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Dentists: New guidelines will not soften blow of Scottish Government plans

The British Dental Association Scotland has said new standard operating procedures for dentists published today will not restore access to pre-COVID levels. With high levels of COVID and other seasonal infections, and now the emergence of the Omicron variant, dentist leaders stress they will also do nothing to avert the potentially catastrophic impact of Scottish Government plans to pull away pandemic support from NHS practices.

Patients in Scotland will now be placed on one of two pathways, given the likelihood of them carrying a respiratory illness. It replaces what amounted to a 'one size fits all' approach that has been in place since the outset of the pandemic, which reduced capacity across the service.

Those on the non-respiratory pathway can be managed in line with pre-COVID standard infection control precautions for non-aerosol generating procedures. However, for an aerosol generating procedure, enhanced precautions will still be required for non-respiratory patients since pre-appointment PCR testing is not carried out in dentistry. Any patient placed on the respiratory pathway and requiring urgent care will remain subject to enhanced precautions for all procedures, which will include maintaining 'fallow time' gaps of up to an hour between treatments.

The new model is unveiled on the day the Omicron variant was confirmed to be present in Scotland. Even setting aside any potential spike in COVID infection, large numbers of patients are likely to end up on the respiratory pathway given typical patterns with seasonal flu and the common cold. It is anticipated a number of dentists may opt for a 'safety first' approach, and use flexibility within new protocols to maintain existing protective measures, particularly given the uncertain effectiveness of triage questions in identifying symptoms of the Omicron variant.

Over 3.5 million NHS dental appointments have been lost in Scotland since the first lockdown, driven by ongoing restrictions.

Cabinet Secretary Humza Yousaf wrote to all NHS dental teams last month stating that all emergency support will be withdrawn by 1 April 2022, as part of a new policy to return to the low margin and high-volume system the service operated pre-pandemic. The move drew criticism from all opposition parties, given the unsustainable pressure it would place on practices. According to a BDA survey conducted at the time, 80% of dentists estimate their practices are set to reduce their NHS commitment should the Scottish Government remove emergency support and return to pre-COVID models of care.

Yousaf told the Scottish Parliament on 3 November that "reform at this stage would be a disruption." Governments in both Westminster and Cardiff Bay are taking through reforms to their NHS dental systems at this time. 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:

"Since the spring we have been pressing for a plan to safely ease COVID restrictions, to help increase patient numbers.

"Sadly, these new guidelines will not magically restore services. They land as we head into winter when respiratory diseases are set to skyrocket. And with Omicron now present in Scotland many practices will understandably take a safety-first approach.

"We are still facing massive backlogs, saddled with a system that is unfit for purpose. New protocols will not soften the blow of plans to pull away emergency support at this challenging time for infections and try and return to a 'business as usual' model during a pandemic.

"Ministers say now is not the time for reform. Reform won't wait for millions of patients in Scotland who need NHS dentistry to have a future."