Scotland

Scottish Dentist juniors to join strike action

The British Dental Association has announced that dentists in Scotland employed under the same contract as junior doctors, will join their medical colleagues in a 72-hour walkout, the dates of which are yet to be confirmed, if BMA ongoing negotiations with the Scottish government do not result in a credible pay offer.

The overwhelming majority of voters (91%) from this small but important cohort backed industrial action, on a turnout of 79%.

British Dental Association Chair Eddie Crouch said: “Our members stand ready to do whatever it takes to secure a fair deal on pay. Just like their medical colleagues these dentists aren’t worth a penny less than they were a decade ago. We are hopeful that a negotiated settlement can be found. But our members will take strike action if the Scottish Government fail to come back to the table with a serious pay offer.”

NHS Dentists issue open letter to new Scottish First Minister

Following the election of Humza Yousaf as SNP leader and his swearing in as First Minister, dentist leaders in Scotland have called for immediate action to ensure the beleaguered service has a future.

The leadership election has delayed the timetable for reform of the low margin/high volume system dentists work to, that has left providers facing the risk of delivering NHS care at a financial loss. In an open letter, the British Dental Association has stressed that without immediate action the exodus from NHS dentistry will accelerate.

A recent survey of high street dentists across Scotland showed over half (59%) have reduced the amount of NHS work they do since lockdown, and four in five (83%) say they plan to reduce or further reduce their NHS commitment in the year ahead.

In the letter BDA’s Scottish leadership state: “In 2021 the SNP made a promise to the Scottish electorate: free NHS dentistry for all. The decisions you take in your first 100 days will effectively determine if that promise is going to be kept.”

Dentistry’s veteran campaigner downs drill to fight for future of service in Scotland

The British Dental Association is delighted to announce dentist and experienced campaigner Charlotte Waite will take on a leading role in the fight for the future of dental services in Scotland.

She will take up the role of Director of BDA Scotland in October, supporting members in negotiations with the Scottish Government and overseeing outreach to the Scottish Parliament, officials, the press and wider stakeholders.

Prior to the pandemic Charlotte exposed the scandal of Westminster’s aggressive NHS fines regime, which saw millions of often vulnerable patients face £100 fines for attempting to claim free dental care or prescriptions. 

Working with the media and speaking up for patients in the UK parliament, she lifted the lid on a system that saw 1.7 million fines – worth £188 million – withdrawn because the ‘fraudsters’ targeted were actually fully entitled to claim support towards NHS dental or prescription charges. Off the back of her powerful evidence to the Westminster Public Accounts Committee, the UK Department of Health and Social Care abandoned a ‘fines first’ policy, based on the presumption of guilt. 

While redeployed on the front line during COVID she revealed chronic PPE shortages that left hundreds of Urgent Dental Care centres struggling to deliver care to patients in agony, when most practices were closed for routine care.

Working with partners including Mencap she has continued to press the UK government for action on backlogs for patients facing yearlong waiting times for dental treatment under general anaesthetic as a result of pandemic disruption. She has also led efforts to encourage the use of Makaton – a unique language programme that uses symbols and signs, alongside speech – within dental settings, to break down barriers to communication with dental patients with learning disabilities. She has also spoken out in the press and lobbied the UK Government for better investment and provision of dental services for people experiencing homelessness and for residents in care homes.

News of Charlotte’s appointment comes in a week the BBC revealed 82% of NHS practices in Scotland were not accepting new adult patients, with 1 in 5 stating they had waiting times of a year or longer. Researchers were unable to find any practices taking on new patients in 9 of Scotland’s 32 local authorities.   

BDA Scotland has warned Ministers and officials they risk undermining the future sustainability of NHS dentistry, with cuts to financial support leaving some practices delivering some NHS treatments at a loss. There is a growing exodus from NHS dental services, with official data showing the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of Covid.

Waite will be pursuing BDA Scotland’s call for development of a new, sustainable long-term model for NHS dentistry, support for dentists in all fields of practice, and effective action to tackle Scotland’s deep oral health inequalities, which are now set to widen as a result of the pandemic.

The Glasgow-born Waite qualified in Dundee, before completing general professional training in the East of Scotland, locuming in Australia and then working in the Community Dental Service (CDS). She will be leaving her longstanding role in the CDS where she has provided dental care for some of the most vulnerable in society.  

Charlotte Waite said: “I’m downing my drill to fight for the future of dentistry in Scotland. The service is on the brink and the public are living with the results. The Scottish Government pledged free NHS dental care for all, but we now face an exodus from the workforce, the risk of a two-tier system, and a shameful oral health gap that will only widen.  

“Our message to every MSP and every party is that this crisis will not end without real commitment. Sit down with us and we can secure a better future for a service millions depend on.”

NHS dentistry on the brink as Ministers cut vital support, says BDA Scotland

The British Dental Association Scotland has warned Ministers they risk undermining the future sustainability of NHS dentistry, as they move to scale down vital financial support for the service.  

For the last three months practices have received a 1.7 multiplier to the fees paid to provide NHS care, a reflection of the unprecedented backlog practices have faced as they try to ‘live with Covid’. The Scottish Government has now moved to pare the multiplier down to 1.3 for the next 3 months. This reduction follows no dialogue with the profession despite the BDA calling for regular discussions with the Government about the latest activity data and any proposed changes.

The discredited low margin/high volume model dentists in Scotland work to means treatment can often be delivered at a loss, a growing problem given the growing levels of unmet need, particularly among those from move deprived communities.   

Official data suggests the total number of high street NHS dentists in Scotland has fallen by over 5% since the onset of Covid. The BDA warn heavy-handed policies will only push Scottish dentists down the road of their colleagues in England, where thousands of dentists have left the NHS since lockdown, amid warnings from MPs south of the border that NHS dentistry now faces a ‘slow death’. 

The BDA has again urged the Scottish Government to, in the short term, develop a suitable interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable long-term model for NHS dentistry. Dentists remain anxious that the Government will look to remove the multiplier altogether at the first opportunity despite its stated intention not to return to the pre-pandemic financial arrangements. The BDA has repeatedly voiced its strong opposition to a return to the pre-Covid “treadmill”.

David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee said:“Ministers are playing with fire, pulling away the life support from a service millions depend on.  

“This multiplier helped ensure NHS dentists received fees for care that actually covered their costs.  Slashing them will leave colleagues churning out dentures at a loss while thinking twice about their future. 

“Scotland has already lost too many NHS dentists since lockdown. Ministers are now blindly heading down the path the Westminster Government has chosen, which has sparked an exodus. 

“Cuts have consequences. The Scottish Government promised free NHS dentistry for all. Short-sighted policies like this will likely result in the exact opposite, and stark oral health inequalities will only widen further.”

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.”

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.”  

 

England and Scotland enter new lockdowns; dentistry ‘unaffected’

On Monday 4th January, Scotland’s First Minister, Nicola Sturgeon, announced that from midnight (5th January), the country would be put into a full lockdown as Coronavirus cases continue to surge. Just hours later, Prime Minister Boris Johnson spoke to the nation in a pre-recorded televised announcement, confirming that England too would enter a new national lockdown – one that resembled more the one from March/April 2020. The new lockdown, which sees schools once again closed in another government U-turn, will reportedly not affect dentistry – on the surface at least.

The original lockdown during the Spring of 2020 saw dental practices closed for almost three months. They were able to reopen from 8th June, although it was a slow start for many as the profession grappled with new SOP measures in efforts to prevent the spread of Covid-19. Patient numbers remain much lower than pre-pandemic, in part due to increased fallow time.

As Scotland enters its latest lockdown, the British Dental Association (BDA) has ‘received confirmation from the Chief Dental Officer that the national lockdown from 5th January will have no impact on dentistry’. The Association has ‘argued that the full range of NHS treatments should not be available while the new virus strain continues to spread significantly. However, the Scottish Government’s position remains unchanged’ as: essential travel includes leaving home for healthcare and dentistry is deemed essential healthcare, meaning it can therefore continue under the revised restrictions announced by the First Minister. The BDA also states that ‘aesthetic treatment is not essential healthcare (and not available on the NHS) and should not be undertaken’.

Scotland’s CDO, Tom Ferris, also reiterated, via the BDA, that if a patient attends a dentist with a concern then the full range of clinical dental care should remain available to the dentist in order to manage the patient’s condition.

Meanwhile, CDO England, Sara Hurley, issued an update immediately following Boris Johnson’s announcement of England’s latest lockdown measures, confirming that ‘dental services are to remain open and see patients’.

Hurley noted that dental professionals are defined by the Government as critical workers, adding: ‘Dentistry is an essential medical service. It is a priority for the NHS. Patients are entitled to travel for medical appointments, include dental. I have included some useful resources in this bulletin for NHS practices to spread the word that dental services are open and seeing patients, please use them.’

The Government guidance on the national lockdown states: ‘The majority of public services will continue and you will be able to leave home to visit them. These include the NHS and medical services like GPs and dentists.’

The BDA also reiterated that ‘services should be carried out in line with the current standard operating procedure (SOPs) . Remote consultation, triage and risk assessment remain key prior to patient attendance for face to face dental care. Social distancing measures remain in place and PPE levels as stated for low, medium and high risk assessed patients remain.’

While dental practices remain open for business unlike last Spring, there will most likely be an impact felt as more patients opt to stay home rather than attend appointments, among other factors. Therefore, the BDA has issued an open letter to Health Secretary Matt Hancock, urging the government to abandon NHS targets that will be ‘impossible to achieve under the new national lockdown, and which risk putting hundreds of practices out of business’.

In addition to patients’ reluctance to continue with dental appointments, the BDA believes that ‘the NHS targets will force dentists to prioritise routine check-ups for the “worried-well” over a time-consuming urgent backlog’. MPs are set to debate the imposition of these targets at a Backbench Business debate on 14 January.

DDU welcomes fairer system for dealing with GDC concerns in Scotland

The DDU has welcomed a new system for dealing with low level concerns about dental professionals in Scotland. Under the new process, concerns which don’t meet the threshold for a fitness to practise investigation, will be re- routed to health boards, instead of being dealt with by the GDC. The process has been agreed between the GDC, CDO, NHS boards directors of dentistry and others.

John Makin, head of the DDU, said: “It is welcome news that low level concerns about dental professionals in Scotland, will now be dealt with at a local level by health boards. This brings Scotland into line with the system that is already operating for colleagues in England and Wales. Where a concern doesn’t raise a fitness to practise issue, it is only right that it is dealt with in the same way as a complaint directly to a health board.

“It is important that these cases aren’t treated as being of a more serious nature simply because they come via the GDC, where the patient chose to complain in the first instance.

“We wish to see a system in which the focus is on resolving low level complaints swiftly and at a local level, which is fairer and less stressful for all concerned.”

Scottish Dental Care Group to acquire two new practices

The Scottish Dental Care Group is set to acquire two new practices by October as part of its ambitious growth plans, after securing a £1.75 million funding package from Bank of Scotland.

Despite the recent pandemic forcing the temporary closure of each of its existing 11 practices, Scottish Dental Care Group acquired a new practice in the central belt during lockdown, with a further one in the final stages of completion. Its practices are currently located across Glasgow, Dumfries, Oban, Inverness, Bishopton and Cardonald.

The business sought support from Bank of Scotland to fund the new acquisitions as part of its wider growth plans to purchase a new practice each quarter throughout 2020 and 2021. The Group also has existing funding in place should any further changes be needed to ensure the practices comply with future government guidance in relation to Covid-19.

The planned acquisitions will bring an additional 23 members of staff to the Group, totalling 91 nursing and clerical staff, 44 dentists and hygienists. The new NHS and private practices will also welcome around 20,000 new patients, bringing the total number to almost 100,000 across Scotland.

Philip Friel, SDC Group’s clinical director, said: “We’ve been very specific in terms of our group structure and ambitions for growth. While no one foresaw the current global pandemic, that same robust structure and management regime stands us in good stead to progress with our growth plans across the country. This is only possible with the support of our extended teams who have demonstrated outstanding cohesion throughout. It’s an exciting time for us, and we hope to return to normal practice soon, and continue growing into 2021 and beyond.” 

Christopher Friel, director of SDC Group, added: “Last year we focused on consolidating our existing practices and processes, as well as refinancing the group with Bank of Scotland which meant that when Covid-19 hit, we were in a strong position. We use a single supplier for all of the practices, from using the same electricity provider to the same manufacturer of clinical materials, meaning that once we’ve acquired a new site, the logistics of bringing that practice into the group are very straightforward.  This process also allows us to focus our efforts on the needs of our new team members and patients.”

Mark Sim, relationship director at Bank of Scotland, also commented: “Parts of the healthcare sector, particularly pharmacies, have been extremely busy throughout the pandemic. However, it has been more damaging for dental practices that have been forced to close their doors to weather this challenging time. SDC Group is a great example of a business that already had strong foundations in place and now, with our support, is ready to continue normal operations quickly as soon as it is permitted. We will continue supporting the firm with its ambitious expansion plans over the next 24 months, and hopefully see SDC Group become one of the sector’s key players over the coming years.”

SDPO raises concerns over out-of-date PPE in Scotland

The Scottish Dental Practice Owners Group (SDPO) has raised serious concerns that NHS dental teams in Scotland have been issued face coverings that may not be “fit for use”. The organisation reported that when practices received their PPE to begin aerosol generating procedures from Monday 17th August, some discovered that the FFP3 masks they received were “significantly beyond their expiry dates, in some cases by almost a decade”.

The SDPO even claimed that, in some cases, the original expiry dates had been covered with a new date of expiry label. To top it off, those dates had also passed, with the most recent being in 2019.

The SPDO said: “Preliminary inquiries to the mask manufacturer 3M suggest that they do not consider masks beyond their expiry date to be fit for use. Practitioners have serious concerns about the safety of masks of this age. How can masks this old be passed as safe when the manufacturer suggests otherwise? SDPO members are practice owners and must consider patient and staff safety. We lack confidence that the masks issued to dental practice staff are fit for use, and we are very concerned that NHS dental teams across Scotland have been issued with masks that may compromise patient and staff safety.”

However, a spokesperson for the Scottish Government stated: “Revalidating stock and extending the shelf-life of masks is standard practice to maintain pandemic stock levels and this was used in relation to FFP3 respirator stocks as announced in March. Any PPE which has been issued to NHS boards for onward distribution to dental practices and may have passed its original expiry date has been re-tested to ensure it remains safe to use. Such testing has been approved and reviewed by the Health and Safety Executive and to standards relevant to the PPE being tested. Critically, this PPE – supplied free of charge by our NHS – enables dentists to carry out urgent and emergency care while ensuring the safety of patients, dentists and all dental staff. Each board has a proactive programme of fit-testing for FFP3 masks under way with each practice requiring a fit test for a dentist and dental nurse; this is a rolling programme of work, there are around 1000 dental practices in Scotland.”