out from under every dedicated NHS dentist. If Ministers had an objective to decimate NHS dentistry, this approach would offer a great starting point. To signal the return of a ‘business as usual’ model when the country is still in the grip of a pandemic is utterly reckless. The net result will be to push colleagues out of the NHS and to leave this profession altogether.

“Ministers put NHS dentistry front and centre in their pitch for government. To deliver on their promises we need real commitment to find a new and better way for delivering for the patients that need us.”

Healthwatch and BDA urge Chancellor to reverse a decade of NHS dentistry cuts

In a joint message Healthwatch England and the British Dental Association have urged Rishi Sunak to use the coming Spending Review to guarantee the future of NHS dentistry.

With over 30 million appointments lost since the first lockdown, the two organisations have pressed the Chancellor to ensure resources are in place for the recovery and promised reform of the service.

The two organisations say: 

  • The crisis in the service continues to grow. Dentistry has risen to be the number one issue raised with Healthwatch over the pandemic, and the volume of feedback continues to grow.  From April to June 2021 feedback was up 55% on the previous three months, and 794% higher when compared with the same period in 2020.  Nearly 4 in 5 people (79%) of those sharing their stories said they had found it difficult to access timely care. 
  • The two bodies are pushing for the reversal of a decade of cuts With no attempt to keep pace with both inflation and population growth, the BDA have said it would take an additional £879m from the Treasury to restore resources to 2010 levels. With £0.6 billion lost in NHS patient charge revenues since lockdown – which the Government appears anxious to retrieve – both bodies have said Ministers must guarantee adequate funding to deliver NHS dentistry to all who need it and rule out both inflation-busting patient charge hikes and cuts to front line services.
  • Invest in the fundamentals. The future of national child and adult dental health surveys – vital for setting strategy – has remained in doubt owing to financial uncertainty. Without this data there is no basis to effectively plan oral health services. 

Sir Robert Francis QC, chair of Healthwatch England, said: “Lack of access to NHS dentistry has exploded as an issue for people over the last year, with both the volume of feedback and negative sentiment going through the roof. We’ve heard from patients up and down the country unable to find care, leaving them in pain and taking matters into their own hands. We’ve also heard from parents unable to register their children with an NHS dentist, as local dental practices weren’t taking on new patients, had gone private or had closed down.

“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void. The Government needs to use the forthcoming Spending Review to provide vital investment in services like dentistry that help keep us all healthy and ensure we build back better for current and future generations.” 

BDA Chair Eddie Crouch said: “In the last Spending Review Ministers chose to make patients pay more into NHS dentistry, so they could pay less. These charges are now a substitute for decent state investment, with no attempt to even try and keep pace with demand or inflation. Ministers have pledged reform. Simply telling dentists to do more with less will not provide the care our patients desperately need.”

A decade of cuts 

As England emerges from the pandemic NHS dental services will confront increased demand, an unprecedented backlog and widening oral health inequality.     

Yet primary care dentistry went into the pandemic receiving less direct support from the Treasury than it did in 2010, a unique status in the NHS. Following the 2015 Spending Review commitments patient charges have formed an ever-greater share of NHS budget. The net result is that in real terms government contributions fell by nearly a third between 2010 and 2019.   

Ministers have pledged wide-ranging reform to the widely discredited system NHS dentistry operates to in England. Sustained cuts will make any attempts to rebuild the service an uphill struggle, with a growing number of NHS dentists already reconsidering their future.  

The Funding Gap

Practices are set to face higher demand but remain forced to do more with less, with no attempt made to keep pace with inflation or population growth.    

  • While the population of England grew by 7.42% between 2010 and 2020, the amount of dentistry commissioned by NHS England was cut by more than 2 million units of dental activity (UDAs). UDAs commissioned per head of population fell from 1.70 to 1.56, while government contributions per head fell from £41.79 to £34.53 in the same period.
  • In 2010/11 the gross budget for high street NHS services was £2.81bn, of which £614m was drawn from patient charges, £2.2bn from direct government contributions. In 2019/20 while the gross budget reached £2.96bn, net government contributions had fallen in cash terms to £2.1bn.
  • To restore the resourcing in NHS General Dental Services to 2010 levels, simply reflecting RPI inflation would require a total budget of £3.6bn for NHS General Dental Services. In order to also reflect population growth in the intervening period would require a budget of £3.9bn.  
  • Should overall patient charge levels remain unchanged an additional allocation of £879m from government contributions, per annum, is required to restore levels of resource seen in 2010. 

The Tax on Teeth 

The 2015 Spending Review committed the Government to annual above-inflation 5% increases in dental charges, which form an ever-growing share of the NHS budget.   

The Government has operated a support scheme during the pandemic, maintaining funding for NHS practices while capacity has been reduced by the suspension of routine care and ongoing restrictions.

Consequently, patient charge revenue fell by £0.6 billion from 2019/20 to 2020/21, a gap which has been filled by the Treasury, which the Government is anxious to retrieve. 

The Government must now write off existing and any ongoing losses from patient charge revenue as a result of COVID and make no effort to reclaim them via above inflation patient charge increases or cuts to frontline services.

Child Asylum seekers: dental age check plan dropped, but key questions remain

The British Dental Association has welcomed reports the Home Office has reconsidered plans to introduce the use of dental x-rays to determine age in asylum cases. The Association has been campaigning against the rollout of dental age checks for migrants, working closely with the Refugee Council, alongside other healthcare bodies and opposition health and home teams.

It is expected government amendments to the Nationality and Borders Bill will still give significant latitude to the Home Office to define in due course what constitutes ‘robust’ and ‘scientific methods’ of age assessment. On that basis the BDA will continue to seek amendments to the Bill to rule out radiographic tests. 

The Association has vigorously opposed the use of dental X-rays to determine whether asylum seekers have reached the age of 18, stressing they are an inaccurate method for assessing age.  

The BDA also believes that it is inappropriate and unethical to subject people to radiation when there is no health benefit for them. X-rays taken for a clinically justified reason must not be used for another purpose without the patient’s informed consent and must be carried out without coercion and in full knowledge of how the radiograph will be used and by whom.

British Dental Association Chair, Eddie Crouch, said: “It’s welcome news that Ministers appear to have ruled out dental checks on migrants that fail basic tests on accuracy and ethics.

“However, new laws will still give the government power to define what constitutes a ‘robust’ measure of age. Dentists do not want to see pseudoscience make a return via the back door.”