BDA

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

BDA: ‘Long-term approach to pay is now required to keep NHS dentistry viable’

The British Dental Association (BDA) has said a long-term approach to pay is now required to keep NHS dentistry viable, following confirmation of a 3% pay award.

The pay award meets the recommendations made in the 49th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) in full, and marks the third consecutive above-inflation increase following a decade of pay restraint, which saw real incomes for practitioners fall by over 35%.

The pandemic has added to long-term pressures facing general dental services across the UK. Recent surveys indicate nearly half (47%) of dentists in England are now likely to reduce their NHS commitment, should current restrictions remain in place, with the same proportion indicating they will seek early retirement or a change in career.

With inflation now at 2.5%, the BDA has stressed an ongoing commitment to fair pay is required to guarantee the long-term sustainability of the service, alongside parallel action on a roadmap to ease pandemic restrictions, and meaningful reform of the contractual systems NHS dentistry operates to. The discredited activity based systems in operation across the UK have fueled recruitment and retention problems and have proved unworkable since lockdown.

The announcement will see the 3% uplift on pay backdated to April, with no staging. This will apply to community dentists in full, with a final uplift to contract values for general dental practitioners to be confirmed following consultations on expenses in the four UK nations. Consultants will see a 3% uplift in basic pay (Specialty and Associate Specialists (SAS) and Juniors have separately agreed pay deals). The BDA has encouraged practice owners to engage with their associate dentists to discuss their contractual arrangements in light of the uplift.

BDA Deputy Chair Peter Crooks said: “An uplift on the right side of inflation is progress. A decade of pay restraint has taken its toll, and we can never return to recommendations that fail to reflect the cost of living.

“Both providers and performers need to see the benefit of this uplift. This has been a hard year for practices, but we look to owners to ensure this increase reaches their associates. Even before Covid, a growing number of colleagues saw no future in the NHS. If we’re ever going to make this service a going concern then fair pay must remain the rule.”

BDA: ‘New GDC Chair a chance to turn the page’

The British Dental Association has responded to the General Dental Council’s appointment of new Chair, Baron Harris of Haringey (Lord Toby Harris).  

BDA Chair Eddie Crouch said: “We are disappointed that the GDC has again chosen not to select a dentist as Chair. This would have been an important step to rebuild trust with this profession.

“However, a new face offers an opportunity to turn the page. We send our congratulations to Baron Harris and offer our commitment to work with him and his team to secure the cost-effective, right-touch regulation dentistry desperately needs.”

BDA: Health Bill must give primary care a seat at the table on commissioning

The British Dental Association has joined with partners across primary care to ensure dentists, pharmacists, opticians and audiologists to have a proper voice on Integrated Care Boards (ICBs) set to be handed responsibility for commissioning decisions. 

The Health and Care Bill currently before Parliament would shift the responsibility for managing the contracts for primary NHS services, including general practice, general dental practice, community pharmacy and primary optometry services from NHS England to ICBs. Partners warn current draft legislation risks leaving around 190,000 non-medical primary care professionals working in the NHS in England shut out of representation on the boards.

Together with the Pharmaceutical Services Negotiating Committee, the Association of Optometrists, the Association of British Dispensing Opticians, FODO The Association for Eye Care Providers, and the National Community Hearing Association, the British Dental Association is pressing for change as the Bill heads for Second Reading in Parliament.

As it stands the Bill only dictates that each ICB includes a member nominated by General Practice, with no insight from any of the other primary care professions. This is despite GPs accounting for only about a third of the primary care workforce in England.

To remedy this, during the passage of the Bill through Parliament partners are seeking the list of ‘Ordinary members’ of ICBs in Schedule 2 (p. 127) amended to include an extra member nominated by clinicians providing non-medical NHS primary care services within the ICB’s area.

BDA Chair Eddie Crouch said: “Voices that make up three-quarters of NHS primary care risk being lost in commissioning decisions that affect their services and the millions of patients they treat and serve every day. General practice simply cannot be expected to effectively represent the views, perspectives and distinct challenges facing colleagues in the wider NHS.

“We believe that for the benefit of patients and the NHS the crucial contribution non-medical primary care professionals make to the local health and care systems must be recognised and reflected at every level of the NHS, including within Integrated Care Boards. The only way this can happen effectively is if colleagues are guaranteed a seat at the table. That means a board presence drawn from non-medical primary care professions such as dentists, community pharmacists or optical professionals.”

PSNC Chief Executive Simon Dukes said: “All primary care providers must have a voice in the new Integrated Care Systems, including community pharmacies and their teams. Every day around 1.6 million people visit a pharmacy in England to access vital medicines, healthcare advice and other important services, such as NHS flu vaccinations. During the pandemic, public reliance on pharmacies has increased, reflecting the importance of pharmacy services to patients and local communities. It is therefore important that these new local systems recognise the critical role played by pharmacies and the whole of primary care, as well as general practice.”  

The representative bodies for primary eye care and audiology – ABDO, the AOP, FODO and the NCHA – said: “Optical practices and other primary care providers are vital to population health and care, and need a voice at all levels of the NHS in England. That’s why we are working together and calling on MPs to include provisions in the Bill to make sure this happens starting with the new Integrated Care Boards.”

Healthcare organisations call for mandatory facemasks

Healthcare organisations from across England have written a letter to Prime Minister Boris Johnson calling for face masks to be mandatory in healthcare settings. From July 19 it will no longer be mandatory for the public to wear face coverings when visiting a pharmacy, dentist, hospital, shop or other establishment in England.

The letter is signed by the Royal Pharmaceutical Society in England (RPS), the British Medical Association, British Dental Association, Royal College of Nursing and the College of Optometrists. It calls for mandatory use of face masks, social distancing and regular handwashing by the public to stay in place past July 19 in all healthcare settings.

As well as this, the signatories want to see the use of appropriate respiratory protection for staff in health and care settings continue, alongside improvements in ventilation wherever possible.

British Dental Association Chair Eddie Crouch said: “No health professional should be left struggling to manage patient expectations come Monday.

“After all the mixed messages we need government to be crystal clear that face coverings will remain in place to protect the public and staff.”

Thorrun Govind, Chair of RPS in England, said: “Using masks in healthcare environments means staff and the public are taking steps to protect each other from Covid-19. It should, therefore, remain mandatory that they are worn past July 19.

“Despite some pharmacies being in retail environments, they remain a healthcare setting and have been relied upon to support and protect the public over the past 18 months.

“We are therefore calling on the Government to make a decision to support and protect pharmacists and healthcare professionals, as well as the public.”

Dr Chaand Nagpaul, Chair of BMA Council, said: “Scrapping the remaining restrictions next week – when a significant proportion of the population still has not been fully vaccinated – will give this deadly virus an opportunity to retighten its grip; pushing infection rates up, increasing hospitalisations and people ill with long-Covid, risking new vaccine-resistant variants developing, and putting more lives at unnecessary risk.

“While the Government has said it will continue to encourage the wearing of face coverings after the 19th, within the same breath ministers confirm that masks will not be mandatory. This is contradictory and shows the Government absolving itself of responsibility while heaping pressure on the public, confused by mixed messaging of the highest order. Ministers must now reassess the decision to lift the remaining restrictions on July 19. Until then, we urge the public to continue taking every precaution by wearing face coverings, maintaining social distancing, and meeting outside where possible.”

Jude Diggins, Interim Director of Nursing, Policy and Public Affairs at the Royal College of Nursing, said: “The recent increase in the number of COVID-19 cases shows that we have some way to go before being free from the pandemic. Using face masks, social distancing and handwashing must continue if we are to continue to protect the population.

“It is important to recognise that nursing staff are more vulnerable than the general public as they work closely with patients who may have contracted COVID-19. To keep them safe, they must be provided with and supported to use the highest level of protection through the use of FFP3 masks where necessary and in all environments.”

BDA urges Priti Patel to drop plans for inaccurate, unethical dental checks on migrants

The British Dental Association (BDA) has urged Home Secretary Priti Patel to think again on plans to introduce dental checks to establish the age of Channel migrants. According to reports, a new independent nationwide panel will use dental records and other ‘scientific evidence’ to verify the age of asylum seekers. 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 take radiographs of people 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.

The new Nationality and Borders Bill will give the Home Secretary the powers to introduce methods of assessing age via regulation. This new position runs counter to statements adopted by the Home Office in 2016, when the Department rejected similar calls from backbencher David Davies MP*.

BDA Chair Eddie Crouch said: “This is a retrograde step from Priti Patel. In 2016 the Home Office ruled out dental checks for migrants, which we considered inaccurate, inappropriate and unethical. In 2021 the science and ethics have not changed.”

* Home Office Statement 19 October 2016: “We work closely with the French authorities and their partner agencies to ensure all those who come to the UK from the camps in Calais are eligible under the Dublin regulations.

“All individuals are referred to the UK authorities by the France terre d’asile (FTDA) and are then interviewed by French and UK officials. Where credible and clear documentary evidence of age is not available, criteria including physical appearance and demeanour are used as part of the interview process to assess age. 

“We do not use dental x-rays to confirm the ages of those seeking asylum in the UK. The British Dental Association has described them as inaccurate, inappropriate and unethical.”