NHS dentistry reprieved as vital support extended in Scotland

The British Dental Association have said NHS dentistry has escaped imminent collapse, following the Scottish Government’s decision to extend vital support until 31 October 2023.

A ‘bridging payment’ – originally due to lapse on 1 April 2023 – uprated NHS fees by 1.1. With spiralling costs and lower patient numbers the professional body had warned ministers the traditional high volume/low margin model NHS dentistry works to was now unsustainable and removing the payment would push practices to bankruptcy or into the private sector. 

BDA Scotland stress a new sustainable model must be in place by 31 October, otherwise the extension will only delay the inevitable. Practices are already facing the risk of providing care that involves laboratory work – like dentures – at loss.

NHS dentistry in Scotland has not returned to anything resembling business as usual. Recent data has indicated claims submitted by NHS dentists for dental work are 43% down on 2019 levels and suggest a growing exodus from the NHS workforce.

The news comes just 24 hours before the Scottish Lib Dems are set to use a parliamentary debate on Wednesday to declare a crisis in NHS dentistry.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said: “This is needed progress. We told the Scottish Government that pulling the plug on these payments would be a body blow to this service. What’s needed now is real reform to a broken system. There can be no more kicking the can down the road – a sustainable model must be in place come October.”

Survey finds that four-in-five teachers are providing pupils with toothpaste and brushes

The cost-of-living crisis is impacting on the oral health of children in classrooms across Britain, with most teachers now stepping in to provide pupils with the basics, according to new research. [1]

A survey of secondary teachers by grassroots hygiene poverty charity Beauty Banks in partnership with the British Dental Association (BDA) revealed:

  • 4 in 5 (83%) say they or their school have given students toothbrushes and toothpaste. 81% said there are children in their school who don’t have regular access to toothpaste.
  •  40% said this leads to students being socially excluded by their peers because of oral hygiene issues. Half report children isolating themselves. One third have witnessed bullying directly.
  •  25% say children miss school because of poor oral hygiene. Three quarters (74%) said children who don’t have regular access to oral health products have discoloured teeth. Half said children had noticeable tooth decay. 30% noted children in dental pain or suffering from halitosis.
  • Nearly a third (31%) of teachers who witness poverty in the classroom report said it effected their mental health. 1 in 4 are kept awake at night worrying about their students’ wellbeing. 38% report feeling helpless.

News follows warnings made early in the New Year from the Royal College of Paediatrics and Child Health, that toothbrushes are becoming a “luxury item” for some families, and that the state of children’s dental health is a “national disgrace”.

Beauty Banks, established in January 2018, supports individuals and families in the UK who can’t afford to stay clean. Jo Jones, co-founder of Beauty Banks says: “We work with charities including food banks, family centres, domestic abuse centres, homeless shelters and universally – across the board – toothpaste is now our most requested item. Before the cost-of-living-crisis, it wasn’t even in the top 3.

“So we initiated this research with the British Dental Association to fully understand the immediate and long-term impact of a lack of access to fundamental but vital oral hygiene essentials”

Tooth decay remains the most common reason for hospital admissions among young children. According to the BDA, tooth decay in children has reached epidemic levels, with any recent gains set to be undone by ongoing access problems and disruption to public health programmes.

British Dental Association Chair Eddie Crouch said: “Our youngest patients face a perfect storm, with millions unable to access care, or even the basics to maintain good oral health. This shocking survey underlines that deep health inequalities are set to widen.

“Yet while our children face an epidemic of decay, the government seems asleep at the wheel.”

The latest NHS dental statistics indicate that just 44.8% of children attended a dentist appointment in the last year, down from 58.7% in 2019/20, a net result of pandemic disruption.

Unsurprisingly, this oral hygiene crisis creates a more challenging working environment for teachers.

Beauty Banks co-founder Sali Hughes said: “Our teaching workforce spends a significant amount of time dealing with the impact of poverty on pupils, that they want to spend on educating their classes.

“Hygiene poverty causes not only social exclusion in children but in educational exclusion, too.”

Severe access problems and the cost-of-living-crisis create a perfect storm for teachers and their students. In August, BBC research in partnership with the BDA found that 91% of practices in England could not take on new adult NHS patients. 79% were not accepting new child NHS patients.

45% of teachers participating in the survey said their local dentist wasn’t accepting new NHS patients. 1 in 4 were anxious about visiting the dentist because of treatment bills.  Over a fifth (22%) said they struggled to afford hygiene basics like toothpaste, shampoo and deodorant.

While NHS dentistry is free for children and some adults, often based on their benefit status, many on modest incomes have to pay. Dental charges were first introduced to discourage attendance, and nearly 1 in 5 adult patients have delayed treatment for cost reasons, according to the last Adult Dental Health Survey. Dentist leaders are now deeply concerned that current economic conditions and access problems will inevitably see more patients deferring treatment.

“Nearly every patient coming through is telling us they’re feeling the pinch,” warns Paul Woodhouse, a dentist in Stockton-on-Tees.

“We’re seeing a spike in last-minute cancellations. Others choose extractions simply because it’s cheaper than treatment that could save a tooth. Appointments are hard to come by, but for many on modest incomes, dentistry is becoming a luxury they simply can’t afford.”

Case study: A secondary school in Central London

The Designated Safeguarding Lead in a secondary school in Lewisham said: “With the cost-of-living crisis, we are getting more calls than ever from parents who cannot afford to buy basic hygiene products. The cases of bullying amongst young people because of symptoms associated with poor oral hygiene is at a record high.”

The Pastoral Leader for Key Stage 3 said: “The pastoral team within school are dealing with many students who are not brushing their teeth every day, are showering infrequently and cannot afford to wash and dry their clothes effectively.”

The assistant head teacher noted “some students are still wearing Covid masks to hide their mouths.”

Reference:

[1] TOOTH HURTS: SMILES SHAPED BY POVERTY Polling by Mortar Research of 260 UK state secondary school teachers, fieldwork October 2022. For more information contact 07968 791684

Latest figures reveal depth of Scotland’s access crisis

The British Dental Association has called on the Scottish Government to fix the broken system underpinning NHS dentistry, as new data reveals little sign of a recovery in attendance and ever-widening health inequalities.

Figures from Public Health Scotland show participation rates – contact with a dentist within the past two years – continued to fall. On 30 September 2022 just 50.4% of all registered patients had seen an NHS dentist within the last two years, still down on the 52.6% seen in 2021, and a considerable reduction from almost two-thirds (65.1%) in 2020. The participation rate among registered children was higher than for adults (65.7% compared to 47.2%).

The gap between the most and least deprived areas in Scotland continues to grow, with the new data showing record inequalities in participation rates. In September 2008, the gap in child participation between the most and least deprived areas was three percentage points; this had increased to seven percentage points by 2010, eighteen percentage points (55.3% compared to 73.1%) in September 2021. The figure now stands at twenty percentage points (55.9% compared with 75.8%).

The BDA has warned that lower levels of participation will inevitably translate into a higher dental disease burden, with deep oral health inequalities expected to widen even further given the cumulative impact of limited access to services, the temporary suspension of public health programmes, and the impact of lockdown diets. Lower participation will reduce the chance of picking up early signs of decay and oral cancers at routine check-ups, and delays in treatment will mean higher costs to the NHS and worse outcomes for patients. 

Registration rates remain high due to lifetime registration – over 95.4% of the Scottish population were registered with an NHS dentist in September 2022– but the percentage of children registered fell marginally. 

Free NHS dental for all remains a key Scottish Government policy. BDA Scotland has long warned that a return to a ‘business as usual model’ – low margin and high volume – will put practices under unsustainable financial pressure, with soaring running costs raising the risk of closure or movement to the private sector. BDA Scotland stresses that Ministers must continue with additional financial support for practices, set to end on 1 April 2023 to support dentists and their teams as they work through the historic backlog of dental care and until a new, sustainable funding arrangement for NHS dentistry is in place. This data follows recent reports of a growing exodus of dentists from the NHS.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said: “Patients in Scotland’s poorest communities are paying the price for the crisis in dentistry. The Scottish Government must not try to hide behind positive sounding registration figures. The reality is patient participation remains on the floor, and inequalities are set to widen. Dentists are reconsidering their futures working in a broken system. NHS dentistry is on the critical list, and real reform won’t wait.”

BDA: Government must turn page on Eleventh Hour pay cuts

The British Dental Association has said government’s approach to pay is driving talent out of the NHS, as below inflation awards leave NHS dentists in England facing a drop in real incomes with no parallel in the UK public sector.

With the Association set to hold talks with Health Secretary Steve Barclay tomorrow morning, the Department of Health and Social Care has finally confirmed a substantially delayed uplift in contract values for general dental practice in England at 4.75% for 2022/23, reflecting a 4.5% rise in pay with an additional uplift applied for practice expenses. With inflation at an historic high, this corresponds to real terms cuts to the funding available to deliver NHS dental services and to pay associate dentists and other staff. Dentists in England have already seen their real incomes collapse by nearly 40% since the financial crash.  

In conjunction with the BMA, the BDA has stressed that root and branch reform is now required to give pay review bodies real independence. The government has interfered in the Review Body for Doctors’ and Dentists’ Remuneration processes as a matter of course, imposing public sector pay freezes and pay caps, and by arbitrarily defining ‘NHS affordability’ each year.

The process has been dogged by interminable delay, with the government routinely providing late evidence. The pay uplift for 2022/23 is set to be implemented ten months late in February 2023, close to the end of the NHS financial year and backdated to April 2022. The political chaos and the resultant churn at the Department of Health and Social Care have been cited as excuses. 

Dentist leaders have stressed that this approach will only push talent out of the NHS.

Research undertaken by the BBC underlined the scale of the current access crisis, with nine in ten practices reporting as unable to take on new adult patients on the NHS. The Health and Social Care Committee is now holding a dedicated inquiry, having been warned by the BDA in May that NHS dentistry in England faced a ‘slow death’, in the face of endemic recruitment and retention problems.

BDA Chair Eddie Crouch said: “England’s dentists have just been handed an unprecedented pay cut at the eleventh hour. If Steve Barclay wants to win over NHS colleagues, he must turn the page. Current pay review processes offer textbook examples of what not to do. Every dedicated health professional requires fair and timely pay uplifts. When so many are reconsidering their future in the NHS, to do otherwise is an act of self-harm.”

Access problems risk wiping out decades of progress on oral health

The British Dental Association has warned the latest official research on the impact of the pandemic on access to dental care in England underlines the need for urgent and fundamental reform, with decades of improvements to the nation’s oral health now at risk.

Based on the findings of the 2021 decennial Adult Oral Health Survey, the Office for Health Improvement and Disparities (OHID) found that during the first year of the pandemic only 43% of those who reported toothache or other pain reported receiving complete professional treatment. 19% received temporary treatment, 23% were given advice on how to manage the problem on their own, 25% received a prescription for antibiotics and 11% received no professional treatment or advice.

Those in the poorest communities suffered the most, with 24% of those in the most affluent communities reporting toothache or other oral pain, compared to 41% in the most deprived.

Dentist leaders stress England’s oral health gap will inevitably widen as a result of ongoing access challenges. BBC research in August 2022 reported 9 in 10 practices were unable to take on new adult NHS patients. Over 47m NHS dental appointments have been lost since lockdown in England alone.

The Health and Social Care Committee has just launched an inquiry into access problems in NHS dentistry. Ministers recently announced minor tweaks to the discredited NHS dental contract fuelling the current crisis, without a penny of new investment attached.

The system continues to put government targets ahead of patient care, and funds services for barely half the population. The number of dentists delivering NHS care in England has fallen to 2017/18 levels, and BDA surveys suggest that for every dentist leaving the NHS since lockdown, 10 have reduced their NHS commitment by significant amounts. This exodus from the NHS will have a major and lasting impact on patients’ ability to access NHS dentistry, with every vacancy that goes unfilled translating into thousands of patients missing out on care.

British Dental Association Chair Eddie Crouch said: “These access problems are still with us. Political choices mean they are set to become the norm, as dentists walk away from a broken, underfunded system. NHS dentistry can be saved, but we’re yet to see evidence government has the ambition to do so. Decades of progress in the nation’s oral health risk going into reverse. If Ministers fail to turn the page the price will be paid in our poorest communities.”

Dentistry inquiry offers chance to bring service back from the brink

The British Dental Association says a new parliamentary inquiry into access to NHS dentistry may represent a last best hope to save the service.

With dental access problems at an all-time high, and an exodus from the NHS dental workforce in motion, the BDA stress real scrutiny is now essential to draw a line under the government’s poverty of ambition on reform.

Ministers recently announced minor tweaks to the discredited NHS dental contract fuelling the current crisis, without a penny of new investment attached. The system continues to put government targets ahead of patient care, and funds services for barely half the population.

The number of dentists delivering NHS care in England has fallen to 2017/18 levels, and BDA surveys suggest that for every dentist leaving since lockdown, 10 have reduced their NHS commitment by significant amounts.  This exodus from the NHS will have a major and lasting impact on patients’ ability to access NHS dentistry, with every vacancy that goes unfilled translating into thousands of patients missing out on care.

In its recent report into the NHS workforce, the Health and Social Care Committee dubbed the dental contract as “not fit for purpose”, stating that “urgent reform is needed to boost recruitment and retention in NHS dental services.” The dedicated inquiry is the first in a generation. A 2008 report prompted a government-commissioned review, outlining fundamental changes to NHS dentistry, which successive administrations have failed to implement. A 2019 inquiry was later cut short by the snap general election.

In May, the BDA told the Committee that NHS dentistry faces a ‘slow death’ without concerted action. The professional body warns that the government’s stated ambitions to improve patient access and retain dentists in the NHS cannot be met without new investment. With skyrocketing inflation, simply to maintain the spending power in recent budgets would require an additional outlay of nearly £0.5b a year. This follows a decade of savage cuts, in which funds failed to keep pace with inflation and population growth. It would take an extra £1.5b a year just to restore resources for NHS dentistry in England to 2010 levels.  

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “This inquiry offers hope to millions of patients left with no options. NHS dentistry faces a man-made crisis, the net result of a decade of choices made in Westminster. To date, Ministers have simply tinkered at the margins. A failed, underfunded system demands real scrutiny and real reform.”

BDA: Tweaking broken system will not end NHS access crisis

The British Dental Association has warned minor tweaks to the widely discredited NHS dental contract – set to roll out from today – will do little to arrest the exodus of dentists from the service or address the crisis in patient access.

The professional body has disputed claims that this represents a ‘new contract’ when the package amounts to tinkering at the margins of the failed target-based model and comes with no additional funding.

The contract still only funds care for little over half the population and maintains perverse incentives to dentists. The unsuitability of this system during the pandemic has accelerated the drift of dentists away from the NHS into a full-on exodus. The number of dentists delivering NHS care in England has fallen to levels not seen since 2017/18, and BDA surveys suggest that for every dentist leaving, ten have reduced their NHS commitment by significant amounts. 

The marginal changes include:

  • A ‘find a dentist’ website offering no appointments. Practices will now be legally compelled to update NHS.uk regularly with details on the availability of appointments. Given BBC research in August indicated 9 in 10 practices were unable to take on new adult NHS patients, the BDA stresses all this change will do is underline the paucity of patient access across England. 
  • A higher reward for treating three or more teeth. Dentists will now receive five Units of Dental Activity (UDAs) for treating three or more teeth, an increase on the former level of three UDAs, which applied to care delivered to any number of teeth. However, with patients now requiring as many as 20 fillings, perversity will remain baked into the system, with less complex work still being rewarded at the same rate as treatments that can take hours.   
  • A new payment rate for complex treatment. Root canal treatment on molar teeth will now be rewarded with seven UDAs, as opposed to three, as a result of BDA lobbying. However, the BDA warns the move is unlikely to be a game changer, given the nature of the challenging and time-consuming treatments – which can take up to three hours on a single tooth. 

In July, Parliament’s Health and Social Care Committee dubbed the dental contract as “not fit for purpose”, stating that “urgent reform is needed to boost recruitment and retention in NHS dental services.” This mirrors the conclusion of a major government-commissioned enquiry 13 years ago.

The BDA has also warned that a return to austerity now risks fatally undermining NHS dental services. The recent Autumn Statement failed to set aside funds to fully insulate the NHS from skyrocketing inflation. The BDA estimates that simply to maintain the spending power in recent budgets for NHS dentistry would now require an additional outlay of nearly £0.5b a year. This follows a decade of cuts, in which funds failed to keep pace with inflation and population growth. It would take an extra £1.5b a year just to restore resources in NHS dentistry in England to 2010 levels. 

Shawn Charlwood, Chair of the British Dental Association’s General Dental Practice Committee said: “Minsters have done little more than rearrange the deckchairs. These minor tweaks will not end the access crisis or give demoralised dentists any reason to stay in the NHS.

“It’s one thing to offer a shiny new website showing patients they can’t get an appointment. It’s quite another to put in place reform and funding so millions can get the care they need.”

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Richard Madeley urged to correct record on NHS dentistry

The British Dental Association has urged TV presenter Richard Madeley to correct the record, following inaccurate comments concerning NHS dentistry made on Good Morning Britain this morning.

Mr Madeley told commentators Kevin Maguire and Andrew Pierce that “NHS dentists are not capable of doing extractions anymore”.

He said: “I was talking to a private dentist only last week, who was saying that so many people now have to go private because NHS dentists are not capable of doing extractions anymore. They are simply not trained up to that level.”

The GMB host also stated as “categorical fact” that instead of extracting rotten teeth, patients are being handed antibiotics and referred to casualty. While complex cases can be referred to hospital, the BDA stresses dentists are fully trained to undertake these procedures. Accident and Emergency services are not placed to provide this sort of treatment, and dentist leaders have warned such suggestions will only place further pressure on other NHS providers. 

The BDA believes Mr Madeley has wholly misrepresented the current crisis in dentistry. The number of dentists doing NHS dentistry has fallen to levels not seen since 2017. Recent BBC research revealed that nine in ten practices in England were unable to see new adult NHS patients. Over 40m NHS dental appointments have been lost since lockdown, over 12m of those for children.

The discredited NHS contract dentists in England work to is fuelling this access crisis. It puts government targets ahead of patient care, and caps spending to cover barely half the population. Minor ‘tweaks’ to the contract announced before summer recess, do nothing to improve access, or halt the exodus of dentists from the NHS and had no additional funding attached.    

The Autumn Statement failed to ‘inflation-proof’ existing funds, and risks leaving a nearly £0.5b hole in the service’s already inadequate budget.

British Dental Association Chair Eddie Crouch said: “Richard Madeley has offered a grotesque misrepresentation of a crisis facing millions of patients.

“His categorical facts are pure fiction. Dentists have the training, what’s really missing is the political will at Westminster to save this service.

“NHS dentistry is at a tipping point and requires fair funding and real reform. It can do without the musings of armchair pundits.”

BDA: failure to inflation-proof NHS is gross negligence

Failure to act leaves £ ½ billion hole in dental budget

The British Dental Association has condemned failure in the Autumn Statement to set aside funds to fully insulate the NHS from skyrocketing inflation, ​warning it will amount to deep cuts to frontline services that are already at breaking point.

The BDA estimates that simply to maintain the spending power in recent budgets for NHS dentistry would now require an additional outlay of nearly £0.5b a year. [1] Recent inflationary pressures follow a decade of austerity, in which funds failed to keep pace with inflation and population growth. It would take an extra £1.5b a year just to restore resources in NHS dentistry in England to 2010 levels. [2]

In July ‘dental inflation’ already sat at over 11%, with practices confronting soaring energy prices, and mounting costs of providing care within a standstill budget [3]. With dentists facing the prospect of delivering NHS treatments at a financial loss, the BDA warn this will only accelerate the exodus from the workforce.

Recent research has indicated nine out of ten practices are unable to offer appointments to new adult NHS patients. While the government has expressed its commitment to reform the widely discredited contract for NHS dentistry, the BDA have repeatedly stressed that stated objectives to improve patient access and workforce retention cannot be achieved without meaningful investment.

Ahead of the statement the BDA warned the new Chancellor that “there is simply no more fat to trim, short of denying access to an even greater proportion of the population.”

BDA Chair Eddie Crouch said: “Failure to protect the NHS from soaring inflation amounts to savage cuts to frontline services. This isn’t fiscal discipline, but gross negligence that will actively undermine patient care. If the Treasury expect practices to provide NHS care at a loss it will only deepen the access crisis facing millions of patients.  

“The last round of austerity brought NHS dentistry to its knees. Another dose of ‘efficiency savings’ will fatally undermine efforts to rebuild and reform this service.”

Further cuts will kill NHS dentistry, BDA warns Chancellor

Following Jeremy Hunt’s emergency statement on the public finances, the British Dental Association has warned any further cuts risk destroying any prospect of saving NHS dentistry in England.

In an open letter to the new Chancellor, the professional body has stressed that without meaningful investment a reform process looks doomed from the outset, and that any further ‘efficiency savings’ will critically undermine existing dental providers and further erode access to the public.

Formal negotiations are yet to begin on reforming the discredited NHS contract dentists in England work to that is fuelling the current access crisis. The system puts government targets ahead of patient care, and caps spending to cover barely half the population. Minor ‘tweaks’ to the contract announced before the summer recess, will do nothing to improve access, or halt the exodus of dentists from the NHS and had no additional funding attached.    

The BDA has long pressed for a decisive break from this failed contract, recently dubbed by Parliament’s Health and Social Care Committee as ‘not fit for purpose’, underpinned by sustainable investment. It warns that the government’s objectives to improve access and boost retention simply cannot be achieved within the historic financial constraints set by the Treasury. Dentist leaders warn another period of austerity will leave the service at risk of collapse. The BDA estimates it would take an extra £880m a year simply to restore resources back to 2010 levels.

In his former role as chair of the Health and Social Care Committee, Jeremy Hunt had been a leading advocate of reform in dentistry, and a fully funded workforce plan for the NHS.

BDA Chair Eddie Crouch said: “Without fair funding for NHS dentistry, there was little scope to do more than rearrange the deckchairs as the ship goes down. New cuts will only speed that process along.

“Since the financial crash, dentists have faced cuts with no parallel anywhere in the NHS. There is simply no more fat to trim, short of denying access to an even greater proportion of the population. 

“We never imagined we would need to defend the wholly inadequate resources currently offered to us. But it seems we must. However, the stark reality remains that sustainable investment is urgently required if we are going to bring this service back from the brink.

“In his former role, the Chancellor recognised the scale of this crisis. NHS dentistry is already on the critical list. Any further cuts will kill the patient.”