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.”

BDA: additional financial support and clear communication needed for phased reopening of Scottish dental practices

The British Dental Association has said the Scottish Government now has a responsibility to manage patient expectations, following confirmation from the First Minister that dental practices were able to offer routine care using non-aerosol generating procedures (AGPs) from 13 July. 

Practices are still only provide a limited range of treatments and will not be carrying out routine examinations. The BDA has stressed the need for clear and consistent communication from the Scottish Government and NHS Boards.

Dentists’ costs have increased as practices began reopening last month. The Scottish Government has announced additional funding for the latest phase of reopening – a 30% increase in General Dental Practice Allowance. While this funding is welcome, it is insufficient to restore practice income to pre-Covid levels and could see some practices struggle to remain viable. The BDA has stressed the need for additional funding, given the financial pressures facing mixed NHS-private practices with a high percentage of private income.

The Scottish Government has also issued a revised Statement of Dental Remuneration (SDR) for the next phase of reopening. The BDA welcomed the inclusion of triage activity in the SDR but has concerns about other aspects, such as the lack of funding for lab bills and the reduced level of care that GDPs are able to provide when routine examinations restart in phase 3. 

David McColl, Chair of the Scottish Dental Practice Committee, said: “The Scottish Government has a responsibility to manage patient expectations. Yes, we are moving to the next phase of reopening, but very little will change in terms of the treatments we can offer to our patients. Routine dentistry has not returned, and this fact needs to be clearly communicated. Dentists now face a vast backlog of dental treatment, and it will be some time before we return to anything resembling ‘business as usual’.

“Ministers now need to provide appropriate financial support to ensure the sustainability of NHS dentistry. We need the Government to engage more regularly and effectively with the profession and the public as we continue to navigate our way through these difficult times.”

Growing inequality between private practice and NHS dentists in Scotland?

NHS dentists in Scotland have expressed concerns over a growing inequality between patients able to afford treatment from private practices and those who rely upon NHS services in the country. NHS practices are not currently able to provide the full range of treatments, with the widespread belief being that this is because of the cost of PPE.

Now, according to The Scotsman, NHS dentists in Scotland have written to the government, asking why they are unable to provide the full service that their private practice counterparts, which have been able to afford fully fitted face masks, are. The Scottish government’s Chief Dental Officer, Tom Ferris, has told NHS dentists, however, that they will only be given standard PPE, ruling out dental treatments that involve drilling or use compressed air.

“There is a difference between dental provision in different places but the CDO has a very clear route map back to full dental care,” commented Scotland’s National Clinical Director, Professor Jason Leitch. “Emergency dental care and drilling has been available on the NHS in 70 or so Urgent Care Centres throughout the country. Tom, the CDO, is working quickly to move to the next step of the route map which would allow aerosol generating procedures to be done in the thousands of practices. I wrote with Tom to the private dental practices and asked them very clearly to follow the same route map as the NHS dentists. We have slightly less control over what they do because of the nature of contracts, but it was clear advice to follow the same as the NHS. Care has been available and it’s coming back to full dental care.”

Members of the public are still apprehensive about returning to the dentist following the Coronavirus outbreak. One Scottish dentist has said that they have only been visited by a few patients each day, and that even then, it is only when the patient is “in complete agony, which is leading to extractions rather than just fillings”.

“Dentistry isn’t putting anyone at risk, they’re well trained at infection prevention and control and I know they’ll all have adequate PPE so I don’t think patients are at risk,” asserted Leitch. “Tom is very keen to get NHS practices back as soon as we can with the full gamut of care. We’re making choices for a broad range of dentists across the nation.”

Yet, Dr Mohammed Samad, Chair of the Scottish Dental Practice Owners Group, claims that Scottish dentists are receiving conflicting advice from the government and individual health boards. “Why can NHS hubs be provided with adequate PPE to do AGPs but AGPs cannot be completed in general practice under the NHS? Is there a belief that dentists in practice are not as skilled or trained as those in hubs or is it the PPE supply?” he asked.

The Scottish government, meanwhile, has said: “There is no two-tiered system of dental health care in Scotland. NHS patients are able to receive care and treatment including aerosol-generating procedures through one of the 71 urgent dental care centres in Scotland. As part of phase three the Chief Dental Officer has commissioned an expert review of aerosol-generating procedures and will be writing to the profession shortly on how they might be introduced safely.”

Dental Group know the drill when it comes to nailing a performance

Dentists, nurses, hygienists and administrative staff were amongst the singers, musicians and performers who made a success of a lockdown concert for staff with Scotland’s fastest growing dental group.

More than 150 Clyde Munro employees and suppliers took part in an online two-hour gig to connect with colleagues across Scotland and have some fun in a concert billed as ‘The Lockdown’.

Bosses with Clyde Munro have been looking at creative ways to keep up the morale of their 500-strong team, made up of dentists, practice and support centre staff, who are either working from home or furloughed during the Coronavirus pandemic.

The brains behind the operation was Clyde Munro founder, Jim Hall, who launched the business in 2015 with the acquisition of seven practices. He said: “The Lockdown concert was a great success and all of the acts were a big hit amongst their colleagues.

“Everyone was blown away by the talent of the performers, we couldn’t quite believe how many musically talented people we had hiding in our practices across the country.”

Entrepreneur Jim said the concert was conceived to bring the Clyde Munro team together in a virtual setting and to lift spirits while helping the team to enjoy an evening of music and singing with everyone participating via Zoom video call.

He added: “We wanted to help take minds off all the worrying stuff that is going on in the world even for a few hours – and judging by the positive feedback, we definitely achieved that.”

At the start of April, as the full extent of the lockdown started to sink in, Jim knew that keeping in touch with staff and maintaining a high morale would be essential to ensuring the business comes through the virus crisis in the best possible shape.

So he tasked his team to come up with fun events to keep staff connected, starting with an Easter Bonnet competition and culminating with the ambitious Lockdown concert on Friday 24 April. Participants even took part in meticulous rehearsals ahead of the big night.

Jim added: “The team really got into the spirit and many even dressed up as if they were going to a summer music festival which was great as it meant even those who were not performing, still got involved and contributing to the atmosphere. It was a fun night that people will remember for a long time.”

Clyde Munro comprises 40 practices across Scotland, with more than 200 dentists, 350 staff and 300,000 patients.

The group’s ambition is to become Scotland’s “local dentist”, operating an expanding network of family dentists across Scotland, with each devoted to providing the best dental care, while reflecting the needs and character of its community.