By Lucy Ashton
The British Dental Association has today published a report which shows the extent of the crisis within NHS dentistry in Scotland.
As the representative organisation for dentists in Scotland, they warn that Scottish Government plans to revert to pre-COVID models of care, without any additional funding, risks sparking a flight of dentists from the NHS, with potentially devastating consequences for patient access across Scotland.
Dumbarton MSP Jackie Baillie, pictured left, said: “This stark warning from the BDA makes it abundantly clear that the very existence of NHS dentistry in Scotland is on the line.
“By removing support at this crucial point, the SNP is threatening to force scores of dentists out of the profession or into the private sector.
“This will lead to thousands of Scots going without vital dental treatment and will lead to a two-tier system in this country. We cannot let this happen. The Health Secretary must listen to the professionals on the frontline and think again.”
The British Dental Association has warned the Scottish Government plans to revert to pre-COVID models of care risks sparking a flight of dentists from the NHS, with potentially devastating consequences for patient access across Scotland.
In October Cabinet Secretary Humza Yousaf, pictured right, wrote to all NHS dental teams that all emergency support will be withdrawn by 1 April 2022.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 infection control restrictions that continue to limit capacity across the service.
According to a new survey of dentists in Scotland:
- 80% of dentists estimate their practices will reduce their NHS commitment should the Scottish Government withdraw emergency support and return to pre-COVID models of care.
- Over a third (38%) of dentists indicate they are now likely to change career or seek early retirement in the next 12 months should the policy be taken forward. 15% say they are likely to practice dentistry outside of Scotland, and 1 in 10 estimate their practice is likely to cease operations.
- Half of dentists report that they are operating at less than 50% of pre-COVID capacity. While the Scottish Government has offered a support packages to boost capacity, many practices are unwilling to commit to a broken NHS model. Over 30% say they have not applied, and among those half (49%) say they are now unable to commit to the NHS long-term. Support for ventilation costs requires a minimum 3 year commitment to the NHS.
- 9 in 10 of dentists (91%) estimate the removal of emergency funding will have a high impact on the short-medium term sustainability of their practices.
BDA Scotland have warned from the outset that a return to a ‘business as usual model’ – low margin and high volume – will put practices under unsustainable financial pressure and will likely lead to closures or movement to the private sector.
Practices are facing an unprecedented backlog, with recent data from Public Health Scotland indicated that the number of treatments delivered in the year to March 2021 was less than 25% of those delivered in the previous 12-month period, corresponding to over 3.5 million appointments lost as a result of the pandemic.
NHS dental care free at the point of use remains a centrepiece SNP policy. BDA Scotland has said the Scottish Government must change course to achieve that goal, develop an interim funding package to support dentists and their teams as they work through the backlog, and begin work on a new, sustainable model for delivering care.
David McColl, Chair of the British Dental Association’s Scottish Dental Practice Committee, said: “Free NHS dentistry for all is a worthy ambition. Rather exploring ways to actually achieve that goal the Scottish Government has blindly headed down a road that could destroy this service.
“COVID has slashed our capacity, yet emergency support will end. Yes, Ministers have offered some support, but with small print many practices simply could not sign up to in good conscience.
“Dentists are unwilling to be shackled to a corpse. When aid hinges on committing to an NHS model that is now frankly unsustainable it is unsurprising take up appears so modest.
“We doubt Humza Yousaf wants to be remembered as the man who killed NHS dentistry in Scotland. Without a willingness to reflect on choices made in recent weeks that risks being his legacy.”
British Dental Association online survey of 1164 General Dental Practitioners practicing in Scotland. Fieldwork 25 October to 1 November 2021.
Please estimate your practice’s current capacity compared to pre-COVID levels
| % | Respondents | |
| 100% (my practice is at full capacity) | 3.62% | 42 |
| 90-99% | 2.41% | 28 |
| 80-89% | 3.36% | 39 |
| 70-79% | 5.68% | 66 |
| 60-69% | 13.87% | 161 |
| 50-59% | 20.41% | 237 |
| 40-49% | 22.22% | 258 |
| 30-39% | 16.54% | 192 |
| 20-29% | 9.04% | 105 |
| 10-19% | 0.95% | 11 |
| 1-9% | 0.17% | 2 |
| 0% (my practice is not operating) | 0.09% | 1 |
| Don’t know | 1.64% | 19 |
| Net less than 50% | 83.03% | 569 |
For each of the statements below please rate the impact each currently has on your morale working as a dentist
| Answer Choices | No opinion | No impact | Slight impact | Considerable impact | Great impact | Net high Impact |
| Inability to provide pre-COVID levels of care | 0.95% | 4.38% | 12.63% | 35.48% | 46.56% | 82.04% |
| 11 | 51 | 147 | 413 | 542 | 955 | |
| Working in High level PPE | 0.26% | 1.29% | 10.91% | 30.24% | 57.30% | 87.54% |
| 3 | 15 | 127 | 352 | 667 | 1019 | |
| Patient anger/abuse | 0.43% | 6.27% | 19.76% | 28.44% | 45.10% | 73.54% |
| 5 | 73 | 230 | 331 | 525 | 856 | |
| Unrealistic patient expectations | 0.26% | 2.92% | 13.40% | 29.90% | 53.52% | 83.42% |
| 3 | 34 | 156 | 348 | 623 | 971 | |
| Expected removal of emergency funding/return to a modified SDR | 0.95% | 2.84% | 7.47% | 22.51% | 66.24% | 88.75% |
| 11 | 33 | 87 | 262 | 771 | 1033 | |
| Other financial uncertainty | 1.03% | 1.55% | 7.99% | 24.05% | 65.38% | 89.43% |
| 12 | 18 | 93 | 280 | 761 | 1041 |
What changes in your working life do you anticipate in the next 12 months should the SDR return and emergency payments be removed by April 2022?
| Extremely unlikely | Unlikely | Neither likely nor unlikely | Likely | Extremely likely | Don’t know/not applicable | Net likely | |
| I will reduce my personal NHS commitment | 2.93% | 4.74% | 8.61% | 25.15% | 54.44% | 4.13% | 80% |
| 34 | 55 | 100 | 292 | 632 | 48 | 924 | |
| I will go fully private | 11.89% | 21.71% | 17.92% | 22.48% | 18.35% | 7.67% | 41% |
| 138 | 252 | 208 | 261 | 213 | 89 | 474 | |
| I will change career/seek early retirement | 20.24% | 21.71% | 13.70% | 21.71% | 16.02% | 6.63% | 38% |
| 235 | 252 | 159 | 252 | 186 | 77 | 438 | |
| I will relocate to practise abroad | 44.19% | 22.83% | 12.14% | 9.13% | 5.60% | 6.12% | 15% |
| 513 | 265 | 141 | 106 | 65 | 71 | 171 | |
| My practice will reduce its NHS commitment | 3.02% | 5.43% | 8.97% | 28.79% | 49.31% | 4.48% | 78% |
| 35 | 63 | 104 | 334 | 572 | 52 | 906 | |
| My practice will go fully private | 15.00% | 23.10% | 18.53% | 21.38% | 12.50% | 9.48% | 34% |
| 174 | 268 | 215 | 248 | 145 | 110 | 393 | |
| My practice will reduce staffing levels | 6.81% | 18.28% | 27.50% | 23.88% | 14.05% | 9.48% | 38% |
| 79 | 212 | 319 | 277 | 163 | 110 | 440 | |
| My practice will cease operations | 25.26% | 33.45% | 17.33% | 7.84% | 2.59% | 13.53% | 10% |
| 293 | 388 | 201 | 91 | 30 | 157 | 121 |
What do you anticipate will be the likely impact of planned removal of emergency funding and return to a modified SDR on the short-medium term sustainability of your practice?
| % | Respondents | |
| No opinion | 0.69% | 8 |
| No impact | 2.58% | 30 |
| Slight impact | 5.77% | 67 |
| Considerable impact | 39.97% | 464 |
| Great impact | 50.99% | 592 |
| Net high impact | 91% | 1056 |
Up to £5 million has been made available from the Scottish Government for the dental sector to help dental practices purchase, renew or upgrade ventilation equipment that meets the requirement of 10 air changes per hour. What additional capacity would you estimate this support has secured – or is likely to secure – in your practice?
| % | Respondents | |
| None – My practice has not applied | 30.74% | 356 |
| None – My practice was not successful with its application | 1.47% | 17 |
| None – It has made no difference | 15.11% | 175 |
| 1-10% increase | 11.92% | 138 |
| 11-20% increase | 9.24% | 107 |
| 21-30% increase | 4.66% | 54 |
| 31-40% increase | 0.86% | 10 |
| More than 40% increase | 0.78% | 9 |
| Don’t know | 25.22% | 292 |
If your practice did not apply for a ventilation grant, what were the reasons for choosing not to do so? Select any that apply
| % | Respondents | |
| Unwilling to commit to the NHS for the next 3 years | 49.84% | 319 |
| Allowance of up to £1.5K per surgery is inadequate | 33.12% | 212 |
| Administrative burden of applying | 19.38% | 124 |
| Difficulty in finding suitable companies to scope and carry out the work. | 15.00% | 96 |